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The Pamphlet Collection of Sir Robert Stout: Volume 78

The Gravity of Asthenopia

The Gravity of Asthenopia.

It is impossible to appreciate the true import of Dr Ferguson's paper without a considerable knowledge of the brain and nervous system. To the layman a failure in eyesight suggests simply a defect of the eye, or, at most, of the nerves, but the asthenopia from school overpressure, of which Dr Fergnson speaks (and of which I have myself seen cases even in country schools) is the manifestation of a break-down in the brain itself; it is a form of neurasthenia, an affection of the brain and nervous system, and may directly lead up to migraine, chorea, hysteria, epilepsy, or other neuroses, or may end in sleeplessness and insanity. In no case can accommodative asthenopia be regarded as a malady limited in its results to restricted areas of the brain. The whole brain—the whole organism, indeed—is secondarily affected in such cases (nerves, muscles, glands, etc.), and the nutrition, growth, and vitality of the body are bound to suffer more or less. In discussing the causation of mental disease Dr Clouston says :

There is in the brain an extreme complexity of tissues, fibres, and groupings, and an extreme delicacy of structure, these corresponding, no doubt, to the multiformity, complexity, and delicacy of its functions. There is an obvious interdependence of parts, a localisation of structures and functions, and yet a real solidarity of the whole brain in structure and function. . . . Localisation is never complete, and solidarity is never perfect.

The brain has fixed limits of energising in all directions. Hence the danger of causing exhaustion or paralysis of function by coming too near those limits or overstepping them.

Two thousand five hundred years ago the Greek Dhilosophers recognised clearly enough this interdependence of different parts of the organism. I find the following in Plato's dialogues:—A youth complains to Socrates that he is subject to headache when he rises in the morning, and the philosopher says (Jowett's translation) :—"I daresay that you have heard eminent physicians say to a patient who comes to them with bad eyes that they cannot cure his eyes by themselves, but that if his eyes are to be cured his head must be treated : and then, again, they say that to think of curing the head alone and not the rest of the body also, is the height of folly. And, arguing in this way, they apply their methods to the whole body, and try to treat and heal the whole and the part together." The subject of the Dialogue in winch this passage occurs is, says Jowett, a "peculiarly Greek notion," expressed by a word for which we have no exact counterpart, combining, as it does, the ideas of Temperance, Moderation, Wisdom, etc. "It may be described as 'mens sana in corpore sano.' the harmony or due proportion of the higher and lower elements of human nature which 'makes a man his own master.'"

One can only regret that some of the practical common sense and wisdom of the Greeks has not come down to us in our schools along with their language.

In the light of the wisdom of the ages, and the practical experience of physicians of today, I think it will be agreed that I was more than justified in writing nine years ago, and in repeating recently at the Froebel Club, the following passage :—

It is extremely important that parents and guardians should clearly recognise that prolonged and excessive mental strain and neglect of exercise, recreation, and rest, especially among girls, during the period of rapid growth and development, cannot be continued without an ultimate dwarfing of both mind and body, and grave peril to the integrity of the organism. In the stress of competition for honors and prizes the brain is so often worked at the verge of the breaking strain, to the neglect of everything else, that one is inclined to wonder that entire mental collapse does not result more frequently.

Dr Lindo Fergusson, speaking as a special ist dealing directly with one field only of the brain and nervous system, told us that in the circumscribed area within which his work fell there had taken place, up to 1899, 175 cases of nervous breakdown associated with cur school conditions. If he were to speak now we may assume that he could cite 250 cases, although, as he implied, only a fraction of the sufferers would come into the hands of "specialists," seeing they had. "no opportunity of examining school children "except in the particular cases brought under their notice in the course of practice.

In the monograph on "Neurasthenia," by Dr Gilbert Ballet and Dr Proust (Professor to the Faculty of Medicine of Paris and Inspector-General of Public Health), occurs the following passage :—

Neurasthenic asthenopia, is often tenacious; it may come on in attacks of longer or shorter duration, or it may be con- page 32 tinuous; it then becomes a cause of despair to the patients, and contributes powerfully to aggravate their cerebral depression.