forehead, dazzling and confusion of vision, inability to continue the use of the eyes, to which by many authors were added the more general sensations of dizziness, nausea, headaches in other parts of the head than the forehead, and general malaise. Antoine Maître-Jan* (1707) gives a good description of the complaint, which he thinks arises from increased intra-ocular tension resulting from strain of the eyes. A century later, Weller † (1832) enumerates tension over the eyes, headaches, nausea, and vertigo, to which train of phenomena Sichel ‡ (1837) adds insomnia, as the group of symptoms arising from excessive use of the eyes. An old author, # in speaking of the people who require glasses for reading, but neglect to use them, remarks facetiously, "Their eyes ache, their head aches, and every bit of 'em aches." Piorry ▲ (1850) quotes from his writings twenty years earlier, his views regarding certain nervous disturbances, “oscillations nerveuses" having their seat in the eye, the ear or in some branches of the fifth nerve. A form of migraine which he calls "irisalgie" has, according to him, its origin in irritation arising either from the iris or from the retina. The migraine results in such cases from excessive or improper use of the eyes. He cites the case of a medical professor who 215. Traité des Maladies de l'eil," 1707, p. 260. "Maladies des Yeux, traduite par Riester," Paris, 1832, tome ii, p. "Traité de l'Ophthalmie," etc., Paris, 1837. # Dr. William Kitchner, "Economy of the Eyes," 1824. habitually suffered from migraine after reading his lectures written in very fine characters, and who was free from the affection when he did not read the lectures. He also mentions the case of another physician who suffered severely from the same affection uniformly after several attempts to use glasses not adapted to his eyes. Piorry made no practical application of these views. These few examples will serve to illustrate the extent to which the eyes were supposed to affect contiguous or more remote parts, up to the era when, by the discovery of the ophthalmoscope by Helmholtz, by the recognition of the rôle played by the ocular muscles in inducing fatigue about the eyes, a subject especially elucidated by Von Graefe, and by the discovery of hypermetropia by Donders, the knowledge of the causes and treatment of asthenopia was infinitely promoted. Notwithstanding these great advances, the phenomena of asthenopia continued to be stated in much the same order as before. Graefe and Donders enumerate the symptoms substantially as they are given above, and Stellwag* concludes his excellent description of accommodative asthenopia as follows: "If the work is continued" (after the sense of exhaustion has commenced), "these feelings" (confusion of vision and swimming of objects before the eyes, with a feeling of pressure, fullness, and tension in the forehead) "soon increase to actual pain in and over *Stellwag, first American edition, 1868, p. 622. the eyes and are soon accompanied by a very painful feeling of dazzling; finally headache, dizziness, universal malaise, and even nausea occur.” Beyond question, however, the most important recognition of the fact that distant pain might be induced by straining the eyes was by Anstie,* who asserted that "functional abuse of the eyes" is a powerful source of irritation tending to induce neuralgia. He also says that hyperopic sewing-girls are specially liable to that affection, and relates that he himself was relieved from neuralgia by desisting from the use of his eyes in reading. Notwithstanding these assertions, Anstie seems to have made no practical application of the important facts thus enunciated, and even seems to regard the conditions as accidental and factitious. Possibly a greater familiarity with the defects which are known to be influential in the production of asthenopia would have encouraged this learned author to make some practical application of a principle which he seems to have very imperfectly recognized. Thus far, then, there had been recognized certain isolated facts concerning irritations arising from disadvantageous use of the eyes, in relation to parts somewhat removed from them. No general principle of sympathetic or reflex irritation had, however, been formulated, and the first printed announcements of the existence of such a principle was made by myself, in a paper presented to the Albany Institute in the early part of 1876, and * "Neuralgia," D. Appleton & Co., New York, 1872. soon after in a paper read before the Academy of Medicine in New York, June 15th of the same year. The doctrine had, however, been publicly taught by me in lectures in the Albany Medical College two years previously to the reading of these papers, and several cases in which chorea and other nervous diseases were in relations of effects of ocular disturbances had been exhibited to my classes. Several papers relating to this subject have been given to the public by myself from time to time in which the doctrine has been somewhat more fully developed.* A few writers have, since my first publications on this subject, recognized certain facts relating to it, but it can not be said that any contribution of considerable importance has been added to the literature beyond what has been stated. If it is remembered that pain over the eyes, and even general headache, with feelings of general malaise, have been long recognized as among the occasional * See "Transactions of the Albany Institute, 1874-1876"; "Chorea," "Transactions of the New York Academy of Medicine," 1876; "Refractive Lesions and Functional Nervous Diseases," "New York Medical Record," September, 1876; "Light in its Relation to Disease," "New York Medical Journal," June, 1877; “Clinical Notes of Cases of Neuralgia and Troubles of the Accommodation of the Eye," "New York Medical Record," October, 1877; "Relations between Corneal Diseases and Refractive Lesions of the Eye," International Medical Congress, Philadelphia, 1877; "Enucleation of an Eyeball, followed by Immediate Relief in a Case of Diabetes Insipidus," "Transactions of the American Ophthalmological Society," 1878; "Two Cases of Enucleation of the Eyeball," ," "Alienist and Neurologist," January, 1880; "Ocular Muscular Defects and Nervous Troubles," "Transactions of the New York State Medical Society, 1880; "Oculo-Neural Reflex Irritation," International Medical Congress, London, 1881; etc. symptoms of asthenopia, it will be understood that, in the treatment of their asthenopic patients, oculists have from time to time casually relieved these more general symptoms while pursuing the rational measures of treatment for asthenopia. Such relief, incidental so far as the design in treatment was concerned, did not, in the minds of oculists suggest the principle that for such general symptoms not attendant upon asthenoria, the condition of the eyes should be examined, and perhaps treated. Thus, while Graefe recognized headache as one of the occasional symptoms of asthenopia, he did not suggest that persons subject to chronic cephalalgia should consult an oculist. If the doctrines taught in the following pages should be accepted by the medical profession, doubtless many oculists might be able to recall relief to headaches as incidental to treatment of asthenopia. It would not be surprising even if the recollection of such an occurrence should induce in the mind of the practitioner the belief that he was then acting upon the principle here developed. A careful and extensive search in the literature of ophthalmology and of general medicine has not enabled the writer to find any mention of the principle that irritations arising from ocular adjustments may act as reflex causes, inducing nervous troubles in distant parts, except in the vague manner already mentioned, prior to his own announcement of it. Should the facts presented in this memoir appear to differ so essentially from the experience of medical practitioners generally as to seem to belong to the |