Biographic Clinics 
 
 DeQUINCEY carlyle 
 
 DARWIN 
 
 HUXLEY 
 
 BROWNING
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 BIOGRAPHIC CLINICS 
 
 GOULD
 
 Thomas De Quincey.
 
 Biographic Clinics 
 
 The Origin of the Ill-Health 
 
 OF 
 
 De Quincey, Carlyle, Darwin, Huxley 
 AND Browning 
 
 BY 
 
 GEORGE M. GOULD, M.D., 
 
 Editor of American Medicine, Author of " An Illustrated Dictionary of Medicine, 
 
 Biology, etc.," " Borderland Studies," " The Meaning and 
 
 Method of Life." etc. 
 
 PHILADELPHIA 
 
 P. BLAKISTON'S SON & CO. 
 
 I0I2 Walnut Street 
 
 1903
 
 Copyright, 1902, by 
 GEORGE M. GOULD, M.D.
 
 }.- t r 
 
 HOB 
 
 " The improver of natural knowledge absolutely refuses to 
 acknowledge authority, as such. For him, skepticism is the 
 highest of duties; blind faith the one unpardonable sin. And 
 it cannot be otherwise, for every great advance in natural 
 knowledge has involved the absolute rejection of authority, 
 the cherishing of the keenest skepticism, the annihilation of 
 the spirit of blind faith; and the most ardent votary of sci- 
 ence holds his firmest convictions because his experience teaches 
 him that whenever he chooses to bring these convictions into 
 contact with their primary source. Nature — whenever he 
 thinks fit to test them by appealing to experiment and to ob- 
 servation — Nature will confirm them. The man of science has 
 learned to believe in justification, not by faith but by verifica- 
 tion." — Huxley, Advisableness of Improving Natural Knowl- 
 edge. 
 
 "He that can abolish pain, relieve his fellow mortal from 
 sickness, he is indisputably usefullest of all men. Him savage 
 and civilized will honor. As a Lord Chancellor under one's 
 horsehair wig there might be misgivings, still more so, perhaps, 
 as a Lord Primate under one's cauliflower, but if I could heal 
 disease I should say to all men and angels without fear * En ! 
 Ecce ! ' " — Carlyle. 
 
 " H by gaining knowledge we destroy our health we labor 
 for a thing that will be useless in our hands." — Bacon. 
 
 Gy57'?6
 
 V\«rv>rt 
 
 TABLE OF CONTENTS. 
 
 Page. 
 
 INTRODUCTION 9 
 
 ^ CHAPTER I. De Quincey 15 
 
 > CHAPTER 11. Carlyle 41 
 
 -t CHAPTER III. Darwin 77 
 
 f CHAPTER IV. Huxley 107 
 
 / CHAPTER V. Browning 125 
 
 CHAPTER VI. Biliousness and Headache . 141 
 
 CHAPTER VII. Some Neglected Points in the 
 
 Physiology of Vision . . 157 
 
 CHAPTER VIII. The Discovery of Astigmatism and 
 
 Eyestrain 171 
 
 CHAPTER IX. Responsibilities .... 197
 
 INTRODUCTION. 
 
 Medical science and art has heretofore busied itself 
 with three aspects or phases of disease : 
 
 1. With the patient's complaint upon the day of con- 
 sultation, or during the time of the special illness. 
 Rightly but crudely the primary function of the physi- 
 cian is held to be to get the patient over his present 
 trouble and let the future take care of the future illness. 
 The average physician will hardly recognize the remote 
 causes which brought about the present disease, its 
 far-off results, and the multiform relations of this 
 special condition with others, physiologic and patho- 
 logic, and with the habits, duties, and necessities of 
 social life; even if these subtle causes and relations 
 were sought and considered the patient would not 
 recognize nor appreciate the service, and certainly 
 would not pay for it. " Make me well again and 
 quickly," is his sole demand, and hence this must be the 
 physician's task. 
 
 2. When the physician has succeeded, or perhaps has 
 failed, in this special duty, he thinks how he may treat 
 other patients suffering from the same complaint, and 
 he writes of his experience and of his success or fail- 
 
 2 9
 
 lo BIOGRAPHIC CLINICS. 
 
 ure, in such cases, always concerning the single disease 
 in question and its cure. Again, the infinite variety of 
 pathologic origin, and, as affecting different patients, 
 the relationship of the special disease to the entire life 
 of the patient, are not thought of. 
 
 3. The philosophic physician and the pathologist 
 seek to learn the pathogeny of a single type or kind 
 of disease, as of tuberculosis, syphilis, etc., apart 
 from all individual origin and relations. The suffer- 
 ing, even the existence, of the individual patient is not 
 in the attention. 
 
 Necessary and wise as are these aspects and duties, 
 there is a fourth professional obligation quite as im- 
 portant as the three, scientifically even more so, which 
 we have entirely ignored. To its consideration we 
 must in the future devote our attention to an increas- 
 ing degree, and in doing so we shall unexpectedly 
 benefit the patient and the world. In this work, too, 
 we shall gain professional power and honor and bring 
 back to his splendid function the almost extinguished 
 family physician, or general practitioner. I allude to 
 the patient's life-problem, the duty of studying the life 
 as a whole, all of his diseases, past, present, and to 
 come, and what relation they bear to his life and 
 sociologic conditions. This clinical life-problem per- 
 taining to the diseases, disabilities, and entire career of 
 life, will in time surely come to interest more and 
 jnore, as '* the problem of the future " becomes of
 
 INTRODUCTION. n 
 
 greater interest to each one, and to science as a whole. 
 Such a consideration of a man's entire life and how 
 disease conditions it, is primarily a historical study. 
 It is true that such a study is impossible with many of 
 our patients, because they sometimes live as long as we 
 do, or longer; but even here this want is filled by a 
 careful study of the family history and ancestors, 
 of the past personal history, and of present conditions. 
 Science is accurate knowledge and foreknowledge, and 
 as our medical science improves in accuracy, we, like 
 the paleontologist, are more and more able to recon- 
 struct the picture of the entire organism and its essen- 
 tial history from a single relic, as, e. g., a bone or a 
 tooth. The patient before us is a history and a 
 prophecy. But the method of thus historically envisag- 
 ing and massing the life-work and life-difficulty, can 
 best be suggested and illustrated by the medical de- 
 scription of past lives. This, so far as I know, has 
 never been done, at least with scientific thoroughness 
 and sociologic largeness of view. Mere hints of such 
 a method, so far as I have any medical knowledge to 
 warrant it, I have sought to give in these sketches of 
 the medical facts of the lives of De Quincey, Carlyle, 
 Darwin, Huxley, and Browning. Manifest imperfec- 
 tions are largely excusable on the ground of an almost 
 utter lack of clinical data. We are able to do no more 
 than catch glimpses, faint and fleeting, of the facts 
 through the incidental, unintended, and medically
 
 12 BIOGRAPHIC CLINICS. 
 
 crude allusions of friends, or of the poor patients as 
 they groan and sigh under the load of their uncom- 
 prehended afflictions. Like flashes of lightning of the 
 past storm these reveal for an instant the whole land- 
 scape of their time and work and suffering. Such 
 swift visions can only be made scientific through a sys- 
 tematic and periodic study of the physiologic and 
 medical tests of patients during their whole lives.^ 
 Clinics should be held on the entire life of the patient, 
 and until this is scientifically possible by a system of 
 biologic and clinical examinations, we must glean our 
 pitiful aftermath from the biographies and letters, etc. 
 The million case-records left by dead physicians are 
 either worthless or lost, as these possibly most precious 
 clinical data are considered of no value. 
 
 The forelying study of the clinical biographies of 
 five of the greatest geniuses of England concerns but 
 one class of symptoms and one disease-producing 
 factor. Of other diseases and other patients I am not 
 competent to speak. The field will be found untilled 
 and productive by specialists in other departments in 
 medicine. But to the historian and psychologist the 
 role of eyestrain will be especially interesting because 
 
 ^The outline of the objects and methods of such biologic 
 and pathologic life-studies I have given in an address, en- 
 titled, "A System of Personal Biologic Examinations the 
 Condition of Adequate Medical and Scientific Conduct of 
 Life," Jour. Am. Med. Assoc, July 21, 1900.
 
 INTRODUCTION. 13 
 
 of its subtle and astonishing influence upon character, 
 upon literature, and even upon history. None could 
 pretend to a fraction of the insight which could see the 
 profound differences in our literature and civilization 
 consequent upon the injection of the eye-strain factor. 
 What could these men not have done, what would they 
 not have done, if this morbidizing horror had not 
 clutched their hearts with its palsying and despoiling 
 hand? Certainly also every tenth person of the slaves 
 of civilization, all those who are compelled to work 
 with their eyes at the reading, writing, and handwork 
 distance, are to-day having havoc played with their 
 minds, dispositions, and workaday lives, by this un- 
 recognized disease factor. I am told that an abnor- 
 mally large percentage of criminals and the youth con- 
 signed to reformatories have high degrees of optical 
 and other defects of the eyes. Out of 68 cases of 
 epileptics examined, 98 percent had astigmatism, and 
 50 percent had the very rare and most injurious 
 defect, unsymmetric astigmatism. There is no con- 
 siderable part or kind of our social life, the drink- 
 problem, the labor-problem, all handicrafts, family 
 tragedies, etc., in which the subtle influence of morbid 
 vision is not at its oflice of evil. 
 
 Whether physiologic or pathologic, the eye is neces- 
 sarily actively functional during every instant of the 
 waking life. It is bound up with every emotion and 
 guides every concept. Our thinking is by photographic
 
 14 BIOGRAPHIC CLINICS. 
 
 images; even the letters of the alphabet are conven- 
 tionalized pictures. When vision is morbid there is 
 therefore no limit to the kind and extent of resultant 
 harm both to the organism and to the life.
 
 DE QUINCEY.
 
 CHAPTER I. 
 
 THOMAS DE QUINCEY. 
 
 The principal clinical facts I have been able to 
 gather from the biography and letters of De Quincey 
 are epitomized in the following notes and quotations: 
 
 He was born August 15, 1785. 
 
 He was, at 14, "a boyish and energetic character." 
 
 At 14 years of age, he was probably the best Greek scholar 
 in Europe, conversing in that language fluently. His Latin 
 verses were paraded as models by his teachers before the older 
 boys. His passion for books was so great that he went heavily 
 in debt for them beyond his allowance. 
 
 He had to be removed from school at the age of 14 or 15, 
 " in consequence of a very alarming illness threatening his 
 head," which lasted more than a year. A slight blow on the 
 head while at school was erroneously spoken of as the cause of 
 his illness. 
 
 Good spirits returned but he continued to suffer much at 
 intervals from pain in the head. 
 
 "As to health, I may say fairly that I have not passed one 
 quarter of the time I have been at this school in health. I 
 have not, it is true, been seriously ill, but I have been, what is 
 to me worse, — weary and torpid and languid." He complains 
 chiefly of want of exercise. (This was at the age of 16.) 
 
 At the age of 17 he could endure it no longer; he borrowed 
 some money and ran away to Wales, where he carried a tent, 
 wandered about, sleeping in the open air, sometimes living on 
 "blackberries, hips, and haws," and random hospitality. His 
 health improved, but his money failed and he came to London.
 
 i8 BIOGRAPHIC CLINICS. 
 
 His life there is told in the first section of the "confessions." 
 "About 1802 a hideous sensation began to haunt me as 
 soon as I fell into a slumber, which has since returned upon 
 me at different periods of my life — viz., a sort of twitching 
 (I knew not where, but apparently about the region of the 
 stomach) which compelled me violently to throw out my feet 
 for the sake of relieving it. This sensation coming on as 
 soon as I began to sleep, and the effort to relieve it constantly 
 awaking me, at length I slept only from exhaustion, and, 
 through increasing weakness, I was constantly falling asleep 
 and constantly awaking." 
 
 He consented to study at Oxford, but in the second year, 
 (1804) he "had been suffering severely from a neuralgic 
 affection " ; opium was recommended by a college friend, 
 and in it he discovered " a panacea " as he exclaims, " for all 
 human woes." He was for some years "an occasional rather 
 than a constant devotee" of the drug. 
 
 " His love of roaming over the hills and valleys " was 
 noticeable. He disappeared from Oxford, and after some years 
 of travel, etc., he settled at Grasmere in 1809, aged 24. 
 
 " He was capable of undergoing great fatigue and took 
 constant exercise." 
 
 " He loved long walks, and had a keen interest in sport." 
 He walked much at night. 
 
 " In 1812 I suffered an attack of nervous horror which lasted 
 for five months, and which went off in one night as unac- 
 countably as it had first come on in one second of time." 
 
 In 1813 the irritation of the stomach recurred with such in- 
 tensity that he increased the doses of opium he had been taking 
 intermittently since 1804. 
 
 He now took 340 grains of opium or 8,000 drops of laud- 
 anum a day, a little more than half what Coleridge was taking 
 at the same time. 
 
 In 1814 he reduced the dose to 40 grains a day, and in 1816 
 he felt he had so conquered the habit that he could marry. 
 
 In 1817-18 he grew worse, was in a bad way, and there was 
 an increase of the opium again.
 
 THOMAS De QUINCEY. 19 
 
 In 1821 he conquered the habit again, but he became " ill," 
 "depressed in spirits," "dejected," "the liver deranged," with 
 " derangement of the liver," etc., and in 1823-24 he again fell 
 under the sway of opium. 
 
 In 1825 he wrote: "I am quite free of opium, but it has 
 left the liver, which is the Achilles heel of almost every human 
 fabric, subject to affections which are tremendous for the 
 weight of wretchedness attached to them." 
 
 " Anxiety seizes on some frail part about the stomach, and 
 produces a specific complaint which very soon abolishes all 
 power of thinking at all." (1825.) 
 
 By 1840 he had been led to deeper relapses into opium than 
 he had known between 1827 and 1837. " His misery was 
 great." By 1844 he was taking 5,000 drops of laudanum a day. 
 
 He once more set himself to subdue the indulgence. " His 
 constant careful jottings of graduated reductions day by day 
 — his patient records of the effect of ordinary articles of diet, 
 his measured round of exercise, amounting to 15 or 20 miles a 
 day, all are touching in the agony that may be read between 
 the lines." He reduced the amount of opium to six grains a 
 day at one time. 
 
 "With a measured space of 44 yards in circuit, so that 40 
 rounds were exactly required for one mile, I had, within 90 
 days, walked 1,000 miles." (1844.) 
 
 "For six months" (reform as to laudanum and keeping up 
 with the walking) "no results," "absolute desolation," 
 " misery so perfect," etc. 
 
 After eight months of " this system " he recovered " in a 
 moment such a rectification of the compass as I had not known 
 for years." He was unable to leave off laudanum altogether, 
 however. 
 
 " He almost entirely overcame his craving for opium, and 
 enjoyed an old age of quiet and repose." 
 
 De Quincey never believed his trouble was due to opium, 
 and expressly states this several times. For instance : " Is 
 there any key, you will say, to its original cause? Sincerely, I
 
 20 BIOGRAPHIC CLINICS. 
 
 do not believe there is. One inevitable suggestion occurred to 
 everybody consulted, viz., that it might be some horrible recoil 
 from the long habit of using opium to excess. But this seems 
 improbable from more reasons than one," especially as before 
 any considerable use of opium he had had " an unaccountable 
 attack of nervous horror," etc. 
 
 In 1847 he speaks of a " famishing," an extreme lack of 
 appetite, or " incapacity for food," " a system utterly famished 
 of all nutriment." " Utter prostration seized me, and which is 
 far worse, utter nervousness," "this is the reason I have not 
 written," "I have been very ill and am only just mending." 
 
 In 1848 he abstained wholly from opium for 61 days but 
 returned to its " moderate use " as the lesser of two evils. 
 
 "I suffer from a most afflicting derangement of the nervous 
 system, which at times makes it difficult for me to write at 
 all." (1850.) 
 
 "The ten last years embrace a period of quiet and steady 
 activity." 
 
 " My father's habits were simple, almost to asceticism. 
 From the neuralgic suffering which led to his first taking 
 opium, he early lost all his teeth, and from the extreme 
 delicacy of his system, he could eat nothing less capable of 
 perfect mastication than bread, so that only too often a little 
 soup or coffee was his whole dinner." (His daughter.) 
 
 " Even at 70 years of age he was active and vigorous, and 
 easily outwalked me, though I was a much younger man" 
 (Hogg). At this time he walked nine or ten miles daily for 
 exercise. 
 
 " For some weeks my eyes had given me so much pain, and 
 consequently so much anxiety about the result," etc. . . . 
 " Now " (through intermission, perhaps, of candle-light read- 
 ing) "my eyes are again better." (De Quincey in undated 
 letter, p. 45, Volume II., Page's "Life"; after 1850.) 
 
 "A nervous malady of a very peculiar character which has 
 attacked me intermittently for the last eleven years." (Ibid., 
 page 48.)
 
 THOMAS De QUINCEY. 21 
 
 " I have suffered much from my eyes since the influenza ; 
 some days all but blind, and on some nights roused up for 
 hours by the pain, and still more by the nervous uneasiness 
 besieging them. Sulphate of zinc is all the remedy I have 
 applied." (1855.) 
 
 "The act of stooping has for many years caused me so 
 much illness." . . . "The stooping kills me." (About 1856.) 
 
 "Whether the fault is in some growing defect of my eyes, 
 or in the badness of such lights as I can command," etc. . . . 
 "The letter cost me three-quarters of an hour, under bad 
 candle-light, to decipher." (Perhaps about 1859.) 
 
 He was convinced that his "dreaming tendencies were con- 
 stitutional, and not dependent upon laudanum." 
 
 According to his own statement (and no man could be 
 more truthful) he had four relapses into the opium habit, 
 1813 to 1816, 1817 to 1818, 1824 to 1825, and 1841 to 1844. At 
 other times, and after 1844 his use was "moderate, not 
 excessive." 
 
 " He deliberately records his conviction in the latter years of 
 his life, that but for opium he would have been in his grave 
 30 years before. As to opium in itself and taken in due limit, 
 he will acknowledge nothing save benefit." (Page.) 
 
 " Opium helped to keep active and entire, during so many 
 long years of bodily feebleness, that large and constantly work- 
 ing brain — that in a word it fed it — I have no manner of 
 doubt, and further, that the almost singular immunity Mr. De 
 Quincey enjoyed from headache, which in the course of his 
 long life he never knew — a common source of annoyance, 
 oftentimes of misery, to ordinary-living students — was likely 
 enough due to the opium, I also believe. (Dr. Begbie, who 
 attended him in his last illness.) 
 
 " I generally found him attempting to read without spec- 
 tacles, which he never employed." (Ibid.) 
 
 " He listened with great interest to what was read to him 
 from the morning papers, if he was not able to read himself. 
 . . . When tired of reading, he was read to by, etc. . . . Day
 
 22 BIOGRAPHIC CLINICS. 
 
 after day books were handed in; these, when unable to read, 
 he nevertheless carefully examined." (Ibid.) 
 
 "To the last he was able to read without the help of spec- 
 tacles — one eye doing all the work, the other one being 
 invariably closed while either reading or writing." (His 
 daughter.) 
 
 He died in December, 1859, in his seventy-fifth year, "his 
 death being ascribed rather to exhaustion of the system than 
 to specific disease." There was no necropsy, although he 
 offered his body to " the gentlemen of Surgeon's Hall." 
 
 He preserved to the last his exquisite and sane humor, his 
 pathetic sympathy with all suffering beings, his self-forgetful 
 generosity, his childlike or childish indifference to himself and 
 the care of his person, his almost unrivalled power of intellect 
 and of writing lucid English, and the graciousness and sweet 
 urbanity that charmed all with whom he spoke. 
 
 His picture prefixed to the Life by Page is " from the por- 
 trait by Mr. James Archer, R.S.A." 
 
 There is an Appendix to Mr. Page's inaccurate and unwork- 
 manlike biography of De Quincey, entitled " A Medical View of 
 Mr. De Quincey's Case" by Surgeon Major W. C. B. Eatwell, 
 M.D., F.R.S. Dr. Eatwell adopts an old method of clearing 
 up a mystery, viz. — explaining a thing by naming it with an 
 inexplainable word. He is sure the patient suffered for a great 
 period of his life " from a terrible and distressing affection of 
 the gastric nerves called gastrodynia." To this neuralgic 
 affection was superadded " gastric ulcer of the mucous mem- 
 brane of the stomach, healing under opium and the regulation 
 of diet, and recurring when the stomach was not carefully 
 managed." Dr. Eatwell writes : " I think this theory is borne 
 out by the circumstances and exciting causes attending the 
 outbreak of the attack (commencing probably under the diet 
 of hips and haws in Wales) and by the subsequent symptoms. 
 Dr. Brinton, in dealing with the causes of this complaint, 
 writes that the disease 'seems to fall with disproportionate 
 severity and frequency on those who suffer from the ills im-
 
 THOMAS De QUINCEY. 23 
 
 plied by penury, excessive toil, insufficient and unwholesome 
 food, foul air, mental anxiety, and those habits of intemper- 
 ance which are the effect as well as the cause of such misery/ 
 The last of these agencies," continues Dr. Eatwell, " we leave 
 out of consideration ; but the remaining agents in the catalogue 
 of evils had undoubtedly exerted their full influence on the 
 helpless boy, De Quincey." 
 
 If we suppose that, as stated, these are the causes of gas- 
 tric ulcer, then surely De Quincey had it not, because, in 
 addition to making an exception of intemperance. Dr. Eatwell 
 should have also excepted all the other etiologic factors 
 named. Except for a little while, and wholly without injury 
 permanent or organic (indeed with benefit), De Quincey never 
 was subject to "penury" or "insufficient and unwholesome 
 food " and so far as " excessive toil," " foul air," and 
 " mental anxiety " are concerned, they never had much share 
 in his lot. This is all " words, words, words." The theory 
 of " gastrodynia " plus gastric ulcer is not of sufficient 
 strength to justify refutation. 
 
 In 1827 Carlyle, then 32 years of age, wrote to his 
 
 brother John as follows : 
 
 "De Quincey was here last Wednesday and sate until mid- 
 night. He is one of the smallest men you ever in your life 
 beheld, but with a most gentle and sensible face, only that the 
 teeth are destroyed by opium, and the little bit of the underlip 
 projects like a shelf. He speaks with a slow, sad, and soft 
 voice, in the politest manner I have almost ever witnessed and 
 with great gracefulness and sense, were it not that he seems 
 decidedly given to prosing. Poor little fellow ! It might soften 
 a very hard heart to see him so courteous, yet so weak and 
 poor. ... He is an innocent man, and, as you said, extremely 
 washable away" 
 
 I have introduced this quotation as a little portrait 
 and because of its diverse illustrativeness. In the first
 
 24 BIOGRAPHIC CLII^ICS. 
 
 place it better testifies than all of his other contem- 
 poraries combined as to De Quincey's marvelous 
 charm. How exquisite it must have been when he was 
 able thus to soften the heart of Ursa Major! It speaks 
 clearly of the character of both men. At this time De 
 Quincey, "aged 44, was going through one of the most 
 critical periods of his life and of his addiction to 
 opium. There is something inexpressibly pathetic that 
 these great men, so different from one another, yet so 
 alike, suffering as I believe from the same disease, a 
 disease that wrought in each the profoundest of trage- 
 dies, and yet, like uhrecognizing brothers, they looked 
 into each other's eyes, knowing neither of the other's 
 way and woe. 
 
 It is a pity and not a little strange that Carlyle should 
 have fallen into the stupid error he did as regards the 
 cause of De Quincey's loss of teeth. Opium does not 
 produce dental caries nor loss of teeth. De Quincey's 
 daughter avoids this childish mistake, but came little 
 nearer the truth by saying that the loss of teeth was 
 due to the neuralgic suffering which led to his first 
 taking opium. Carlyle's incidental remark is of value 
 only as showing the opinion of those with whom he 
 talked as to De Quincey and thus showing the hap- 
 hazard manner in which everything peculiar to the man 
 was ascribed with ridiculous indiscrimination to opium. 
 A similar misreading, indeed, of his whole life-tragedy 
 seems to me perfectly apparent when we look over the
 
 THOMAS De QUINCEY. 25 
 
 entire clinical biography with unprejudiced and philo- 
 sophic minds. 
 
 I wish first to" emphasize that a careful study of De 
 Quincey's mind and writings brings out the clearest 
 conviction that even about himself and even in matters 
 pathologic (of which one would naturally think him 
 hazy, at least as much so as any litterateur and layman) 
 De Quincey never loses a marvelous sanity, lucidity, 
 and discrimination. The lines of distinction, reserve, 
 and consciousness — lines that are not observable or that 
 are faint to the ordinary eye — are yet most sharply 
 drawn and seen by this subtle beautiful intellect. There 
 is never an instant's doubt as to what is normal and 
 what is not so, and, more even than the physicians that 
 attended or wrote about him, I would trust his calm 
 statements about these things. The superciliousness of 
 the poor omniscients who affect to look down upon that 
 sublime intelligence and ascribe everything to " opium, 
 opium," is not to be weighed against his own lambent 
 and penetrating keenness and rightness of observation. 
 The soft gentle manner in which he states the facts as 
 to his health and habits also heightens the effect of his 
 clearness and accuracy of perception. 
 
 We note then that his dreamings which were later 
 only intensified and sometimes morbidized by opium, 
 were natural to him and began before his drug-taking. 
 He himself was convinced that the dreaming tendencies 
 were constitutional. A dispassionate examination of 
 3
 
 a6 BIOGRAPHIC CLINICS. 
 
 the clinical facts of his life compels an ever increasing 
 conviction that his addiction to opium was never a cause 
 of his physical affliction ; that, except in the case of the 
 dreams of the " Confessions," it was not the cause of 
 his mental peculiarities. The discrimination he drew 
 may as a rule, be readily accepted. He never thought 
 his troubles due to opium; he had nervous horror and 
 other nervous symptoms before he took opium, and the 
 spasmodic gastric, or rather intestinal, seizures he de- 
 scribes as beginning in 1802, show that the ultimate 
 cause of his affliction was also at its horrible work 
 before opium-taking, and in fact that it led directly to 
 the opium as a means of relief. I think that it is liter- 
 ally true, as De Quincey thoroughly believed, that 
 opium saved his life, enabled him to live and work, pre- 
 vented his death at middle age, and on the whole, and 
 when " taken in due limit " was of benefit to him. 
 That, of course, is far from justifying its use by others 
 and at the present time, and equally as far from admit- 
 ting that a true cure does not exist for De Quincey's 
 trouble, and for that of others due to the same 
 cause. 
 
 The strange fatalism and impenetrable mystery of 
 the true nature and source of his misery, was of course 
 present to his own mind, but it was a problem too near 
 at hand, too astonishingly near, to be even suspected. 
 He stands before the Sphinx and asks : " Is there any 
 key to its original cause? Sincerely I do not believe
 
 THOMAS De QUINCEY. 27 
 
 there is." " One inevitable suggestion," etc., did not 
 explain, was in fact, based upon error. 
 
 Something more than the unrivalled intellect stares 
 at one in the fact that the 14-year-old boy v^as the best 
 classical linguist in Europe, and that at the same time 
 he was reading so omnivorously that he would sacrifice 
 his allowance and go in debt for books. One's astonish- 
 ment grows to the greatest marvelling when he finds 
 that this lad was also an energetic and boyish fellow, 
 most fond of outdoor life and activity. But now begin 
 the silent palsying blows of an unseen and most mys- 
 terious fate. The boy of 14 or 15 has to be taken from 
 school " in consequence of a very alarming illness 
 threatening his head." This lasted for more than a 
 year, and was followed by a return of good spirits, 
 though he continued to suffer much at intervals from 
 headache. Again he was put to school, but three- 
 fourths of the time he is out of health, not seriously 
 ill, but worse, weary, torpid and languid. About this 
 time begin the gastric " twitchings, the loss of sleep, and 
 the increasing weakness." Finally, his sufferings and 
 the lack of exercise, etc., could not longer be endured, 
 and he breaks into absolute revolution, and at the age of 
 17 he borrows money, runs away to Wales, and lives a 
 wanderer's life among the farmers and on the hills. 
 His health gains, but his money does not, and he goes 
 to London, where for a short time he finds out what 
 real poverty means. Its power of logic probably de-
 
 2 8 BIOGRAPHIC CLINICS. 
 
 cided him to accept advice and to try study once 
 more. 
 
 The tremendous influence of eye-strain upon disposi- 
 tion, character, and vocation, was borne in upon me the 
 first year I was in practice.^ Almost every day since then 
 the truth has become more striking and evident. Chil- 
 dren's lives and minds are unconsciously and constantly 
 modified, always unnaturally and morbidly, because of 
 the fact, unconscious to them, that reading and study 
 and writing irritates and disorders the central nervous 
 system, the digestional organs, etc. De Quincey could 
 not escape his fate, but others do — and meet another, 
 however! Every child's eyes should be periodically 
 examined, under mydriasis, by an expert refrac- 
 tionist. 
 
 Much against his will young De Quincey consented 
 to try to study once more, this time in Oxford. In his 
 second year (1804) his severe neuralgic affection led 
 him to try opium for the first time. With a less well- 
 balanced mind than that of De Quincey, and especially 
 if we remember his intense suffering, this method of 
 treatment would at once have been equivalent to 
 " throwing the baby away with the bath," but with De 
 Quincey, although it at once gave a heavenly relief, he 
 became only an occasional rather than a constant 
 
 ^ " The Psychological Influence of Errors of Refraction and 
 of their Correction," Medical and Surgical Reporter, Septem- 
 ber 29, 1888.
 
 THOMAS De QUINCEY. 29 
 
 devotee of the drug for nine years. His love of 
 roaming over the hills and valleys was kept up at 
 Oxford, but despite this, and also notwithstanding the 
 opium, w^hich indeed masked and relieved but could not 
 cure the symptoms, least of all their cause, he again 
 could not endure systematic and continuous study — he, 
 par excellence, a born student and lover of books and 
 study ! He soon left Oxford and spent several years in 
 objectless travel or wandering about, settling at last 
 in 1809, aged 24, at Grasmere. Here were kept up 
 the constant exercise, the long walks, the interest in 
 sport, and the seemingly morbid solitary walks in the 
 darkness of the night. Despite these things, in 18 12 
 there was a suddenly appearing and as suddenly dis- 
 appearing five months' attack of " nervous horror " and 
 in 1813 such an increased intensity of the "irritation 
 of the stomach " that for relief he increased the inter- 
 mittent doses of opium he had been taking since 1804, 
 until he was soon taking as much as 340 grains a day. 
 He would not marry while taking so much, and by 18 16 
 he had so far conquered the habit that he felt justified 
 in marrying. This period of 1813-1816 was his first 
 one of excess, but immediately after marriage his suf- 
 fering became more unendurable and for a year he 
 relapsed. His heroism in 1821 in again fighting and 
 winning the battle was only rewarded by great suffer- 
 ing, dejection, " derangement of the liver," etc., and 
 there followed another relapse into excess from 1824
 
 30 BIOGRAPHIC CLINICS. 
 
 to 1825. The last relapse was from 1841 to 1844. At 
 other times and after this time there was moderate, not 
 excessive use. 
 
 This history of his splendid struggle and success in 
 1844, his absolute abstention for 61 days in 1848, and 
 his wise choice thereafter of moderate use as the lesser 
 of two evils, his ten last years of life in " quiet and 
 steady activity," are also noteworthy. 
 
 There are two factors that should not be lost from 
 view : The first relates to the fact that a man so 
 destined by nature and profession to the life of a 
 scholar and writer as was De Quincey, must devote 
 a certain portion of his time, of each day usually, to 
 reading, writing, and revising proof-sheets. The 
 second is closely related to it — mathematically so, one 
 might say, as well as logically — and concerns the mat- 
 ter of physical exercise. No one who has studied the 
 life of De Quincey (or the lives of the other men whom 
 we are to observe later) seems to have adequately pon- 
 dered, at least not to have asked for the significance ofy 
 the irresistible necessity these men were under to walk 
 or exercise. Ocular accommodative effort and reflexes 
 cease in walking almost entirely, and absolutely so in 
 walking at night. All his life De Quincey walked 
 many miles a day, walked in day and darkness, in sun- 
 shine or in rain, and in the worst time of trials he would 
 walk round and round a ring, like a poor, dumb, driven 
 animal, 40 rounds to the mile, from 400 to 500 times a
 
 THOMAS De QUINCEY. $1 
 
 day. At the age of 70 he was still active and vigor- 
 ous, outwalking younger men. 
 
 Another clear indication of the ultimate cause of De 
 Quincey's affliction is given by noticing the dates of the 
 relapses into opium-addiction. The first two are prac- 
 tically one, extending from 1813 to 181 8, the second, 
 1824 to 1825, the third 1 841 to 1844. Observant 
 ophthalmologists know that in the life history of 
 patients suffering from uncorrected eye-strain, or 
 optical error, there tends to be three critical periods or 
 crises. In girls and women these crises are of some- 
 what different ordering. Here I speak only of boys 
 and men, and in them the first is at or within a few 
 years of puberty. The second is in early adult life, the 
 third comprises the period of the failure of accommoda- 
 tion extending normally from about 45 to 60, but vary- 
 ing according to the amount and kind of ametropia. In 
 hyperopic or " far-sighted " astigmatism it begins five 
 or even ten years earlier. In De Quincey's case the 
 first crisis came at the logical age of 14, when he had to 
 be taken from school because of the " very alarming 
 illness threatening his head." Every ocuHst knows 
 well enough about these ocular or ametropic head- 
 aches. They more seldom occur in boys and men than 
 in girls and women. The reflex of eye-strain in the 
 latter is usually to the head, with more or less implica- 
 tion of the digestional organs. In boys the tendency is 
 to the eyes (styes, blepharitis, conjunctivitis, etc.),
 
 32 BIOGRAPHIC CLINICS. 
 
 while ill men, especially in severe eye-workers, it is 
 usually to the digestional organs alone. But there are 
 many cases of modified or masked symptoms, depend- 
 ing upon the always varying conditions of the eyes, 
 native vigor, external circumstances, etc. The note- 
 worthy fact is the long-continued increased intensity of 
 all reflexes during the failure of accommodation, and the 
 sudden cessation of direct ocular reflexes at about 60. If 
 the long-continued functional diseases of the digestional 
 and cerebral centers have at that time not been too 
 badly injured, there is peace for the rest of life. But 
 if irreparable harm has been done them, symptoms will 
 be changed but will persist. Of course, according to 
 circumstances and conditions one period may extend 
 into another, and the habit of drug-taking or the hap- 
 hazard catching up of a pair of spectacles may modify 
 but not abrogate the symptoms. In De Quincey's case 
 the first critical period (head pains), plainly due to 
 eye-strain, passed off in a year, but recurred in one 
 form or another until he was compelled to run away 
 from school and seek rest from eye-strain even by 
 vagabondage if necessary, at all events by the walking 
 or exercise which all such sufferers are unconsciously 
 compelled to undertake. Of course, one so endowed as 
 De Quincey could not escape the literary life, and his 
 compromise with the unknown enemy that possessed 
 him was opium and walking. The first hid and modi- 
 fied the results of eye-strain, the second gave the
 
 THOMAS De QUINCEY. 33 
 
 health to resist, and the eye-rest demanded for recuper- 
 ation. 
 
 In all severe eye-strain, insomnia, apparently due to a 
 number of mysterious causes, is almost always a con- 
 stant symptom. (" Kicks about at night and cries out 
 in his sleep " is an almost invariable report of parents 
 in astigmatic children.) How it affected De Quincey 
 may be seen throughout the biography. At the age of 
 28 the " stomach and liver symptoms " became greatly 
 intensified and the doses of opium became enormous. 
 Love and marriage nerved him to moderation for a 
 year or two, but continued and increased eye-work 
 drove him again to his enemy-friend. During the two 
 years of his greatest ocular labor in middle life all his 
 great strength of will to renounce opium entirely was 
 in vain and indeed unwise. Even physicians are per- 
 haps in this and similar cases too apt to forget the 
 established clinical fact that the greater the pain and 
 inflammation the higher the dose of the anodyne re- 
 quired. For example, in peritonitis doses of morphin 
 may be, must be, given, a very small part of which 
 would kill if the patient was in a normal condition. 
 In De Quincey's case the anodyne in large doses was 
 necessary to give him relief from the " misery," 
 *' gnawing," '' the horrors," the " specific complaint," 
 the " twitching," the '' depression," etc., from which 
 he suffered whenever he discontinued the drug. 
 Notice that only at 62 was he able to discontinue it
 
 34 BIOGRAPHIC CLINICS. 
 
 entirely, but in two months found it wiser to continue 
 its moderate use for the rest of his life. Notice also 
 again that these last years were years of " quiet and 
 steady activity." 
 
