errors of refraction, I believe there are some cases practically cured. I have personally seen many cases in which the choreic manifestations were very markedly lessened by the correction of errors of refraction when by suitable medicinal treatment the same effect was not produced. In fact, when the glasses were left at home, for instance when attending school, choreic manifestations over and above the ordinary were developed, and disappeared as soon as the glasses were resumed.

I also wish to speak of the so-called latent errors the doctor calls attention to. I think this is a great bugbear on which the family physician often fails. If the little school child is able to read test type at 20 feet, which according to the generally accepted rule should be read at 20 feet, the parents and teachers and often the family physician are deluded with the idea that the eye is perfect ; that there is not much trouble or the child could not read at that distance. Very frequently the parents, and possibly the family physician, also, do suspect an error and will refer them to the ordinary jeweler or optician. He uses the subjective test, and if the patient will not accept either a concave or a convex lens, the optician is likely to say "I find no difficulty." More frequently, though hypermetropic, they will admit seeing the letters a little more distinctly with the concave lens, and every oculist, I am sure, has had more than one experience with concave lenses when hypermetropia was the error. The reason is, the error is latent. That error may be very large, amounting to from three to four diopters, all of which are latent and none manifest. The correction of this error is absolutely demanded in order to give the child relief. I might say also that the manifestation of this error in blurred vision in reading comes about, perhaps, after many years of very comfortable use of the eye and is due entirely, perhaps, to deficient digestion or some other ailment like whooping-cough or measles, which for the time being has rendered the patient unwell.

Dr. F. C. Heath, of Indianapolis: Every well-informed and up-to-date practitioner certainly now recognizes the frequency of eyestrain as the cause of headache. There is a difference of opin

ion as to its frequency and much difference as to its producing other reflex disturbances. Now it was not the oculist that first drew the attention of the profession to this question, but a neurologist Dr. Weir Mitchell, of Philadelphia. Indeed, if you will read the text book of Dr. Osler and look for the etiology of that condition, excessive acidity of the stomach, you will find he mentions hypermetropia as one cause. If hypermetropia may cause such nervous disturbances of the stomach, much more apt is astigmatism, which is a much more potent factor in the causation of eyestrain. You perhaps have read more or less in the literature of the writings of Dr. Gould, of Philadelphia, upon this subject. You may know he has taken what many consider very extreme ground. He has said that all or practically all of migraine is due to eyestrain. He has written a series of essays called "Biographical Clinics," in which he has gone into the symptoms of celebrated people like Carlyle. Huxley, Darwin, Spencer and others, and has attributed their symptoms to eyestrain. His conclusions have not been very generally received with favor. But, gentlemen, although I said a year ago that I thought he was an extremist, I wish to modify the statement then made. I believe he is somewhat overenthusiastic, but it is as a reformer. Every reformer is apt to be overenthusiastic and the rest of us follow far enough behind. He is enthusiastic, but enthusiastic in the right direction, and if not absolutely right he is very near it, and I say this as a correction of my statement last year because of this fact. When I spoke then I had seen these books and had read the unfavorable criticisms. I had read a few words in them, and had laid them down and joined in the general cry against them. Since then I have read the books very carefully, and I want to say now to any of you gentlemen who will read the "Biographical Clinics," you will concede that he makes a very strong argument for his side of the case. He endeavors to prove that the symptoms of ill-health of Carlyle, Mrs. Carlyle, Browning, George Eliot and others given in his book were due to eyestrain. I realize that my position is something like the man who, at a Democratic gathering, was trying to sell some pups. He said

they were fine Democratic pups. A short time afterward he tried to sell the same pups at a Republican gathering and said they were fine Republican pups. Some one said, "How is this; I thought they were Democratic pups?" The man said, "Yes, but they have got their eyes open now." Since reading the books I have got my eyes open and realize that I was somewhat in the wrong. And while I am not yet ready to go as far as Dr. Gould, especially on the subject of migraine, I believe he is taking advanced ground in the right direction, and I would be glad if the gentlemen present would make an investigation of their own and join in the movement, which I believe is in the right direction.

Dr. G. V. Woollen, of Indianapolis: I have for a long time hesitated to say what I am going to say. This seems to be an opportune time, and I make the observation for the benefit of the brethren interested along this line. It has seemed to me first that we have only half approached the subject when we say this eyestrain is due to hypermytrophia or astigmatism. It seems to me there must be some cause behind that. I have had numerous cases come to me, after the eyes had been supplied with glasses, to look after the nose, and I have frequently observed what I want to announce as to a great number of these cases, that after the ethmoidal diseases present has been controlled how many can lay their glasses away. Now that may teach something or it may not teach something, but that has been my observation, and many of you who give attention to the nose and eye both ought to have a chance to prove this better than I, but it has been an observation of my own for years.

Dr. W. N. Sharp, of Indianapolis: Of course we like to know what the text-books say on any subject, but after a man has had nearly a quarter of a century of actual experience he begins to believe some things that have come within his own field of observation. We can not look upon these things lightly, and we must have some faith in things that are actual facts, proven by experience. I have seen many cases of headache relieved by the proper correction of errors of refraction, and many other nervous dis

turbances relieved, which I have cited in the paper. I think a man who has practiced a number of years should state facts that have come within his own experience, and not depend upon the experience of someone else even in the same field of work.

Dr. Bulson spoke of the four o'clock headache. I think this is particularly an eyestrain headache. It is found in children, bookkeepers and clerks, and I have seen many such cases relieved by correction of the refraction. I believe where the general practitioner has failed to relieve these headaches by other means that the eyes should certainly receive attention.

HEADACHE AS A SYMPTOM.

BY J. F. HICKS, M. D., OF ARCADIA, IND.

Headache is, of course, always a symptom and never a disease, and because of this fact a careful research should always be made to find the cause, and the causes of headache are numerous; but I can discuss only the more practical and important in this paper. It is of especial importance to examine with reference to rheumatism of the scalp, gastrointestinal disorders, ocular defects in its various forms, neurasthenia, hysteria, anemia and uterine conditions, the existence of nasal disease, particularly inflammation of the frontal and ethmoidal sinuses. These should be considered as the cause of functional headache. Less frequently, but far more important, from a diagnostic standpoint, is headache seen in persons suffering from renal disease, brain-tumor, brain-abscess and meningitis in its various forms. The causes, or some of the causes of this class are cranial periostitis, middle ear disease, syphilis, acute inflammation of the eye or in the jaw.

The most common cause of headache is probably disorder in the function of the digestive apparatus, which is accompanied by evidences of such disorder, consisting of gastric or intestinal distress, hiccoughing or vomiting, or even diarrhea. Often there is a distinct history of the ingestion of indigestible food, or digestion-disturbing drink, but in other cases exposure to cold so congests the abdominal viscera that catarrh of the stomach and bowels is induced, and with it congestion of the liver, followed by jaundice. The headache of disturbed digestion is nearly always frontal and of a pulsating character, and in many cases congestion to such an extent that the face is flushed, or at least the intracranial circulation is so disturbed that the patient is unable to lower the head because such a position increases the pain. Such cases are relieved by hot foot-baths, which relieve the congestion of the