 Without a scrap of direct evidence as to the exist- 
 ence of eye-strain, a study of the clinical biography of 
 De Quincey by a competent oculist should con- 
 vince him that the mystery of De Quincey's life 
 and disease, " the key to the original cause," as 
 he puts it, of his suffering, was reflex ocular neur- 
 osis. Why then did his eyes not pain him and 
 suffer? It is one of the greatest of unutilized truths, 
 long known, strangely ignored, that in the vast 
 majority of cases of eye-strain the morbid results of the 
 astigmatism, etc., are not felt in the eyes. It is per- 
 fectly explainable why this is so. The value of the 
 eye so overtops that of almost any other organ that 
 the reflex results of its unphysiologic function must be 
 shunted anywhere except back to the eye itself. In 
 women it goes to the head, and the world is full of 
 those tortured nearly every day of their life with head- 
 ache and sick-headache (" biHous " or " nervous " 
 headaches). In many, and especially in men working 
 much with the eyes, the reflex is to the digestional 
 organs, with " indigestion " and " liver derangements," 
 " anorexia," etc. The truth that eye-strain induces 
 these functional gastric, intestinal, and biliary disorders 
 cannot much longer be ignored. When acted upon it
 
 THOMAS De QUINCEY. 35 
 
 will constitute one of the greatest advances in practical 
 medicine that has ever been made. In the meantime 
 the supercilious indifference and ignoring of the fact 
 is one of the awful expenses of life and an opprobrium 
 of medicine. 
 
 We must not forget that in the days of De Quincey, 
 Carlyle, etc., candles and rush-lights were the common 
 sources of artificial light. When even our wonderful 
 best modern lights are by no means equal to daylight, 
 and are found taxing to weak and defective eyes, what 
 must have been the degree of eye-strain in the days of 
 candles ? 
 
 At about 65 De Quincey's eyes began troubling him. 
 When accommodation had been entirely lost, the morbid 
 reflex could not be shunted elsewhere, and must be 
 returned to the eyes themselves. He had " pain," 
 which means, beyond question, inflammation of the ex- 
 ternal or visible parts of the eye. (Cataract and retinal 
 inflammations are painless.) Stopping reading by 
 candle-light naturally relieved him. It returned worse 
 than ever and affected the cornea ("all but blind") 
 and sulphate of zinc was the excellent remedy used. 
 This conjunctival trouble continued to the end of his 
 life, and in the last years most of the reading was done 
 for him by others, reading aloud. 
 
 As I have said, the trained oculist would not need 
 direct evidence of ametropia, etc., to convince him of 
 the subtle source of De Quincey's affliction. But as
 
 36 BIOGRAPHIC CLINICS. 
 
 such positive evidence would aid in bringing convic- 
 tion to the layman and to the ultra-conservative physi- 
 cian, he would welcome any such demonstration of 
 the optical abnormality of this patient's eyes. Luckily 
 it exists, and in a duplicate and mutually corroborative 
 form. The first is the picture (reproduced herewith) 
 of De Quincey, prefixed to the " Life and Letters " 
 (by Page), made from the portrait by Mr. James 
 Archer, R.S.A. In this, as any ophthalmologist, or 
 even any observant layman, can see, the eyes are diver- 
 gent. In sitting for a portrait in which the eyes are 
 not directed (" centered ") upon the spectator, they 
 naturally fall into a position of noninnervation, de- 
 scribed as " at rest," " fixed upon vacancy," or " look- 
 ing at an infinite distance." When the external ocular 
 muscles are balanced (" orthophoria," " parallelism," 
 etc.), the axes unite at a far point such as a star, the 
 horizon, or at twenty feet distance. When there is 
 imbalance of the muscles (" heterophoria," "squint," 
 " strabismus ") there is no such uniting of the axes in 
 a state of rest or noninnervation. Naturally in sitting 
 for the painter De Quincey's eyes took this position — 
 literally one of rest, and it speaks much for the paint- 
 er's fine ability that he painted the truth as he found it. 
 That truth was that De Quincey had what the Amer- 
 ican oculist calls " exophoria," and the European 
 names "insufficiency of the interni." It is not squint or 
 strabismus, at least not permanently that, but so far
 
 THOMAS De QUINCEY. 37 
 
 as symptoms go it is infinitely worse than permanent 
 divergence. The eyes, or one eye, is not always diver- 
 gent, or turned out, but only when attention and 
 " fixation " are not aroused. Then, as in the portrait, 
 it is manifest. At other times the eyes appear, and are, 
 normally " fixing." That De Quincey had not diver- 
 gent strabismus is all but certain, because many — at 
 least Carlyle ! — would have described the striking fact. 
 Naturally none but the painter would record the fact 
 of the divergence of the eyes at rest. 
 
 Our own attention is interestedly fixed, also, by a 
 perfect bit of corroborative testimony — the statement 
 that De Quincey in his later years used but one eye 
 when reading and writing, the other " being invariably 
 closed." If this unused eye had been always or per- 
 manently divergent it would not have been closed, 
 because it would have been blind, amblyopic, or its 
 visual activity psychically ignored (as all oculists 
 understand) so that there would have been no need 
 of shutting it out by the closed lid. Fixation in " near 
 work " with it was in the late years so tiresome that 
 nature must allow it to diverge. That this eye had fair 
 vision is shown by the fact that the conflicting double 
 image (in divergence) had to be extinguished by 
 closing the lid. That this closing of one eye in read- 
 ing and writing was adopted late in life is demon- 
 strated by the two facts, that it was not ambly- 
 opic (required lid closure), and that there was no
 
 38 BIOGRAPHIC CLINICS. 
 
 permanent " ptosis," or paralytic closing of the lid. 
 Even to his death both eyes were " open " when look- 
 ing at any person, or at a distance. When looking at a 
 book, etc., after accommodation failed, there could not 
 be the double convergence required except by a strain- 
 ing effort greater than that required to hold one lid 
 closed. 
 
 A capital proof of all this, moreover, is offered to us 
 in the statements of his daughter and of his physician 
 that even at 74 he never used spectacles for reading. 
 We now know that even with the best application no 
 spectacles that any person could have obtained at that 
 time would have completely relieved eye-strain. Oph- 
 thalfnology at that time had not risen to its splendid 
 opportunity. It has only done so exceptionally to-day. 
 To its disgrace operations and inflammatory diseases 
 still occupy the specialist's attention too exclusively. 
 Spectacles of the crudest kind were discovered only 
 about 500 years ago and science and some scientific 
 men seem often inclined to ignore for another 500 
 years their use and improvement in correcting the 
 optical defects of the eye that looks through their 
 infinitely studied and perfected microscopes. But all 
 the lenses of all the opticians of that country and time 
 would not have helped poor De Quincey. Why? Be- 
 cause he had myopic astigmatism, and of some anom- 
 alous and anisometropic variety. Had he not been 
 afflicted with this optical fault of his eyes, he could
 
 THOMAS De QUINCEY. 39 
 
 not have read a line of any book at the age of 70. It 
 should also be noted that the opium he took would pro- 
 duce myosis, or narrowing of the pupil to a " pin 
 point " diameter. This would also greatly aid him in 
 shutting out the confusing rays or diffusion circles, 
 caused by astigmatism, and would thus, in a way, 
 make his vision better. Unconsciously this fact may 
 also have aided in the addiction to the opium-habit 
 itself. Up to the age of about 62 he was able to pre- 
 serve binocular vision, but at an expense to his nervous 
 and digestional system which was essentially the cause 
 of his opium habit, and of all his suffering.^ At any 
 time of his life a proper pair of spectacle lenses would 
 have relieved De Quincey of his sufferings, would have 
 enabled him to quit opium-taking, and would have 
 allowed him to pursue a far more wonderful literary 
 career. 
 
 Even with De Quincey's incomparable brilliancy and 
 accuracy of insight he could not have divined all this. 
 How near to it he came, however, is to be found in a 
 number of selections from his writings. If he could 
 have suspected that the source of the disorders of " the 
 whole process and elaborate machinery of digestion " 
 in his case was in that most delicate, important, and 
 wonderful organ of vision, he would probably have 
 
 ^ Dr. Begbie thinks De Quincey's immunity from headache 
 was due to the opium. He did not know that myopic patients 
 do not have headache.
 
 40 BIOGRAPHIC CLINICS. 
 
 made the following passage even more beautifully 
 powerful and pathetic than it is : " The whole process 
 and elaborate machinery of digestion are felt to be 
 mean and humiliating, when viewed in relation to our 
 mere animal economy. But they rise into dignity, and 
 assert their own supreme importance, when they are 
 studied from another station, viz., in relation to the 
 intellect and temper. No man dares then to despise 
 them. It is then seen that these functions of the 
 human system form the essential basis upon which the 
 strength and health of our higher nature repose, and 
 that upon these functions chiefly, the genial happiness 
 of life is dependent. All the rules of prudence, or gifts 
 of experience that life can accumulate, will never do as 
 much for human comfort and welfare as would be 
 done by a stricter attention, and a wiser science, 
 directed to the digestive system."
 
 CARLYLE. 
 
 4«
 
 CHAPTER II. 
 THOMAS CARLYLE. 
 
 The formidable number of the following excerpts 
 should not deter the reader, if at all interested in the 
 subject, from attentive consideration of each. I have 
 omitted a hundred or more which were merely general 
 expressions, or repetitions of these, in order to reduce 
 the space as much as possible. But, for one reason or 
 another, I think every line quoted has some special 
 significance in helping to give a thorough understand- 
 ing of the clinical biography of the patient : 
 
 Thomas Carlyle was bom December 4, 1795. 
 
 At the age of 23, says Froude, " he was attacked with dyspep- 
 sia, which never wholly left him, and in these early years 
 soon assumed its most torturing form, 'like a rat gnawing at 
 the pit of his stomach.' " At this time he says of himself, 
 just entering upon "the three most miserable years ot his life," 
 he was fast losing his health (while a student in Edinburgh), 
 "a prey to nameless struggles and miseries, which have yet a 
 kind of horror in them to my thoughts, three weeks without 
 any kind of sleep, from impossibility to be free from noise." 
 
 " In sickness of body and mind," " dyspepsia had him by the 
 throat," "irritable," "gey ill to live wi '," etc., are further 
 descriptions of these years, 
 
 "I enjoyed any amount of walking in those young years." 
 
 "Bad health does depress and undermine one more than 
 all other calamities put together." (24 years of age.) 
 
 43
 
 44 BIOGRAPHIC CLINICS. 
 
 " With stupidity and sound digestion man may front much." 
 (25.) 
 
 " It is these * coorsed nervous disorders.' If I had but 
 strong health !" (26.) 
 
 " In spite of all my dyspepsias, and nervousness and hypo- 
 chondrias." (27.) 
 
 " He had been working hard on Schiller and Meister. He 
 had been complaining of his health again." (28.) 
 
 " Is Tom got better ? Does he sleep well yet ? It gaed to my 
 heart when he told me in the last letter that he couldna sleep 
 without his finger in his ear." (His father.) 
 
 " I sleep irregularly here, and feel a little, very little, more 
 than my usual share of torture every day. What the cause is 
 would puzzzle me to explain. I take exercise sufficient daily; 
 I attend with rigorous minuteness to the quality of my food ; I 
 take all the precautions that I can, yet still the disease abates 
 not." (28.) 
 
 " Wrecked with want of sleep." 
 
 "Ill-health, the most terrific of all miseries." 
 
 " A state of health worse than ever it was." 
 
 "I was consulting doctors who made me give up my dear 
 nicotine, and take to mercury." 
 
 " Grown sicker and sicker. ... I want health, health, 
 health. On this subject I am becoming quite furious. ... If 
 I do not soon recover, I am miserable forever and ever. They 
 talk of the benefit of ill-health from a moral point of view. 
 I declare solemnly, without exaggeration, that I impute nine- 
 tenths of my present wretchedness, and rather more than nine- 
 tenths of all my faults, to this infernal disorder in the 
 stomach." (Aged 28, at work on Meister.) 
 
 " These drugs leave me scarcely the consciousness of exist- 
 ence. . . . There is mercurial powder in me, and a gnawing 
 pain over all the organs of digestion, especially in the pit and 
 left side of the stomach." (Ibid.) 
 
 " Stupid, unhappy, by fits wretched, but also dull— dull and 
 very weak." (Ibid.)
 
 THOMAS CARLYLfi. 4S 
 
 "*A long ^airy-eared jackass/ as he called some eminent 
 Edinburgh physician, had ordered him to give up tobacco, 
 but he had ordered him to take mercury as well; and he told 
 me that along with the mercury he must have swallowed 
 whole hogsheads of castor oil." (Ibid.) 
 
 " On days when moderately well, I feel as happy as others ; 
 happier, perhaps." 
 
 "... A Mr. Badams, a graduate in medicine, though his 
 business is in chemical manufactures in Birmingham, . . . 
 is one of the most sensible, clear-headed persons I have ever 
 met with. . . . After going about for a day or two talking 
 about pictures and stomach disorders, in the cure of which he 
 is famous, and from which he once suffered four years in 
 person, what does the man do but propose that I should go up 
 to Birmingham for a month and live with him that he might 
 find out the make of me, and prescribe for my unfortunate 
 inner man. I have consented. ... Of his skill in medicine 
 I augur favorably from his general talent, and from the utter 
 contempt in which he holds all sorts of drugs as applied to 
 persons in my situation. Regimen and exercises are his 
 specifics, assisted by as little gentlest medicine as possible. On 
 the whole, I think I never had such a chance for the recovery 
 of health. ... I am going to take books and read," etc. (28.) 
 
 Eight weeks with Badams brought no relief. "The con- 
 tempt of drugs which Badams had professed in London had 
 been rather theoretic than practical," says Froude. Carlyle 
 puts it thus : " I have been bephysicked and bedrugged. I 
 have swallowed about two stoupfuls of castor oil since I came 
 hither; unless I dose myself with that oil of sorrow I cannot 
 get along at all." Badams wished him to come back " for 
 another month until he had completed his doctorial and castor 
 oil system with me. Some of Badams' drugs had not pros- 
 pered with me, and I fell below par in point of health." (29.) 
 
 Badams himself took to drink, as described by Carlyle six 
 years later, " for the sake of an intolerable headache which 
 brandy was wont to cure/' and soon " died miserably."
 
 46 BIOGRAPHIC CLINICS. 
 
 The complaints of "bad stomach," "bad health," etc., now 
 became frequent and bitter, and the passionate resolves to get 
 health most pathetic. 
 
 " Could I live without taking drugs for three months, I 
 should even now be perfectly well." (29.) 
 
 Upon his farm at Hoddam Hill he improves. "Long soli- 
 tary rides on my wild Irish horse Larry, good for the dietetic 
 part," He steadily gains in health, "and for my occupations 
 {i. e., literary work) they amount to zero." "It is rather a 
 holy time, a pax Dei which exhausted Nature has conquered 
 for herself." (29.) 
 
 He threw himself into a course of wide and miscellaneous 
 reading, and at the time of his recent marriage and settlement 
 in London, he asks, " Why am I not happy then ? Alas, Jack, 
 I am bilious. I have to swallow salts and oil ; the physic leaves 
 me pensive yet quiet in heart, and on the whole happy enough ; 
 but the next day comes a burning stomach and a heart full of 
 bitterness and gloom." (31.) 
 
 " Sick with sleeplessness, nervous, bilious, splenetic, and all 
 the rest of it." {Ibid.) 
 
 "Beggarly want of hope." {Ibid.) 
 
 " It is strange how one gets habituated to sickness." {Ibid.) 
 
 " The new book is going at a regular rate. . . . Oh, that he 
 were indeed well." (Mrs. Carlyle.) 
 
 " I fight with dullness and bile in the forenoons as of old." 
 (He worked in the forenoon and "walked diligently" in the 
 afternoon.) 
 
 " I have been in considerably better health ever since I came 
 to Craigenputtock and found my red chestnut Irish doctor 
 saddled, waiting for me in his stall." (33.) 
 
 " None can say how bilious I am, and am like to be ; but I 
 have begun to ride daily on Larry, and so Jeffrey shall have 
 his article at the appointed time." (33.) 
 
 " He went out in all weathers, indifferent to wet, and in 
 spite of his imagined ill-health, impervious to cold." (Froude.) 
 
 " You cannot figure the stillness of these moors in November
 
 THOMAS CARLYLE. 47 
 
 drizzle. Nevertheless I walk often under cloud of night, down 
 as far as Carstammon Bum, sometimes to Sandy Wells," etc. 
 
 (33.) 
 
 " He took his nightly walks on the frozen moor." (Froude.) 
 
 " Farthing rushlights for illumination after dark." (At 
 Craigenputtock, aged 36.) 
 
 " Mrs. Carlyle's faith in physicians is somewhat on a level 
 with my own; that she will give them no more of her blood, 
 but trust to exercise, diet, and the return of settled weather." 
 (36.) 
 
 "His health was essentially robust." (Froude.) 
 
 " My husband is as good company as reasonable mortal could 
 desire. Every fair morning we ride on horseback for an hour 
 before breakfast." (Mrs. Carlyle.) 
 
 "I am better resting. I had made myself bilious enough 
 with my writing, and had need to recover as I am doing. (At 
 Edinburgh, aged 38.) 
 
 "Her complaint (Mrs. Carlyle) seems like mine, a kind of 
 deep-seated dyspepsia ; no medicine is of avail, only regimen 
 (when once one can find it out) free air and, if that is possible, 
 cheerfulness of mind." {Ihid.) 
 
 " I, when I take walking enough, get along as I was wont 
 in that particular. Continued sickness is a miserable thing, 
 yet one learns to brave it." (39.) 
 
 "The world is God's world, and wide and fair." (Ibid.) 
 
 "The history of the French Revolution, the most powerful 
 of all his works, and the only one which has the character of 
 a work of art, was the production of the mind which he 
 brought with him from Craigenputtock, undisturbed by the 
 contradictions and excitements of London society and Lon- 
 don triumphs. Poverty, mortification, and disappointment had 
 done their work upon him, and he had risen above them, ele- 
 vated, purified, and strengthened." (Froude, upon Carlyle 
 leaving "the six years' imprisonment on the Dumfriesshire 
 moors.") 
 
 " He had laid in, too, on the moors a stock of robust health. 
 Lamentations over indigestion and want of sleep are almost
 
 48 BIOGRAPHIC CLINICS. 
 
 totally absent from the letters written from Craigenputtock. 
 The simple natural life, the wholesome air, the daily rides or 
 drives, the poor food, . . . had restored completely the func- 
 tions of a stomach never so far wrong as he had imagined. 
 . . . Afterwards he was always impatient, moody, irritable, 
 violent. These humors were in his nature, and he could no 
 more be separated from them than his body could leap off its 
 shadow. ... He looked back to it as the happiest and whole- 
 somest home that he had ever known. He could do fully twice 
 as much work there, he said, as he could ever do afterwards 
 in London." (Froude.) 
 
 " I read dozens of pages and find at the end that I have not 
 the slightest knowledge what they were about." (39, in Lon- 
 don.) 
 
 "Mood tragical, gloomy, as of one forsaken." (Ibid.) 
 
 " Bad health, too (at least singularly changed health), brings 
 all manner of dispiritment." (Ibid.) 
 
 "Weary, dispirited, sick." (Ibid.) 
 
 " All of us have tolerable health. ... I am diligent with the 
 shower-bath; my pilgrimages to the museum and on other 
 town errands keep me in walking enough." (Ibid.) 
 
 "Bilious, too, in these smothering windless days." (Ibid.) 
 
 "Broke down in the park; konnte nichts mehr, being sick 
 and weak beyond measure." (Ibid.) 
 
 " Many days of suffering, of darkness, of despondency. . . . 
 Ill-health has much to do with it." (Ibid.) 
 
 " His name was not seen on charity-lists, but he gave away 
 every year, perhaps half what he received. (Froude.) 
 
 "All the mornings he was at his desk; in the afternoons he 
 took his solitary walks in Hyde Park, seeing the brilliant 
 equipages, and the knights and dames of fashion prancing 
 gaily along the Row." (Ibid.) 
 
 " His impatience, his irritability, his singular melancholy, 
 . . . were the effects of temperament first, and of a peculiarly 
 sensitive organization; and secondly of absorption in his 
 work," etc. (Froude.)
 
 THOMAS CARLYLE. 49 
 
 " The first book of the French Revolution is finished. Soul 
 and body both very sick." (40.) 
 
 " If literature will refuse me both bread and a stomach to 
 digest bread, then surely the case is growing clear." (40.) 
 
 "If Providence ever did warn, it warns thee to have done 
 with literature, which will never yield thee bread, nor stomach 
 to digest bread." (Of himself, aged 40.) 
 
 " The pipeclay state, as (^arlyle has designated a state too 
 common with those who are too well furnished with bile." 
 (Mrs. Carlyle.) 
 
 " Occasionally sharp pain (something cutting or hard grasp- 
 ing me around the heart). . . . Something from time to time 
 tying me tight as it were, all around the region of the heart, 
 and strange dreams haunting me." (40.) 
 
 " My sight inward, as well as outward, is all as if be- 
 dimmed." (40.) 
 
 " I am yellow and thin, and feel that a rest will be very 
 welcome and beneficial." (40.) 
 
 " * The accelerated speed ' slackened to slow, and then to no 
 motion at all. He sat daily at his desk, but his imagination 
 would not work. . . . He locked up his papers, and sat for a 
 fortnight reading novels. ... He w^ould be idle, he would rest. 
 He would try, if the word was not a mockery, to enjoy 
 himself." (Froude.) 
 
 " My bodily health is actually very bad. ... I am full of 
 dyspepsia, but also of hope. . . . No work to-day, as of late 
 days and weeks." (40.) 
 
 " He wrote * with his heart's blood ' in a state of fevered 
 tension." (Froude.) 
 
 " My poor nerves, for long months kept at the stretch, felt 
 all too waste, distracted. . . . That things should come to a 
 crisis is what I wish." 
 
 The fortnight's idleness expired. He had seen many friends, 
 he had walked and sat in the park. The novels had proved 
 without charm. He writes now of "the perceptible increase 
 of health this otherwise so scandalous faulenzen (idleness)
 
 so BIOGRAPHIC CLINICS. 
 
 had given him ; " he went to work again on the lost volume, 
 but became so sick that he still made little progress. 
 
 He managed to complete the volume, locked it up, felt " like 
 a man who had nearly killed himself in accomplishing zero," 
 and went to Scotsbrig, where he talked and smoked and 
 " walked far and fast among the hills." " Health is greatly 
 improved since I got hither. Alas! the state of wreckage I 
 was in, fretted to fiddle-strings, was enormous. Even yet after 
 a month's idleness, and much recovery, I feel it all so well." 
 (40.) 
 
 Even at Scotsbrig " a little overwork hurts me, and is found 
 on the morrow to be quite the contrary of gain." 
 
 Returned to Chelsea, Froude says of his health : " Nothing 
 was essentially the matter, but he slept badly from overwork. 
 Toil was as severe as ever." With work his health grows 
 worse; "physical pain is bad dispiritment. ... It many times 
 strikes me, being in ill-health and so miserable, art thou not of 
 a surety wrong? Why not quit literature? ... I am weary 
 almost of life itself." (41.) 
 
 "Went out and had long swift-striding walks — till ten — 
 under the stars. . . . The unrested horse or writer cannot 
 work. . . . Have had two or three days of the most perfect 
 rest now. . . . Have finished Chapter I., . . . and gone idle 
 for a week after, till as usual, I am now reduced to a caput 
 mortuum again." (41.) 
 
 " My printers had only ceased the day before ; I was wasted 
 and fretted to a thread. My tongue, let me drink as I would, 
 continued as dry as a charcoal." (42.) 
 
 " My health is not fundamentally hurt. Rest will cure me. 
 I grow better daily. I delve, I walk much, generally alone 
 through the lanes and parks." (42.) 
 
 " He fled to Scotland fairly broken down. He had fought 
 and won his long battle. The reaction had come, and his 
 strangely organized nervous system was shattered." (Froude, 
 June, 1837.) 
 
 " My soul's one wish," he writes from Scotland, " is to be
 
 THOMAS CARLYLE. 5^ 
 
 left alone, to hear the rustle of the trees, the music of the bum, 
 and lie vacant, as ugly and stupid as I like. ... I am doing 
 nothing; witnessing nothing. My stupidity is great. . . . They 
 say I am growing better, looking better." " With talk and 
 locomotion, the days pass cheerily." (42.) 
 
 Returned to Chelsea, he attended "a party" and returned 
 about one in the morning, " with a headache that served me 
 for more than a day after, . . . sick and nervous." He "did 
 nothing all winter." (43.) 
 
 There is a shivering precipitancy in me, which makes 
 emotion of any kind a thing to be shunned. " It is my nerves, 
 my nerves. . . . Such a nervous system as I have. . . . Thomas 
 feeling in his breast for comfort and finding bilious fever. . . . 
 All palpitating, fluttered with sleeplessness and drug-taking, 
 etc. . . . Weary and worn with dull blockheadism, chagrin 
 (next to no sleep the night before)." (43.) 
 
 " Nothing keeping him in health so much as riding." (43.) 
 
 "Dyspepsia working continually. . . . Dispirited, in miser- 
 able health. . . . Ride daily. . . . Swift riding and solitude. 
 . . . For two hours every day I have almost an immunity from 
 pain. . . . Health perceptibly improved. I have distinctly less 
 pain in all hours." (44.) 
 
 " Going into society " was " at the cost of a shattered set of 
 nerves and head set whirling for the next 48 hours." (45.) 
 
 " I pass my days under the abominable presence of physical 
 misery — a man foiled. I mean to ride diligently for three com- 
 plete months, try faithfully whether in that way my insup- 
 portable burden and imprisonment cannot be alleviated into at 
 least the old degree of endurability." (45.) 
 
 " I am sick and very miserable. I have kept riding for the 
 last two months. My health seems hardly to improve. I have 
 been throwing my lectures upon paper. ... If I were a little 
 healthier, — ah, me ! all around would be well." (45.) 
 
 "A head full of air; you know that wretched physical feel- 
 ing; I had been concerned with drugs, had awakened at five, 
 etc. It is absolute martyrdom." (45.)
 
 52 Biographic cLiNicS. 
 
 At the height of his success, complaints grow more bitter; 
 he longed to be in the country ; " I shall never be other than 
 ill, wearied, sick-hearted, etc. . . . Bilious, heartless and for- 
 lorn. . . . Sick, sleepless, driven half mad." (His horse had 
 been given up as too expensive.) 
 
 " My reading goes on ; my stupidity seems to increase with it 
 more and more. . . ." Walking and solitude are "indis- 
 pensable " for health. " I am sure to be sick everywhere." 
 (45.) 
 
 " One asks with wonder why he found existence so intoler- 
 able. . . . He was now successful far beyond his hopes. The 
 fashionable world admired and flattered him. The cleverest 
 men had recognized his genius, and accepted him as their equal 
 or superior. He was listened to with respect by all; and, far 
 more valuable to him, he was believed in by a fast increasing 
 circle as a dear and honored teacher. His money anxieties 
 were over. If his liver occasionally troubled him, livers 
 trouble most of us as we advance in life, and his actual con- 
 stitution was a great deal stronger than that of ordinary men. 
 . . . Why could not Carlyle, with fame and honor and troops 
 of friends, and the gates of a great career flung open before 
 him, and a great intellect and a conscience untroubled by a 
 single act which he need regret, bear and forget too? Why 
 indeed! The only answer is that Carlyle was Carlyle." 
 (Froude.) 
 
 " Want of rest in the past summer had upset Carlyle's 
 internal system. Work he could not." He went to Fryston. 
 " My hope and expectation is that I shall improve in health 
 here." (46.) 
 
 But, "there was no help for it; he had to do what in the 
 past year he knew he must do, allow himself a season of com- 
 plete rest and sea air." At Scotsbrig : " I grow daily better, 
 and am really very considerable recovered now." (46.) 
 
 The meaning of the word, idle, to Carlyle, is to be kept in 
 mind. Note that reading is never wholly discontinued. While 
 at Scotsbrig lazy and idling, he writes in his journal: "Much
 
 THOMAS CARLYLE. 53 
 
 French rubbish of novels read, a German book, etc. Nothing 
 read, nothing thought, nothing done." Reading was only 
 relatively less, and out-of-door life far greater than usual. 
 Later he says, " I do not read much." 
 
 " I cannot be healthy anywhere under the sun." (47.) 
 
 " What a pity a man cannot sleep, and so live something 
 like other men. . . . My sleep was a sleep as of hospitals, of 
 men in a state of asphyxia, a confused tumult, a shifting from 
 headache to headache." (Ibid.) 
 
 " No man was lately busier, and few sicklier, than I now 
 am. Work is not possible for me except in a red-hot element 
 which wastes the life out of me. I have still three weeks of 
 the ugliest labor (correcting proofs), and shall be fit for a 
 hospital then." (48.) 
 
 "The lassitude that always followed the publication of a 
 book." (Froude.) 
 
 " Past and Present " was completed in February, 1843, and 
 after six months of resting and touring he had, at Scotsbrig, 
 in August, "no appetite for writing, for speaking, or in short, 
 doing anything but sitting still as a stone." (48.) 
 
 " These were times when Carlyle was like a child and a 
 very naughty one." " His work would not go, . . . his task 
 seemed impossible." (Froude, after the return to Chelsea in 
 October.) 
 
 " The dinner hour was changed to the middle of the day to 
 improve the biliary condition. No result came. He walked 
 about the streets to distract himself." " So it was, is, and 
 must be with every serious man when he is first starting upon 
 any great literary work." (49.) 
 
 " Above a hundred museum headaches." (49.) 
 
 " My progress in ' Cromwell ' is frightful. I am no day 
 absolutely idle, but the confusions that lie in my way require 
 far more force of energy than I can muster on most days, and 
 I sit, not so much working as painfully looking on work." 
 (49.) 
 
 " Lack of sleep and dull headache. Very stupid." (49.) 
 
 "As a preliminary" (to finishing "Cromwell," and getting
 
 54 BIOGRAPHIC CLINICS. 
 
 away on the road) " I have started to-day, by — a blue pill and 
 castor." (49.) 
 
 "The devil of sleeplessness and indigestion." (49, just 
 finishing " Cromwell.") 
 
 ** Cromwell thus disposed of (August 25) he was off to 
 Scotland . . . dreadfully bilious, and almost sick of his life." 
 (Froude.) 
 
 "Then troublesome proof sheets came which would stir the 
 bile a little." " I seem to improve in health a little, but still 
 do not sleep. The habit of utter idleness getting possession of 
 me is very strange." (50.) 
 
 "Very unwell;" "sleepless," "totally idle, trying merely to 
 read books, and the books a disgust to him." (51.) 
 
 " A huge nightmare of indigestion, insomnia, and fits of 
 black impatience with myself and others, — self chiefly. ... I 
 am heartily sick of my dyspeptic bewilderment and imprison- 
 ment." (52.) 
 
 " For two years now I have been as good as totally idle, 
 composedly lying fallow. It is frightful to think of. After 
 getting out of * Cromwell ' my whole being seemed to say, 
 more sulkily, more weariedly than ever before, ' What good is 
 it ?' I am wearied and near heartbroken. Nobody on the whole 
 'believes my report.*" (53.) 
 
 " Never till now was I so low — utterly dumb this long 
 while, barren, undecided, wretched in mind." " Never spent 
 five lonelier, idler weeks." (54.) 
 
 "Little done hitherto, nothing definite done at all." (54.) 
 
 " My work needs all to be done with my nerves in a kind 
 of blaze ; such a state of soul and body as would soon kill me, 
 if not intermitted." "I have to rest accordingly; to stop and 
 sink into total collapse, to get out of which again is a labor of 
 labors." (54.) 
 
 " I am getting weary of suffering, feel as if I could sit down 
 in it and say, well then, I shall soon die at any rate." (55.) 
 
 " I had no idea I was so sick of heart and had made such 
 progress toward age and steady dispiritment. Alas! alas! I
 
 THOMAS CARLYLE. 55 
 
 ought to be wrapped in cotton wool, and laid in a locked 
 drawer at present. I can stand nothing. I am really ashamed 
 of the figure I cut," etc. (55.) 
 
 " Robust constitutional strength . . . was not among the 
 gifts which Nature had bestowed upon Carlyle." (Froude.) 
 
 "In hope, desire, or outlook, so far as common mortals 
 reckon such, I never was more bankrupt." (55.) 
 
 He had been prevailed to sit for his portrait : " No more 
 abominable blotch, without one feature of mine. ... It is the 
 portrait of an idiot that has taken Glauber's salts and lost his 
 eyesight. We burn it and forget it." (56.) 
 
 " He fled to Malvern for the water-cure, and became, with 
 his wife for a few weeks the guest of Dr. Gully. . . . The 
 bathing, packing, drinking, proved useless — worse, in his 
 opinion, than useless. ' He found by degrees that water, taken 
 as a medicine, was the most destructive drug he had ever 
 tried.' He *had paid his tax to contemporary stupor.' . . . 
 He hastened to hide himself in Scotsbrig, full of gloom and 
 heaviness, and totally out of health." (56.) 
 
 " Although beginning * Frederick ' he is glad to get home to 
 a slighter measure of dyspepsia, inertia, and other heaviness, 
 ineptitude and gloom." (57.) 
 
 " Writing of all kinds in these sad biliary circumstances, 
 with half-blind eyes." (57.) 
 
 During the trip to Germany loss of sleep is complained of, 
 but " on the whole, was not so unhappy after all." " He could 
 not conceal that he was pretty well, and had nothing really to 
 complain of." (57.) 
 
 " My survey of the last eight or nine years of my life yields 
 little * comfort,' " etc. " Health miserable; " " diseased liver; " 
 " cannot yet learn to sleep well. . . . For the rest, I guess it is 
 a change of epoch with me, going on for good perhaps. I am 
 growing to perceive that I have become an old man." (57.) 
 
 "She (Mrs. Carlyle) reads now with specs in the candle- 
 light, as well as I; uses her mother's specs, I perceive," etc. 
 (58.)
 
 56 BIOGRAPHIC CLINICS. 
 
 " Here are now ten years, and what account can I give of 
 them? The work done in them is very small, even in com- 
 parison." (58.) 
 
 " I really feel almost better than I have done in late years ; 
 . . . it is strange how little decay I feel; nothing but my eye- 
 sight gone a very little." (58.) 
 
 The sensitiveness to noise continues — "the great cock ques- 
 tion " is settled, but " Frederick " does not make the headway 
 desired, because he is " in a heavy stupefying state of health," 
 and he is afflicted with terrible dreams. " Nearly all of my 
 dreams in this world have come from bodily conditions of the 
 nerves, I think." (59.) 
 
 "My eyes are very dim; bad light (from the sky direct) 
 though abundant." (59.) 
 
 After eighteen months at " Frederick," " all things go 
 prosperously," and he sleeps well. (60.) 
 
 "Doing really excellently well as regards health." (62.) 
 
 " Villainous headaches," " feverish headaches " come on 
 with his proofs all day, but "the world was well; all was 
 well," generally speaking, and "indoors the old affectionate 
 days had come back." (62.) 
 
 At the completion of his six years' task (Frederick) he was 
 " slightly out of health " ; took a trip to Germany, " improves 
 in bodily health, and sleeps well." (63.) 
 
 There are some complaints henceforth, of nerves, stomach, 
 darkness, stupidity, etc., but they are not so frequent, nor by 
 any means so passionate as formerly. He " worked without 
 respite, rode except on walking days, chiefly late in the after- 
 noon, in the dark of the winter months," etc. (67-68.) 
 
 " I have mainly consorted with my horse for eight years 
 back." (69.) 
 
 He was thrown from his horse and hurt in 1868 (73 years 
 old), and renounced riding thenceforth. 
 
 Tremulousness and twitching of the right hand came on in 
 1870, and made writing impossible. 
 
 At the age of 80 he had " bright reminiscences of health."
 
 THOMAS CARLYLE. 57 
 
 " He was attended by a Scotch physician. He disliked doc- 
 tors generally, and through life had allowed none of them 
 near except his brother; but he now submitted to occasional 
 visits." (83.) 
 
 He died February 5, 1881, aged 85. 
 
 If the theory I have formed of the origin of Carlyle's 
 ill-health is correct, the reasons that the first appear- 
 ance of symptoms is so late as at the age of 23 may be 
 one or more of three : 
 
 1. Symptoms of headache, indigestion, etc., during 
 boyhood may not have been recorded. Very often 
 such symptoms take the form of, or are supposed to 
 be, other diseases. 
 
 2. His sound constitution and fine Scotch inheritance 
 from a rugged, resistant, and healthful ancestry en- 
 abled him to conquer disease in the critical period of 
 youth, when another would have succumbed. There is 
 also no evidence that he was a hard student as a boy. 
 
 3. His " error of refraction " may not have developed 
 until his twenty-second or twenty-third year. During 
 this growing period astigmatism and other optical 
 defects may increase or decrease in a few years or even 
 a few months.^ 
 
 ^ I have had one fine boy as a patient whose eyes had to be 
 retested every few months and whose astigmatism steadily 
 increased from a low degree until it became very high as he 
 approached manhood. Whenever his astigmatism had in- 
 creased one half of a diopter everything eaten would at once 
 be vomited, until his spectacles had been changed. Persistence 
 of neglect resulted in positive emaciation. 
 5
 
 $8 BIOGRAPHIC CLINICS. 
 
 Upon entering- adult life Fate knocked at Carlyle's 
 door as abruptly, ominously, and clearly as at the 
 beginning of Beethoven's Fifth Symphony. While a 
 student at Edinburgh, and applying himself severely, 
 dyspepsia seized upon him with the train of symptoms 
 so persistently and clearly described by him for almost 
 exactly 40 years. He spoke of the next three years as 
 " the most miserable of his life," but it is plain that 
 from 42 to 56 his sufferings were far more intense. 
 The bitter want of sleep, and complaint of noise, and 
 the heartrending heartsickness, intermitted only dur- 
 ing the life at Craigenputtock, for the four coming 
 decades. That they did stop, and exactly when the 
 accommodating function was paralyzed by age — this is 
 to me a most significant fact. With most noteworthy 
 wisdom he says at 57 : " It is a change of epoch with 
 me, going on for good perhaps. I am growing to per- 
 ceive that I have become an old man." The full estab- 
 lishment of presbyopia is the beginning of old age with 
 every man. 
 
 Carlyle's Constitution. — With characteristic froudery 
 his biographer thus alludes to Carlyle's physical endow- 
 ment in three different places: 
 
 (a) " His actual constitution was a great deal stronger than 
 that of ordinary men." 
 
 (6) " His health was essentially robust." 
 
 (c) "Robust constitutional strength was not among the 
 gifts which nature had bestowed upon Carlyle."
 
 THOMAS CARLYLE. 59 
 
 This is a minor one of the thousand illustrations of 
 the inexplicable blunder Carlyle committed in entrust- 
 ing his manuscripts and biography to the ineptitude of 
 this caricature " Greek Chorus." How unconquerably 
 tough and sound must have been the natural consti- 
 tution that, after 40 years of continuous daily excruciat- 
 ing torment, could enjoy 22 years of healthy old age, 
 and die at the ripe age of 85. At 58 Carlyle says : " It 
 is strange how little decay I feel; nothing but my 
 eyesight gone a little." At 60 " the world was well ; 
 all was well." Even at 41 he says of himself that 
 " nothing was essentially the matter," and at 42, " my 
 health is not fundamentally hurt." 
 
 His physiologic habits were also of the best possible. 
 His food was always of the simplest but it had to be of 
 the best quality, usually sent from the old Scotch home. 
 He was careful, he was compelled to be most careful, 
 in all matters of personal hygiene, as regards exercise, 
 etc., and physical sin was as impossible to him as 
 moral sin. The reader of his life and letters will per- 
 haps wonder if tobacco may have had anything to do 
 with his irritability and bad health. But smoking (in 
 moderation as Carlyle practised it) does not have that 
 physiologic effect, as millions can testify. Carlyle's 
 judgment in this and in many such matters was most 
 accurate. Some Edinburgh physician in the early 
 years of his " dyspepsia " had told him that tobacco 
 was the cause of his digestional difficulty, and by his
 
 6o BIOGRAPHIC CLINICS. 
 
 advice he gave it up, but " found I might as well have 
 poured my sorrows into the long hairy ear of the first 
 jackass I came upon as of this select medical man."^ 
 And he rightly continued the habit to the day of his 
 death. One of the earliest, most continuous, and latest 
 grievances was insomnia. " It goes to my heart when 
 he told me in his last letter that he could not sleep 
 without his finger in his ear." All oculists know that 
 insomnia is one of the most common and persistent 
 symptoms of eye-strain. 
 
 What I have called the second critical period ended 
 with Carlyle at about the age of 32, and the six years 
 at Craigenputtock were the happiest he was ever to 
 have — for after 60 there were other reasons than phys- 
 ical for unhappiness. Like De Quincey (and Hke Dar- 
 
 ^ That Carlyle's judgment concerning those physicians he 
 met was not far wrong, I quote the following remarkable 
 " clinical observations " from the British Medical Journal, 
 November 9, 1895, page 1147. 
 
 " The late Mr. Carlyle was a patient of mine. As all the 
 world knows he was a man of great j udgment and great power 
 of observation. With regard to himself, the only remedy I 
 could ever get him to take was grey powder. He lived to 82 
 or 83. Grey powder was his favorite remedy when he had that 
 wretched dyspepsia to which he was subject, and which was 
 fully accounted for by the fact that he was particularly fond 
 of very nasty gingerbread. Many times I have seen him 
 sitting in the chimney corner smoking a clay pipe and eating 
 this gingerbread. He overcame the difficulties incident to 
 this habit by his grey powder, which did him much good." 
 (Sir R. Quain.)
 
 THOMAS CARLYLE. 6i 
 
 win, Huxley, and Browning also) Carlyle found that 
 the sole and absolute condition of ability to read and 
 write as well as to live, was continuous and prolonged 
 exercise in the open air. When he could afford a 
 riding horse he was better. A large part of his life 
 was spent in riding horseback (he speaks of one of his 
 horses having carried him 20,000 miles), or in walking, 
 often in the night. Besides the quiet, the eye-resting 
 distance, etc., this is another reason why he was so 
 much better at Craigenputtock. "He could do fully 
 twice as much work there as in London." The more 
 he read and wrote the worse his health. Many quota- 
 tions show that he knew the direct relationship between 
 writing and distress. In the forenoons at his desk he 
 fights with dulness and bile " as of old," while in the 
 hours of riding in the afternoon he has " almost an 
 immunity from pain." He even reduced the fact to a 
 generalization, finding that literary work caused his 
 suffering : 
 
 " If literature will refuse me both bread and a stomach to 
 digest bread " — 
 
 " If Providence ever did warn it warns me to have done 
 with literature which will never yield the bread nor the 
 stomach to digest bread." 
 
 " I had made myself bilious enough with my writing." 
 
 But thousands of other people all over the world 
 work at literary work many more hours a day than did 
 Carlyle and without "upsetting the stomach," "derang- 
 ing the liver," or producing irritability and melan-
 
 62 BIOGRAPHIC CLINICS. 
 
 cholia. There are a few million in the world in whom 
 these are the results of the use of the eyes at near 
 range, but there are many more millions, clerks, sew- 
 ing-women, craftsmen, artists, etc., who have no such 
 troubles. 
 
 His Symptoms. — Throughout the annotations of 
 the unendurable are scattered the insinuations that 
 Carlyle's sufferings were largely the products of his 
 disordered fancy. " His imagined ill-health," he says : 
 " He saw his ailments through the lens of his imagi- 
 nation " ; " it .was in his nature " ; " he could not con- 
 ceal that he was pretty well and had nothing really to 
 complain of " ; " why at the acme of success and fame 
 could he not bear and forget too ? Why indeed ! The 
 only answer is that Carlyle was Carlyle," — a hundred 
 such poor sneers could be gathered. But no man not 
 eaten up with incorrigible conceit can read the pathetic 
 record of those forty years of poignant wretchedness 
 and doubt the reality of the suffering. The physician 
 who has heard the same pitiful recitals of anguish 
 from his patients recognizes the utter sincerity of 
 Carlyle's utterance : " Am getting weary of suffering, 
 feel as if I could sit down in it and say, well then, I 
 shall soon die, at any rate." '' I am near heartbroken. 
 Nobody on the whole believes my report." 
 
 As regards his irritableness, melancholia, and mental 
 misery generally, Froude says in a hundred ways and 
 " insinuendos " it was all in ''his nature," that he could
 
 THOMAS CARLYLK 63 
 
 no more escape from these things than his body '* could 
 leap off its shadow," etc. But what more beautiful 
 character ever showed itself than in the early essays? 
 The man who, poor and self-denying as he was, 
 secretly gave away to the poor at least half his income, 
 and who honored his father and passionately loved his 
 mother — he a genius, they peasants; the man who 
 wrote and felt to Mrs. Carlyle as he did — such a man 
 was to be honored rather than pitied. As regards 
 religion, so as to literary work, he could neither accept 
 nor reject, and in both he was compelled to follow the 
 advice of Clough — 
 
 "Take it not and leave it not 
 But fight it out, O Man!" 
 
 Carlyle himself knew better : " I declare solemnly 
 without exaggeration that I impute nine-tenths of my 
 present wretchedness, and rather more than nine- 
 tenths of all my faults to this infernal disorder in the 
 stomach." " On days when moderately well I feel as 
 happy as others; happier, perhaps," and a thousand 
 lines could be quoted as lovely and as true as, " The 
 world is God's world, and wide and fair." Even poor 
 Mrs. Carlyle, who " married for ambition," could but 
 say, " My husband is as good company as reasonable 
 mortal could desire." That he was at times gloomy, 
 irritable, morose, harsh, etc., no one would deny, least 
 of all Carlyle himself. But that it was his essential 
 nature to be so — every page of the letters gives the lie
 
 64 BIOGRAPHIC CLINICS. 
 
 to this faithless indictment. Those things were simply 
 the symptoms of his awful disease. 
 
 Carlyle had throughout his life more or less of what 
 American oculists call " theater headaches " or " pano- 
 rama headaches." A great many of our patients, until 
 eye-strain has been stopped by glasses, cannot attend 
 banquets, concerts, theaters, etc., without disastrous 
 effects to head and " nerves." When Carlyle went 
 much to the Museum he had what he called " musseum 
 headaches." When he went to a " party " he returned 
 with " headache and shattered nerves," and vowing 
 never to do such a foolish thing again. 
 
 As regards the actual ocular conditions, the refrac- 
 tion, etc., we have in Carlyle*s case the indefiniteness we 
 should expect. Illuminating suggestions may exist in 
 letters not printed. The complaint of musccB volitantes 
 spoken of in the Emerson letter (Vol. I., p. 91) has no 
 significance whatever, and his explanation of it (as 
 " part of the retina protesting against the liver and 
 striking work ") is as childish physiology as any sav- 
 age " medicine-man " could devise. So far as concerns 
 conditions of ocular work we must not forget the 
 increased difficulty in dark, smoky London, and from 
 the use of " farthing rush-lights " and candles. The 
 first complaint of " dimmed sight " is at 40. At 42 
 " reading proof wasted and fretted him to a thread and 
 made his tongue as dry as charcoal." At 56 the 
 painter of his portrait could not help carrying to the
 
 THOMAS CARLYLE. 65 
 
 canvas the pained, exhausted look of eye-strain to be 
 seen in all the later portraits of him, and which tells 
 the oculist with the first glance at many patients the 
 epitome of years of morbid ocular labor. Carlyle said 
 the picture was of " an idiot that had taken Glauber's 
 salts and lost his eyesight," and he was disgusted in a 
 Carlylean way. At 57 he spoke of " half-blind eyes." 
 At 58 the note about " specs " is so vague, we cannot 
 draw any conclusions from it. It only shows the old, 
 old, popular folly of picking up mother's specs or 
 grandmother's, when irreparable injury has been done 
 and life nearly lived out and suffered away. " Eye- 
 sight gone a little," at 58, tells probably of the ambly- 
 opia that finally follows long lack of correction of 
 ametropia, and " eyes very dim even with abundant 
 light," at 59, emphasizes the fact, and also almost 
 demonstrates the existence of astigmatism, which 
 failed accommodation revealed and which no common 
 optician's (spherical) lenses could help. That the 
 ametropia was not due to cataract is certain because he 
 retained useful vision for 26 years afterward. Head- 
 aches with proof-reading at 62 show the return of the 
 reflex neurosis to the head instead of as formerly 
 almost solely to the digestive organs. 
 
 His treatment of himself — for he took no physi- 
 cian's advice but once and for a brief time — was 
 chiefly by castor oil, which he felt obliged to take most 
 of his life, and most copiously and constantly the
 
 66 BIOGRAPHIC CLINICS. 
 
 greater the amount of his " biliousness " and of his 
 correlated eye-strain. At times we hear of salts and 
 of blue pill in addition to the castor. It is evident, I 
 think, that the digestive function was inhibited, and 
 that the bile was deficient instead of the reverse, as his 
 descriptions would imply. It is a poor oculist that 
 has not learned that eye-strain produces constipa- 
 tion. Many thousands of American patients know it 
 well. 
 
 Carlyle's opinion of the medical profession was, so 
 far as concerned his own case, entirely justified and 
 justifiable. Had he consulted a hundred of the best 
 general physicians in England he would have got no 
 more help than from the one he sought out in Edin- 
 burgh. It was exactly so later with Darwin, Huxley, 
 and Browning. " The stomach," and " the liver," 
 would have been charged with bad function, and travel 
 and rest would have been ordered. Indeed it would be 
 precisely the same story to-day. It is certainly time 
 that the question were asked. Why do the stomach and 
 liver work so poorly ? A functional disease is a curable 
 disease if the cause of the malfunction is diligently 
 sought for. The fleeting sensations about the heart 
 twice spoken of by Carlyle are of little consequence. 
 The Badams incident is, to a physician, most amusing, 
 although it was serious enough to Carlyle. One is 
 almost glad that the stomach-curer met a sorry reward 
 in his " intolerable headache " "cured " by drink.
 
 THOMAS CARLYLE. 67 
 
 Carlyle also quickly saw through the nonsense of the 
 Gully water-cure. The diagnostician who from the 
 hundreds of references made to his symptoms by Car- 
 lyle would seek to gather any definiteness of pathologic 
 finding will fail. Picturesque, passionate, terrible as 
 they are, they are even more indefinite. At first it was 
 more clearly stomachal, if we may trust that his loca- 
 tion of this organ was topographically correct. " Like 
 a rat gnawing at the pit of his stomach," are his words. 
 But the complaints of " nervousness," of " coorsed 
 nervous disorders," of " stupidity," " sickness of body 
 and mind," " hypochondria," " sleeplessness," " dull- 
 ness," " weakness," etc., make one wonder just what 
 organ was the most affected. " Bile," " bilious," and 
 " derangement of the liver " are so commonly repeated 
 that if one could by any possibility learn what lay peo- 
 ple mean by such words we might stop to consider the 
 blameworthiness of the poor liver. The pretty nearly 
 certain thing is that to Carlyle and such complainers 
 the " liver " and the " stomach " were mythical scape- 
 goats upon which all vague miseries could be laid and 
 both properly and improperly cursed. The sad thing 
 is that the sorrows were not got rid of by this pro- 
 cedure. In fact it is perhaps true that when Carlyle 
 complained of bile, he should have complained of lack 
 of bile. The drugs he took during most of his life 
 would imply this without the strange and strabismic 
 allusion to the " ' pipeclay state ' too common with
 
 68 BIOGRAPHIC CLINICS. 
 
 those who are too well furnished with bile." Indeed 
 the digestional reflex of an ocular irritation is essen- 
 tially inhibitive. 
 
 On the whole it is clear both from the profound 
 reality of suffering and from the impossibility of local- 
 izing it in any organ, that there was never any organic 
 disease whatever. " Gastrodynia " there was, if one 
 has any satisfaction in such tautologic and meaningless 
 words, and many other dynias, and dys's, but not " gas- 
 tric ulcer " or any other morbid tissue changes or 
 lesions. Such pathologic conditions do not disappear 
 suddenly at 60 years of age, and leave one free for 25 
 more. The mystery of his affliction had struck the 
 attention of Carlyle (as under similar circumstances it 
 had done with De Quincey), and he said, " What the 
 cause is would puzzle me to explain." Looking at the 
 symptomatology more closely we find that the daily 
 rhythm of the rise depends exactly upon the amount 
 of reading and writing, and of the fall upon the amount 
 of disuse of the eyes. Then there is the enormously 
 heightened intensities clustering about the execution of 
 the more important works. After each, except at 
 Craigenputtock, there is a terrible revulsion. After 
 the completion of Meister at 29, things were so bad as 
 to warrant the sadly ludicrous Badams incident. Wide 
 and miscellaneous reading brings a great increase 
 of the bitter complaints at the age of 31. At 
 Craigenputtock he produced with little complaint the
 
 THOMAS CARLYLE. ^9 
 
 essay on Burns, German literature, Characteristics, 
 Diderot, and others, and the incomparable " Sartor." 
 Would that he could have remained there the rest of 
 his life ! After " The French Revolution ", " he fled to 
 Scotland fairly broken down," and the sufferings of 
 the next years are perhaps the greatest of his life. He 
 produced little for five or six years, and at the height 
 of his success he was most miserable. Even after such 
 a small work as " Past and Present " (48) he required 
 six months' rest and travel and then was incapable of 
 work. " Cromwell " took three years of his life, and 
 was composed with infinite suffering, and then is three 
 years of rest. " Frederick " is begun at 57 and com- 
 pleted at 69. But now appears the new phenomenon, 
 what he calls the " change of epoch." Complaints end, 
 although he is working hard at his great task. There 
 is no working hypothesis except that of eye-strain that 
 will explain all these things. After each day's work, 
 each essay, each volume, each entire work, there was 
 the need of rest, the increase of poignant complaint, 
 the exhaustion of despair, the startling approach to 
 death which up to the beginning of '' Frederick " be- 
 came more and more frightful. After each was the 
 sickness of weariness, the weariness of sickness, the 
 " dulness," the " stupidity," the appalling lack of 
 energy. But Carlyle knew he was not stupid, or dull, 
 and when it seemed that he was most so, he could for 
 hours roll forth such brilliant monologue and conversa-
 
 70 BIOGRAPHIC CLINICS. 
 
 tion as to make the richest and wisest of the land 
 delight to hear him, and to invite him to their houses 
 in order to hear him. Intellectual activity did not tire 
 or hurt him — it was only intellectual activity plus read- 
 ing or writing that soon gave atrocious suffering. This 
 is demonstrated by the further fact that, after each 
 work, it took a longer time and a great and greater 
 self -scourging to whip himself into the new labor. He 
 would sit and stare at his book or writing, shut in 
 unconscious stupor, until he had spurred himself into 
 the white heat of passion which was required to enable 
 him to work, and which when it had passed left him a 
 wreck of exhaustion. He says : 
 
 "There is a shivering precipitancy in me which makes 
 emotion of any kind a thing to be shunned. It is my nerves, 
 my nerves." 
 
 " My work needs all to be done with my nerves in a kind of 
 a blaze, such a state of body and nerves as would soon kill 
 me if not intermitted. I have to rest accordingly, to stop and 
 sink into total collapse, to get out of which is a labor of 
 labors." 
 
 " He wrote * with his heart's blood ' in a state of fevered 
 tension," says Froude. 
 
 " Work is not possible for me except in a red-hot element, 
 which wastes the life out of me." 
 
 All of which is inexplainable except upon the theory 
 that eye-strain was the cause of his trouble. It was not 
 so during the writing of " Frederick " which, begun at 
 the age of 58 or 59, was carried forward leisurely with- 
 out pain, and without appalling groans and cries of
 
 THOMAS CARLYLE. 71 
 
 anguish at the end. Noticeable also is the fact, how- 
 ever, that after its completion and during the last six- 
 teen years of his life there was practically no produc- 
 tion of work. The " ablaze " and the " white heat " 
 of his nerves, with which he had been compelled to 
 work to develop the power to counteract the inhibition 
 and irritation of morbid ocular function, had ended in 
 final paralysis of brain and will. 
 
 And Carlyle was actually conscious that with his 
 great powers he had been able to do so little work. 
 There are generally no better and more productive 
 years than those between, say, 42 and 58. Carlyle 
 writes at the age of 58 : " Here are now ten years, and 
 what account can I give of them? The work done in 
 them is very small even in comparison." If I take the 
 number of pages of the edition at hand, of his collected 
 works, I find that they foot up about ten thousand. 
 Dividing this number by the number of days of his 
 sixty years of working life I find that he produced at 
 the rate of less than one half a page a day. If we sup- 
 pose that for every printed page he read ten pages to 
 get his data, we find that the entire reading and writing 
 was thus equal on the average to about five and one 
 half printed octavo pages a day. 
 
 In some men the untoward conditions of circum- 
 stances, the ill-health, the mental abnormalism, etc., 
 may have little or no effect upon the quality of their 
 literary labors. In others this may be subtly modified,
 
 72 BIOGRAPHIC CLINICS. 
 
 and in others still the differences caused may be most 
 profound. Carlyle, I think, is an example of the last 
 class. Every work he brought forth is in almost every 
 line modified by the direct result of the conditions of 
 eye-strain while engaged upon it. The very choice of 
 subjects are dictated by it. With the resistance and 
 energy of youth overcoming all disease we have the 
 beautiful objectivity, the combined " sweetness and 
 light ", the humor, and the charm of the early essays 
 and of " Sartor ". What could be more like his wrecked 
 soul than the " French Revolution ", both in subject 
 and treatment ? History written by lightning flashes it 
 is indeed, but the lightnings are those of his own mind 
 in thunderstorm that brought in its fury, brief peace, 
 but that also brought destruction. Again how impera- 
 tive of his mood and how logically responsive was 
 " Chartism ", " Heroes ", " Cromwell ", and " Past and 
 Present " ! But, at last at peace, " Frederick " (tak- 
 ing twelve years to write) shows what the character of 
 the lifework might have been if the thirty-eight pre- 
 vious years had not been lived upon the rack of atro- 
 cious suffering. The unauthorized pessimism, the 
 pitiable antiscience, the foolish arrogance, the outrage- 
 ous " Ilias Americana in Nuce," and all such things 
 are excusable. Such trifles may be forgiven him in 
 that he loved much and heroically, but it is to me 
 beyond question that deductive as his mind essentially 
 was, not inductive, prophetic and ethical as was his
 
 THOMAS CARLYLE. 73 
 
 inevitable function, he would not have been the subject 
 of such blundering if he had not been stung to it by 
 his tortures. They were the groans and deliriums of 
 a nervous system in awful agony. 
 
 When the storms of the life voyage were over Car- 
 lyle had a splendid opportunity to gather to a focus all 
 the experience and wisdom he had gained. And splen- 
 didly he improved it! Among the noble truths there 
 glowing with softened but exquisite light he urged that 
 the function of universities was to create libraries and 
 teach the student to read. Assiduity in reading is the 
 great study of the intellectual man. There was not a 
 word of course as to the mechanism of reading, and one 
 is grieved to think of this and the fact that the labor of 
 reading with an optically wretched instrument had 
 been the cause of the speaker's life-tragedy. And that 
 it would be the same with thousands of his pupils then 
 and since! 
 
 Lastly comes the lesson called " a very humble one," 
 but which not even he could realize how and why it 
 was far from humbly important: 
 
 " In the midst of your zeal and ardor, . . . remember the 
 care of health. ... It would have been a very great thing for 
 me if I had been able to consider that health is a thing to be 
 attended to continually, that you are to regard that as the very 
 highest of all temporal things for you. There is no kind of 
 achievement you could make in the world that is equal to 
 perfect health. What to it are nuggets and millions? The 
 French financier said, 'Why is there no sleep to be sold!' 
 6
 
 74 BIOGRAPHIC CLINICS. 
 
 Sleep was not in the market at any quotation. ... I find that 
 you could not get any better definition of what * holy' really 
 is than ' healthy.' Completely healthy ; mens sana in corpore 
 sano. A man all lucid, and in equilibrium. His intellect a 
 clear mirror geometrically plane, brilliantly sensitive to all 
 objects and impressions made on it and imaging all things in 
 their correct proportions; not twisted up into convex or 
 concave, and distorting everything so that he cannot see the 
 truth of the matter, without endless groping and manipula- 
 tion : healthy, clear, and free and discerning truly all around 
 him." 
 
 He is compelled by the very nature and mathematics 
 of the subject to use the images of physical and physio- 
 logic optics. It is as necessary for the eye to be 
 optically right as for the intellect. Moreover, he did 
 not know, as even then he might have known, that the 
 intellect whose function he could best describe in 
 optical terms is psychologically most literally and abso- 
 lutely the creation of the act of vision. It has the quali- 
 ties of geometric and imaging perfection only because 
 by the heredity of millions of years the optically cor- 
 rect, or approximately correct, eyes of innumerable 
 ancestors have produced the optically correct intellect. 
 The acme of physical and intellectual suffering is to 
 supply a correct intellect, the product of eyes, with an 
 optically morbid pair of eyes, and compel them to work 
 for sixty years against the demands of the laws of all 
 past time. 
 
 Let us make one last quotation from the inaugural 
 address. In the face of the fact that numberless thou-
 
 THOMAS CARLYLE. 75 
 
 sands and even millions of hard eye- workers (literary 
 and others) are clear-sighted physically and mentally, 
 and have no considerable suffering therefrom — despite 
 this which Carlyle should have thought of, he says : 
 
 " We can never attain that [the holy and healthy, optically 
 perfect intellect] at all. . . . You cannot, if you are going to 
 do any decisive intellectual operation that will last a long 
 while; if, for instance, you are going to write a book — you 
 cannot manage it (at least I never could) without getting 
 decidedly made ill by it: and really one nevertheless must; 
 if it is your business, you are obliged to follow out what you 
 are at, and to do it, if even at the expense of health. Only 
 remember at all times, to get back as fast as possible out of it 
 into health, and regard that as the real equilibrium and 
 center of things." 
 
 How clearly the virtue and also the vice of the 
 deductionist type of intellect is seen in these words. 
 The subjective experience carried over as a general 
 rule and demand ! But how infinitely pathetic ! And 
 also how instructive to those who are now seeking to 
 unite the two methods of intellectual activity, deduc- 
 tion, and induction, in one fused flame of philosophic 
 science. The earnest woeful pleading to read books, 
 and to look above all things to the health, by one who 
 had never committed a conscious hygienic sin in his 
 life, and who had looked most carefully after his health 
 every instant almost, of his whole life ! And yet, who 
 had suffered as great physical and mental anguish 
 from ill-health as ever mortal did ! What every one of 
 his hearers needed and what millions of others still
 
 76 BIOGRAPHIC CLINICS. 
 
 need to be told is not to care for their health, but how 
 to do it. That Carlyle had never once seriously con- 
 sidered; only an enlightened science, an enlightened 
 medical science can teach that. Alas that Carlyle cared 
 for neither ! The more imperative is our own duty.
 
 CHARLES DARWIN. 
 
 77
 
 CHAPTER III. 
 
 CHARLES DARWIN. 
 
 The following quotations and epitomizations of the 
 data of Darwin's life are drawn from " The Life and 
 Letters " by his son : 
 
 Charles Darwin's father was a highly successful physician, 
 six feet two inches tall, very corpulent, with close powers of 
 observation, and of sympathy. He at first hated his profes- 
 sion, but practised it for sixty years, although he had a horror 
 of operations, or even to see a person bled. This same horror 
 existed in Charles. Modern physicians may to-day read with 
 profit what Charles writes of his father as a physician. 
 
 The health of his brother Erasmus was " weak from boy- 
 hood and he failed in energy." " His spirits were not high, 
 sometimes low, more specially during early and middle man- 
 hood." " He read much, even whilst a boy." " Our tastes 
 were so different." 
 
 Charles Darwin was born February 12, 1809. 
 
 He was a fleet runner as a boy at school, and loved long 
 walks ; his father once said to him : " You care for nothing 
 but shooting, dogs, and rat-catching, and you will be a dis- 
 grace to yourself and all your family." 
 
 He had great love of poetry and music while young, which 
 entirely disappeared before he was old. 
 
 He did " no good " at school, and was taken away to Edin- 
 burgh, to study medicine; but he hated it, could not dissect, 
 detested the lectures, and could not endure to see an opera- 
 tion. After two sessions there, as he seemed bound to be " an 
 idle sporting man" his father proposed that he become a 
 
 79
 
 8o BIOGRAPHIC CLINICS. 
 
 clergyman. This plan finally " died a natural death " in both 
 their minds, and, after spending three " wasted " years at 
 Cambridge, he joined The Beagle as naturalist. 
 
 The three years at Cambridge, " worse than wasted " in 
 shooting, hunting, riding, and sporting, were the most joyful 
 in his life, because he was in excellent health and high spirits. 
 
 When he was compelled to do some reading, it had the 
 result of making him " have spirits for nothing." 
 
 " I am so disgusted by reading that I have not the heart to 
 write anybody." (Aged 20.) 
 
 " Reading makes me quite desperate." (Aged 21.) 
 
 " I do not know why the degree should make one so miser- 
 able, both before and afterwards. What makes it more ridicu- 
 lous is I know not what about." (22.) 
 
 The Beagle voyage began December 27, 1831, and ended 
 October 2, 1836. 
 
 While waiting two months at Plymouth for the departure 
 during bad weather, he was inexpressibly gloomy and miser- 
 able, and troubled with pain and palpitation about the heart. 
 (22.) 
 
 " We worked together for several years at the same table 
 in the poop cabin of the Beagle, he with his microscope, and 
 myself at the charts. He suffered greatly from sea-sickness. 
 After perhaps an hour's work he would say to me, * Old 
 fellow, I must take the horizontal for it.' A stretch out on 
 one side of the table for some time would enable him to 
 resume his labors for awhile, when he had again to lie down." 
 (Admiral Lord Stokes, The Times, April, 1883.) 
 
 " He was a dreadful sufferer from sea-sickness, and at times 
 when I have been officer of the watch, and reduced the sails, 
 making the ship more easy and thus relieving him, I have 
 been pronounced by him to be 'a good officer' and he would 
 resume his microscopic observations in the poop cabin." (A. 
 B. Usborne.) 
 
 " He was habitually in full vigor. ... He had, however, 
 one severe illness in South America. ... I have heard him
 
 CHARLES DARWIN. 8i 
 
 say that in this illness, every secretion of the body was 
 affected, and that when he described the symptoms to his 
 father, Dr. Darwin could make no guess as to the nature of 
 the diseases. My father was sometimes inclined to think that 
 the breaking up of his health was to some extent due to this 
 attack." (His son.) 
 
 "It has been assumed that his ill-health in later years was 
 due to his having suffered so much from sea-sickness. This 
 he did not himself believe, but rather ascribed his bad health 
 to the hereditary fault which came out as gout in some of the 
 past generations. I am not quite clear as to how much he 
 actually suffered from sea-sickness; my impression is distinct 
 that, according to his own memory, he was not actually ill 
 after the first three weeks, but constantly uncomfortable when 
 the vessel pitched at all heavily. But, judging from his 
 letters, and from the evidence of some of the ofiEicers, it would 
 seem that in later years he forgot the extent of the discom- 
 fort from which he suffered." (His son.) 
 
 " I am quite well again after being in bed for a fortnight." 
 (25.) 
 
 " It is lucky for me that the voyage is drawing to a close, 
 for I positively suffer more from sea-sickness now than three 
 years ago." (27.) 
 
 From 1836 to 1842 (when he settled at Down because of 
 his ill-health) he lived at London and at Cambridge. The 
 period is marked by " the gradual appearance of that weak- 
 ness of health," the " bitter mortification " of it, its " per- 
 manency," the learning of the narrowness of the limit of his 
 working ability, etc. (27 to 33.) 
 
 In 1837 he had an attack of uncomfortable palpitation of 
 the heart. The doctors advised knocking off work and living 
 in the country. Dr. Clark urged " giving up entirely all 
 writing, and even correcting press for some weeks." (28.) 
 
 Work brings on ill-health in 1838, and a three days' holiday 
 trip to Cambridge did him " such wonderful good " and 
 "filled his limbs with such elasticity." (29.)
 
 82 BIOGRAPHIC CLINICS. 
 
 " I am coming into your way," he writes to Lyell,* " of only 
 working about two hours at a spell ; I then go out and do my 
 business in the streets, return and set to work again, and thus 
 make two separate days out of one. The new plan works 
 capitally." (Ibid.) 
 
 "I worked as hard as I possibly could (1839-1842) but had 
 frequently recurring unwcllness and one long and serious 
 illness." (30 to 33.) 
 
 "I could collect facts bearing upon the origin of species 
 when I could do nothing else from illness." (Ibid.) 
 
 Ill-health increases in 1839, the holidays become more 
 frequent and longer; at one time a "thirteen months' inter- 
 val." (30.) 
 
 "Read a little, was much unwell, and scandalously idle." 
 (Ibid.) 
 
 "The entries of ill-health increase in number during these 
 years, the holidays longer and more frequent." (30-33-) 
 
 " I have been steadily gaining ground, and really believe 
 now I shall some day be quite strong. I write daily for a 
 couple of hours, and take a little walk or ride every day. I 
 grow very tired in the evenings." (32.) 
 
 "Wearisome drives." (33.) 
 
 "It was the last time I was ever strong enough to climb 
 mountains, or to take long walks such as are necessary for 
 geological work." (33.) 
 
 "I manage only a couple of hours a day (writing) and that 
 not very regularly." (34.) 
 
 "I have not had one whole day, or rather night, without 
 my stomach having been greatly disordered during the last 
 three years, and most days great prostration of strength." 
 (36.) 
 
 " Many of my friends, I believe, think me a hypochondriac." 
 " Although strong corporeally, he cannot stand mental fatigue, 
 and must have silence after dinner." (36.) 
 
 "I therefore write this in case of my sudden death, as my 
 most solemn and last request," etc. (36.) 
 
 ^Thcn Lyell probably had eye-strain too.
 
 CHARLES DARWIN. 83 
 
 "I have of late been slaving (writing) extra hard, to the 
 great discomfiture of wretched digestive organs." (35 or 36.) 
 
 " Short intervals of good health that followed the long ill- 
 nesses, which often times rendered life a burden to him 
 between 1844 and 1847." (Sir J. Hooker.) 
 
 " My little ten-day tour made me feel wonderfully strong 
 at the time, but the good effects did not last." (36.) 
 
 " I have been prevented from writing by being unwell, . . . 
 abominable press work." (37.) 
 
 "We go to Southampton if my courage and stomach do 
 not fail." (37.) 
 
 " Almost continually unwell." " In bed nearly all Friday 
 and Saturday." (38.) 
 
 "Very unwell, incapable of doing anything." (38.) 
 
 "All this winter I have been bad enough, . . . my nervous 
 system began to be affected, so that my hands trembled, and 
 my head was often swimming. I was not able to do anything 
 one day out of three." (Ibid.) 
 
 " Health very bad, with much sickness and failure of 
 power. Worked on well days. The water-cure has most 
 extraordinary effect in producing indolence and stagnation of 
 mind. I now increase in weight; have escaped sickness for 
 thirty days." (40.) 
 
 " Every one tells me," writes Darwin in 1849, " that I look 
 quite blooming and beautiful, and most think I am shamming, 
 but you have never been one of those." His son adds : " And 
 it must be remembered that at this time he was miserably ill, 
 far worse than in later years." (40.) 
 
 He got Dr. Gully's book (on the water-cure) and goes with 
 the entire family to Dr. Gully's establishment. "Dr. Gully 
 feels pretty sure he can do me good, which most certainly the 
 regular doctors could not." (40.) 
 
 " It is a sad flaw in my beloved Gully that he believes in 
 everything. When Miss was very ill, he had a clair- 
 voyant girl to report on internal changes, a mesmerist to put 
 
 her to sleep — an homeopathist, viz., Dr. , and himself as 
 
 hydropathist, and the girl recovered." (41.)
 
 84 BIOGRAPHIC CLINICS. 
 
 He keeps up the water-cure at home and thinks he is better 
 as the months go on. 
 
 " I am allowed to work now two and a half hours daily, 
 and I find it as much as I can do; for the cold water-cure 
 together with three short walks is curiously exhausting, and 
 I am actually forced to go to bed at eight o'clock completely 
 tired. I steadily gain in weight, and am never oppressed by 
 my food. I have lost the involuntary twitching of the 
 muscles, and all the fainting feelings, etc., black spots before 
 my eyes, etc. Dr. Gully thinks he shall quite cure me in six 
 or nine months more. The greatest bore which I find in the 
 water-cure is the having been compelled to give up all read- 
 ing, except the newspapers. For my daily two and a half 
 hours at the barnacles is fully as much as I can do of any- 
 thing which occupies the mind; I am consequently terribly 
 behind in all scientific books." (40.) 
 
 " I dread going anywhere on account of my stomach so 
 easily failing under any excitement." " My nights are always 
 bad." He takes the water-cure, five or six weeks of treatment 
 every two or three months, " always with good effect." (43.) 
 
 He is constantly dreading "hereditary ill-health" for his 
 children. " Even death is better for them." (Ibid.) 
 
 "The other day I went to London and back, and the 
 fatigue, though so trifling, brought on my bad form of vomit- 
 ing." (Ibid.) 
 
 " My stomach has much deadened my former pure enthu- 
 siasm for science and knowledge." (45.) 
 
 There were several visits to water cure establishments 
 from 1856 to 1858. "I cannot in the least understand how 
 hydropathy can act as it certainly does on me. It dulls one's 
 brain splendidly." (48.) 
 
 " As usual, hydropathy has made a man of me for a short 
 time." (49.) 
 
 " I have come here for a fortnight's hydropathy, as my 
 stomach has got, from steady work, into a horrid state." 
 (Ibid.)
 
 CHARLES DARWIN. 85 
 
 ■' Nor has my stomach recovered from all our troubles." 
 {Ihid.) 
 
 " I pass my time by doing daily a couple of hours of my 
 abstract." {Ibid.) 
 
 " I am quite knocked up,, and am going next Monday to 
 revive under water-cure." {Ibid.) 
 
 " So poorly," " health so poor," " health so wretched of late, 
 and has incapacitated me for everything," " I am weary of 
 my work." (50.) 
 
 "It is a very odd thing that I have no sensation that I 
 overwork my brain; but facts compel me to conclude that 
 my brain was never formed for much thinking." {Ibid.) 
 
 " My health has quite failed. I am off to-morrow for a 
 week of hydropathy. I am very sorry to say that I cannot 
 look over any proofs in the week." {Ibid.) 
 
 " Two chapters in type, and though not yet corrected, I am 
 so wearied out and weak in health that I am resolved not to 
 add one word, but merely to improve the style." {Ibid.) 
 
 " I have corrected one hundred and thirty pages ; I long to 
 finish, for I am nearly worn out." {Ibid.) 
 
 " I have corrected all but the last two chapters — . . . my 
 health has been very bad, and I am becoming as weak as a 
 child, and incapable of doing anything whatever except my 
 three hours' daily work at proof sheets. . . . Long fit of sick- 
 ness yesterday. It is so weariful killing the whole afternoon, 
 after 12 o'clock doing nothing whatever." {Ibid.) 
 
 " I intend, if I can keep to my resolution, of being idle this 
 winter. But I fear ennui will be as bad as a bad stomach." 
 {Ibid.) 
 
 The complaints were never so bitter and frequent as now 
 during the work of getting the abstract made and proofs 
 through the press of his " Origin." " Before starting here 
 (hydropathic establishment) I was in an awful state of 
 stomach, strength, temper, and spirits." " My confounded 
 book nearly killed me." " I am here hydropathizing and 
 coming to life, after having finished my accursed book." " It 
 is astonishing how idle a three weeks I have passed." {Ibid.)
 
 86 BIOGRAPHIC CLINICS. 
 
 Concerning the general life at Down, his son says that 
 " indoors he sometimes used an oak stick, and this was a 
 sign that he felt giddiness." He rose early, after his always 
 bad nights, walked before breakfast, and the one and a half 
 hours after breakfast was his best working time. He was 
 then read aloud to, and then from 10:30 to about 12 he was 
 able to work some more with his eyes. His day's work was 
 then over. 
 
 "With regard to the Sand- walk" (a walk about a one-and- 
 a-half-acre plot of land) " in connection with my father, my 
 earliest recollections coincide with my latest. We continually 
 saw my father as he walked around." 
 
 "I think the newspaper was the only non-scientific matter 
 which he read to himself. Everything else, novels, travels, 
 history, was read aloud to him." 
 
 "In the evening after he had read as much as his strength 
 would allow, and before the reading aloud began " — 
 
 " German was a great labor to him ; in reading it he could 
 read very little at a time. He called it the Verdammte." 
 
 "Anything attempted beyond the regular routine was 
 attended with pain and difficulty." 
 
 " He was generally persuaded by my mother to take these 
 short holidays, when it became clear from the frequency of 
 bad days, or from swimming of his head, that he was being 
 overworked." 
 
 " He thought the water-cure was a cure for his troubles, 
 but like all other remedies, it had only a transient effect on 
 him." 
 
 After the completion of the hard task of putting the 
 " Origin " through the press, he " could hardly sit up " and 
 found that two or three months at Ilkley this time " did him 
 no essential good." The doctor had told him this would be a 
 " unique crisis." " Now, under water-cure, with all nervous 
 power directed to the skin, I can possibly do no head work." 
 (50.) 
 
 " I have been poorly with almost continual bad headache
 
 CHARLES DARWIN. 87 
 
 for forty-eight hours, and I was low enough, and thinking 
 what a useless burden I was to myself and others." (51.) 
 
 In 1863 began a six months' illness; he remained ill and 
 depressed despite the hopeful opinion of one of the most 
 cheery and skilful physicians of the day. " He (the physi- 
 cian) does not believe my brain or heart are primarily 
 affected." (54.) 
 
 In 1864 " his health took a turn for the better " and he was 
 able to do not more than one and a half hours* work on his 
 best days. " My brain feels far stronger, and I have lost 
 many dreadful sensations." (55.) 
 
 In 1865 there was again ill-health, but towards the close of 
 the year he began to recover under the care of the late Dr. 
 Bence- Jones who dieted him severely. (56.) 
 
 Even scientific books were now read aloud to him. (Ibid.) 
 
 " It is a horrid evil for me that I can read hardly anything, 
 for it makes my head almost immediately begin to sing 
 violently." (Ibid.) 
 
 His health improved in 1866, and he can work one or two 
 hours a day. (57.) 
 
 " Science makes him forget for some hours every day his 
 accursed stomach." (59.) 
 
 Health grows better in 1870. (61.) 
 
 During the last ten years of his life, the condition of his 
 health was a cause of satisfaction and hope to his family. 
 His condition showed signs of amendment in several par- 
 ticulars. He suffered less distress and discomfort, and was 
 able to work more steadily. 
 
 In later years he became a patient of Sir Andrew Clark, 
 under whose care he improved greatly in general health. It 
 is certain that he had no serious and permanent trouble of 
 his heart until shortly before his death. 
 
 He died in 1882, aged 73, of heart disease, angina pectoris, 
 atheromatous and senile heart changes. 
 
 " For nearly forty years he never knew one day of health 
 of ordinary men, and thus his life was one long struggle of 
 the weariness and strain of sickness." (His son.)
 
 88 BIOGRAPHIC CLINICS. 
 
 The Influence of Eye-Strain upon Character and 
 Life. — In the article upon De Quincey, I spoke of the 
 psychologic influence of errors of refraction, the power- 
 ful and subtle effect of eye-strain in the developing boy 
 upon the character or disposition, the choice of a 
 career, etc. I found reason to believe that this factor 
 had been at work in De Quincey's case, as the unrecog- 
 nized cause of the seven years' vagabondage of the 
 unequalled scholar. It was the only way the wisdom 
 of the organism could devise to rid itself of the pro- 
 found injury which reading and writing was causing 
 the nervous and digestive systems. It even made the 
 evil of the opium habit preferable to the unbroken 
 impact of the ocular irritation. To such a mind as that 
 of De Quincey, the literary career could not be escaped, 
 and so there was the life-long tragedy we have 
 witnessed. 
 
 In Carlyle's case the dour Scotch inheritance, body 
 and mind, together with physical work, country Hfe, 
 and an absence of an enslaving literary ambition, made 
 him miss the evil effects of eye-strain during youth; 
 but from the age of 23 onward the conditions (reading 
 and writing) of the chosen career made him a great 
 sufferer so long as there was any ocular " accommoda- 
 tion " left. As Mrs. Carlyle said there would have been 
 no "tongues " if Irving had married her, so there 
 would have been no vagabondage and no opium in De 
 Quincey's case if he had chosen the career of a farmer ;
 
 CHARLES DARWIN. 89 
 
 and if Carlyle had chosen his father's occupation there 
 would have been as utter absence of the misery of his 
 life and the peculiar qualities of " history by lightning- 
 flashes." 
 
 When we come to Darwin, we find the same causes 
 producing the same results, but with the diiferences of 
 detail which all biologic, and especially all psychologic, 
 phenomena exhibit. For, be he oculist, general physi- 
 cian or intelligent layman, when one reads the life and 
 letters of Darwin, he must be struck with the aston- 
 ishing fact of the strangeness and illogicality of the 
 life of the great scientist's youth. Up to the age of 22 
 he had done nothing but waste, " worse than waste," 
 time and opportunity in hunting, walking, riding, 
 athletics, rat-catching, with dogs, etc., so that even his 
 most kind and indulgent father said he would be a 
 disgrace to himself and to his family. Medicine could 
 not attract the attention of the " idle sporting man " 
 and also the function of clergyman had no charm. 
 Why? Because he was in excellent health and high 
 spirits when he did not use his eyes at near range, but 
 any reading made him " have spirits for nothing," 
 made him " so disgusted that he had not the heart to 
 write anybody ", — made him *' quite desperate." The 
 degree at Cambridge caused him to become " so miser- 
 able, both before and afterward," and, '' what makes it 
 more ridiculous, I know not what about." Once at the 
 age of 22, he was for two months compelled by bad 
 7
 
 90 BIOGRAPHIC CLINICS. 
 
 weather to keep indoors in a strange place, without 
 friends, and without amusements other than reading, 
 and he was " inexpressibly gloomy and miserable," and 
 even troubled with pain and palpitation about the 
 heart.^ The simple recital of facts compels one to 
 recognize that the wasted years of Darwin's youth were 
 not " worse than wasted " by choice ; it was not because 
 of the compulsion of inherent mental tendencies, nor of 
 fashion, nor because of his dislike of classic studies. 
 There was nothing in his ancestry nor in his life-work 
 of after years that would force him to such amuse- 
 ments and to the escape of all study ; there were plenty 
 of earnest men at Cambridge, there was opportunity 
 for congenial study — if study of any kind had been 
 possible, and health retained. There was no way to a 
 serious and honorable life, was the unconscious com- 
 mand of the wisdom of the organism, except perhaps 
 through some such a plan as the Beagle voyage. Thus 
 science gained its martyr, although he did not know, 
 and indeed he never knew, the exact nature of the 
 cause of his martyrdom. 
 
 As to Darwin's Sea-Sickness. — A careful reading 
 of notes I have collated as to Darwin's sea-sickness are 
 quizzically puzzling. From his study of the case his 
 
 * Similar symptoms were also complained of by Carlyle and 
 Huxley. It was purely functional. Extreme eye-strain will 
 sometimes cause such signs of cardiac irritation, as has been 
 noted by oculists.
 
 CHARLES DARWIN. 9^ 
 
 son concludes in a state of inconclusion as to the sever- 
 ity, continuance, and even actuality of the suffering 
 from sea-sickness, especially after the first three weeks. 
 This strikes one as very strange. According to the 
 testimony of the rest of us, genuine sea-sickness is not 
 unrecognized and never forgotten by one who has 
 endured it. This haziness of Darwin's own mind and 
 memory upon the subject is illuminating, particularly 
 if we remember that he says in 1836 towards the end 
 of the voyage, that he " positively suffers more from 
 sea- sickness than he did three years ago " and that he 
 is therefore glad it is about over. Even here there is 
 an amusing inexactness. As the voyage began two 
 years more than " three years ago " when he had the 
 " actual " illness of three weeks. It is highly probable 
 that the greater " sea-sickness " towards the end of the 
 voyage was due to the fact that he was far more occu- 
 pied with his journals and records, writing more in 
 order to put his experiences in literary order, making 
 up for lost time, etc., prior to disembarking. One finds 
 a clue through this odd sort of fog or haze, and begins 
 to understand these peculiar contradictions, when he 
 notes Admiral Lord Stokes' description of the actual 
 facts. When working with his microscope, Darwin 
 was not putting his eyes to the strain they would suffer 
 when reading or writing, and yet, at this early age, and 
 with this slight strain, even an hour's work compelled 
 him to " take the horizontal for it," and a "stretch out
 
 92 BIOGRAPHIC CLINICS. 
 
 upon the table for some time would enable him to 
 resume his labors for awhile, when he had to lie down 
 again." One smiles cynically at an old sailor like 
 Stokes, who calls that " suffering greatly from sea- 
 sickness." I never yet saw one downright ill with that 
 malign mal who could get relief by lying down on a 
 table for a little while, and, thus, repeatedly, be enabled 
 to resume intellectual labor. Plainly, Darwin's sea- 
 sickness on the Beagle voyage was the same nausea 
 and morbid nervous symptoms that thousands of 
 patients have described to their oculists, as following 
 use of the eyes without the proper spectacles, and dis- 
 appearing at once, the moment all use of the eyes is 
 stopped. Darwin had found great discomfort during 
 his youth and up to 22, upon the use of his eyes ; it was 
 more pronounced and intense now during the voyage 
 (some slight sea-sickness cooperating) ; and, in the 
 productive years of his after Hfe, from the ages of 
 about 40 to about 60, it was a daily tragedy and horror. 
 Is it not at once clear from all the symptoms and the 
 accounts given that it was not true sea-sickness that 
 was the chief trouble experienced by Darwin during 
 the voyage; that during the time Darwin himself and 
 others said that it was this affection ; that in after years, 
 Darwin was in great doubt about it; and that his re- 
 ports made more problematic the nature of the malady ? 
 Moreover, he had little of this problematic affection, 
 according to some of his statements, after the first three
 
 CHARLES DARWIN. 93 
 
 weeks. It was of course natural that the vomiting he 
 had aboard ship should be called sea-sickness, but he 
 had it for thirty years afterward, and the cause of it 
 was probably the same both on ship and shore. It is 
 also as natural that there should afterward be much 
 confusion and indecision in Darwin's mind as to the 
 very existence of true sea-sickness, when he found pre- 
 cisely the same symptoms continuing throughout the 
 greater part of his life. If his vomiting was due to 
 eye-strain, all the haze and discrepancy disappear and 
 the matter stands clear. Why, it may be asked, did he 
 not have the symptom more constantly when on board 
 the B eagle f Because, if the expression is allowable, he 
 was younger than when he was ten or twenty years 
 older ; i. e., he was more resistant, and he reacted more 
 quickly; but the chief reason is that comparatively he 
 did little or no reading and writing there. It is true, 
 as his son says, that " the amount of work that he got 
 through on the Beagle shows that he was habitually in 
 full vigor," but his time was occupied almost entirely 
 with geologizing, botanizing, collecting specimens, and 
 long trips and stays ashore, and with the microscope, 
 and probably with " the horizontal " and idling when 
 sailing. There was no pressing duty of writing or 
 reading, and indeed little occasion for either, so that 
 whenever he felt ill during the little desultory reading 
 he did, he could at once drop it and "take the hori- 
 zontal for it " or lounge about deck. It was different
 
 94 BIOGRAPHIC CLINICS. 
 
 in after life, although at best, and whatever the in- 
 centive, he could never do but two or three hours' work 
 a day. 
 
 There is a striking confirmation of the view I have 
 intimated, and one that shows Darwin to have been 
 singularly resistant to genuine and uncomplicated sea- 
 sickness. In 1838, between one and two years after the 
 end of the Beagle voyage, Darwin went to Scotland 
 (on a holiday for bad health) by steampacket to Edin- 
 burgh. Upon his return he wrote to Lyell : 
 
 " My trip in the steampacket was absolutely pleasant, and 
 I enjoyed the spectacle, wretch that I am, of two ladies and 
 some small children quite sea-sick, I being well. Moreover, 
 on my return from Glasgow to Liverpool, I triumphed in a 
 similar manner over some full-grown men." 
 
 He was geologizing and not reading, writing, or even 
 using the microscope. It seems evident, therefore, 
 that at best the Beagle " sea-sickness '' except perhaps 
 during the first three weeks, was not due to the ship's 
 motion, but rather to the same cause that produced the 
 nausea, etc., in after years. 
 
 The Severe Illness in South America. — Although 
 " habitually in full vigor " during the Beagle voyage 
 (with the exception of the reflex neuroses due to the 
 use of the eyes with the microscope, etc.), Darwin had 
 one " severe illness " of so strange a type that " every 
 secretion of the body was affected." When the symp- 
 toms were described to Darwin's father, he " could
 
 CHARLES DARWIN. 95 
 
 make no guess as to the real nature of the disease." If 
 we knew accurately, instead of knowing nothing of the 
 actual life of Darwin during the weeks or even days, 
 before the seizure, we should, I doubt not, find that 
 during some time of forced bodily inactivity severe 
 use of the eyes had precipitated the attack. If we 
 could have far more accurate description of all the 
 symptoms we could understand better just what took 
 place, what organs bore the brunt of the derouted 
 reflex, what was the morbid result, or what disease this 
 protean ocular " insult " led up to or assumed. Noth- 
 ing better proves the almost uncanny inerrancy of the 
 diagnostic acumen of Darwin's father than his index- 
 ing perception of the possible unity and connection of 
 this special attack with the bad health of the later 
 years. The adumbration of the truth, the mixture of 
 the truth and error, in the passing remark, is of 
 especial suggestiveness. 
 
 The First Two Years at Home, after the Beagle 
 Voyage. — Darwin arrived at home October 5, 1836, in 
 most excellent health and spirits. He was very soon 
 busy getting his specimens and collections off the 
 Beagle, properly disposed of, unpacked, etc. At this 
 time he wrote to Captain Fitz-Roy : 
 
 " However others may look to the Beagle's voyage, now 
 that the small disagreeable parts are well nigh forgotten 
 (italics mine), / think it far the most fortunate circumstance 
 in my life (italics are the author's) that the chance afforded 
 by your offer of taking a naturalist fell on me."
 
 96 BIOGRAPHIC CLINICS. 
 
 On November 6, he wrote : 
 
 " My London visit has been quite idle so far as natural his- 
 tory goes, but has been passed in exciting dissipation among 
 the dons of science. All my afifairs, indeed, are most pros- 
 perous." 
 
 In March, 1837, he wrote: 
 
 "The only evil found in Cambridge was its being too 
 pleasant; there was some agreeable party or other every even- 
 ing, and one can not say one is engaged there with so much 
 impunity as in this great city." 
 
 The last allusion is the first ominous sign we find of 
 what he later called " London for smoke, ill-health, and 
 hard work." But in October, one year after the end 
 of the Beagle voyage, we have these words : 
 
 "I have not been very well of late, with an uncomfortable 
 palpitation of the heart. . . . When I consulted Dr. Clark in 
 town he at first urged me to give up entirely all writing and 
 even correcting press for some weeks." 
 
 He was busily engaged in literary work on the 
 results of his voyage, which he continued despite Dr. 
 Clark's advice. But in May, 1838, he was compelled 
 by his symptoms to stop work for a holiday at Cam- 
 bridge. This he thoroughly enjoyed, and it did him 
 *' such wonderful good and filled my limbs with such 
 elasticity that I must get a little work out of my body 
 before another holiday." 
 
 But in June he was worse and had to give up work 
 and take the geologizing trip in Scotland wherein, as
 
 CHARLES DARWIN. 97 
 
 we have seen, he was still able to triumph over others 
 as regards sea-sickness. 
 
 Thus ends what may be called the period of youth 
 and health of Darwin's life. He had escaped all the 
 disastrous effects of eye-strain in boyhood by not 
 studying at all, by the " waste and worse than waste " 
 of his time, as his father said, in sports. It was a wise 
 waste, as we now know. The same unconscious wis- 
 dom drove him along " the line of least resistance " in 
 the study of natural history and in seeking the appoint- 
 ment of naturalist in the Beagle expedition, during 
 which there had been comparatively little use of the 
 eyes in reading and writing, and much out-of-door 
 activity of all kinds. By disuse of the eyes in reading 
 and writing he therefore certainly escaped the " first 
 critical period " of eye-strain in boyhood. The " sec- 
 ond critical period " he also came near missing in the 
 same way, but it was represented by his Beagle sea- 
 sickness, and perhaps the strange illness in South 
 America. Certain it is that he returned in 1836 in per- 
 fect health and spirits, full of hope and ambition, and 
 when the short period of " dissipation " was over, the 
 effects of his plunge into work were at first resisted 
 with remarkable strength. The first slight intimation 
 of ill-health was in six months, but in one year it was 
 so sharp that Clark advised stopping all writing, proof- 
 reading, etc. In two years after his return, the en- 
 forced holidays did little or no permanent good, al-
 
 98 BIOGRAPHIC CLINICS. 
 
 though while taking place there was immediate relief; 
 the resiliency had not yet been entirely lost. Hence- 
 forth, however, the escape from reading and writing 
 was impossible (ah, that he had tried dictation to an 
 amanuensis!) and as the duty grew more unavoidable 
 there was also at last, the growing handicap of pres- 
 byopia. 
 
 From the Age of Twenty-Nine, to the End of Ac- 
 commodation Failure. — It is strange that Darwin him- 
 self and his physicians should have supposed that 
 intellectual labor was the cause of his symptoms. It 
 is true that Dr. Clark was accustomed to tell his literary 
 patients to quit proof-reading, writing, etc., and take 
 a holiday, but this was routine, and with the plain in- 
 tent to break up mental work, and of course, infinitely 
 far from any consciousness that it was abnormal ocular 
 function, instead of intellectual over-exertion that was 
 at fault. Once Darwin recognized this when at the 
 age of 50 he wrote: "It is a very odd thing that I 
 have no sensation that I overwork my brain." This 
 was when he was hardest at work on the " Origin." 
 As if thought and laborious intellectual action could 
 be stopped in De Quincey, Carlyle, Huxley, or Darwin 
 by making them walk half their lives or more about 
 rings, sand-walks, or moors, or ride 20,000 miles on 
 one horse, etc. ! In reality such things made mental 
 action the greater, adding also worry, introspection, the 
 regret of lost time, etc. Indeed, Darwin says that
 
 CHARLES DARWIN. 99 
 
 when he could do nothing else from illness, he could 
 collect his facts for the "Origin of Species." Cor- 
 recting proofs is by no means such intellectual work 
 as thinking out and composing the "Origin of Spe- 
 cies," and yet Darwin himself wrote, "and, also, there 
 yet remains the worst part of all, correcting the press." 
 It was worse because it was more laborious to the eyes. 
 Doubtless the splendid inductive quality of his mind, 
 the patient and tireless gathering of facts which dis- 
 tinguishes his books and bottoms them upon an incon- 
 trovertible basis, was in great part due to this, that 
 he was unconsciously compelled to spend his time so 
 largely in some manner as did not induce the reflexes i £ 
 of eye-strain. In this connection it is noteworthy that \ '■ 
 he so early adopted the suggestion of Lyell of dividing ! 
 the working day into two parts, working about two \ 
 hours at a spell, and resting between. But nothing ' 
 could prevent the frequently recurring " unwellnesses," 
 the long and serious illnesses, the longer and more 
 frequent holidays, one thirteen months long at the age 
 of 33> when he congratulates himself that he can work 
 two hours a day, etc. 
 
 There is one noteworthy difference between Darwin 
 and all the others we are studying in this series. At 
 the age of 33 he regrets that he must renounce long 
 walks, mountain-climbing, etc., whereas the others 
 never lose this kind of physical vigor. I think this 
 difference is explainable as due, for the most part, to
 
 loo BIOGRAPHIC CLINICS. 
 
 the vomiting from which he suffered.^ This with 
 insomnia was his most constant symptom; the result- 
 ing denutrition was great, and left him with little 
 nerve-force for muscular innervation. What little was 
 left was further reduced by his morbid addiction to 
 hydropathy, which, while it " dulled his brain splen- 
 didly " and rested his eyes a little, still, did more harm, 
 I think, than good. 
 
 At 36 he had not a day or rather a night for three 
 years without great stomach disorder, most days with 
 great prostration of strength. He became so alarmed 
 that he believed he should die, and made " a solemn 
 and last request." Trembling of the hands and 
 " swimming " of the head were added to the other 
 symptoms in 1838, whilst severe headaches were al- 
 luded to at the age of 51. If it was possible for a 
 worse than usual to exist from the age of 30 to that 
 of about 57, it was when he was putting the " Origin " 
 through the press at the age of 50. At the completion 
 of that hurried work, he was in a deplorable condition. 
 I need not repeat or recapitulate the evidences of his 
 physical condition I have partly gathered in the pre- 
 ceding selections. There are a number of indications 
 of the close connection of ocular labor and the im- 
 mediate appearance or recrudescence of systemic 
 
 * He dreaded at 43 to go anywhere, fearing that his stomach 
 would so easily fail; excitement or fatigue would cause the 
 "bad form of vomiting."
 
 CHARLES DARWIN. loi 
 
 symptoms, the exhaustion, etc. Reading at 20 and 21, 
 we remember, made him have " spirits for nothing," 
 " disgusted him so he had not the heart to write any- 
 body," made him " miserable before and after," etc. 
 Such allusions constantly recur, e. g., at 30 he " read a 
 little, was much unwell " ; at 36, " slaving (writing) 
 extra hard brought great discomfiture of wretched 
 digestive organs " ; at 37 " abominable press work " 
 prevented him from writing, being unwell; at 45, his 
 " stomach deadens his former pure enthusiasm for 
 science and knowledge " ; at 49 his stomach " got into 
 a horrid state from overwork " ; at 50, " health failed, 
 cannot look over any proofs " ; he is " wearied out," 
 " worn out," " weak as a child," etc., with proof- 
 reading. At the completion of the " Origin " he was 
 in an awful state of stomach, strength, temper, and 
 spirits ; " my confounded book half-killed me." 
 
 There are several facts that should be borne in mind 
 as to all the terrible years at Down and at the hydro- 
 pathic establishments: 
 
 1. He had to give up all extra reading and writing 
 except the newspapers whilst he was at the water-cure 
 establishment, as two and one half hours at his regular 
 work was all that was allowed, and with the exhaust- 
 ing, brain-dulling water-cure he was completely tired 
 and had to go to bed at eight o'clock, etc. 
 
 2. The compelled and tiresome idleness, as he was 
 able to work but one and a half to three hours a day.
 
 I02 BIOGRAPHIC CLINICS. 
 
 " It is so weariful killing the whole afternoon after 12 
 o'clock doing nothing whatever. ... I intend if I can 
 to keep my resolution, of being idle this winter. But, 
 I fear ennui will be as bad as a bad stomach." 
 
 3. The necessity of exercise and its peculiar kind — 
 the daily round upon round of the " sand-walk," year 
 in, year out. " In connection with my father, my 
 earliest recollections coincide with my latest. We con- 
 tinually saw my father as he walked around." 
 
 4. " I think the newspaper was the only non-scien- 
 tific matter," says his son, " which he read to himself. 
 Everything else, novels, travel, history, was read aloud 
 to him." 
 
 5. The great labor German was to him. He could 
 read but very little of these " verdammte " eye-weary- 
 ing forms of letters. 
 
 Each one of these facts adds to the cumulative evi- 
 dence that eye-strain was the fundamental cause of 
 Darwin's ill-health. 
 
 The influence of completed presbyopia and the re- 
 markable cessation of almost all of the troublesome 
 symptoms that had made such a tragedy of his life, is 
 a further proof, if needed, of the theory. In 1866, 
 when he was 57, his health improved so that he could 
 work one or two hours a day ; at the age of 59, " sci- 
 ence makes him forget for some hours his accursed 
 stomach." From this time on the complaints cease 
 almost entirely ; in these last years of his life " the
 
 CHARLES DARWIN. 103 
 
 condition of his health was the cause of satisfaction 
 and hope in his family ; ... he was able to work more 
 steadily." 
 
 It was plain that there was no organic disease, and 
 that miost strangely there was a sudden and apparently 
 causeless cessation of the cause of the afflictions of the 
 past thirty years. I do not judge that this return of 
 health was due to the care of — any physician. The 
 loss of accommodation ended the life-long struggle of 
 the ciliary muscle to overcome the compound hyperopic 
 astigmatism of his eyes, the existence of which will 
 alone explain the mystery of Darwin's ill-health. His 
 symptoms, vomiting and other functional digestional 
 disorders, insomnia, vertigo, headache, apathy, and 
 neurasthenia, are precisely those which the best Ameri- 
 can oculists find are the most common symptoms of 
 this refractive anomaly of the eyes. Every fact con- 
 cerning his health and, indeed, almost every day's ex- 
 perience during his life demonstrated that use of his 
 eyes at near range produced these symptoms. 
 
 The Literary Product. — Up to the time when Dar- 
 win's health began to improve, i. e., about 1866, when 
 he .was 57 years of age, he had written five major works, 
 the "Naturalist's Voyage," "Coral Reefs," "Origin 
 of Species," " Fertilization of Orchids," and " Move- 
 ment in Plants," aggregating, in the edition I have, 
 about 2,400 pages, or an average of writing of about 
 eight lines a day. Against the five books in thirty
 
 I04 BIOGRAPHIC CLINICS. 
 
 years we have eight books (omitting the " Life and 
 Letters"), published in the fifteen years from 1867 to 
 1882, and aggregating about 3,700 pages, or an aver- 
 age more than three times as great as in the former 
 period. As .with Carlyle, the total product averaged 
 less than one half-page a day. I cite such figures only 
 as indicative of the difficulties under which both men 
 worked, and not as a suggestion that one page of their 
 writing is not of a thousand times the value of those 
 of more fluent writers. 
 
 Postscript. — The foregoing pages were written ex- 
 actly as they stand when I turned to the article (which 
 I had kept unread until I should have made my own 
 study) written by Dr. W. W. Johnston, of Washing- 
 ton, D. C, upon "The Ill-Health of Darwin," and 
 appearing in the American Anthropologist, Vol. 3, No. 
 I, January-March, 1901. Dr. Johnston emphasizes 
 the following points : 
 
 1. The indefiniteness and paucity of statements as to the 
 health during the voyage, and Darwin's great powers of phys- 
 ical endurance. 
 
 2. He was only " occasionally unwell " for two years and 
 three months after his return. 
 
 3. " Frequently recurring illness " and " losing ground year 
 by year " for the next three years until the removal to Down. 
 
 4. The symptoms and habits of life as described. 
 
 5. " For increasing suffering there was but one remedy — a 
 complete abandonment of all writing and absence from home 
 and study " . . . " Overwork or a long-continuance of moderate 
 work made him ill : rest from work made him better."
 
 CHARLES DARWIN. 105 
 
 6. The marked change for the better is placed at 63; the 
 relief for the rest of his life. 
 
 7. "The discomforts, fatigues, and mental overstrain of the 
 Beagle voyage can fairly be set down as the initial cause of 
 Darwin's subsequent invalidism. . . . When he landed in 
 England his nervous system was exhausted. . . . On arriving 
 in London ... he at once began to work as hard as he pos- 
 sibly could, although interrupted by frequently recurring ill- 
 nesses, and one long and serious illness. . . . Persistent over- 
 strain. . . . The necessary result of all this was to multiply 
 many times the original acquired exhaustion, and to create a 
 condition which was permanent." 
 
 8. " He lived a modified form of rest-treatment j ust such as 
 is now advised for cases like his." 
 
 9. " The alternation of work and complete rest was essen- 
 tial for his studies." 
 
 10. " Darwin's disease was chronic neurasthenia of a severe 
 grade due first to the overstrain of the Beagle voyage, and 
 second to the life of hard intellectual work." 
 
 I regret to differ from so eminent an authority and 
 excellent physician as Dr. Johnston, as to the etiology 
 and diagnosis in this case. Far more do I dislike to 
 notice that there is not a particle of evidence for the 
 supposition that there were any " discomforts, fatigues, 
 and mental over-strain " during the Beagle voyage 
 which undermined or impaired Darwin's health, and, 
 as we have seen, thinking not of the " small disagree- 
 able parts " of the voyage, but that it was the most 
 fortunate thing of his life. When he landed in Eng- 
 land his " nervous system " was not only not " ex- 
 hausted " but was in an exceptionally sound and ac- 
 tive condition. He had no illness at all for the next 
 8
 
 io6 BIOGRAPHIC CLINICS. 
 
 year, and as his son says, failing health after that 
 came on only " gradually." There was no " persis- 
 tent overstrain " of " hard intellectual life " ; there 
 was indeed but a small part of what thousands of 
 others carry on without a symptom. There seems to 
 be a childish popular error, shared even by those who 
 should be accurate, that the solving of intellectual prob- 
 lems such as those which busied Darwin's mind is more 
 wearing and disastrous to the health and mind than the 
 mental exertion of the simplest intellects in the stren- 
 uous life which millions have to carry on. The fact 
 is that almost all great thinkers have lived to a ripe 
 old age. As to the " rest-treatment " it frequently 
 happens that the rest-cure does not cure unless reading 
 and writing are interdicted, or proper glasses ordered, 
 and that many neurasthenics are cured by glasses with- 
 out the rest-cure. In other words, " neurasthenia " 
 may be caused by eye-strain. The ill-defined symp- 
 toms grouped under the indefinite word are those most 
 commonly enumerated by patients to the oculist, and 
 their relief by correction of the optical errors is the 
 rule. Calling the symptoms neurasthenia does not ex- 
 plain their origin, and to cure them scientifically and 
 permanently it is necessary to prevent the causes 
 upon which they depend.
 
 THOMAS HUXLEY. 
 
 i«7
 
 CHAPTER IV. 
 
 THOMAS HUXLEY. 
 
 The following excerpts and facts concerning the 
 life of Thomas H. Huxley are from the " Life and 
 Letters " by his son. 
 
 He was bom May 4, 1825. 
 
 As a boy he " read everything he could lay hands on in his 
 father's library." " Not satisfied with the ordinary length of 
 the day, he used, when a boy of 12, to light his candle before 
 dawn, pin a blanket around his shoulders, and sit up in bed to 
 read Hutton's 'Geology.'" (His son.) 
 
 " While very young I commenced the study of medicine 
 under a medical brother-in-law." (Huxley of himself.) 
 
 " I am now occasionally horrified to think how little I ever 
 knew or cared about medicine as the art of healing." (Ibid.) 
 
 " I was a mere boy — I think between 13 and 14 years of age 
 — when I was taken by some student-friends of mine to the 
 first post-mortem examination I ever attended. All my life 
 I have been most unfortunately sensitive to the disagreeables 
 which attend anatomical pursuits, but on this occasion my 
 curiosity overpowered all other feelings, and I spent two or 
 three hours in gratifying it. I did not cut myself, and none of 
 the ordinary symptoms of dissection-poison supervened, but 
 poisoned I was somehow, and I remember sinking into a 
 strange state of apathy. ... I soon recovered, but for years I 
 suffered from occasional paroxysms of internal pain, and from 
 that time my constant friend, hypochondriacal dyspepsia, com- 
 menced his half-century of co-tenancy of my fleshy taber- 
 nacle." (Ibid.) 
 
 109
 
 no BIOGRAPHIC CLINICS. 
 
 About the age of 21, in studying for an examination he 
 " worked really hard from 8 or 9 in the morning until 12 at 
 night." " A great part of the time I worked till sunrise. The 
 result was a sort of ophthalmia which kept me from reading 
 at night for months afterwards." (Ibid.) 
 
 He received the degree of M.B., in 1845, and entered the 
 Navy as Assistant Surgeon in 1846. The cruise of The 
 Rattlesnake ended November 9, 1850. He at once plunged into 
 work, and in 1852 is described as looking " thin and ill." (27 
 years of age.) 
 
 The hopelessness of obtaining a living by pure science came 
 near making him take up some other occupation. " I will not 
 attempt my own profession," chronicles his renunciation of 
 medicine. (27.) 
 
 His son says that in 1853 to go abroad from home or to do 
 any work (reading) before breakfast ensured him a head- 
 ache for the rest of the day, so that he was never one of 
 those risers with the dawn who do half a day's work before 
 the rest of the world is astir. He had a bad bout of ill- 
 health at the end of the year, when he " reformed," rising at 
 8, and going to bed at 12. (28.) 
 
 In a letter from Tenby, South Wales, he says: "I have 
 been here since the middle of August . . . banishing dyspep- 
 sia, hypochondria and all such other town afflictions." (29.) 
 
 " With you I envy . . . his gastric energies. I feel I have 
 done for myself in that line, and am in for a life-long 
 dyspepsia. I have not now nervous energy enough for stomach 
 and brain both — and if I work the latter, not even the fresh 
 breezes of this place (Tenby) will keep the former in order. 
 (29.) 
 
 " I wish I could ascertain the exact juste milieu of work 
 which will suit, not my head or will, these can't have too 
 much; but my absurd stomach." (31.) 
 
 Open-air occupation and tramping from ten to sixteen miles 
 a day gave him immediate relief. " You can't think how well 
 I am so long as I walk eight or ten miles a day, and don't 
 work too much." (31.)
 
 THOMAS HUXLEY. in 
 
 Longer walking tours, in England, and in Switzerland 
 during the summer holidays now become the necessity and 
 the rule to recruit from "overwork." (31.) 
 
 In 1857-1858 his health was greatly tried. Headache ! head- 
 ache! is his repeated note. There are many entries such as 
 the following: "Used up," "hypochondriacal and bedevilled," 
 "not good for much," "toothache, incapable all day," "voice- 
 less," "missed lecture," "unable to go out." (32-33.) 
 
 In 1862 he was compelled to go to bed for ten days by an 
 unaccountable prostration of strength which he thinks was due 
 to "obstruction of the liver." (37.) 
 
 " I had a pain about my eyes a few months ago, but I found 
 spectacles made this rather worse, and left them off again. 
 However, I do catch myself holding a newspaper further off 
 than I used to do." (39.) 
 
 At the age of 47 his son says that " dyspepsia, the most 
 distressing of maladies, had laid firm hold upon him." Even 
 rests and holidays did no good at this time. He confessed 
 that " in the long struggle against ill-health he had been 
 beaten." "Beyond general weariness, incapacity and disgust 
 with things in general, I do not know precisely what is the 
 matter with me." (47.) 
 
 " My incessant dyspeptic nausea." (47.) 
 
 He was now (1872) forced to take a long vacation, and 
 from Egypt he writes that a month of utter and absolute 
 laziness had completely set him up and he was " well as ever." 
 (47.) 
 
 He returned home sunburnt and bearded almost beyond 
 recognition; but "as soon as he began to work again in 
 London, his old enemy dyspepsia returned." Special diet and 
 another trip abroad were ordered by Dr. Andrew Clark, and 
 this effected a " cure." (47.) 
 
 But in two weeks after this "cure" he was "just keeping the 
 devil of dyspepsia at arm's length." In two months more he 
 was forced to give up again for two months and go away for 
 a rest.
 
 112 BIOGRAPHIC CLINICS. 
 
 " It isn't my brains that get wrong but only my confounded 
 stomach." " As my doctor told me, I was sound mind and 
 limb, and had merely worn myself out." (47.) 
 
 " I have been worried to death with dyspepsia, and the 
 hypochondriacal bedevilments that follow its train." 
 
 The fact is repeated in another letter. (47.) 
 
 In January, 1873, he was "getting better from a fresh 
 breakdown of dyspepsia," but he was forced to exist on the 
 "strictest ascetic principles." 
 
 He had been seriously ill with severe mental depression. He 
 now took a long summer vacation, walking, geologizing, etc., 
 and " gradually discarding doctor's orders." In a few days he 
 was better, and in two months, "wonderfully" so, "another 
 man," etc. He now thinks "the enemy is beaten," tracing it 
 all to cutting down food, etc. (48.) 
 
 In 1875 his health was maintained on a satisfactory level, 
 "thanks to the regimen," etc. (50.) 
 
 But in 1876, he is "in rather a hypochondriacal state of 
 mind"; "I will see if this course of medicine will drive the 
 seven devils out." (51.) 
 
 There is less complaint from this time to 1884, when "the 
 burden of ill-health grew slowly and steadily. Dyspepsia and 
 the hypochondriacal depression again attacked him as they 
 had attacked him twelve years ago." " His energy was 
 sapped." Nothing could bring him to work. We note that 
 in the worst condition ("spoon-meat" and "inanity") a ten- 
 mile walk was possible and helpful. (59.) 
 
 He eats, drinks, and sleeps "like a top." (59.) 
 
 "We are fearfully and wonderfully made, especially in the 
 stomach — which is altogether past finding out." (59.) 
 
 "I find myself distinctly aged, tired out, body and soul, 
 afraid of work. Physically I have nothing much to complain 
 of except weariness." "There is not the slightest sign of 
 organic disease anywhere." (59.) 
 
 " I am convinced that the prophet Jeremiah must have been 
 a flatulent dyspeptic— there is so much agreement between his 
 views and mine." (59.)
 
 THOMAS HUXLEY. 113 
 
 Sir Andrew Clark now finds " nothing wrong except a slight 
 affection of the liver and general nervous depression. He 
 orders him to go South and do nothing but amuse himself for 
 three or four months." (59.) 
 
 He again complains of " weariness and deadness hanging 
 over him, accompanied by a curious nervous irritability." (59.) 
 
 He goes to Italy, but writes from Rome in January, 1885, 
 that he is no " forarder." He is well for a few days and 
 then all adrift, and "have to put myself right by dosing with 
 Clark's pills, which are really invaluable." The pills were 
 strychnin, but by February " Clark's strychnia did not answer 
 so well," and he began taking quinin. By March there was 
 some improvement. In April he returned home, and Clark 
 could only tell him he had a "bad color." (60.) 
 
 Lassitude and depression seized him and Clark ordered 
 him to quit all work. He resigns his government positions. 
 By May he was " in a disgusting state of blue devils," although 
 there was really nothing the matter, and a month later he 
 was worse — "blue devils and funk, funk and blue devils. 
 Liver I expect." (60.) 
 
 In 1886 he had been "going steadily down," and he called 
 in a physician who told him that " more physicking was no 
 good," and told him to be off to the moors to see what exer- 
 cise and fresh air, etc., could do. Ten to sixteen miles a day 
 at once brings him up again, banishes the blue devils, etc. " I 
 wish I know what is the matter with me." (61.) 
 
 "I do a minimum of ten miles per diem without fatigue 
 and as I eat, drink and sleep well there ought to be nothing 
 the matter with me. Why under these circumstances I 
 should never feel honestly cheerful or know any other desire 
 than that of running away and hiding myself, I don't know. 
 No explanation is to be found even in Foster's * Physiology ' ! 
 The only thing my demon can't stand is sharp walking, and I 
 will give him a dose of that remedy when once I get into 
 trim." A single day at Ilkley improves him so that he says he 
 feels like an impostor for running away and " I can hardly
 
 114 BIOGRAPHIC CLINICS. 
 
 believe that I felt so ill and miserable twenty-four hours ago." 
 (61.) 
 
 In 1886, in June, from the country he writes that he has for 
 five months found that a few days in London knocks him up, 
 and he must go back to the moors. (61.) 
 
 He goes abroad again, getting better at once, as usual, but 
 in London he came down again, and went to Yorkshire in 
 December to be "mended." (61.) 
 
 The first half of 1887 "was chequered by constant returns 
 of ill-health." In June he is sent to bed, " a touch of pleurisy 
 with muscular rheumatism," and he is ordered off to Switzer- 
 land, and at once was well again. There was more pleurisy 
 in 1888. (62.) 
 
 "As long as I have nothing to do I have nothing to com- 
 plain of"— but he gets worse steadily. He was on his back 
 and taking iron and digitalis in June, as it turned out "his 
 heart was out of order." He was very ill when he again 
 arrived at Maloja, not being able to walk 100 yards, but in 
 two months he could again walk ten miles and climb 2,000 
 feet without difficulty. 
 
 His heart gets bad when he is kept indoors, however. On 
 his return to England he is again bad, but goes to Eastbourne 
 and the downs and the daily walk again made the bad symp- 
 toms disappear. In December his physician (Hames) tells 
 him there are left only slight indications of heart trouble. (63.) 
 
 There was returning vigor in 1889; he was out of doors all 
 the time; Sir Henry Thompson scoffed at the idea of his ever 
 having had a dilated heart. (64.) 
 
 There was little complaint now. "Broken health was 
 restored" and with out-of-door life, until 1895 when influ- 
 enza and bronchitis supervened some "renal trouble," and 
 death followed on June 29, at the age of 70. 
 
 As a medical case we have, therefore, a man who 
 from childhood applied himself to study with tre- 
 mendous energy and persistence. Beyond all doubt
 
 THOMAS HUXLEY. 115 
 
 he never had any organic disease; the supposed dila- 
 tion of the heart was even laughed at by Sir Henry 
 Thompson a few years before his death. And yet 
 from the age of fourteen he was a great sufferer. A 
 man of Huxley's nature does not complain except upon 
 the most adequate and real warrant. His suffering 
 for fifty years wrung from him the most bitter com- 
 plaints, and forced him for the latter part of his Hfe 
 to renounce what he held dear in the world, and to 
 renounce it more and more absolutely with every added 
 year of life. The result of all his study of his own 
 case, the result of all his consultation of physicians, 
 was that neither he nor the physicians had the least 
 idea what ailed him. He was constantly puzzled by 
 the inexplicable mystery. As Carlyle had said of him- 
 self, he '' might as well have poured his sorrows into 
 the long hairy ear of the first jackass he came upon, 
 as of this select medical man." The result of all treat- 
 ment except of one kind was nil. Even up to his last 
 years walking in the open air and renunciation of 
 study, reading, and writing, never failed to give him 
 immediate relief, again made him " as well as he ever 
 was in his life," so that after such walks he ate, drank, 
 and slept, " like a top." It shows how truly Huxley 
 diagnosed his own unfitness for the work of a prac- 
 tical physician, when we reflect that his wretchedness 
 of fifty years never made him catch any hint of the 
 fact that whenever he began study, reading, or writing
 
 ii6 BIOGRAPHIC CLINICS. 
 
 he suffered, and whenever he stopped these things he 
 was at once well. During his whole life he was teach- 
 ing and urging upon others the study of physiology. 
 But he never suspected the significance of the physiol- 
 ogy of the eye and of astigmatism, and of their rela- 
 tion to his bad health. What was his disease? It 
 was functional, surely, and it was so terribly real that 
 one can hardly imagine what tragedy it brought to 
 him; great as were the study, work, and scientific re- 
 sults of his life, it prevented him from making far 
 more of that life than we can know. The mellowing 
 effect of years, experience, and love of his fellow men 
 were indeed but just beginning to show the splendid 
 possibilities of the future, when, " Resign, renounce, 
 stop work ! " became the absolute commands of the 
 doctors, and of fate. 
 
 At the age of fourteen he had been reading for a 
 number of years with all that fiery energy and reck- 
 lessness so characteristic of him. At this time he was 
 present at the dissection table " for two or three 
 hours." One smiles as one reads the naive words, " I 
 did not cut myself, and none of the ordinary symp- 
 toms of dissection poison supervened, but poisoned I 
 was, somehow, etc." He had indeed a strange sort of 
 toxemia, but its origin was surely not the post-mortem 
 table. '' Apathy " and his fifty years of " hypochon- 
 driacal dyspepsia " now began. 
 
 At about the age of twenty-one, excessive ocular
 
 THOMAS HUXLEY. 1 17 
 
 labor brought on " a sort of ophthalmia " which pre- 
 vented him from reading at night for months. During 
 the four years of the cruise of the Rattlesnake there 
 was no complaint of ill-health, as in Darwin's case also 
 there was no eye-strain or not enough to cause it. On 
 his return to work on shore at the age of twenty-six 
 he was soon thin and ill, and at the age of twenty- 
 seven he could not read before breakfast without re- 
 sultant headaches for the rest of the day, so that, after 
 an illness, he " reformed " his habits and went to bed 
 at midnight, and arose at 8. Nothing now checks the 
 reign of the mysterious dyspepsia, liver affection — 
 stomach-trouble, nausea, flatulent dyspepsia, headache, 
 hypochondria — nothing, except quitting study. At 
 the age of about forty-nine he got some respite and 
 for about ten years there was far less complaint. But 
 from the age of 59 to 64 his old troubles and some 
 new ones brought him much grief. With the estab- 
 lishment of complete presbyopia at 63 or 64 there was 
 no further complaint. 
 
 It is certain that our patient had far-sighted astig- 
 matism at least of one or two diopters (compound 
 hyperopic astigmatism), probably with a difference in 
 the refractive error of the two eyes (anisometropia) ; 
 perhaps he had also some lack of balance of the ex- 
 ternal ocular muscles (heterophoria) and almost cer- 
 tainly he had good or normal acuteness of vision of 
 the two eyes. He probably never consulted an oph-
 
 ii8 BIOGRAPHIC CLINICS. 
 
 thalmologist. How, then, may all of this be more than 
 guessed ? By his own " Method of Zadig." It is a 
 pity that this method had not been applied to himself; 
 that his physiology was not practical, or morbid, or 
 clinical. 
 
 He had far-sighted astigmatism because every per- 
 son has it upon whose attention it has been forced, 
 that at the age of 38 or 39 he had been compelled to 
 hold the paper farther away than heretofore. Pres- 
 byopia is not manifest in the emmetropic eye for half 
 a dozen years later in life. He had astigmatism and 
 probably anisometropia because of the fact that the 
 crude spectacles he got from some optician, were, of 
 course, simple plus spherical lenses, and both alike, 
 and as they increased his trouble rather than lessened 
 it he surely was astigmatic, and almost certainly anis- 
 ometropic. He probably had heterophoria (" insuffi- 
 ciency " or latent strabismus) because long-continued 
 eye-strain from the causes mentioned usually produces 
 this imbalance of the external ocular muscles. He 
 had retained, or normal, visual acuteness because, as is 
 the almost exceptionless rule, that, when a vicious eye- 
 strain reflex spends its strength on other organs, cere- 
 bral or digestional, the eye itself is spared. If Huxley 
 had had persistent ocular symptoms such as conjunc- 
 tivitis, amblyopia, etc., he would not have had the 
 systemic symptoms, gastric, digestional, etc., which 
 he endured for fifty years. The superlative impor-
 
 THOMAS HUXLEY. 119 
 
 tance of the function of vision to the organism, animal 
 or human, has made Nature, with perfect wisdom, 
 turn the harmful eye-strain reflex upon other organs 
 than the eye. Huxley's eye-strain symptoms corre- 
 spond in a general way to those of others but with 
 the inevitable differences and peculiarities of all bio- 
 logic phenomena. We must remember that his extra- 
 ordinary energy of mind and body gave him note- 
 worthy powers of resistance and recuperation. This 
 demonstrates all the more convincingly the single na- 
 ture and cause of his sufferings. The immediate 
 cessation of the effects of eye-strain when he walked 
 from ten to sixteen miles a day, or climbed mountains, 
 or tramped the moors, shows at once the natural rug- 
 gedness and health of all his organs, and the single 
 cause of his ill-health. Lectures, teaching, experi- 
 mental work, etc., would have doubtless given him 
 relief from eye-strain, if he could have had a stenog- 
 rapher, or some one to read aloud to him, and if he 
 had not himself read useless things. 
 
 The mounting of the childhood curve of symptoms 
 to a crisis came at about the age of 14, when there 
 was the strange experience he so naively describes as 
 if resulting from his attendance at the dissection table. 
 From it Huxley dates the beginning of " the half- 
 century of co-tenancy of dyspepsia of his fleshy taber- 
 nacle." The emotional revulsion against dissection ^ 
 was plainly a part but a very small part of the cause
 
 I20 BIOGRAPHIC CLINICS. 
 
 of the " co-tenancy." At 21 Huxley's use and abuse 
 of his eyes caused an attack of conjunctivitis which 
 lasted for several months. The resistance of the cere- 
 bral and digestional organs to the morbid reflexes, a 
 resistance greatest at this time of life, threw these 
 reflexes back upon the eyes themselves. During the 
 next seven years all organs withstood the strain the 
 best, but at 28 reading before breakfast caused head- 
 ache for the rest of the day, and he had such a bad 
 bout of ill-health that he changed the habits of his life, 
 quitting study at 12 o'clock at night, and rising at 8 
 A. M. He had now to take a vacation to banish " dys- 
 pepsia, hypochondria, and other town afflictions," and 
 he began to learn that if he worked his brain much he 
 had stomach trouble and not even the fresh breezes of 
 Tenby would enable him to recuperate. It is, of 
 course, absurd to think that in Huxley brain-work 
 alone could have such a result. He knew better well 
 enough. His " head or will could never," as he later 
 said, " have too much work." But eye-labor always 
 and quickly brought an end of the " nervous energy " 
 necessary for digestion. And so as in the lives of 
 all those we have studied began the " tramp, tramp, 
 tramp," in the open air, which alone gave relief. And 
 even with this the "headache, headache," dyspepsia, 
 and dyspeptic nausea, hypochondria, and apathy, con- 
 tinued and grew worse, and prove tragic until about 
 the age of 48 or 50, when there was some relief last-
 
 THOMAS HUXLEY. 121 
 
 ing eight or ten years. This period of partial relief 
 is illogical on the theory of unrelieved eye-strain, as it 
 usually does not come until at about the age of 60, at 
 the completion of accommodation failure. It would 
 surely be readily explainable if we had all the facts at 
 hand, and had not to deal with hints, unintended sug- 
 gestions, overhearings, etc., as to the actual clinical 
 history. I suspect that at the age of 48 or 49 when 
 there was some change for the better in his general 
 symptoms, there was a considerable lessening of eye- 
 strain from some spectacles which he would now be 
 compelled to catch up somewhere, in order to decipher 
 print. Ten years previously he had felt the need of 
 lenses, had tried such as he could get, but with these 
 the ocular pain was worse and he struggled on for the 
 next years of his severest trials. That his relief from 
 49 to 59 came from the relief of eye-strain is to me 
 indubitable, and although it was not then possible that 
 his error of refraction could be at all accurately cor- 
 rected, there are many things that could have cooper- 
 ated to lessen the results of abnormal ocular function. 
 His presbyopia, which had become manifest at least 
 six years earlier than usual, shows that his ametropia 
 was of a high degree, and the guess-work spectacles 
 could have had any one of a number of effects. While 
 the spectacles, in the long run, were harmful, or at 
 least not accurately corrective, still they helped to give 
 some kind of more or less morbid relief. Moreover, 
 9
 
 122 BIOGRAPHIC CLINICS. 
 
 accommodation in his case was failing fast at 50 ; lastly 
 it would have been strange if in thirty-six years Hux- 
 ley should not have learned, even if blindly and em- 
 pirically, how far he could go in the use of the eyes 
 without too much injury. However much or little he 
 may have temporarily bettered, there was a distinct 
 recrudescence of all symptoms at the age of 59, and 
 he was driven to resign his public offices and again to 
 attack the moors, where, even now, walking ten or 
 sixteen miles a day again brought health and happi- 
 ness. His demon, as of old, could not stand sharp walk- 
 ing. This fact strongly suggests that he had always 
 and still had an unsymmetric or anisometropic astig- 
 matism which could not then have been even approxi- 
 mately corrected and of which the direct irritating 
 results would continue until presbyopia was complete; 
 the secondary consequences might last for the re- 
 mainder of life. 
 
 " Let me,'' says Huxley, " confine myself to the one 
 matter on which my experience as a student of medi- 
 cine, and an examiner of long standing, who has taken 
 a great interest in the subject of medical education, 
 may entitle me to a hearing. What is the object of 
 medical education ? It is to enable the practitioner, on 
 the one hand, to prevent disease by his knowledge of 
 hygiene, and on the other hand, to divine its nature, 
 and to alleviate or cure it, by his knowledge of pathol- 
 ogy, therapeutics, and practical medicine. That is his
 
 THOMAS HUXLEY. i^3 
 
 business in life, and if he has not a thorough and prac- 
 tical knowledge of the conditions of health, of the 
 causes which tend to the establishment of disease, of 
 the meaning of symptoms and of the uses of medicines 
 and operative appliances, he is incompetent, even if he 
 were the best anatomist, or physiologist, or chemist, 
 that ever took a gold medal or won a prize certificate. 
 To understand the nature of disease we must under- 
 stand health, and the understanding of the healthy 
 body means the having a knowledge of its structure 
 and of the way in which its manifold actions are per- 
 formed. Physiology is, to a great extent, applied phys- 
 ics and chemistry. What we call therapeutics has to 
 do with the action of drugs and medicines on the 
 living organism.^ And there is no position so ignoble 
 as that of the * liberally-educated practitioner,' who 
 finds himself with the issues of life and death in his 
 hands, ignorant, blundering, and bewildered, because 
 of his ignorance of the essential and fundamental 
 truths upon which practice must be based." (" Uni- 
 versity Education," Huxley.) 
 
 These words, from the Johns Hopkins address, 
 were spoken in the fullness of his powers, by the 
 physiologist, par excellence, and the " student of medi- 
 cine," who thought himself and was indeed in one 
 way, especially well fitted to speak with authority upon 
 the subject; but he had been, as we know, a profound 
 
 ^A small part of therapeutics nowadays.
 
 124 BIOGRAPHIC CLINICS. 
 
 sufferer all his life from some disease which baffled 
 his best medical advisers, and of which he said, " I 
 wish I knew what is the matter with me." One of 
 the most fundamental and important of the senses, one 
 of the greatest of physiologic functions, the origin and 
 creator of intellect, is vision. Of its physiology Hux- 
 ley was incurious. Its malfunction in his case 
 wrecked his life and when he read, made every day 
 a day of wretchedness. Whenever he read or wrote 
 he suffered, whenever he stopped reading or writing 
 he was well. Notwithstanding this Huxley wrote 
 " The Method of Zadig."
 
 ROBERT BROWNING. 
 
 "S
 
 CHAPTER V. 
 
 ROBERT BROWNING. 
 
 When, in 1845, Robert Browning fell in love with 
 Elizabeth Barrett, he was 32 years of age. The first 
 quotation given below from one of the early letters 
 shows that while certainly not connected, his headache 
 began about the same time. Up to this time he had 
 been free from such symptoms. Let me gather a few 
 of the many allusions in two years' correspondence to 
 the symptoms of ill-health of which he complained or 
 to which Miss Barrett referred: 
 
 " I have had a constant pain in the head for these two 
 months, which only very rough exercise gets rid of. I thought 
 I could never be unwell." (May 3, 1845.) 
 
 " I am quite well now or next to it — but this is how it was. 
 I have gone out a great deal of late, and my head took to 
 ringing such a literal alarum that I wondered what was to 
 come of it : and at last, a few evenings ago, as I was dressing 
 for a dinner somewhere, I got really bad of a sudden and kept 
 at home. Next morning I was no better." (May 12, 1845.) 
 
 How is your head? (E. B. to R. B., May 27, 1845.) 
 
 " You will have advice, will you not, if that pain does not 
 grow much better directly? It cannot be prudent or safe to let 
 a pain in the head go on so long and no remedy for it be 
 attempted? You cannot be sure that it is merely a nervous 
 pain and that it may not have consequences, and this quite 
 
 127
 
 128 BIOGRAPHIC CLINICS. 
 
 apart from the consideration of suffering?" (E. B., June 7, 
 
 1845.) 
 
 " I am confident that that pain should not be suffered to 
 go on without something being done. What I said about 
 nerves related to what you had told me of your mother's 
 suffering and what you had fancied of the relation of it to 
 your own. Not that I believe in the relation . . . because such 
 things are not hereditary, are they? and the bare coincidence 
 is improbable. You see it is just as I thought — for that 
 whether too much thought or study did or did not bring on 
 the illness — . . . yet you admit that reading and writing 
 increases it — as they naturally would any sort of pain in the 
 head. ... If it does you good to go out and take exercise, 
 why not go out and take it? If you will agree to be well, first, 
 I will promise to be ready afterwards to help you in anything 
 I can do — transcribing or anything to get the books through 
 the press in the shortest of times. I am capable of a great 
 deal of that sort of work without being tired, having the habit 
 of writing in any sort of position, ... on the arm of a 
 chair, or the seat of one, sitting myself on the floor and calling 
 myself a Lollard for dignity. ... Do give up the writing and 
 all that does harm." (E. B., June 24, 1845.) 
 
 " I fear I shall not be able to bring you the rest [of the 
 MSS.] to-morrow because I have been broken in upon more 
 than one morning; nor, though much better in my head, can 
 I do anything at night just now." (July 9, 1845.) 
 
 "Are you any better to-day? . . . Will you attempt to do 
 none of the writing which does you harm — nor of the reading 
 even, which also may do harm?" (E. B., July 25, 1845.) 
 
 "Let me try and answer your note to-morrow. I will not 
 hide from you that my head aches now." (July 28, 1845.) 
 
 " To-day I cannot write — though I am very well otherwise." 
 (July 31, 1845.) 
 
 "And your head, how is it?" (This query of Miss Barrett 
 occurs in fully one third of her letters.) 
 
 " So much reading hurts me ; . . . whether the reading be 
 light or heavy, fiction or fact, and so much writing —
 
 ROBERT BROWNING. 129 
 
 whether my own — such as you have seen, or the merest com- 
 pliments — returning to the weary tribe that exact it of one." 
 (August 8, 1845.) 
 
 " How can it be that you are unwell again, and that you 
 should talk of being weary in your soul ! You ? What should 
 make you weary in soul? Or out of spirits in any way? Or 
 is it that, being unwell, your spirits are affected by that?" (E. 
 B., August 25, 1845.) 
 
 " Do take more exercise this week and make war against 
 those dreadful sensations in the head." (E. B., August 31, 
 
 1845.) 
 
 "And my all important headaches are tolerably kept under 
 — headaches proper, they are not — ^but the noise and slight 
 turning are less troublesome." (September 5, 1845.) 
 
 "How is the head? I fancied the other day you were look- 
 ing better rather than otherwise; but those sensations in the 
 head are frightful and ought to be stopped by whatsoever 
 means." (E. B., November 21, 1845.) 
 
 " And now that the headache has begun again, and the 
 worse than headache — " (E. B., November 25, 1845.) 
 
 " When your brother and I took the book between us, we 
 turned to the index between us and stopped at * Miss B.,' and 
 he, indeed, read them or some of them, but holding the 
 volumes at such a distance as defied my short-sighted eye, that 
 all I saw was the faint small characters." (December 9, 
 
 1845.) 
 
 " I will not try to write much to-night, for my head gives 
 warning." (January 26, 1845.) 
 
 " To my sorrow, I must give up the delight of seeing you 
 this morning. I went out unwell yesterday and a long noisy 
 dinner^ with speechmaking and long walk at the end of it — 
 these have given me such a bewildering headache that I 
 really see some reason in what they say here about keeping the 
 house." (February 7, 1846.) 
 
 ^ Called to-day theater-headache, panorama-headache, crowd- 
 headache, etc., and often occurring in astigmatic patients.
 
 I30 BIOGRAPHIC CLINICS. 
 
 "I am rather hazy in the head." (March i8, 1846.) 
 
 "For all the walking my head aches." (March 24, 1846.) 
 
 "Do you notice how stupid I am to-day? My head begins 
 [to ache] again; that is the fact; it is better a good deal than 
 in the morning. With the deep joy in my heart below, what 
 does the head mean by its perversity." (March 29, 1846.) 
 
 " Say how are you to-morrow— don't forget. The cause of 
 the unwellness I see, if you do not. It was the proof correct- 
 ing—I expected that you would be unwell." (E. B., March 31, 
 1846.) 
 
 " I confess to have written myself all, but— tired— headachy." 
 (April 7, 1846.) 
 
 On April 21, R. B. writes : " My love must sit to-day in the 
 gondola chair and let me talk to-day — not write — to her, for 
 my head aches — part from pure perversity and a little from 
 my morning spent over a novel of Balzac's — that is it, not 
 any real illness I know — however the effect is the same." To 
 which E. B. responds, April 22, 1846 : " How could you get 
 that headache? First with not walking; then with walking! ! 
 and reading Balzac!" To this R. B. answers, April 23, 1846: 
 "I was never very ill and am now much better. I mean to 
 cooperate with your wishes and my doctor's doings and so, 
 how should I fail of bringing into subjection this restive ill- 
 conditioned head of mine?" 
 
 " I scarcely know what to say about the poem. It is almost 
 profane and a sin to keep you from writing when your mind 
 goes that way — yet I am afraid that you cannot begin without 
 doing too much and without suffering as a consequence in 
 your head." (E. B., May 26, 1846.) 
 
 "I will write more to-morrow — the stupid head will not be 
 quiet to-day — (my mother's head is sadly affected too) partly 
 because I have been reading." (June 2, 1846.) 
 
 "I think my head is dizzy with reading the debates this 
 morning." (June 30, 1846.) 
 
 " Since you will be teased with intelligence about it, my 
 head was not very well yesterday, but it is decidedly better 
 this morning." (July 20, 1846.)
 
 ROBERT BROWNING. 131 
 
 " I was not quite so well this morning early, but the little 
 head there was to go, has gone, and I am about to go out. My 
 mother continues indisposed. The connection between our 
 ailings is no fanciful one. A few weeks ago, when my medical 
 adviser was speaking about the pain and its cause (my mother 
 sitting by me) he exclaimed, * Why, has anybody to search 
 far for a cause of whatever nervous disorder you may suffer 
 from, when there sits your mother whom you so absolutely 
 resemble! I can trace every feature,' etc." (August 22, 1846.) 
 "I write with an aching head." (August 31, 1846.) 
 " My head will not get quite well." (September 2, 1846.) 
 "When I had finished that letter this morning, before I 
 could seal it even, I became quite ill and so sick as to be 
 forced to go upstairs and throw myself on the bed." The next 
 day (September 4) he writes: "I am very much better — my 
 head clear from pain if a little uncertain." Again on Septem- 
 ber 5 he writes : " My head still teases rather than pains me." 
 Two days later he writes : " I am not to see you to-morrow. 
 I got up with the old vertiginousness or a little worse, and so 
 went to consult the doctor — I am bidden to go to bed for a 
 day or two. So here I am writing, leaning on my elbow in 
 bed, as I never wrote before, I think. Mind, I may read or 
 write — only in bed I must lie, because there is some tempera- 
 ture to be kept up in the skin — or some other cause as good — 
 " for reasons, for reasons." The next day he writes : " Here 
 I lie with a dizzy head — unable to read more than a page or 
 two — there is something in the unwonted position that tires 
 me — but whenever the book is left off, I turn to the dark side 
 of the room — and so I am soon better and able to try again." 
 The following day " the lightness, slight uneasiness of the 
 head continues, though the general health is much better, it 
 seems." 
 
 " Each summer brought him to the state of nervous pros- 
 tration or physical apathy." (Mrs. Orr in " Life of E. B. B.") 
 " Liver," " deranged liver," etc., is the complaint made, 
 "though no doctor pronounced the evil serious." (Mrs. Orr.)
 
 132 BIOGRAPHIC CLINICS. 
 
 He caught a "bronchial cold" in Venice, just before his 
 death, and the symptoms were aggravated by "the asthmatic 
 tendency," and "exhaustion of the heart." He laid it, as 
 usual, to the liver. 
 
 He died December 12, 1889, at the age of 'jd. 
 
 "He was very proud of his retentive memory, and of his 
 well preserved sight. The latter he attributes to his practice 
 of bathing his eyes in cold water every morning. He was 
 proud too of his strength, of his power of walking for hours 
 without fatigue, of the few requirements of his Spartan-like 
 daily life." (Katharine De Kay Bronson, The Century Maga- 
 zine, February, 1902,) 
 
 Browning was a man of refined and sensitive na- 
 ture, self-controlled, careful of himself and of his 
 health, a perfectly well-regulated man, living temper- 
 ately in all things, well-to-do, and with no need, by 
 inheritance, or conditions, ever to go to any extreme 
 in life. He had been remarkably well, he informs us, 
 up to the age of 32. If we had accurate data prior to 
 this time we should doubtless find that the moderation 
 and quietness of his nature and demeanor were in 
 great part the lessons unconsciously derived from the 
 forgotten experiences as regards health in youth. A 
 boy with the astigmatism he had could never have been 
 a hard student or immoderate in any way without ill- 
 health resulting. After the time we know him (32) 
 we find him always extremely sensitive to slight ex- 
 cesses of irritation, such as a late dinner, excitement, 
 etc. It never needed but a small thing to upset his 
 delicate health. Even reading a few minutes would
 
 ROBERT BROWNING. I33 
 
 bring on the head trouble, and a few minutes of 
 ocular rest would make it disappear. Each winter's 
 work (with the eyes) brought him to the state of 
 nervous prostration and physical apathy, and, as of 
 old, it was charged automatically to " liver, deranged 
 liver," although the evil was " not serious," and he 
 had no organic disease whatever. For the twenty 
 months of the time of the letters, the only time we get 
 any very definite insight of his life, he was plagued 
 and tormented by what he called headache, but which 
 Miss Barrett said was worse than headache. Ver- 
 tigo, or, as he wrote, " the old vertiginousness," " diz- 
 ziness," '' not headaches proper but the noise and slight 
 turning," " ringing in the head," " lightness," " hazi- 
 ness," etc., are other terms used to describe it. Like 
 Huxley he found that he must take long walks every 
 day in order to be free from suffering, and like him 
 he also found he must give up use of the eyes at night. 
 There are also crises of " nervous prostration," 
 " weariness of soul," " physical apathy," all relieved 
 at once by walking. There is one noticeable differ- 
 ence between Browning and Huxley in the time of the 
 onset of the ocular reflexes. In Huxley's powerful 
 and tough system they did not begin immediately, but 
 seemed to culminate in the crises at longer intervals 
 and more severely. In Browning's case they came at 
 once with a very little reading or writing. Sometimes 
 a few minutes' reading would produce them, and a
 
 ^3*4 BIOGRAPHIC CllNicS. 
 
 few minutes of rest give relief. This is according t6 
 the rule; when the insult of the reflex expends itself 
 upon the cerebrum the symptoms show the closer and 
 quicker nexus ; when upon the digestional system they 
 are slower in appearing. The more sensitive the na- 
 ture, the more the reflex tends to be cerebral, the more 
 resistant, the more it tends to be digestional. Carlyle 
 and Huxley would, therefore, not have headache so 
 much as dyspeptic or " liver " symptoms. Browning 
 had chiefly, though not solely, the cerebral type of 
 reflex. The worst kind of organization is that in 
 which there is a balance, or such a combination of 
 the two that the reflexes aflfect both sets of organs. 
 The result in these cases is " biliousness," " biUous 
 headache," or " sick-headache," one of the most awful 
 affections and most frequent which afflicts humanity. 
 The case of Darwin is an illustration. In Browning's 
 case, although according to the fashion, he occasion- 
 ally blamed the " Hver," and sometimes had nausea, 
 the headache and the dizziness, with other odd symp- 
 toms of cerebral disorder were the chief complaints. 
 He was a man without organic disease, living a tem- 
 perate life of ease, and yet in the prime of life, with 
 every attempt at reading, writing, or correcting proof, 
 he found himself with headaches and vertigo; imme- 
 diate relief came by stopping near use of the eyes, by 
 walking, etc. Nothing can be more certain in diag- 
 nosis than that a man with such symptoms is suffer-
 
 ROBERT BROWNING. 13S 
 
 ing from reflex ocular neurosis. Miss Barrett saw 
 the close connection between proof-reading or writing 
 and headache, although Browning seems not to have 
 noticed it, even in writing the words which he said 
 caused it. 
 
 But is there no better proof? Zadig shall again 
 help us. Browning says that with a book between 
 himself and Mr. Barrett, " he [Barrett] indeed read, 
 but holding the volume at such a distance as defied my 
 short-sighted eye, so that all that I saw was the faint 
 small characters." These last words cannot of course 
 be taken literally, i. e., it was not the faint small char- 
 acters alone of the page that he saw, the large clear 
 letters not being seen. His symptom-description was 
 as incorrect and obscure as some say his poetry fre- 
 quently is. He meant that at the distance Barrett held 
 the book all the letters appeared small and faint. 
 There is no form of ametropia which increase of 
 distance would make faint small characters appear 
 more visible than large clear ones. Moreover, it could 
 not have been simple " short-sightedness " which 
 Browning said he had, that produced the impression 
 of faintness and smallness in the letters when held far 
 away. Patients have yet to learn the facts about the 
 optical terms commonly used. A " far-sighted " man 
 may not be really far-sighted, and a so-called " near- 
 sighted " man may not in fact be near-sighted. That 
 is to say, a man with a high degree of far-sightedness,
 
 136 BIOGRAPHIC CLINICS. 
 
 or hyperopia, may be unable to see far-off things clear- 
 ly, and a "near-sighted" man may not be myopic, as 
 several defects, especially amblyopia, may compel him 
 to hold the book very close to his eyes. The presence 
 of complicating astigmatism and amblyopia may make 
 the word " near-sighted " have no literal or scientific 
 significance. Simple myopia (near-sightedness) could 
 not have the effect Browning described, nor could 
 simple hyperopia (or far-sightedness). Moreover, 
 these simple isometropic defects of either kind would 
 not produce the reflex headaches and vertigo plainly 
 due to his eyes. It is only astigmatism that could 
 have produced both the pain and the " faint small char- 
 acters," and an astigmatism which could no longer be 
 neutralized by the muscle of accommodation. That 
 by care and ease of life Browning reached the age of 
 32 without severe symptoms of eye-strain and ill- 
 health shows that at that time a greater amount of 
 writing and reading was undertaken, or that the astig- 
 matism could no longer be overcome by the ciliary 
 muscle or the function of " accommodation." Pos- 
 sibly both causes were operative, the latter dominating. 
 That the astigmatism was hyperopic and not myopic 
 is also certain or extremely probable, and it must have 
 been of a high degree or he would not have thought 
 himself "near-sighted." This "near-sightedness" 
 was doubtless also heightened by amblyopia, for a high 
 degree of hyperopic astigmatism existing uncorrected
 
 ROBERT BROWNING. i37 
 
 for thirty-two years almost certainly produces ambly- 
 opia. All patients think such amblyopia is " near- 
 sightedness," because to see print plainly they have to 
 force the page closer than the fourteen-inch normal, 
 and conversely when the page is held say at two feet 
 or more away the letters become " faint and small." 
 
 I have noted that, once, walking did not cure Brown- 
 ing's headache, and Miss Barrett glanced at the fact 
 with her keen diagnostician's eye. The contradictions 
 she caught him in as regards the cause and cure of 
 his headache at this particular time, should not be tak- 
 en too seriously. While Cupid blinds men he makes 
 women almost supernaturally clairvoyant. Brown- 
 ing's own reportings of his case are less clear and 
 truthful in what he really says than in what he implies 
 or unintentionally says. 
 
 The glimpses we get of the medical attendant are 
 not encouraging. In one respect his therapeutics re- 
 sembles that of some modern rest-curers who send 
 patients to bed and allow them to read there, as 
 Browning did, when the cause of their " neurasthe- 
 nia," etc., is due to eye-strain. Then there is wonder 
 that the rest-cure did no good. Others stop the read- 
 ing and writing while the patient is in bed, and there 
 is a speedy return of health — followed, with near use 
 of the eyes, by a '* breakdown " as prompt. Browning 
 is sent to bed in order that " some temperature shall 
 be kept up in the skin (sic!), or for some cause as 
 
 10
 
 138 BIOGRAPHIC CLINICS. 
 
 good, at least, ' for reasons, for reasons.' " And he 
 may read and write, so he stays in bed, although it 
 causes headache at once to do so, and whenever the 
 book is left off and he turns to the dark side of the 
 room he is relieved and is able to read another page. 
 
 Both Browning and the medical adviser find a per- 
 fect explanation of Browning's headache in heredity. 
 " Why has anybody to search for a cause ? There sits 
 your mother whom you so absolutely resemble ! I can 
 trace every feature, etc." If this explains it, Adam, 
 or rather. Eve, must have been afflicted in the same 
 way, and all of her descendants to Browning's mother. 
 One marvels how a headache can be inherited, and 
 why family facial resemblances demonstrate the fact. 
 Throwing the responsibility back upon the mother, or 
 upon Eve, will no longer do, and I think we should 
 give it up. Browning and his medical adviser may 
 not be censured for such a naive medical philosophy, 
 but really we grown-ups must quit such hide-and-go- 
 seek childish games. We must find what caused the 
 headache in each case, separately, of son and mother, 
 at least if we wish to cure the son. An antihereditive 
 medicine has not so far been discovered effective after 
 the patient's birth. 
 
 For forty-two or forty-three years after this Brown- 
 ing lived, but I find few data of value or trustworthi- 
 ness for further knowledge of his clinical biography. 
 Like De Quincey, Carlyle, Darwin, and Huxley,
 
 ROBERT BROWNING. I39 
 
 Browning never suspected the cause of his suffering, 
 
 and learned only that it was in some mysterious way 
 
 eluded by long walks and persistent exercise. Mrs. 
 
 Bronson says he never passed a day without taking one 
 
 or more long walks; indeed, his panacea for most ills 
 
 was exercise, and the exercise he chiefly advocated was 
 
 walking. He wrote: 
 
 " I get as nearly angry as it is in me to become with people 
 I love when they trifle with their health, — that is, with their 
 life, — like children playing with jewels over a bridge-side, 
 jewels which, once in the water, how can we, the poor 
 lookers-on, hope to recover? You don't know how absolutely 
 well I am after my walking."
 
 BILIOUSNESS AND HEADACHE. 
 
 141
 
 CHAPTER VI. 
 
 BILIOUSNESS AND HEADACHE. 
 
 According to the composite medicine and psychol- 
 ogy of the ancient and medieval philosophers there 
 were four cardinal liquids, or humors, of the body, 
 which, according to the predominance of one, and the 
 mixture of all, were supposed to form the tempera- 
 ment, temper (temporo, to mix), or disposition of a 
 man. These humors were called the blood, the 
 phlegm, the choler, and the black choler. We to-day 
 say of one that he is sanguine, phlegmatic, choleric, or 
 melancholic, and the meanings are not much different 
 from those given them for the past 2,000 years. If a 
 horse has a certain affection he is said to have the 
 distemper, that is, the four humors are badly mixed, 
 and our terms, good-tempered, good-humored, in a 
 temper, bad-humored, etc., show how thoroughly this 
 old humoral physiology was believed and worked into 
 our language and our habits of thought. Even our 
 word, humor, meaning wit, is derived from the same 
 source. The blood has retained its old significance. 
 Phlegm we understand now as the viscid mucus of 
 the inflamed upper air-passages (^Xiyetv, to burn), 
 and the choler, or yellow bile, we also know. But 
 
 143
 
 144 BIOGRAPHIC CLINICS. 
 
 what could have led to the belief in a black bile or 
 choler? As near as we can say, it was a blunder due 
 to the lack of a scientific spirit in anatomy and phys- 
 iology. The liver secreted choler or yellow bile, and 
 the renal and suprarenal glands were believed to secrete 
 black bile or atrahilis, whence our obsolescent word, 
 atrabiliary, used as late as 1849 by Lowell, 1866 by 
 Carlyle, and even in 1877 by Froude. Two things 
 were thus supposably explained by the theory of the 
 humors : The first that mental qualities, character, and 
 disposition, were thus formed. Science, or scientific 
 physiology, thus began with an unconscious material- 
 ism and fatalism — the material construction and func- 
 tions of the body inevitably produced and dominated 
 character. Perhaps this old snake of superstition (or, 
 preferably, "substitution") is not yet wholly dead; 
 Weissmann, Lombroso, and the scientific monists are 
 still able to stimulate some wriggling of its tail, but 
 a wise psychology smiles cynically at the crude gal- 
 vanistic experiments. 
 
 The second conclusion of the humoral theory was 
 the humoral pathology, that all diseases are due to 
 disorder and abnormalism of the humors. We were 
 early able to exclude the black bile from the patho- 
 genic role because there is no black bile. Perhaps the 
 gloomy hypochondriac should have some black bile to 
 explain his despair in such a world as ours, but it must 
 evidently be accounted for in some other way. That
 
 BILIOUSNESS AND HEADACHE. i45 
 
 one who is physically sanguine should be emotionally 
 so we no longer believe, and that pharyngitis or bron- 
 chitis has any power to produce psychic phlegmatism 
 is hardly consistent with sound laryngology. 
 
 But how is it with the yellow choler? Is there any 
 doubt that Carlyle (and thousands of sufferers from 
 similar diseases) thoroughly believed his daily wretch- 
 edness for forty years was due to " bile " ? Sir An- 
 drew Clark told the patient Huxley he had a better 
 color, i. e., less choler, than when he sent him to Italy. 
 Biliousness was a very real complaint to the physicians 
 of the past century, and try as they may the writers 
 of modem medical books can not abolish the word 
 " bilious." As to the lay world that word is used 
 almost every day in almost every household in the 
 land, and to the users it signifies some mysterious con- 
 nection with hepatic function and product. Quackery 
 may be said to feed upon biliousness (which may ex- 
 plain its extraordinary gall!), and the quack or the 
 physician who could cure it by any medicine would be 
 the most successful physician in the world. For it is 
 evident that in some mysterious way this most mys- 
 terious of diseases is responsible for a big round share 
 of the world's suffering. 
 
 But what is it to be bilious? I have asked many 
 men and more books, and no two answers are alike, 
 no two reconcilable. Originally, of course, it must 
 have meant the secretion of too much bile, as pre-
 
 146 BIOGRAPHIC CLINICS. 
 
 dominance of any one of the humors made the indi- 
 vidual physically and mentally the exponent of the 
 qualities of that humor. But, although this error will 
 still persist for long, there are a hundred opinions and 
 conditions and facts which make it impossible to hold 
 it with any degree of absoluteness or consistency. Of 
 Ben Thompson, the noted desperado of Texas, one of 
 his sympathizers said, " Ben is a little bilious, but he 
 will come all right again as soon as he has killed a 
 man." There are many such supposed connections 
 between biliary, psychic, and sociologic functions. 
 
 To the lay mind the logical and physiological connec- 
 tion between ill-temper or choler, and derangement of 
 the liver, was so unquestionable that the conclusion 
 was inevitably drawn that if a man were fault-finding 
 and bad-humored he must certainly be pathologically 
 bilious. Probably that logic has incited more purge- 
 taking and dyspepsia-treating than the profession 
 would now care to acknowledge. Traces of it may 
 be plainly seen in the text-books of to-day, but the fact 
 is undoubted in those of fifty or one hundred years 
 ago. 
 
 But those were good and wise books nevertheless — 
 quite as helpful, much more so, even, as those issued 
 from the press last year, so far as pertains to this 
 subject. Let me make a few selections from two of 
 these old books by Drs. Watson and Tweedie, and 
 written about sixty years ago:
 
 BILIOUSNESS AND HEADACHE. i47 
 
 " There are states of mind and habits of life, which, having 
 no direct relation to the organs of digestion, yet exercise a 
 material influence over their functions. Mental distress ; 
 mental solicitude; mental toil; over-much study; want of 
 exercise : these are all prolific sources of dyspepsia. . . . Pre- 
 scribe change: change of air; change of place and of scenery; 
 change of society. Get him to travel in search of health; and 
 the chances are in favor of his finding it. Six weeks among 
 the mountains of Switzerland, etc. . . . with these disjointed 
 hints, gentlemen, I must request you to be satisfied in respect 
 to the principles upon which dyspepsia — and the hypochon- 
 driasis which is generally so closely linked with dyspepsia — 
 are to be managed. A full discussion of these subjects in 
 detail would furnish matter for several lectures." 
 
 " Indigestion is often accompanied by pain in the head, with 
 some confusion of thought : or at all events with a loss of 
 mental energy and alertness. Together with a violent head- 
 ache there are frequently nausea and vomiting; and the com- 
 plaint is popularly known by the name of the sick-headache: 
 or, in the fashionable jargon of the day, as a bilious 
 headache." 
 
 "... Scarcely a winter passed over in which several of his 
 pupils did not apply to him on account of palpitations sup- 
 posed by them to depend upon structural disease of the heart : 
 and in no single instance were these apprehensions well 
 founded. They were all cases of mere dyspepsia and hypo- 
 chondriasis." Cullen defines hypochondriasis to be dyspepsia 
 — cum languore, maestitia, et metu, ex causis non sequis. 
 
 " The symptoms of acute dyspepsia are anorexia, weight and 
 fullness at the epigastrium, nausea, eructations, . . . dull 
 headache along the supraorbital ridge, confusion or incapacity 
 of thought, and despondency. . . . The evacuation of the 
 stomach is generally followed by a feeling of great relief, and 
 the sympathetic disorders soon subside. . . . Another form of 
 acute functional disorder, to which the stomach is liable is 
 what passes under the popular term bilious seizure. Many
 
 148 BIOGRAPHIC CLINICS. 
 
 of the symptoms in this affection are the same as in the 
 former, but the spontaneous sickness is more violent, etc. . . . 
 The attack is generally preceded by indisposition, languor, 
 dulness, chilliness, loss of appetite, and giddiness. Some can 
 foretell its approach by derangement of sight, consisting of 
 general indistinctness, or a sensation of darkness, etc. . . . 
 Such persons are constitutionally liable to such disorders, and 
 are said to possess the bilious temperament." 
 
 " In chronic dyspepsia the symptoms are almost coextensive 
 with the whole economy, . . . discomfort, indisposition, lassi- 
 tude and an aching weariness, which patients often designate 
 emphatically as wretchedness. . . . Dejection, anxiety, irrita- 
 bility of temper, and incapability of taking pleasure or interest 
 in anything whether in the physical or moral world. . . . 
 Muscae volitantes, . . . headache particularly over the eyes." 
 
 " Gastralgia is an affection that corresponds to the gas- 
 trodynia and cardialgia of some authors, the morbid sensi- 
 bility of the stomach described by Dr. James Johnson, and 
 the irritable gastric dyspepsia of Dr. Todd. . . . Temper irri- 
 table, . . . costive, . . . headache of a tense character, . . . 
 prey to morbid gloom." 
 
 " As to the restriction of diet, patients say that their friends 
 partake of all such things; but the best answer to such 
 remarks is, that, as * to the pure all things are pure,* so, in our 
 sense, to the whole all things are wholesome." 
 
 " Without insisting on the general physiological doctrine of 
 the despondency of glandular action upon the nervous sys- 
 tem, we may remark that various pathological phenomena 
 lead to the recognition of an organic influence exerted by the 
 brain over the biliary function in particular; but we shall find 
 that it is not always very clear whether it is the secretion or 
 excretion of the bile that is primarily affected in this manner. 
 . . . The recognition of a class of maladies, termed bilious, 
 without the precise significance of this term having been 
 clearly defined. Some physicians understand excess of bile, 
 others deficiency, or when it is vitiated, others extend the term
 
 BILIOUSNESS AND HEADACHE. i49 
 
 to all derangements of the digestive functions, attended with 
 any form of biliary disorder." 
 
 " We have little, in the way of palliation, in our power. . . . 
 It must be admitted that the knowledge we at present possess 
 of the biliary secretion in health and disease does not enable 
 us to lay down any rational indications for the correction of 
 its morbid conditions." 
 
 If we turn from the pathology and practice of sixty 
 years ago to that of to-day do we find anything more 
 helpful? I do not think so. As to these matters our 
 most modem books seem to me to be infinitely less 
 helpful. When the young medical graduate goes out 
 to treat patients these most common complaints and 
 tormenting complainants will turn up the first day and 
 every day. He has not as a rule been taught in book, 
 lecture, or clinic, anything half as good as was taught 
 the student of the olden time. In the first place his 
 most newest Practice of Medicine Bible will probably 
 ignore the real Practice of Medicine pretty thoroughly. 
 It is made for the author's benefit, not for that of the 
 student. It is theoretical not practical, " diagnostical 
 not therapeutical." And just in proportion to the 
 author's fame will it be so. In the second place it has 
 usually succeeded in ignoring functional diseases alto- 
 gether, whereas the functional diseases produce far 
 more suffering than the organic diseases. I believe 
 that these troubles labeled bilious and headache alone 
 cause more wretchedness than all the organic diseases 
 in the world. And yet little or no simple common help
 
 15© BIOGRAPHIC CLINICS. 
 
 will the puzzled young doctor get from most of the 
 modern books. They are all very scientifical, it is 
 true, and it is all very ** magnificent, but it is not war " 
 — at least against disease. The modern patient as a 
 last resort can also be waved to Switzerland, if he is 
 rich enough to go, or to the dispensary if he is one of 
 the 999 in i,ooo. Book after book will utterly ignore 
 these subjects, or only speak of the symptoms in a 
 score of different places as those of a score of different 
 organic diseases, always however as a bit of necessary 
 routine, mechanically, because others have done so, etc. 
 Out of many I have found two that cursorily allude 
 to eye-strain as etiologic factors, but plainly without 
 any thought or care for the subject, and stupidly un- 
 derstanding by the term the over-use of normal eyes, 
 instead of the use of optically abnormal eyes. From 
 a very up-to-date book I quote the following: 
 
 "... At the same time, owing to the absorption of poisons 
 into the system, certain constitutional symptoms are noticed 
 such as a sense of fatigue, oppression, vertigo, headache, and a 
 disturbance of sight. The complexion may be more or less 
 muddy, having lost its clear character. Such a collection of 
 symptoms is usually placed under the head of 'biliousness,' 
 and not without reason, as the liver is no doubt inadequate 
 to the proper arrest of the ptomains, found in such large 
 quantity." 
 
 "An objection to these views may arise from the fact that 
 many individuals suffer for years from chronic constipation 
 and maintain a fair standard of health." 
 
 " It is however a well-known fact that individuals suffering 
 from chronic constipation frequently exhibit symptoms of
 
 BILIOUSNESS AND HEADACHE. 151 
 
 biliousness, such as headache and vertigo, as well as many 
 mental peculiarities, hypochondriasis, tendency to melancholia, 
 etc. These are no doubt the result of . . . action of ptomains 
 upon the nerve centers. ... If the power of the liver as a 
 sentinel is lessened, the toxins ordinarily found in the diges- 
 tive tract may circulate through the system producing many 
 of the symptoms of biliousness." 
 
 We are also told by this author that disturbances of 
 innervation cause acute and chronic congestion of the 
 liver and that in biliousness more or less hepatic in- 
 sufficiency exists, whether primary or secondary. The 
 primary may be of a hereditary character, slight sec- 
 ondary causes provoking nervous exhaustion may pro- 
 duce it, and neurasthenic cases are frequently explained 
 by derangement of the liver, and that mental emotion 
 influences the liver secretion. Other symptoms are: 
 bitter taste, dyspepsia, cardiac irregularity, character- 
 istic alvine evacuations, nervous phenomena, especially 
 headache as a dull pain in the forehead, vertigo, dim- 
 ness of vision, double vision, and sleeplessness. The 
 treatment consists in increasing the secretion of bile, 
 etc. 
 
 One naturally expects to find that the last days of 
 humoralism would be humorous ! Perhaps in his des- 
 peration a multivolumed cyclopedia is bought by the 
 young practitioner only to find that in the parcelling 
 out of subjects great gaps exist which should be filled 
 with the discussion of the subjects of greatest interest. 
 Headache, for instance, is either not in the list of
 
 152 BIOGRAPHIC CLINICS. 
 
 subjects written upon, or is only spoken of in the dead 
 lists of symptoms of a hundred diseases. In one such 
 " system," however, I have found many pages of mat- 
 ter upon this topic in which the forms are duly enu- 
 merated and each at length described ; it would take a 
 page or two merely to list the chief heads of para- 
 graphs, the nervous headache, sick, periodical, heredi- 
 tary, constitutional, dietary, hemicranic, menstrual, in- 
 digestional, or bilious headache; that from mental or 
 bodily overwork, of childhood, of tubercular menin- 
 gitis, of school children and students, from affairs of 
 family and business, of bad ventilation, of malaria, of 
 rheumatism, of uterine diseases, from constipation, of 
 hysteria, of diseases of the brain and spinal cord (tu- 
 mors, abscess, etc.), of fevers, of anemia, of delayed 
 menstruation, of syphilis, and so on, and so on. " Fi- 
 nally," not to forget the " quibusdam aliis," of the 
 " omni re scibili," finally there are headaches that find 
 no place in the preceding enumeration and that defy 
 all attempts to find their cause or explanation " — and 
 " many cases of headache cannot be relieved by remov- 
 ing the cause. . . . Many patients should spend as 
 much of their time out-of-doors as possible." 
 
 "In explaining the recurrence of periodical headaches, the 
 theory seems rational that supposes a nerve explosion or 
 storm to occur at stated intervals, regardless of exciting 
 causes, as the centers reach a climax of accumulation or 
 exhaustion of energy or of some force or principle. Such an 
 unavoidable occurrence is exactly what happens; a seizure
 
 BILIOUSNESS AND HEADACHE. i53 
 
 will come when the time is ripe for it whatever is done to 
 prevent it. . . . The explanation of reflex headaches is noth- 
 ing more nor less than the explanation of reflex pains of other 
 parts of the body, and may be omitted here." 
 
 " The sympathetic or reflex influences cause a large number 
 of headaches. These influences are almost innumerable. 
 Among them are" — (not eye-strain, astigmatism, etc.). 
 
 In place of the thousands of years of medical super- 
 stition and pseudoscience, in place of the meaningless, 
 self-contradictory and mutually contradictory disquisi- 
 tions upon these subjects, in place of the endless end- 
 ings in the clouds of practical helplessness and thera- 
 peutic nihilism, even of quackery, it would seem ad- 
 visable for future lecturers and text-book makers to 
 insert a few sentences somewhat like the following: 
 
 Even up to the last years the diseases called bilious- 
 ness, headache, dyspepsia, acute lithemia, and by many 
 other terms, were entirely misunderstood and treat- 
 ment was in the highest degree unsatisfactory. But 
 there was brought into practical use during the last 
 quarter of the nineteenth century a discovery of as 
 great medical importance as any made during the cen- 
 tury, and so far as the relief of actual suffering is con- 
 cerned, of far greater significance than any. Astig- 
 matism, its influence upon the general health and char- 
 acter, and the methods of correcting it, is the discovery 
 of which we speak, and with the discovery the last 
 great stronghold of the ancient and medieval supersti- 
 tion of the humoral pathology was taken. Whenever 
 II
 
 154 BIOGRAPHIC CLINICS. 
 
 the symptoms of functional cerebral, mental, and diges- 
 tional disease, such as headache, dyspepsia, " bilious- 
 ness," sick-headache, migraine, neurasthenia, anemia, 
 vertigo, insomnia, anorexia, constipation, eructation of 
 gas, languor, ill-temper, melancholia, etc., are tempor- 
 ary or acute and dependent upon well-knozvn excess 
 or abnormalism in eating and drinking, the patient is 
 more than stupid if he does not tell you of the fact. 
 When these symptoms are dependent upon organic dis- 
 ease you are equally inexcusable if you do not soon 
 discover it. The vast majority of such cases, say, at 
 least go percent, are not caused by dietary indiscre- 
 tion or organic disease, and of these over po percent 
 are reflex ocular neuroses; i. e., due to " eye-strain " — 
 a term denoting morbid function, not over-use of nor- 
 mal function. Most eye-strain is due to astigmatism, 
 but astigmatism and all its dependent ocular and gen- 
 eral residts is not to be corrected by the oculist whose 
 motive is fame, success, or money. It is not corrected 
 by machinery, or without a mydriatic. The work of 
 the optician also conditions success, and recorrection 
 is necessary every year or tzvo. 
 
 The trend of medical opinion may be seen from a 
 recent editorial in the Lancet of August 23, 1902 : 
 
 Chronic dyspepsia has from time immemorial been one of 
 the greatest opprobria of medicine. Judicious medicinal and 
 dietetic treatment relieves many of the cases, but there are still 
 many remaining in which all ordinary treatment fails to do
 
 BILIOUSNESS AND HEADACHK i55 
 
 any permanent good. The immediate danger to life is small— 
 for here we are not speaking of malignant disease— but exist- 
 ence is a burden. Unless the greatest care is devoted to the 
 diet discomfort and pain will torment the patient for hours 
 after a meal and often relief will only be obtained when the 
 stomach rejects its contents. Sometimes the vomiting may be 
 profuse, many pints being brought up. The food, whether 
 ejected or retained, fails to nourish. Emaciation, often 
 extreme, naturally follows. The sufferer, worn out with pain 
 and weakened by lack of food, falls at length into such a state 
 that death itself comes as a relief. Even when the symptoms 
 are not so extreme they are sufficient to interfere with ordi- 
 nary life. The patient is able to devote himself to only a very 
 limited extent to his work. He cannot forget his dyspepsia; 
 his mind is centred in his stomach ; his diet, his beverages, his 
 symptoms occupy his whole attention and he has none to 
 devote to the ordinary concerns of life. Every medical man can 
 testify to the correctness of this picture. Fortunately, such 
 extreme cases are not very common, but instances of a milder 
 type are often met with, and everyone must acknowledge how 
 little relief is to be expected from drugs. There are doubtless 
 some of these cases of disease which are functional in origin 
 and in which the most minute examination of the stomach 
 and abdominal viscera after death cannot reveal any lesion, 
 but these form the exception, for in the majority of cases a 
 necropsy will show some definite structural change to which 
 may reasonably be attributed all the symptoms. For many 
 years a connexion between these chronic dyspepsias and some 
 definite organic disease of the stomach was hardly suspected. 
 They were not cases likely to be detained in hospitals for any 
 length of time and therefore would but rarely come to a 
 necropsy, for post-mortem examinations are very exceptional 
 outside hospitals. But it came gradually to be recognized 
 that in many cases some definite structural change could be 
 found, and now it may confidently be laid down that in the 
 vast majority of cases of severe chronic dyspepsia the disease
 
 156 BIOGRAPHIC CLINICS. 
 
 is not merely functional but has an organic basis. The condi- 
 tions discovered on examination are very various, but it is 
 remarkable that a large proportion of them result from the 
 healing of simple gastric ulcers. 
 
 From which, I judge, the lessons should be drawn 
 that long-continued functional disease assuredly begets 
 organic disease; that it behooves us to learn what 
 causes these long-continued functional diseases; that 
 we should seek to prevent the necessity of surgical 
 cures even if it be true that the surgical cure does in 
 fact cure.
 
 SOME NEGLECTED POINTS IN 
 THE PHYSIOLOGY OF VISION. 
 
 •57
 
 CHAPTER VII. 
 
 SOME NEGLECTED POINTS IN THE PHYSIOLOGY 
 OF VISION. 
 
 With all the last-century study of the laws of optics 
 and of the organ of vision, it is strange that the sig- 
 nificance of so many ocular structures and functions 
 has been misconceived or neglected. Most extensive 
 investigations with the keenest ingenuity have been 
 made upon the photochemistry of the dead retina/ 
 and yet the important organs and essential functions 
 concerned, in the living eye, in the avoidance of retinal 
 exhaustion, and the reinstitution of retinal sensibility, 
 have been left almost unnoticed. Theories of vision 
 have been elaborated with tireless ingenuity, and yet 
 the fundamental conditions of actual vision have not 
 been recognized. All the theories may be left out of 
 the attention if we wish to fix upon the fundamental 
 fact and causes of retinal fatigue, and the methods 
 and devices for reestablishing retinal sensibility. In 
 truth the observation underlying all theories is that 
 the persistent action of the light-stimulus or image 
 upon one part of the retina speedily lessens and extin- 
 guishes the sensation-response. The more intense the 
 
 ^ Epitomized in the " System " of Morris and Oliver, Vol. I. 
 159
 
 i6o BIOGRAPHIC CLINICS. 
 
 light the greater the injury, and the quicker it is pro- 
 duced. The reinstatement of sensitiveness is by means 
 of shadings, darkness, and variations of the stimulus. 
 I have seen no systematic and thoroughgoing state- 
 ment of the devices and the methods whereby this 
 deterioration of function is prevented, and the resen- 
 sitizing process is brought about. The matter is of so 
 much practical significance that they deserve enumera- 
 tion: 
 
 1. The shadows cast by the retinal arteries, veins, 
 and capillaries, according to the direction and intensity 
 of the entering light, are constantly shifted and modi- 
 fied, so that the retina behind them and in their imme- 
 diate neighborhood is allowed variations of fatigue 
 and recuperation. The most shaded portions serve 
 perhaps as centers whence extends the mysterious re- 
 sensitizing process. 
 
 2. Certain sensitive and trained eyes, when looking 
 toward the sky or a bank of cloud, can see a multitude 
 of little lights like pin-points flashing in and out of 
 view all over the field of vision. These may be re- 
 solved into illuminated paths or lines of light, zigzag- 
 ging everywhere and appearing and disappearing seem- 
 ingly without law or order. These have been called 
 phosphenes, corpuscular reflections, phoses, and 
 aphoses.^ They are the reflections from the blood- 
 
 * See an article upon the subject in the Philadelphia Medical 
 Journal, July 22, 1899.
 
 PHYSIOLOGY OF VISION. i6i 
 
 corpuscles of the capillaries of the retina, which, as 
 they turn and twist along their routes, act as tiny mir- 
 rors to throw darting points or traveling lines of light 
 upon all parts of the retina. These multitudes of cor- 
 puscles also, of course, cast unobserved shadows of 
 themselves upon the retina. The reflections may also 
 have a function in producing needed physiologic irri- 
 tation in parts of the retina not habitually stimulated 
 by the incoming light, and in this way keeping it in a 
 state of preparedness or responsiveness. 
 
 3. The shadows of muscse volitantes are probably of 
 greater service. Muscae should be recognized as of 
 physiologic, not pathologic, significance. They exist 
 in all eyes, although not usually recognized. Every 
 part of the fundus of all eyes during the waking life 
 is protected by these floating and waving muscae shad- 
 ows. 
 
 4. The retinal pigment extends so far toward the 
 periphery of the retina that functionally it joins that 
 of the iris in preventing all light, except that slight 
 amount possibly transmitted through it, from entering 
 the interior of the eye except through the pupil.^ 
 
 ^The strange tendency of xanthelasma and other pigment 
 spots to appear upon the lids and about the eyes, bears witness 
 to the difficulty of attainment of normal ocular pigmentation. 
 This is still more striking in the pathologic dark rings or 
 half-circles that appear about the eyes of girls and women 
 suffering from anemia, chlorosis, and other forms of denu- 
 trition.
 
 i62 BIOGRAPHIC CLINICS. 
 
 5. The iris-pigmentation is essential for retinal shad- 
 ing. The tragedy of albinotic eyes is largely due to 
 iris-translucency. 
 
 6. The alternation of contraction and dilation of the 
 pupil under ever varying light-changes and intensities 
 varies the size of the retinal image, and in this way 
 adds another to the agencies inducing changes of stim- 
 uli and rest. 
 
 7. The natural pigmentation of the skin in the non- 
 albinotic gives added exclusion of useless and harmful 
 light which passes more freely through the eyelid of 
 the albino. 
 
 8. The function of the eyelashes has been supposed 
 to be the protection of the eyeball from a striking body, 
 which, first touching the lashes, is followed by reflex 
 closure of the lids. I am convinced that the lashes are 
 of little or no service of this kind, and that their pre- 
 dominant use is to screen the light and shade the pupil, 
 while at the same time allowing the passage of suffi- 
 cient light to give a useful image of an object above 
 or below the eye. The existence of this function can 
 be observed in others who are standing in sunlight, or 
 in the photographs of sitters in open daylight, etc. 
 
 9. Winking has been explained as necessary for 
 moistening and cleaning the cornea, and spreading the 
 tears uniformly over the exposed surface of the eye. 
 It has this function of course, but another, fully as 
 important if not more so, is that of completely shutting
 
 PHYSIOLOGY OF VISION. 163 
 
 out the entire retinal stimulus for an instant thousands 
 of times a day.^ 
 
 10. Binocular vision also serves more than would 
 the Cyclopean eye in breaking up the continuance of 
 the stimulus of the retina upon any one spot. 
 
 11. Of greater importance than any single one of 
 the preceding devices is that of the incessant move- 
 ments of the eyes, those of the body and head aiding. 
 In a child it is almost impossible to secure any steady 
 fixation of the axis of vision, even for a few seconds, 
 and the eyes of adults, when healthy, are thus held 
 with difficulty for only ten or fifteen seconds at most. 
 But the motionless stare of the blind or highly ambly- 
 opic eye is noticed even by the layman. This cease- 
 less motion of normal eyes produces a similar rapid 
 variation of images, shadings, and rests of all parts 
 of the retina in the region of the macula. The nystag- 
 mus of albinotic eyes may be defined as the ceaseless 
 chase after a portion of the retina which may have 
 been a little less exhausted than others by the terrible 
 flooding of the entire retina with light. 
 
 12. The eyebrow does, indeed, have the subordinate 
 
 function of leading water and the sweat away from the 
 
 palpebral opening, but a more important use of it is to 
 
 shade the eye. A noteworthy confirmation of this is 
 
 the otherwise inexplicable growth of the eyebrow hairs 
 
 ^ Many animals wink little or not at all. Visual function is 
 more perfect in man, and requires more mechanisms of shad- 
 ing.
 
 1 64 BIOGRAPHIC CLINICS. 
 
 in old men. A striking example is shown in the photo- 
 graph of the scientist, Powell, in SciencCy October lo, 
 1902. I have sometimes had to cut off these long 
 hairs in the aged in order to keep them from injuring 
 the eye by incurvation against the eyeball. In old age 
 the resensitizing process of the retina is more difficult 
 owing to failing nutrition, etc., and there is a need for 
 a still greater protection of the pupil from the incident 
 light of the sun and sky. This is effected by the visor 
 of the eyebrow which at this time of life frequently 
 takes on a startlingly luxuriant growth. 
 
 Some of these minor devices doubtless serve the pur- 
 pose suggested only incidentally, or accidentally, but 
 nevertheless actually, and one must be struck by the 
 fact that so many different methods combine and co- 
 operate toward a common end. One will scarcely find 
 in the entire organism such a large number of 
 diverse mechanisms focussing to one final aim and 
 result. If the end were not of the supremest impor- 
 tance this would hardly be permitted. If interruption 
 of the stimulus were undesirable, the ingenuity of 
 nature would have found a dozen ways to prevent it 
 instead of as many to encourage it. 
 
 These numerous devices are, in fact, but a very few 
 of the many proofs of the enormous difficulties met 
 and conquered by nature in the evolution of the eye. 
 These difficulties are, apparently, a hundred times as 
 numerous and as complicated as those of any other
 
 PHYSIOLOGY OF VISION. 165 
 
 organ of the body. Hence the fineness of the adjust- 
 ment, the ease with which disease takes the place of 
 health, the limits of normality being almost infinitely 
 delicate and narrow. A glimpse into this amazing 
 mystery is caught by the observation that all this di- 
 verse mechanism from cornea to macula must be highly 
 transparent, and yet the greater portion is not con- 
 trolled by nerve-agencies, and all is nourished by blood 
 which is scarlet. And millions of transparent optic 
 nerve fibers divested of their insulating covering must 
 perform independent and accurate functions! 
 
 The most fundamental of the difficulties of the ocu- 
 lar mechanic has undoubtedly been to create a mechan- 
 ism that shall respond to a stimulus lasting but 0.00144 
 of a second, and that is hundreds of millions of millions 
 of times more slight than that of sound. This explains 
 why the receiving mechanism or photographic plate 
 of the retina can be kept sensitive for only a few sec- 
 onds. In order to resensitize it a change or cessation 
 of the stimulus must be insured at least every few 
 seconds. Hence the elaboration of at least twelve 
 methods of insuring the result. 
 
 There are many practical lessons to be derived from 
 the physiologic mechanisms mentioned. The almost 
 universal custom of wearing hats, bonnets, caps, etc., 
 finds its raison d'etre in the need of shading and pro- 
 tecting — not the head so much as the eyes. The chief 
 suggestion that arises is of course the avoidance of
 
 i66 BIOGRAPHIC CLINICS. 
 
 subjecting the eye to a constant stimulus or to a harsh 
 or intense light. It is amazing what the eye will en- 
 dure when its ametropia is perfectly corrected. It is 
 equally astonishing how easily a little ametropia mor- 
 bidizes the whole bodily and nervous organism. But 
 it must be noted that not even reading demands abso- 
 lute uniformity and continuance of the image. There 
 is always a gliding and changing of the shape and 
 size of the image by fluctuations, interruptions, shad- 
 ings, variations, etc. If our reading was always by 
 means of a consecutive series of letters each appear- 
 ing for a fraction of a second at one and the same 
 point, there would be very little reading possible. But 
 even with large print, and good paper and ink, one 
 should not demand fixation of the eyes too long at a 
 time. There should be little rests by closing the eyes, 
 looking away, etc., at least every few minutes. In all 
 continuous eye-work of any kind there should be such 
 interruptions. The light should also not be in front, 
 but should illuminate the book, paper, sewing, etc., 
 from behind or above. The book should be held as 
 nearly on the level of the eyes as possible. It is a 
 pity that printing with white ink on a dead black sur- 
 face is at present an impossibility. 
 
 When this important law of retinal fatigue and re- 
 cuperation is recognized, there will take place a speedy 
 revolution in almost all our practical and esthetic arts. 
 The furniture, wall-papers, carpets, curtains, and win-
 
 PHYSIOLOGY OF VISION. 167 
 
 do.ws of our houses will then be very different from 
 what they now are. Let us more closely consider one 
 or two of the many illustrations. 
 
 It should dictate the fundamental tones, colors, 
 shape, and extent of our picture-frames. By the old- 
 fashioned gilt barbarisms the artist allowed the framer 
 and gilder almost to monopolize the mental, emotional, 
 and physiologic attention of the spectator and to de- 
 tract as much as possible from interest in the picture 
 itself. It is only for a few seconds that any human 
 eye can look at a picture when the greater portion of 
 the retina is outraged and exhausted by the adjacent 
 images of the atrocious frame. In the ordinary gal- 
 lery of pictures these ludicrous and retina-paralyzing 
 frames, close beside each other, become positively tor- 
 turing. It all seems designed to exhibit, not art, not 
 nature, not esthetic charm and emotional peace, but 
 only the abject hideousness of the plebeian frame- 
 gilder's unart. Almost every traveler has noticed the 
 utter exhaustion and headache that is produced by a 
 short visit to a large picture-gallery. The crude harsh 
 gilt is the most wearying of all colors. Recently there 
 has arisen a reaction of which probably no one under- 
 stands the reason, consisting in the making of frames 
 with solemn and monotonous black. This extreme is 
 infinitely preferable to the other but it is also mechan- 
 ical and stupid. Each picture should be framed by 
 the painter, or at least, and because he has shown him-
 
 1 68 BIOGRAPHIC CLINICS. 
 
 self so blunderful about it, by another artist with this 
 single task in view. Each picture presents a special 
 problem to the artistic framer. It should be done so 
 as to produce a peculiar, logical, and physiologic color- 
 effect, as little wearying to the eye as possible, while 
 dictated primarily by the character, the colors used, 
 the esthetic aims, etc., of the painter. It should by all 
 means be hung sufficiently apart from all other pic- 
 tures to allow it the proper necessities of its own indi- 
 viduality and not to destroy that of others hung in the 
 neighborhood. Pictures crowded together give evi- 
 dence of esthetic sin quite as decidedly as the physical 
 crowding of human beings demonstrates other sorts 
 of immorality. In a word, the present fashion of 
 framing and hanging pictures could not be more un- 
 esthetic and anesthetic, more unphysiologic and patho- 
 logic, than it is. 
 
 Another corollary of the law of ocular tire and re- 
 sensitization may be noticed in passing — a law that is 
 outraged by the lighting of most of our churches, and 
 of all of our private houses, theaters, public halls, etc. 
 The millions of dollars spent each year in illumination 
 are in great part wasted and misspent, and by the 
 methods used all the harm is done to the eye that is 
 possible. No room should be lit in such a manner 
 that the individual lights are visible. Illumination 
 should be by transmitted, dissipated, and reflected light.^ 
 
 'See "Artificial Illumination," by Dr. L. A. W. Alleman, 
 Brooklyn Medical Journal, December, 1900.
 
 PHYSIOLOGY OF VISION. 169 
 
 There is nothing more tiring to the eye than numerous 
 separate Hghts whose images upon various parts of the 
 retina create there a large number of useless and ex- 
 hausting stimuli and from which there is no escape by 
 and device or turning. American oculists have so 
 many patients who, even with the best spectacles, can- 
 not escape suffering whenever they go to the theater, 
 opera, etc., that the term " theater-headache," or " pan- 
 orama headache," has come into general use. As 
 much as to the character of the sermon or of the wor- 
 shiper, the famous sleepiness of the church-goer was 
 due to the somnolence caused by ocular fatigue from 
 harsh lights in front. One of the most common symp- 
 toms of eye-strain, known of all oculists, is sleepiness 
 when reading by artificial light. Part of this is cer- 
 tainly due to unphysiologic systems and qualities of 
 the light used.
 
 DISCOVERY OF ASTIGMATISM 
 AND EYE-STRAIN. 
 
 »7«
 
 CHAPTER VIII. 
 
 THE DISCOVERY OF ASTIGMATISM AND EYE- 
 STRAIN. 
 
 Among the many minds fused in the personality of 
 Thomas Young there were those of the physician and 
 the physicist. Astigmatism was discovered by the 
 mind of the physicist, and great as was the discovery 
 it is a pity that it was so. Many others, and inde- 
 pendently of each other, soon rediscovered the fact, so 
 that the world would not long have been without the 
 knowledge of it. While we are proud that we owe 
 the researches and the memoir,^ " On the Mechanism 
 of the Eye," 2 to a physician, the fact that it sprang 
 from the intellect of the nonmedical scientist is of tre- 
 mendous significance. The optical and mechanical 
 way of looking at astigmatism instituted by Young 
 was carried on by Airy, Bonders, Helmholtz, and their 
 successors, and is to-day the certain and sole cause 
 that many millions of people are needlessly enduring 
 lives of intense suffering and wretchedness. To 
 Young and to the youngest ophthalmologist, excepting 
 
 ^ Read before the Royal Society, November 27, 1801. 
 
 ^Thomas Young: Philosophical Transactions, 1793, p. 169; 
 1794, p. 21; 1795, p. i; see also a "Course of Lectures," etc., 
 1807, Vol. 2, p. 575- 
 
 173
 
 174 BIOGRAPHIC CLINICS. 
 
 a relatively small number of Americans, the signifi- 
 cance of astigmatism has been physiologic instead of 
 pathologic, has related solely to optics and the increase 
 of visual acuity instead of to disease, and the remote 
 effects of morbid physiology. This strange and fatal 
 prepossession at once came out in Airy, who discov- 
 ered " abnormal astigmatism," that is, " astigmatism 
 that interfered with vision," by which term there was 
 an utter ignoring of the all-important truth that dis- 
 ease is nothing more than morbid physiology. All 
 over the world socalled medical men practising oph- 
 thalmology as a specialty have the same conception 
 of the matter, and everywhere the ignorant and greedy 
 optician is criminally allowed to pursue his calling of 
 using articles of the materia medica (spectacle lenses) 
 which have as powerful an influence in curing or caus- 
 ing disease as any other, except the violent poisons. 
 
 Concerning Young's discovery his worthy successor, 
 Bonders,^ may be quoted : 
 
 The distinguished natural philosopher, whose brilliant merits 
 in the domain of physiologic optics were first duly estimated 
 by Helmholtz, was himself nearsighted. In relaxation of the 
 eye, consequently in determination of the farthest point, he 
 saw in his optometer, held in a horizontal position, the double 
 images of the thread intersect one another at seven inches from 
 the eye, on the contrary, at ten inches when in a vertical posi- 
 tion. This indicates, on reducing the English to Parisian 
 inches, an astigmatism of 1/25; and it is, therefore, strange 
 that Young, as he himself remarks, had experienced no dis- 
 
 ^ " Refraction of the Eye," 1864, pp. 456-457-
 
 ASTIGMATISM AND EYE-STRAIN. i75 
 
 lurbance from it. The optician, Gary, to whom Young com- 
 municated his discovery, stated to him that he had before 
 often found that nearsighted people distinguished objects much 
 more acutely when the glasses suited to them were held in a 
 particular oblique direction before the eye; now by this 
 maneuver, at least when strong glasses are necessary, a certain 
 degree of astigmatism may be corrected. Young, too, had 
 already studied and delineated the form of the diffusion spots. 
 The source of astigmatism he sought in the crystalline lens, 
 because it continued when he plunged his cornea into water 
 and replaced its action by that of a convex lens. He now 
 assumed an oblique position of the crystalline lens as a cause, 
 and even thought that from the diffusion-images of a point of 
 light it might be deduced that the two surfaces of his lens 
 were not centered. In a double point of view, therefore, 
 Young's eyes presented an exception : the refraction was 
 stronger in the horizontal than in the vertical meridian, and 
 the cause lay principally in the lens. 
 
 Nagel^ states that Gerson, 1810, described astigma- 
 tism, in the inaugural dissertation at Gottingen, in the 
 eyes of Professor E. G. Fischer, of Berlin. 
 
 We hear nothing more concerning the subject until 
 
 1815, when in Vol. XXVIIL, "Repertory of Arts," 
 
 1816, Stedman Whitewell, an architect, describes 
 square shaped lenses for spectacles in which each side 
 is ground as a cylinder, with the axis of one at right 
 angles with that of the other. No mention is made of 
 the device as regards the correction of astigmatism. 
 
 In the " Repertory of Patent Inventions " for De- 
 cember, 1826, there is an article entitled, *' On the 
 
 ^ Archiv f. Ophth., Berlin, 1866, XII., 25-30, " Historische 
 hotz iiber Hyperopie und Astigmatism."
 
 176 BIOGRAPHIC CLINICS. 
 
 means of ascertaining the true state of the eyes, and 
 of enabling persons to supply themselves with spec- 
 tacles the best adapted to their sight," by John Isaac 
 Hawkins, Chase Cottage, Hamstead Road, and dated 
 September 21, 1826. From this I extract as follows: 
 
 I have, through life, noticed that I could not see so dis- 
 tinctly with my right eye as with my left, and recently by the 
 use of the optometer I have ascertained that the indistinctness 
 is occasioned by the vertical focus of that eye being greater 
 than the horizontal focus, while in the left eye they are both at 
 nearly the same distance. By vertical focus is meant the focus 
 of those rays that enter the eye one above the other; and by 
 horizontal, the focus of those rays that enter the eye side by 
 side, the difference no doubt arising from the vertical curvature 
 of the eye being different from the horizontal which may take 
 place either in the cornea or front part of the eye or in the 
 crystalline lens situated within the eye. Having ascertained 
 the average measurements of each focus of my two eyes, I 
 contemplate making glasses for my right eye that shall have 
 greater magnifying power vertically than horizontally; to 
 accomplish which I shall avail myself of a plan patented in 
 France by M. Chamblant, optician, of Paris, and make the sur- 
 faces of my glasses segments of cylinders, one side vertical and 
 the other horizontal as described in Dr. Rees' encyclopedia 
 under the article " Spectacles." 
 
 In places where an optometer cannot be procured, a book 
 ruled for music will afford the means of ascertaining whether 
 there is any considerable difference between the horizontal and 
 vertical foci of the eyes, and of approximating toward an accu- 
 rate measurement of them. 
 
 To measure the horizontal focus of the left eye, hold the 
 music book with the lines vertical and shut or cover the right 
 eye, move the book nearer to and further from the eye until 
 the ruled lines appear most distinctly; then measure the dis- 
 tance from the book to the eye as before described.
 
 ASTIGMATISM AND EYE-STRAIN. i77 
 
 Then hold the music book with the lines horizontal and 
 again move it until the lines appear most distinctly, the dis- 
 tance from the eye will be the vertical focus; open the right 
 eye and shut or cover the left and proceed in the same way to 
 ascertain the two foci of the right eye, always recollecting that 
 to measure the horizontal focus the music lines must be held 
 vertically, and to measure the vertical focus the music lines 
 must be held horizontally. 
 
 Hawkins adds that these and other observations in 
 the same article are the results of eighteen years of 
 experience, so that it is probable that he understood 
 astigmatism previous to 1826. 
 
 The foregoing reference to Chamblant may be sup- 
 plemented by the remark of Sulzer,^ of Paris, who says 
 that lenses formed by two equal cylinders either con- 
 vex or concave, crossing one another at right angles, 
 were known before 1820. An article by Goode, pub- 
 lished in 1847, states that Chamblant had also ground 
 piano-cylinders and unequal crossed cylinders that 
 were intended for the correction of astigmatism. 
 
 The next contribution upon the subject is that of 
 Airy, the Royal Astronomer of England, described in 
 the Transactions of the Cambridge Philosophical So- 
 ciety, 1827, Vol. II., p. 267. We may again conven- 
 iently quote the abstract of Bonders :^ 
 
 Airy was the first to discover abnormal astigmatism ; that 
 is, astigmatism that interfered with vision, in fact, in his own 
 
 ^ Annales d'Oculistique, 1902, abstracted in Annals of Oph 
 thalmology, August, 1902. 
 "Refraction of the Eye," 1864, pp. 510 and 483.
 
 178 BIOGRAPHIC CLINICS. 
 
 left eye. At the same time he conceived that a cylindrical glass 
 might correct the asymmetry, which he actually found to be 
 the case, the disturbance of vision being corrected by such a 
 glass. The form of his astigmatism was the compound myopic. 
 Airy conceived that if he had two concave cylindrical surfaces 
 ground, with axes directed perpendicularly to each other, each 
 corresponding to the degree of myopia to be corrected in the 
 principal meridians, the object should be attained. 
 
 As point of light a small opening in an opaque disk is 
 employed, turned toward the light of the sky, toward a dull 
 glass or the globe of a lamp, and this is moved along a gradu- 
 ated scale, for example, that of an optometer. We then find a 
 greatest distance at which the point of light appears as the 
 most slender line, and a shortest distance at which it again 
 becomes a thin line, perpendicular to the first. The distances 
 then give about the degrees of myopia in the principal merid- 
 ians.i 
 
 According to Lawrence^ the lenses by which Airy 
 corrected his own astigmatism were ground by Fuller 
 at Ipswich (London Medical Gazette, Vol. I., p. 134). 
 
 The term astigmatism was first used by Rev. Dr. 
 Whewell to designate the defect described by Airy. 
 
 In the American Journal of the Medical Sciences for 
 April, 1872, N. S., Vol. LXIIL, pp. 355-359, there is a 
 note respecting the first recorded case of astigmatism 
 in America for which cylindric lenses were made, con- 
 
 ^The theory of refraction by asymmetrical surfaces was 
 developed by Sturm (Comptes rendus de I'Academie des Sci- 
 ences de Paris, t. XX., pp. 554, 761, 1238, and Poggendorif's 
 Annalen, B. 65, 116). (Compare with Fich, " Mediz. Physik," 
 p. 327.) 
 
 2 "Diseases of the Eye," Am. ed. by Hays, 1854, p. 669.
 
 ASTIGMATISM AND EYE-STRAIN. I79 
 
 tributed by Dr. Henry D. Noyes, of New York. 
 From this the following extracts are made: 
 
 By the kindness of Dr. Gray, of the New York State 
 Lunatic Asylum, Utica, I have come in possession of a pair of 
 cylindrical glasses which I suppose were the first ever made in 
 this country. They belonged to Rev. Mr. Goodrich, who at the 
 time of his death was chaplain of the asylum. They were given 
 to me wrapped in a piece of writing paper on which, in the 
 owner's handwriting, was inscribed the following memoran- 
 dum : " No. 7 French No. (number) cylinder, con. got of 
 McAllister May, 1828. I wrote fourteen months, t. e., till July, 
 1829. Again put into use March 11, 1843; they were laid aside 
 December 10, 1850." 
 
 The glasses are plano-concave cylinders of seven inches focus 
 with axes horizontal and were mounted in a spectacle frame 
 with oval eyes. The maker is the old and well-known optician, 
 Mr. John McAllister, of Philadelphia. 
 
 The following is extracted from the account given 
 by Mr. Goodrich himself: 
 
 From my earliest years I have been sensible of a defi- 
 ciency in sight which I was induced to call nearsightedness 
 because I was obliged to approach nearer to objects to see 
 them than most persons, which is still the case. This defic- 
 iency until I was about sixteen years of age was accompanied 
 with weakness of sight, but my eyes are now strong. I com- 
 menced my studies regularly at the age of nineteen and am now 
 twenty-four. Close study has had no other effect upon my 
 sight than to strengthen its endurance but not its precision or 
 length. My right eye is and always has been much better than 
 my left, but the defect in both is precisely of the same nature. 
 At the age of sixteen I procured a pair of plain green glasses, 
 which were some little assistance in moderating the intensity 
 of the light. I tried to get concave glasses, but could find none 
 that were of any essential assistance. I afterward used a small
 
 i8o BIOGRAPHIC CLINICS. 
 
 convex lens of about ten inches focal distance, as a microscope, 
 to assist me in reading, which was some assistance, but during 
 the five years of studying I have used no glasses whatever. In 
 November last (1825) I procured a pair of concave glasses in 
 New York, about five or six, which will accompany this letter. 
 Until then I had never discovered that a change of position 
 had any influence on my sight, but in looking through these 
 glasses I found that any object whose length is in a horizontal 
 direction appears much more distinct than a similar object 
 whose length is perpendicular to the plane of the horizon. 
 Thus the cross-rigging of a ship appears much more distinct 
 than the mast and perpendicular ropes. I have since been led 
 to make experiments first on the naked eye, then on it in con- 
 nection with my glass, which I send you, and the result at 
 which I have arrived has been universally the same. These 
 facts [experiments and diagram of Goodrich omitted] would 
 lead me to conclude that the crystalline lens of my eye is cylin- 
 drically convex or, perhaps, oblately convex, and that its great- 
 est length is in a perpendicular direction (that is, in a line 
 parallel with the length of my body) ; consequently I would 
 conclude that a glass whose shape resembled the probable shape 
 of the crystalline lens of my eye, placed before my eye so that 
 its greatest length would be at right angles with the lens of 
 my eye, would produce a perfect image. If it be true that my 
 eye requires a glass whose shape does not correspond to a por- 
 tion of a true sphere, but rather to a portion of a spheroid or, 
 perhaps, a cylindric, I cannot tell from any observations I have 
 yet made on my eyes, whether the glasses should be of the con- 
 cave or convex form. The great difficulty is why should the 
 appearance of objects be entirely changed by the interposition 
 of a concave glass? When I purchased my glasses I was not 
 aware of this curious fact in regard to my eyes either with or 
 without glasses. I only knew that I got those through which, 
 on the whole, I could see best. If it be asked whether I con- 
 sider the glasses in question are essential assistance to my 
 sight, I answer that if my object be to examine a horizontal
 
 ASTIGMATISM AND EYE-STRAIN. i8i 
 
 object, they truly are assistance and they are so in the exami- 
 nation of a perpendicular one, provided I turn my head at a 
 right angle.^ 
 
 Leuff- determined the radius of curvature of one 
 cornea in the vertical and horizontal meridian. 
 
 Wharton Jones^ and Wilde* assume that the founda- 
 tion of astigmatism is really to be sought in the cornea 
 and that the cornea in its vertical meridian has a 
 shorter radius of curvature than in the horizontal and 
 they explain Airy's case by a peculiar development of 
 that difference. 
 
 Hamilton^ reports a case of abnormal astigmatism 
 in 1847. 
 
 Dr. Goode^ described astigmatism in his own eyes 
 and those of three other gentlemen in the University 
 of Cambridge in 1848. 
 
 Stokes' invented the astigmatic lens for determin- 
 
 ^ In Lawrence's " Diseases of the Eye," 1854, p. 669, two 
 other cases corrected for him by McAllister in Philadelphia in 
 1853 are described by Hay. 
 
 2Conf. Volkmann, "Art. Sehen," p. 271, in Wagner's 
 " Handworterbuch der Physiologie," 1846. 
 
 ^ " Manual of Ophthalmic Medicine and Surgery," second 
 edition, London, 1855, p. 352. 
 
 * " Dublin Journal of Medical Science, First series, Vol. 
 XXVIII, p. 105. 
 
 ^Monthly Journal of Medical Science, Edinburgh, 1847, p. 
 891. 
 
 ^Monthly Journal of Medical Science, Edinburgh, 1848, p. 
 711, and Transactions of the Cambridge Philosophical Society, 
 Vol. VIIL, p. 493. 
 
 ^ " Report of the British Association for the Advancement of 
 Science" for 1849, p. 10.
 
 i82 BIOGRAPHIC CLINICS. 
 
 ing the degree of astigmatism in 1849. This consisted 
 of two cyUndrical lenses, the one plano-convex of yV> 
 the other plano-concave of xV- These are fastened in 
 copper rings .which are fitted into one another and can 
 turn past one another around their axis. The lenses 
 rotate past one another, at the same time their flat 
 surfaces being toward each other. The degree of 
 astigmatism is ascertained by an index and scale on the 
 rings. 
 
 Pastor Schnyder, according to Bonders,^ of Meuz- 
 burg, discovered astigmatism in his own person.^ 
 
 In 1855 Helmholtz confirmed previous findings as to 
 the ellipsoidal nature of the cornea, and in i860 Bon- 
 ders brought the matter to a full and complete scien- 
 tific statement. 
 
 An important factor of progress was now supplied 
 by an American, Dr. Ezra Dyer, who, after extensive 
 studies abroad, returned to Philadelphia in 1861 to 
 practise ophthalmology. He was the first, I think, to 
 perfect the methods of accurate and scientific diagnosis 
 of astigmatism, and its relief by spectacles, as a daily 
 clinical practice. I cannot learn that Dyer had any 
 intellectual conception of the pathologic significance 
 of his work. That honor is reserved for Mitchell and 
 for other Philadelphia specialists in diseases of the 
 
 ^ " Refraction of the Eye," 1864, p. 542. 
 
 M«n. d'Oculistique, t. XXI., p. 222, Bruxelles, 1849, taken 
 from the " Verhandlungen der Schweizerischen Naturfor- 
 schenden Gesellschaft."
 
 ASTIGMATISM AND EYE-STRAIN. 183 
 
 eye. Dyer's great service was that he first as routine 
 practice did honest and scientific work in refraction. 
 The results soon showed that patients were at once 
 and unexpectedly relieved of their previous headaches 
 and other sufferings.^ The systemic effects of the 
 neutralization of ametropia by glasses were almost 
 magical, and immediately a number of keen-minded 
 physicians caught the truth and began their successful 
 life-work as refractionists. These were Doctors 
 Thomson, Norris, Harlan, Hay, Morton, Risley, and 
 others. 
 
 The house of Queen & Co. began filling prescrip- 
 tions for cylinders in 1874, the order of the first ones 
 being signed by Norris, Thomson, Thomson, Norris, 
 Norris, Risley, etc., respectively. 
 
 Dyer first put into use the test types previously sug- 
 gested by Snellen, and which in the United States were 
 called " Dyer's Types," or " Dyer's Test Letters." 
 
 In 1863 Dr. Hasket Derby, of Boston, reported^ 
 four cases of astigmatism, the correcting cylinders 
 being ground by Paetz and Flohr, of Berlin. The 
 first examination for astigmatism and prescription of 
 
 ^ Dyer first sent his prescriptions for cylinders abroad to be 
 filled, but in 1862 or 1863 the Philadelphia optician, Zentmayer, 
 was able to fill them. According to Bumstead (Atn. Med. 
 Times, 1863, VIL, pp. 203-205) cylinders were ground by Paetz 
 and Flohr in Berlin, and by Natchet in Paris. In the same 
 article Dyer's test types are described. 
 
 Mw. Med, Times, 1863, VIL, pp. 277-278.
 
 i84 BIOGRAPHIC CLINICS. 
 
 cylindrical lenses in Boston was one of these cases, and 
 was made by Derby on May 12, 1862. The patient 
 was still living on September 30, 1902. 
 
 Dr. G. Hay described a case of astigmatism in the 
 Boston Medical and Surgical Journal, 1867, LXXV., 
 
 pp. 513-515. 
 
 Dr. John Green,^ in 1867, wrote a paper on astig- 
 matism as an active cause of myopia. 
 
 Dr. O. M. Pray described his test type for the diag- 
 nosis of astigmatism in 1869.^ 
 
 Dr. Mills reported a case of compound myopic astig- 
 matism in the service of Dr. Harlan in Wills Hospital 
 in 1871.^ 
 
 But up to this time there had been no word or hin/" 
 that astigmatism had any pathologic significance. 
 With all these investigators it had been solely a matter 
 of physiology, of optics, mechanic or physiologic, re- 
 ferring at best only to visual acuteness. Now, how- 
 ever, arose a man, an American, Dr. S. Weir Mitchell, 
 who must be recognized as one of the greatest medical 
 discoverers and benefactors of the race. So far as I 
 can learn he first taught the pathologic significance of 
 astigmatism and eye-strain, and that the prescription 
 of cylindric lenses is of vast importance in the cure and 
 prevention of systemic diseases. 
 
 "■Arch. Ophth. and Otol, 1869, I., No. i, pp. 17-21. 
 ^ Am. Jour. Med. Sci., January, 1867. 
 ' Phila. Med. Times, 1871, II., p. 70.
 
 ASTIGMATISM AND EYE-STRAIN. 185 
 
 Nothing that our distinguished colleague has ever 
 contributed to medical progress can equal the value of 
 that of the masterly articles which he wrote in 1874, 
 1875 and 1876 upon the subject of eye-strain. The 
 first was entitled '' Headaches from Heat-strokes, from 
 Fevers, after Meningitis, from Overuse of the Brain, 
 from Eye-strain."^ The second was called " Notes on 
 Headache,"^ and the third "Headaches from Eye- 
 strain."^ The last article is a recapitulation and com- 
 pletion of the data and conclusions set forth in the 
 first two, and from it I make the following quotations : 
 
 My consultations have plainly enough taught me that hardly 
 any men in the general profession are fully alive to the need 
 of interrogating the eye for answers to some of the hard 
 questions which are put to us by certain head symptoms, since 
 many of the patients treated successfully by the correction of 
 optical defects never so much as suspected that their eyes were 
 imperfect. What I desire, therefore, to make clear to the pro- 
 fession at large is : 
 
 1. That there are many headaches which are due indirectly 
 to disorders of the refractive or accommodative apparatus of 
 the eye. 
 
 2. That in these instances the brain symptom is often the 
 most prominent and sometimes the sole prominent symptom 
 of the eye troubles, so that, while there may be no pain or 
 sense of fatigue in the eye, the strain with which it is used may 
 be interpreted solely by occipital or frontal headache. 
 
 ^Medical and Surgical Reporter, July 25, 1874, and August i, 
 1874 
 ^ Ibid., February 6, 1875. 
 
 ' Am. Jour. Med. Set., April, 1876, pp. 363-373. 
 »3
 
 1 86 BIOGRAPHIC CLINICS. 
 
 3. That the long continuance of eye troubles may be the 
 unsuspected source of insomnia, vertigo, nausea, and general 
 failure of health. 
 
 4. That in many cases the eye trouble becomes suddenly 
 mischievous owing to some failure of the general health, or to 
 increased sensitiveness of brain from moral or mental causes. 
 
 In seeking to prove these propositions I shall use some of 
 the cases which I have already given in the Reporter, and 
 others which I have since seen, or which have been put at my 
 disposal by friends who are engaged in the practice of oph- 
 thalmic surgery. 
 
 I may here remark that the books on diseases of the eye 
 scarcely more than allude to the distressing cerebral symptoms 
 of which I have spoken, except when discussing the subject of 
 accommodative asthenopia from hypermetropia. Yet in prac- 
 tice almost all of the extreme refractive or accommodative eye 
 troubles give rise, in a certain proportion of people, to these 
 symptoms, while in those congenitally sensitive, or who become 
 so in after-life, even slight optical defects, especially when 
 unequally developed in the two eyes, may also give rise to like 
 annoyances. 
 
 I have certainly seen cases in which the form of headache 
 caused by eye troubles was a pure migraine or hemicrania, but 
 this I believe to be rare; while I am sure also that in many 
 persons who are already the victims of migraine it has been 
 made worse and more frequent by the over-use of defective 
 eyes, as, indeed, it may be from any cause of exhaustion, and 
 has again been lessened in severity and as to number of 
 attacks by proper correction of the eye disorder. Dr. Liveing, 
 in his interesting and thoughtful work on sick-headache (t. e., 
 megrim) states that M. Piorry long ago described megrim as 
 capable of being caused in those with weak eyes by straining 
 at near or minute objects, and this is doubtless the case; but 
 the form of head-pain, to which I am about to refer, is cer- 
 tainly not, as a rule, of the nature of megrim, and as soon as
 
 ASTIGMATISM AND EYE-STRAIN. 187 
 
 it disappears when the eyes are corrected, is lacking, happily, 
 in the obstinacy of that distressing malady. 
 
 The following cases fairly illustrate the first two of the 
 propositions I have stated above. First of these I put the fol- 
 lowing case, because it was the one which earliest opened my 
 eyes on this subject. My tardy knowledge certainly cost my 
 patient a long period of unrelieved distress : 
 
 Case I. — Mr. E., a prominent merchant, consulted me for 
 pain in the upper spine and occiput. It increased day by day 
 every winter, and left him during the summer, which was 
 spent in shooting and fishing — a tent life, in fact. Mr. B. was 
 even cauterized in New York for these pains, and here at home 
 he had much able advice beside my own. When I first saw 
 him I was thoroughly misled. It was late in the winter, and, 
 as usual, while in the autumn only writing at first, and then 
 later reading, and then any near work, caused pain; as time 
 went by there came a period when all mental labor, when 
 excitement, motion, or any thought caused pain. He was in 
 this over-sensitive state when I saw him, and was aided by 
 nothing I did. His holiday cured his head, and on his return 
 some friends, I believe, suggested to him that his eyes might 
 be weak, and with this idea he consulted Dr. William Thom- 
 son, who gave me the following additional particulars from his 
 notebook : 
 
 "Writing had become so distressing to this gentleman, that 
 for a year past all letters have been written by a secretary, at 
 his dictation. He states that a few moments spent in writing 
 give him a creeping sensation up the spine and through the 
 back part of the head, followed by giddiness and severe pain, so 
 urgent as to render him fearful of a ' fit of some kind.' . . . 
 His compound hyperopic astigmatism was corrected, and on 
 using the glasses habitually, his distressing symptoms quickly 
 disappeared. He has long since forgotten his apprehensions of 
 an impending apoplexy or epilepsy; he can see as sharply as 
 any of his companions, and he can use his eyes continuously in 
 reading, writing, or any near work."
 
 1 88 BIOGRAPHIC CLINICS. 
 
 Relief in this case followed at once the use of 
 glasses, which proved competent without other means 
 to conduct him to perfect and useful health again. 
 
 The following case will answer to show how pro- 
 foundly the whole system may be perturbed by an 
 ocular defect : 
 
 Case II. — Miss J., an accomplished and energetic single 
 lady, aged 30, from New Jersey, having the care of a sick 
 mother and of a household, began some five years ago to have 
 evening headaches, pain in the back of the head and neck, sense 
 of extreme fatigue and violent flushing if she persisted in 
 exerting her mind in writing or reading. Unfortunately, a 
 portion of her income and much of her pleasure in life 
 depended upon her ability to write, so that for a long time she 
 continued to do so, despite the increase of all her troubles. 
 When at last she came to me, a feeble, nervous, anemic 
 woman, sleeping little and cursed with headache almost con- 
 stantly, I confess that for nearly two years while I saw her at 
 intervals, I looked everywhere but to her eyes for the cause 
 of the mischief. At length, after a most unsatisfactory winter 
 of rest from work, freedom from care and many tonics, I made 
 a more careful study of her eyes, and having grown sure that 
 they were imperfect, asked her to consult an ophthalmic sur- 
 geon. At this time the use of the eyes brought about pain in 
 them and sense of fatigue, whereas at first the headaches, 
 which came only after long use of the eyes were, as I have 
 said, unaccompanied by any sense of trouble in the eyes. Her 
 compound hyperopic astigmatism was corrected (by Dr. 
 Thomson) and she was seen again May 26. Headache has 
 disappeared, sleeplessness has vanished; she can read and 
 write without pain, and she uses her glasses constantly. In 
 October this lady was seen again, and pronounced herself long 
 since relieved and able to use her eyes constantly, with the 
 correction, in all near work.
 
 ASTIGMATISM AND EYE-STRAIN. 189 
 
 I myself saw this lady anew this autumn. The change in 
 her appearance was remarkable, and was, I think, solely due 
 to relief of the strain with which she used her eyes. The 
 headache left early, and with it the sleeplessness. Once able 
 to slumber and to get rest, the body swiftly repaired damages, 
 and the anemia also departing, a general gain in flesh, color 
 and strength were the results. 
 
 Another patient (corrected by Dr. Thomson) reports her- 
 self as perfectly comfortable, and only distressed at the loss of 
 16 years of useful life, and now able to read or sew as much as 
 she wishes. 
 
 The cases j ust told seem to me enough to prove that the eyes 
 may long rest unsuspected as the cause of headache, and of 
 other intracranial distresses and disorders. Case II. is the 
 more remarkable of those which illustrate this fact, because 
 when attending this lady I was already on my guard as to this 
 cause of headache, and yet was for a long time altogether mis- 
 led. Who, indeed, could have supposed that a mere ocular 
 defect could have given rise to so serious a train of evils — 
 beginning with headache and ending with unconquerable 
 anemia — and who that had not seen it could believe that the 
 correction by glasses of the eye trouble could have given a 
 relief so speedy and so perfect that she herself described it as 
 a miracle. 
 
 Case V. was that of a woman of 27, who had nervous and 
 spinal troubles, frequent headaches, and prolonged hysterical 
 states. Dr. Wm. F. Norris, to whom she was sent, corrected 
 her astigmatism, compound myopic in one eye, and compound 
 hypermetropic in the other, and the relief given in the case was 
 almost immediate, but some time elapsed before the headaches 
 were entirely lost. 
 
 Dr. Wm. F. Norris sends me the following very striking 
 case of hypermetropic astigmatism in which there was no eye 
 pain, but violent headache, described as neuralgic, with nausea 
 and vomiting. The relief given by glasses was absolute and 
 abrupt.
 
 I90 BIOGRAPHIC CLINICS. 
 
 The third proposition, to the effect that vertigo of most 
 alarming character, as well as other intracranial symptoms, 
 may be the chief expression of eye lesions, is illustrated by the 
 following cases : 
 
 Case VIII. — Miss B., aged i6, was well until her periods 
 began, and these being copious, she found that for several days 
 afterward she had headaches which came only upon use of the 
 eyes and were less grave as the month of interval passed by. 
 I suspected the cause, and, in fact, learned that she had un- 
 equally myopic eyes. I advised that these should be corrected, 
 but as her family physician insisted that she must have had 
 the eye lesion always, and could, therefore, not be suffering 
 suddenly from what had always been present — she was easily 
 persuaded to yield to her own dislike of glasses, and so noth- 
 ing was done save only to strive to lessen the menstrual flow. 
 
 After a year more she came back to me with an addition to 
 her symptoms of occasional unsteadiness of gait, with a sudden 
 sense of terror and vertigo. The headaches were no better. In 
 a half-conscious self-defence she had given up sewing and 
 writing and read little, yet still the headaches continued 
 because she had now reached that advanced stage of sensitive- 
 ness in which the ordinary every-day use of the eyes was hurt- 
 ful. Of late, too, her rest was broken and disturbed by 
 dreams. Meanwhile, also, she had been reexamined, and by 
 the aid of the ophthalmoscope discovered to have cerebral 
 anemia, because, as I was told, the headaches went away in the 
 night, when, owing to her prone position, more blood went to 
 the head. 
 
 The ophthalmoscope is just now where the stethoscope was 
 forty years ago, and is called upon to do things which I do not 
 think it can do, so that I am grown a little suspicious of state- 
 ments as to diagnosing by the eye-ground vessels the amount 
 of blood in the head. Save only in the case of gross lesions the 
 value of the ophthalmoscope has been overrated. I, at least, 
 am unable to diagnose slight degrees of cerebral anemia from 
 the state of the vessels of the disk,
 
 ASTIGMATISM AND EYE-STRAIN. 191 
 
 My patient had been endlessly treated with tonics, but some- 
 how none did any good, and she was surely hastening toward 
 a course of uterine treatment, the usual goal in difficult cases 
 of obscure disease in women. At this time I urged her to 
 travel in Europe, and while there to have her eyes corrected. 
 She took the agreeable part of my advice, but gaining little 
 from a few months of too rapid and wearying travel, again 
 wrote to complain of increasing headaches and of more fre- 
 quent spells of ocular vertigo. I could only urge anew the 
 correction of the eyes, especially since she had improved in 
 color and as to gain of flesh, with no like bettering of the 
 cephalic troubles. This time she took my advice and was per- 
 suaded to wear her glasses steadily. At first the vertigo grew 
 worse, but soon it and the headaches and the insomnia passed 
 away, so that in a month she was able to sew, write, or read for 
 hours at a time. 
 
 This briefly-told case is somewhat instructive, but I have 
 given it chiefly because of the vertigo, which is seen in some 
 instances, but which few physicians would suspect to be due to 
 troubles in the eye; nevertheless, I have learned to look to it 
 as one source of the symptom vertigo. There is an ocular 
 vertigo as well as an aural vertigo, and I believe that I have 
 seen it under three sets of conditions. Thus it is sometimes 
 caused by a sudden lessening of intraocular pressure, but is 
 more often seen in cases of disorder of the accommodative, or 
 of the extraocular muscles; being after all neither so common 
 nor so easily caused as the analogue, aural vertigo. Usually, 
 indeed, it comes only after the eye trouble and some other 
 cause of general weakness have made the intracranial circula- 
 tion unstable. Occasionally, as I believe the oculists know, a 
 dose of atropia used in one eye will bring it suddenly; and this 
 is more notably seen in persons whose balancing power is 
 already affected by posterior spinal sclerosis or by cerebellar 
 growths. Perhaps the most important, because the most mis- 
 leading point in all of this subject, is the fact that such as are 
 in sturdy health are often able for years to overcome, without
 
 192 BIOGRAPHIC CLINICS. 
 
 sense of strain, muscular difficulties in binocular accommoda- 
 tion, and to endure unharmed astigmatism with accommodative 
 troubles. But with increase of years their powers fail, and 
 they begin to feel the added exertion now needed in some 
 shape — either in eye or head, or in both. Or else it chances 
 that to one of these people comes an attack of illness, a moral 
 or emotional strain, or a time of overwork with worry, when 
 at once the eye trouble leaps into mischievous prominence, and 
 once felt is felt through all the future more and more by a 
 brain which, in the language of the photographer, I might aptly 
 describe as having become oversensitized. I have seen in my 
 practice or in that of others examples of this sequence. 
 
 I must now, I think, have amply illustrated the fact that eye- 
 strain causes headache and worse disorders, and is often their 
 unsuspected cause. Simple deficiency of power in one internal 
 rectus muscle, if extreme, results in the patient being so utterly 
 unable to overcome it as to give up the effort and allow the eye 
 to roll out, contenting himself with clear monocular vision. 
 The effort needed to overcome lesser weakness is a competent 
 one, but ends in incessant exertion and fatigue. The accommo- 
 dative effort needed in hypermetropia, especially with astig- 
 matic trouble, is extreme, owing to the instinctive and never- 
 satisfied craving for distinct vision, and hence the source of 
 fatigue. I presume that the strain made on the eye by these 
 various forms of trouble in sight is due largely to the fatigue 
 which ever comes of the need to make volitional efforts to 
 effect movements which, in ordinary use, are sensually guided, 
 and are more or less in this view automatic. Besides which 
 the use of the eyes is so incessant that it is impossible for the 
 victims by any means save glasses to put the eyes at rest; so 
 that often the strain is nearly incessant. 
 
 The profound and far-reaching importance of these 
 conclusions of Dr. Mitchell .will not be adequately 
 recognized for generations. Since he established them
 
 ASTIGMATISM AND EYE-STRAIN. i93 
 
 many an American oculist has personally seen thou- 
 sands of such cases in which, as if by miracle, lives 
 have been changed from abject misery to happiness. 
 As he looks over the world, and especially the Euro- 
 pean world, he knows that there are millions suffering 
 in the same way who could be immediately cured were 
 it not for the false conception of astigmatism and other 
 forms of ametropia entertained by medical men and 
 ophthalmologists. For the genius that first recognized 
 the truth and for the fearlessness that published it no 
 honor is too great. 
 
 Several weighty improvements, however, .were still 
 needed to give the discovery that accuracy and prac- 
 tical usefulness which should make it play in the world 
 its role of splendid beneficence. These were: 
 
 1. The extension of the method of estimating and 
 correcting astigmatism to the hyperopic, compound 
 hyperopic, mixed, irregular, and unsymmetric varie- 
 ties. This was done largely by the Philadelphia spe- 
 cialists contemporary with Mitchell. The astigma- 
 tism observed before Dyer was myopic, a very small 
 portion of that existing, and relatively speaking pro- 
 ducing few reflexes. 
 
 2. The practical correction of anisometropia. All 
 
 text-books up to 1892 taught, in the language of the 
 
 German master, Fuchs, that 
 
 " In anisometropia we give the same glasses for both eyes, 
 or correct only one eye and place a plain glass before the 
 other."
 
 194 BIOGRAPHIC CLINICS. 
 
 This pernicious error was controverted, so far as I am 
 aware, for the first time in 1892.^ It was contended 
 that it is unmedical, unprofessional, and unnecessary 
 to leave an amblyopic eye, injured from disuse, to its 
 fate. 
 
 3. The bifocal spectacles. An American genius, 
 Benjamin Franklin, invented bifocal lenses for use in 
 presbyopia, and an important improvement, the " ce- 
 ment bifocal," was adopted in 1888 by Philadelphia 
 physicians. These devices have been of vast service 
 in lessening and extinguishing the evil effects of eye- 
 strain in presbyopes. 
 
 4. The perfecting and making practical of the ait 
 of retinoscopy. This was also the work of Philadel- 
 phia specialists. Only by this method can there be 
 accuracy of diagnosis of ametropia in children and in 
 the amblyopic. 
 
 5. The recognition of the pernicious influence of 
 eye-strain upon the digestive and assimilative system, 
 in the production of functional gastric and intestinal 
 diseases, of chorea, of hysteria, of epilepsy, etc. This 
 has been brought about by the advocacy of other spe- 
 cialists of Philadelphia or by their pupils located else- 
 where. 
 
 6. The repression of unprofessional methods, e. g., 
 the operative manias of the tenotomists ; the attempted 
 
 * " Amblyopiatrics," by George M. Gould, M.D., Medical 
 News, December 31, 1892.
 
 ASTIGMATISM AND EYE-STRAIN. 19S 
 
 diagnosis of ametropia by machinery, the ophthalmo- 
 scope, ophthalmometer, etc.; the uselessness and inac- 
 curacy of diagnoses made without cycloplegia; the 
 medical barbarism of the refracting opticians,^ etc. 
 These things bring discredit upon the true science of 
 ophthalmology. 
 
 7. The evil psychologic influence of eye-strain. 
 This was first pointed out by a Philadelphia oculist in 
 1888. Children suffering from ametropia have their 
 intellects and dispositions warped, injured, or wrecked. 
 The subtle malign influence of eye-strain upon charac- 
 ter is of enormous importance. 
 
 8. The economic and social significance, both public 
 and personal, of the correction of eye-strain. A life 
 may be handicapped in its usefulness or even wasted 
 without such correction. Eye-strain is one of the 
 great causes of weakening of vital resistance, so that 
 other diseases secure easier foothold. It causes in- 
 flammatory and operative diseases of the eye. It 
 creates many of the defective and criminal classes. It 
 is so large an unrecognized expense item in our educa- 
 tional and school system that it would pay the State, 
 
 ^ These are becoming more and more scarce in Philadelphia, 
 and consequently there is a growing class of honorable firms 
 who take pride in their true function and from whom patients 
 can get such serviceable and scientific work as the " eyes- 
 examined-free " men never dreamed of doing. The optician 
 must no more sell glasses than the druggist poisons without a 
 physician's prescription.
 
 196 BIOGRAPHIC CLINICS. 
 
 cities, and institutions of learning to have an official 
 oculist whom every pupil and student having no pri- 
 vate oculist should consult. 
 
 There is thus a genuine significance in the term The 
 Philadelphia School of Ophthalmology. It is that to- 
 day a hundred or more conscientious and skilled ocu- 
 lists in this city are, before and above all, physicians, 
 convinced of the clinical value of refraction when esti- 
 mated by subjective tests under cycloplegia, in curing 
 numerous types of headache, neuralgia, vertigo, func- 
 tional diseases of digestion, assimilation, and of the 
 nervous system. They also know that such diagnoses 
 and such cures cannot be made by the methods in 
 vogue in Europe, and that the great clinical value of 
 refraction consists precisely in preventing those inflam- 
 matory and operative diseases of the eyes which make 
 up the daily practice of the vast majority of the ocu- 
 lists of the world. Learning their art directly or in- 
 directly from the so-called Philadelphia school, hun- 
 dreds of oculists are finding a noble lifework through- 
 out the United States, and are giving a million patients 
 the indubitable proof of personal experience that eye- 
 strain is the cause of terrible and varied diseases, the 
 cure of which, by spectacles, is one of the greatest 
 medical discoveries of the nineteenth century.
 
 RESPONSIBILITIES. 
 
 •97
 
 CHAPTER IX. 
 
 RESPONSIBILITIES. 
 
 All agree that the great men, and especially the lit- 
 erary and scientific geniuses of a nation, are its most 
 valuable assets. They belong, indeed, to the world 
 rather than to a part of it, and to civilization itself. 
 No valuation can be put upon their lives and work, so 
 far are they beyond all ratings. So far as money 
 goes, the aim of three of the men whose clinical biog- 
 raphies we have considered was a mere living, provi- 
 dence for the simplest wants, in order to give for all 
 and for all time the priceless products of their minds. 
 The other two men asked for no material reward for 
 their life-work. All, however, beyond any other thing, 
 wanted health and freedom from suffering, but the life 
 of each was one of constant endurance of pain and 
 misery. None can know how this fact crippled their 
 productivity, and how profoundly it changed the char- 
 acter of their works. To themselves the cause of their 
 afflictions was the most absolute and tormenting mys- 
 tery. When we bring to a focus the few hints, echoes, 
 and traces of symptoms we may gather concerning the 
 cause and nature of their diseases, we discover a most 
 
 remarkable likeness of symptoms, of conditions start- 
 
 199
 
 200 BIOGRAPHIC CLINICS. 
 
 ing them, and of the method of reUef to which all were 
 driven. By whatever name they described their com- 
 plaint, headache, vertigo, biliousness, dyspepsia, 
 apathy, misery, it was closely and inevitably conse- 
 quent upon use of the eyes in reading and writing, and 
 was relieved by stopping such use. These men, pur- 
 suing a literary occupation, used their eyes in this way 
 whenever they were not actively exercising, and so 
 they naturally held that their relief came from such 
 exercise in the open air. It is strange to us how each 
 one of them never once clearly saw the significance of 
 the fact, the connection between ocular function and 
 suffering, while every day it was plainly before their 
 attention, and even many times expressed in words. 
 Miss Barrett almost caught sight of the law several 
 times, and if she had been a physician she might have 
 uttered it so sharply that it would have been recog- 
 nized by the medical profession. And the medical 
 men to whom they turned in their agonies had no sug- 
 gestion to offer as to this terrible mystery. The empty 
 words " biliousness," " overwork," " indigestion," 
 " heredity," etc., were all they could utter, and as for 
 therapeutics the simplest said " mercury," and the wis- 
 est said " walk " ! Each of the patients was finally 
 reduced to treating himself; one settled on opium,^ 
 
 ^ From the Browning correspondence I excerpt : 
 "Did you walk past this house on the other side of the 
 street Sunday about 2 o'clock? I am so near-sighted that I
 
 RESPONSIBILITIES. 201 
 
 another, after drug-failures, on castor-oil, a third on 
 wet-packs, and the fourth and fifth solely on walking, 
 which indeed for all was the final and only effective 
 
 could only see a shadow in the dimness— but the shadow had 
 — or seemed to have — a sign of you — a trace of you." (E. B. to 
 R. B., April 14, 1846.) 
 
 " My opium comes in to keep the pulse from fluttering and 
 fainting — to give the right composure and point of balance to 
 the nervous system. I don't take it for my spirits in the usual 
 sense; you must not think such a thing." (E. B. to R. B., Vol. 
 I, p. 277.) 
 
 "Do you care so much about the opium? Then I must care 
 —and get to do with less at least. ... It might strike you so 
 strange that I, who have no pain, no acute suffering— should 
 need opium in any shape. But I have had restlessness till it 
 made me almost mad— at one time I lost the power of sleeping 
 quite— and even in the day the continual aching sense of weak- 
 ness has been intolerable. So the medical man gave me opium." 
 (Ibid., p. 45I-) 
 
 " You wonder how I can spend quarterly the forty pounds 
 that come to me? I do spend them. . . . My greatest personal 
 expense lately has been the morphine." (Ibid., p. 399.) 
 
 All through the correspondence and in the life of Mrs. 
 Browning there are vague allusions to headache and ill-health. 
 At the age of fourteen when saddling her pony she had fallen 
 backward, and hurt her spine. This caused her a great deal 
 of suffering, " the nature of which remained for some time 
 undiscovered." How much or little this was the cause of her 
 life of ill-health must remain a mystery. And the same may 
 be said as regards her certainly existing ametropia. Between 
 one and two dollars' worth of morphin a day was, even in 
 1846, a large amount. Mrs. Browning died years after this. I 
 append the quotations as evidence of another phase of the 
 question, and as one more illustration of : " and so the medical 
 man gave me opium." 
 14
 
 202 BIOGRAPHIC CLINICS. 
 
 cure — though at best but partially and temporarily so. 
 Cure, of course, it was not in a strict sense, because 
 all genuine cure depends upon a knowledge of the 
 cause of the disease. The physicians of these men did 
 not suspect, and thousands of the physicians of other 
 patients have not suspected the cause, because of their 
 faulty observation. Up to a certain time, say for the 
 last thirty years, this inaccuracy of observation was 
 perhaps not blameworthy, though one wonders that the 
 thousands whose official duty was diagnosis should 
 have been less curious and quick-sighted than Miss 
 Barrett. The nearest any came to a glimpse of the 
 evident fact was Sir Andrew Clark, with whom it was 
 routine to order his Hterary patients to quit work and 
 to travel. He evidently recognized the good result em- 
 pirically but had no insight of the reason of the conse- 
 quent improvement in health. It seems to us now that 
 it is a very easy step in logic and the analysis of symp- 
 toms to see that when reading, writing, or proof-read- 
 ing was always followed by intense suffering they 
 probably stood in some causal relation to the suffer- 
 ing.^ Two of our patients knew what the optical 
 powers of lenses meant, and all of their physicians 
 should also have understood microscopes; they also 
 knew that the eyeball is an optical instrument. They 
 
 ^Even in the time of De Quincey Dr. Begbie noticed that 
 literary men and students had headache, and that it was to 
 them "a common source of annoyance oftentimes of misery."
 
 RESPONSIBILITIES. 203 
 
 would have flung a microscope into the corner in dis- 
 gust had it been in a small degree as optically faulty 
 as their own eyes, which they used as a part of the 
 system of lenses in microscopic investigations. And 
 one of these microscopists was also a physiologist. 
 
 If it is to be admitted that criticism is out of place, 
 as to physicians of half a century ago, the rule cannot 
 obtain as to the physicians of the last twenty-five or 
 thirty years. In that time astigmatism and the method 
 of its cure have been the common knowledge of the 
 alert-minded. In all of that time the evidence of the 
 influence of errors of refraction in producing head- 
 aches has been before the scientific world. But few 
 medical men have made that knowledge an integral 
 part of their practice, and the vast body of the pro- 
 fession has ignored it. Moreover, for ten or more 
 years proof has been obtainable and offered that this 
 same eye-strain may and frequently does cause func- 
 tional digestional disorders.^ And yet to-day learned 
 books are being issued by learned physicians, on head- 
 ache, neurasthenia, and stomach diseases, which either 
 contain no mention of eye-strain as an etiologic factor, 
 
 * My first cases of such reflex ocular neuroses as flatulent 
 and other dyspepsias, cardiac palpitation, chorea, etc., were 
 reported with statement of the general law in the Medical and 
 Surgical Reporter, January 9 and March 9, 1889, and in the 
 American Journal of Medical Sciences, January, 1890, and in 
 the Journal of the American Medical Association, September 
 19, 1891.
 
 204 BIOGRAPHIC CLINICS. 
 
 or such mere mention as to make the truth more stu- 
 pidly and more superciliously ignored. Why is this? 
 There are several reasons for this strange and morbid 
 persistence of error: 
 
 I. The biologic or evolutional history of organs and 
 of disease is neglected, and often this only can explain 
 present functions and malfunctions. In the day when 
 food is far better, more constant, and when the art of 
 its preparation is most perfected, when life is more 
 orderly and temperate, dyspepsia is said to be far more 
 prevalent than ever before. The influence of civiliza- 
 tion upon the eye is also not recognized as being so 
 highly different from that in previous ages of man or 
 animal. The value of vision to the organism is so 
 great that any other organ and even all others must be 
 made to endure the injury rather than that of vision. 
 Hence the whole system must often become the vicari- 
 ous sufferer for the sins of the eye. To this is also 
 added the powerful action of sexual selection. The 
 eye is so absolutely essential to beauty that in women 
 especially, inflammation, the natural result of malfunc- 
 tion, must not be allowed to harm its appearance. 
 Headache, nutritional and other inhibitions, and multi- 
 form reflex neuroses, are the inevitable results. It is 
 impossible for nature, who never made anything per- 
 fect or symmetric, to make the eye an optically per- 
 fect instrument, either organic or functional. Helm- 
 holtz said of the eye that if his optician were to send
 
 RESPONSIBILITIES. 205 
 
 him such an instrument he would return it for altera- 
 tions. The least optical imperfection may endanger 
 the organism and prevent success, and the efforts of 
 compensation, especially in civilization, become as pain- 
 ful as are all excessive and continuous efforts, and even 
 more so, because of the delicacy of the mechanism and 
 the infinitesimal nature of the stimulus. 
 
 2. Modern medical science has been expending all 
 its strength and intellect on the discovery of the causes 
 of infectious disease and on the treatment of organic 
 disease. In essence the plan was good but the neglect 
 of other things was not good. There is a tragedy in 
 the neglect of non-infectious and functional diseases, 
 which do not cause so many deaths, but which do cause 
 vastly more direct suffering than the organic and germ 
 diseases combined. And the scientific medical man is 
 also forgetful of the fact that functional disease is the 
 cause of much organic disease. Evolution itself is the 
 formation and modification of habits. At least 80 
 percent or 90 percent of headaches and a very large 
 proportion of digestional or nutritional diseases are 
 dependent upon eye-strain, and these headaches and 
 digestional disorders together are direct or secondary 
 sources of a large part of the functional diseases and 
 misery of the world. 
 
 3. Science and even medical science is slow to recog- 
 nize the unity of the organism and the close interrela- 
 tion of its parts. " The passing of the reflex " has
 
 2o6 BIOGRAPHIC CLINICS. 
 
 even filled medical journals with jubilations. But the 
 reflex remains. All physiology, in method of mechan- 
 ism, is little else than a system of reflexes, and there is 
 no escape from the much ignored truth that pathology 
 is morbid or abnormal physiology. Hence the origin 
 of the disease is very frequently morbid reflexes. 
 
 4. The general physician has not failed to add to the 
 neglect of " the ophthalmic gospel " by consciously and 
 unconsciously ignoring v^hat should have been his 
 noblest opportunity. " Curing " headache and dyspep- 
 sia by drugs and vi^ithout curiosity as to cause, " cur- 
 ing " these in the same patient at frequently recurring 
 intervals for years — this is neither medicine nor morals. 
 It is an unpleasant subject, a hateful truth, but one 
 must speak if frankness is advisable and error w^rong. 
 Every week books, editorials, and articles still appear 
 upon neurasthenia, vertigo, headache, stomach-dis- 
 eases, etc., in .which not a word is said as to the great- 
 est single cause of these disorders. 
 
 5. The lay world, so far as it has any opinion on the 
 question, thinks that spectacles are only to enable one 
 to read and write when old age has begun to appear. 
 No one likes to admit the oncoming of old age, even 
 to himself, and so profound is the influence of pride 
 and sentiment that they have been potent causes in 
 preventing the needed adoption of one of the greatest 
 reforms and blessings in the world. " It is so sad to 
 see bespectacled children and young people ! " But if
 
 RESPONSIBILITIES. 207 
 
 they are needed it is infinitely more sad to see them 
 without spectacles. 
 
 6. There is an almost universal belief on the part 
 of the laity that glasses are not needed because the 
 (distant or about-the-room) vision is good or supposed 
 to be perfect. " If the eyes do not hurt, and the vision 
 is good, then," the popular logic is, " of course glasses 
 cannot be needed." The truth is that the morbid dis- 
 tant reflexes to the head, stomach, etc., take place only 
 when the vision is good and the eyes do not suffer. It 
 is when the neutralization of the ametropia is possible 
 and is attained with intense though perhaps uncon- 
 scious exertion, when the eye does not suffer or lose 
 clearness of vision — it is then that most commonly 
 appear the reflexes of dyspepsia, biliousness, headache, 
 etc. 
 
 7. The want of the requisite accuracy and scientific 
 attention to detail on the part of the oculists makes it 
 difficult in the greater part of the civilized world to 
 obain a diagnosis of errors of refraction which shall 
 be so precise as to give relief of the suffering that 
 flows from them. Few even of scientific men realize 
 the infinitesimal conditions and forces they are dealing 
 with. The eye responds to a stimulus many millions 
 of millions times more slight than the ear; the entire 
 defects of the eye upon which eye-strain depends, con- 
 cern only 1/200 or 1/300 of an inch in the measure- 
 ments of diameters and curves; the evolution of the
 
 2o8 BIOGRAPHIC CLINICS. 
 
 eye is such that civiUzation puts it to a new function 
 in recent years for which it was not created or hab- 
 ited. The success of the animal or savage depended 
 on sharp distant vision; that of the city-dweller usu- 
 ally on sharp near vision, which requires a different 
 ocular mechanism. 
 
 8. Oculists have also trusted too much in instru- 
 ments and the objective methods of diagnosing ame- 
 tropia. The subjective method, with mydriasis, when, 
 as is usual, it is possible, is the sole reUable method. 
 It is physiologic optics with which we have to deal, not 
 mechanic; the living ever-varying eye, not the refrac- 
 tion, e. g., of a piece of glass. There is in all medicine 
 no work requiring such untiring patience, almost in- 
 finite expertness, and broad-minded perfection of judg- 
 micnt, as the solution of the problems of refraction. 
 
 9. Ophthalmologists have been derelict in their duty 
 in giving way to popular prejudice, in seeking surgi- 
 cal success, while indifferent to the higher and nobler 
 function of preventing disease by means of the relief 
 of eye-strain. Men nine-tenths of whose office work 
 and income is from refraction will make up their so- 
 ciety programs with papers nine-tenths of which con- 
 cern operations, tumors, and inflammatory diseases. 
 
 10. Scientific ophthalmology has been hurt by the 
 absurd faddism of the muscle-cutters. The failure of 
 their wild enthusiasm and exaggerated claims has nat- 
 urally disgusted the professional and lay world with
 
 RESPONSIBILITIES. 209 
 
 the whole specialty, and in this way has withdrawn 
 attention from refraction, the real source of manifold 
 reflexes and of muscle-imbalances themselves. 
 
 II. In his proper art and work the optician has usu- 
 ally been so backward, and in his impertinence and 
 assumption so forward, that both have conspired to 
 engender disappointment and disgust. Few opticians 
 can rightly do their legitimate work, the making and 
 fitting of spectacles. And this is because they are 
 striving to do the physician's duty. It should be as 
 illegal and impossible for an optician to sell a pair of 
 lenses without a physician's prescription as it is for 
 a druggist to sell poison without medical warrant. 
 The latter kills instantly, the other slowly. 
 
 I have chosen to study only five men whose occupa- 
 tion demanded much " near work " with their eyes. 
 Those selected have been such as the accidents of bor- 
 derland reading called to my attention. In the lives 
 of a number of others I found no suggestion of the 
 pernicious influence of eye-strain upon life and labor. 
 In the biographies and letters of others there are the 
 most striking suggestions of this truth, but however 
 convincing to me, they would not at present be so to 
 others. The Berlin oculist Liebreich was certain that 
 the peculiar character of Turner's pictures was due to 
 his astigmatism, and that if they are viewed through 
 proper astigmatic lenses, these paintings would appear 
 as those of other painters with normal eyes. The
 
 2IO BIOGRAPHIC CLINICS. 
 
 musician Tschaiko wsky was troubled all his life by 
 sleeplessness, fatigue and depression, and in his 
 thirty-seventh year he had a complete nervous col- 
 lapse. The necessity of gleaning the few significant 
 clinical facts of a man's life from the modern slip- 
 shod, unworkmanlike, unindexed biography, .with its 
 inattention to those matters of the most profound im- 
 portance, makes it difficult in the few, but, impossible 
 in the many, to get the data for making up a true 
 picture of the real physical and physiologic man. 
 Doubtless many other literary and scientific workers 
 have been and still are sufferers from the same cause 
 as the five cited. Surely the foolish excuse offered 
 that their great mental labor caused their ill-health is 
 the veriest nonsense. Their mental strain was no 
 greater for them than it is for thousands of their col- 
 leagues, and for millions of workers in other fields of 
 intellectual labor. The particular lesson of their lives 
 is of value as we learn and apply it to others who are 
 to-day enduring the same agonies, unconscious, as were 
 they, of the true nature of their malady. The saying 
 that " genius breeds upon dyspeptic soil," is as stupidly 
 untrue as any ever devised by ignorance and conceit. 
 And not only for the great and famous, the sound of 
 whose complaining may come to our ears, but for the 
 millions of the slaves of civilization who complain only 
 to their nearest friends and to their family physician. 
 Eye-strain is crippling the mental, moral, and physical
 
 RESPONSIBILITIES. 2 1 1 
 
 health of a certain proportion of all school children and 
 students. I believe this proportion is larger, but let us 
 say that it is only one in ten ; that in the civilized world 
 .would include at least 10,000,000 to 15,000,000. Then 
 there are the clerks, the hand workers in manufactur- 
 ing industries, the seamstresses, etc. — the large major- 
 ity of the inhabitants of civilized countries — whose eyes 
 are put to the same strain, and a certain portion of 
 whom we know have astigmatic and other ocular de- 
 fects causing eye-strain. 
 
 There are several ways of answering the indifferen- 
 tist and the unconvinced. The question is capable of 
 easy and certain decision, so soon as the present indo- 
 lent skepticism shall give way to intelligent interest. 
 
 1. Examine the evidence! There are hundreds of 
 honorable conservative physicians who have put their 
 experiences on record or who would willingly testify 
 that eye-strain is often the cause of the disorders such 
 as those of our five patients. It would be easy to 
 gather from medical literature an astonishing mass of 
 reports of cures of these affections by the relief of eye- 
 strain. The suggestion would call up in the minds of 
 most American oculists memories of a large number of 
 patients who have been cured in this way of precisely 
 the same symptoms as those of the five examples chos- 
 en. I know one who would bring the proofs of several 
 thousands of such cures. 
 
 2. Make the actual test. Every person has several
 
 212 BIOGRAPHIC CLINICS. 
 
 acquaintances who are great sufferers from headache, 
 " biliousness," vertigo, dyspepsia, etc., not due to 
 organic disease. Let such a person be taken to an 
 expert refractionist, and if spectacles are needed, let 
 them be prescribed after cycloplegia and subjective 
 testing. If one case does not convince, there is no diffi- 
 culty in finding subjects for a hundred repetitions. 
 
 3. Try the test for differential diagnosis — the in- 
 stillation, the patient being under professional care, in 
 the eyes, once daily, of a solution of atropin (four 
 grains to the ounce), for ten days. If the symptoms 
 are due to eye-strain, and if not so chronic as to have 
 induced organic changes, the paralysis of the muscle 
 of accommodation will give almost immediate relief. 
 
 4. Reverse a few tests. There are many thousands 
 of American patients who have learned that the spec- 
 tacles they have been wearing cured them of these 
 symptoms and who find that when the refraction 
 changes, as it often does, when lenses are broken or 
 badly fitted, there is at once a return of the old symp- 
 toms. Secure the cooperation of such patients in 
 human vivisection experimentation, and get them to 
 stop wearing their glasses for a week or two. 
 
 5. Produce the symptoms in a new case. Take a 
 well and uncomplaining person and get him (or her) 
 to wear a pair of astigmatic and anisometropic spectacle 
 lenses, the same as are prescribed by oculists for the 
 cure of these reflex symptoms. Such spectacles will
 
 RESPONSIBILITIES. 2 1 3 
 
 produce artificially the same ametropia as exists nat- 
 urally in other patients, and they will also produce the 
 symptoms complained of by Darwin and the rest. 
 
 This theory is at least a working hypothesis, and as 
 there is admittedly no other scientific etiology of these 
 affections worth consideration, and no cure that cures, 
 it behooves the entire profession to test the hypothesis 
 most seriously and vigorously. Mere indifference, 
 neglect, or contempt, will not longer answer the de- 
 mands either of an earnest philanthropy, or of a digni- 
 fied science.
 
 INDEX. 
 
 Accommodation failure — in Carlyle 70 
 
 in Darwin 98 
 
 in De Quincey 35 
 
 in Huxley 120 
 
 Accommodative effort ceases in walking 30 
 
 Aphoses, part of in resensitizing retina 160 
 
 Arteries and veins of eye, part of in resensitizing retina.. .. 160 
 
 Artificial light in 1780-1870 35 
 
 Artificial lighting, necessary reform in methods of 168 
 
 Astigmatic lens, invention of 181 
 
 Astigmatism and eye-strain, discovery of i73 
 
 and eye-strain, prevalence of 211 
 
 diagnosis of, methods used by Dr. Dyer 182 
 
 effect of relieved by opium 39 
 
 in Browning's case 136 
 
 in Carlyle's case 65 
 
 in Darwin's case 103 
 
 in De Quincey's case 34 
 
 in Huxley's case 117 
 
 physiology of 1 74 
 
 recognition of pathologic significance 184 
 
 Biliousness and Headache 143 
 
 and quackery I45 
 
 Carlyle's 66, 67 
 
 Binocular vision, function of 163 
 
 Browning 125 
 
 clinical facts concerning 122 
 
 Browning's ailment and heredity X38 
 
 astigmatism 136 
 
 215
 
 2i6 INDEX. 
 
 Browning's exercise in the open air 133, 139 
 
 health in youth 132 
 
 physiologic habits 132 
 
 Carlyle 41 
 
 and De Quincey 23 
 
 clinical facts concerning 43 
 
 exercise in the open air . . , ^. 61 
 
 first appearance of symptoms 57 
 
 Carlyle's — biliousness 66, 67 
 
 constitution S8 
 
 complaints, Froude's interpretation of 62 
 
 " gastrodynia " 68 
 
 insomnia 60 
 
 lesson on health 73 
 
 opinion of the medical profession 66 
 
 physiologic habits 59 
 
 second critical period 60 
 
 self-medication 65 
 
 symptoms 62 
 
 use of tobacco 59 
 
 work and symptoms, a comparison 69 
 
 Cases of Carlyle, Huxley, Darwin, and Browning compared.. 134 
 
 Case-records, preservation of 12 
 
 Character influenced by eye-strain 88 
 
 Charles Darwin 77 
 
 Clinical data — concerning Browning 127 
 
 concerning Carlyle 43 
 
 concerning Darwin 79 
 
 concerning De Quincey 17 
 
 concerning Huxley 109 
 
 life-problem of patients must be studied 10 
 
 Comparison of cases of Darwin, Huxley, Carlyle, and Brown- 
 ing 134 
 
 Constipation and eye-strain 66 
 
 Critical period, second — of Carlyle 60 
 
 of Darwin 97
 
 INDEX. 217 
 
 Critical period, second— of De Quincey 32 
 
 of Huxley 117 
 
 Cylindric lenses, first made in America 1 78 
 
 Darwin 77 
 
 clinical facts concerning 79 
 
 and presbyopia 102 
 
 Darwin's — alleged sea-sickness, explanation of 90 
 
 early life, idleness of 89 
 
 father's diagnosis 95 
 
 first two years ashore 95 
 
 literary product 103 
 
 loss of physical vigor 99 
 
 period of accommodation failure 98 
 
 second critical period 97 
 
 South American illness 94 
 
 state as analyzed by Dr. W. W. Johnston 104 
 
 symptoms and " neurasthenia " 106 
 
 Definition of eye-strain 150 
 
 De Quincey i5 
 
 and Carlyle .^ 23 
 
 beginning of headaches 27 
 
 clinical facts concerning i7 
 
 conscious of eye-trouble 35 
 
 disease from which he suffered 34 
 
 evidences of exophoria 36 
 
 exercise in the open air 29 
 
 first use of opium 28 
 
 nonuse of spectacles 38 
 
 portrait, deductions from 36 
 
 use of but one eye 37 
 
 De Quincey's — attack of " nervous horror " 29 
 
 dreaming tendencies 25 
 
 relapses into opium-addiction 3i 
 
 Diagnosis — by Darwin's father 95 
 
 differential, in eye-strain 212 
 
 of astigmatism by Dr. Ezra Dyer 182 
 
 15
 
 2i8 INDEX. 
 
 Diagnosis of Darwin's state by Dr. W. W. Johnston 104 
 
 Differential diagnosis in eye-strain 212 
 
 Digestional disorders and eye-strain 203 
 
 Discovery of astigmatism and eye-strain 173 
 
 Disease — from which De Quincey suffered 34 
 
 not caused by intellectual activity 70, 99, 120 
 
 phases of interesting to the profession 9 
 
 Dreaming-tendencies of De Quincey 25 
 
 Dyer, Ezra — and diagnosis of astigmatism 182 
 
 first use of test-types 183 
 
 Dyspepsia, beginning of — in Carlyle 58 
 
 in Darwin 100 
 
 in De Quincey 33 
 
 in Huxley 116 
 
 Effect of early study on Darwin 90 
 
 Etiologic factor, eye-strain as an 204 
 
 Exercise — Darwin's loss of ability for 99 
 
 in open air and accommodative effort 30 
 
 by Browning 133, 139 
 
 by Carlyle 61 
 
 by De Quincey 29 
 
 by Huxley 115 
 
 physical, necessity for 30 
 
 Exophoria, De Quincey 36 
 
 Experimentation proof of effects of eye-strain 212 
 
 Eye, use of but one by De Quincey 37 
 
 Eyebrow — function of 163 
 
 growth of in old age 164 
 
 Eye-defect — analysis of Browning's 136 
 
 of Carlyle's 64 
 
 of Darwin's 98 
 
 of De Quincey's 36 
 
 of Huxley's 121, 122 
 
 Eyelashes, function of the 162 
 
 Eyes, constant movement of 163 
 
 Eye-strain and astigmatism, discovery of 173
 
 INDEX. 
 
 219 
 
 Eye-strain — and astigmatism, prevalence of 211 
 
 and constipation 66 
 
 and digestional disorders 203 
 
 and insomnia 33 
 
 as an etiologic factor 13, 24, 204 
 
 defined 150 
 
 De Quincey conscious of 35 
 
 differential diagnosis in 212 
 
 experimentation proof of effects of 212 
 
 factor in functional diseases 13, 24, 204 
 
 influence of on disposition, character, vocation, etc. ... 28, 88 
 
 recognition of pathologic significance of 184 
 
 reflexes of 204 
 
 Failure of accommodation — in Carlyle 70 
 
 in Darwin 98 
 
 in De Quincey 35 
 
 in Huxley 120 
 
 Fatigue of retina and reestablishment of sensibility 159 
 
 Froude's — interpretation of Carlyle's complaints 62 
 
 self-contradictions 58 
 
 Functional diseases — eye-strain a factor in 13, 34, 204 
 
 ignoring of 149, 205 
 
 " Gastrodynia " — as Carlyle's ailment 68 
 
 and De Quincey 22 
 
 Habits, physiologic — of Browning 132 
 
 of Carlyle 59 
 
 Hats, reason for wearing 165 
 
 Headache and biliousness 143 
 
 Headaches — ametropic 31 
 
 beginning of De Quincey's 2^ 
 
 recurring, " cure "of 206 
 
 study of 152 
 
 Health — Carlyle's lesson on 73 
 
 of Browning in youth 132 
 
 " Heart-disease " and Huxley's ill-health 115 
 
 Heredity and Browning's ailment 138 
 
 Horror, nervous, De Quincey's attack 39
 
 220 INDEX. 
 
 Humoral pathology i44 
 
 Humoral theory, the 143 
 
 Humors of the Body I43 
 
 Huxley 109 
 
 and astigmatism 117 
 
 and presbyopia 117 
 
 beginning of dyspeptic symptoms 116 
 
 Huxley's — exercise in the open air 115 
 
 eye-defect, analysis of 117 
 
 habits of study 114 
 
 " heart-disease " 115 
 
 partial relief from symptoms 121 
 
 Ignoring of functional diseases 149, 205 
 
 Ill-health — and intellectual effort 70, 99, 120 
 
 Browning's, and heredity 138 
 
 of Huxley and " heart-disease " 115 
 
 Illness of Darwin in South America 94 
 
 Insomnia — and eye-strain 33 
 
 of Carlyle 60 
 
 Intellectual effort and ill-health 70, 99, 120 
 
 Introduction 9 
 
 Invention of astigmatic lens 181 
 
 Iris pigmentation 162 
 
 Johnston, Dr. W. W., opinion of Darwin's ailment 104 
 
 Knowledge without health valueless 7 
 
 Lens, astigmatic, invention of 181 
 
 Lenses, cylindric, first made in America 178 
 
 Life-histories, clinical, and physiologic, of patients 12 
 
 Life influenced by eye-strain 88 
 
 Life-problem of patients most important 10 
 
 Lighting, artificial — in 1 790-1870 35 
 
 reform in methods of 168 
 
 Literary product — Carlyle's 71 
 
 Darwin's 103 
 
 Medical profession, Carlyle's opinion of 66 
 
 Mitchell, Dr. S. Weir, recognition of pathologic significance 
 
 of astigmatism 184
 
 INDEX, 221 
 
 Mottoes 7 
 
 Movement of eyes 163 
 
 Muscae volitantes, part of in resensitizing retina 161 
 
 Mydriasis, necessity for 208 
 
 Necessity — for mydriasis 208 
 
 for physical exercise 30 
 
 Neglect of functional diseases 149, 205 
 
 Nervous horror, De Quincey's attack 29 
 
 " Neurasthenia " and Darwin's symptoms 106 
 
 Ocular headaches 31 
 
 Ophthalmology, Philadelphia School of 196 
 
 Opium-addiction, De Quincey's relapses 31 
 
 assistance of, in relieving effect of astigmatism 39 
 
 De Quincey's first use of 28 
 
 effect of, on the teeth 24 
 
 Optician, duties of 24 
 
 Pathogeny of disease interesting to philosophic physicians 
 
 only 10 
 
 Patient's entire history makes life-problem 10 
 
 Philadelphia School of Ophthalmology 196 
 
 Phosphenes, part of in resensitizing retina 160 
 
 Picture-frames, effect of on vision 167 
 
 Pigmentation — around the eye 161, 162 
 
 of iris 162 
 
 Pigment of retina, part of in conserving sensitization of the 
 
 retina 161 
 
 Physician, true, usefulness of 7 
 
 Physiologic habits — of Browning 132 
 
 of Carlyle 59 
 
 Physiology — of astigmatism 174 
 
 of vision, some neglected points in 158 
 
 Presbyopia — and Huxley 117 
 
 influence upon Darwin 102 
 
 on Carlyle 58 
 
 Prevalence of astigmatism and eye-strain 211 
 
 Pupil, alternate contraction and dilation of 162 
 
 Quackery and biliousness 145
 
 2 22 INDEX. 
 
 Recurring headache, " cure " of 206 
 
 Reflexes, increased intensity during failure of accommodation . 32 
 
 of eye-strain 204 
 
 Responsibilities 199 
 
 Retina, how it is resensitized 160 
 
 Retinal — fatigue and reestablishment of sensibility 159 
 
 pigment, conserving action in sensitization of retina.... 161 
 
 resensitizing, part of muscae volitantes 161 
 
 part of phosphenes, phoses, or aphoses i6o 
 
 part of veins and arteries 160 
 
 Robert Browning 127 
 
 Science justified by verification 7 
 
 Sea-sickness, Darwin's alleged explanation of 90 
 
 Self-medication, Carlyle's 65 
 
 Some Neglected Points in the Physiology of Vision 158 
 
 Spectacles — careless use of 65 
 
 non-use of by De Quincey 38 
 
 when needed, popular ideas concerning 207 
 
 Stimulus, interruption of in retinal function 164 
 
 Stomach disorder — Carlyle's 58 
 
 Darwin's 100 
 
 De Quincey's 33 
 
 Huxley's 116 
 
 Study, Huxley's habits of 114 
 
 Study of headaches 152 
 
 Symptoms — and work, Carlyle's, — a comparison 69 
 
 Carlyle's 62 
 
 late appearance in Carlyle 57 
 
 partial relief of in Huxley 121 
 
 Systematic and periodic study of phyiologic and medical tests 
 
 of patients throughout life 12 
 
 Teeth and opium 24 
 
 Test-types, first used by Dyer 183 
 
 The Discovery of Astigmatism and Eye-strain 171 
 
 Thomas Carlyle 43 
 
 Thomas De Quincey 17 
 
 Thomas H. Huxley 109
 
 INDEX. 223 
 
 Tobacco, use of by Carlyle 59 
 
 'Tschaikowsky, probable astigmatism of 210 
 
 Turner, probable astigmatism of 210 
 
 Usefulness of true physician 7 
 
 Veins and arteries of eye, part played in resensitizing the 
 
 retina 160 
 
 Verification the justification of science 7 
 
 Vision — binocular, function of 163 
 
 some neglected points in physiology of 158 
 
 Vomiting, Darwin's 100 
 
 Walking and accommodative effort 30 
 
 effect on ocular accommodation and reflexes 30 
 
 necessity for in persons suffering from astigmatism 30 
 
 Winking, function of 162 
 
 Work and symptoms, Carlyle's — a comparison 69 
 
 Yellow choler 145
 
 UNIVERSITY Ot CALltUmMA i.ioiv/vxvi 
 
 Los Angeles 
 This book is DUE on the last date stamped below. 
 
 * NOV 17 1963 
 
 ■■ HOVlORECT) 
 
 HEC'D LD-URU 
 
 13/ 
 
 10(2554)444
 
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