THE ESTHETIC RELATIONS OF MEDICINE 
AND LIFE.' 
Every physician has doubtless often stumbled upon some sur- 
prising and interesting facts in reference to his patients in which 
the question of disease viewed simply cosmetically, or estliet- 
ically, had most serious and even tragical effects ? The most 
astonishing instance that has come to my personal knowledge is 
that a certain large railroad will not allow its employees to wear 
spectacles. There is of course nothing in the printed or enacted 
rules of the company to this effect, and whether it is an unwritten 
law of which the chief officers are conscious, or whether it is the 
result of the superintendent’s special prejudice, I am unable to 
say. The fact, however, is one that might be well-made the 
subject of official inquiry and legal enactment. In the case of 
the Army and Navy regulations the matter is somewhat 
different, because here the frequent impossibility of replacing 
the easily-broken lenses, their positive disadvantage in storm, 
wind, etc., makes the rule at least somewhat morfe sensible and 
justifiable. Probably, however, few know to what an extent 
the single item of errors of refraction is the sole reason for 
excluding otherwise sound men from the Army and Navy ser- 
vices. A careful examining surgeon assures me that perhaps 
George M. Gould, A.M., M.D., Philadelphia. 
1 Read before the American Academy of Medicine, at Denver, June 4, 1898. 2 
one-half are refused on this ground alone. With proper specta- 
cles probably 90 per cent, of these could be given perfect vision. 
But in the cases of the railway brakerneu, engineers, firemen, 
signalmen, etc., the refusal to let them wear spectacles is not 
only diametrically against the company’s interests but it is 
against the safety of the traveling public. It is impossible to 
say how many accidents chargeable to so-called color-blindness, 
and to many other causes, have been due to the much more 
dangerous failure to see clearly because of errors of refraction. 
On this railroad the myopes, astigmatics, and presbyopes know 
their positions are in danger if they put on glasses, and so they 
continue to forego their use ; the foolish superintendent who 
knows nothing of glasses and of presbyopia except his silly 
belief that spectacles are a sign of old age leading to discharge 
of the servants, permits their vision (upon which the safety of 
his property and the lives of his travelers depends), to de- 
teriorate until signals cannot be seen by them. 
Another instance that has come to me is the pathetic struggle 
of a poor girl to hold her position as a waitress in a large 
restaurant. “ If the boss sees me with spectacles on, he will at 
once lay me off,” she said, and the non-wearing, as she has a 
hundred times proved, means an attack of violent sick headache. 
We offered to call upon the “boss,” and convince him of his 
error, but the attempt, she was sure, would result in her dis- 
charge,—as it had in many cases of which she knew. 
Many mistresses of “Christian” households will not permit 
their servants to wear glasses, however much they may be 
needed, and bespectacled nurses have found the prejudice active. 
Neither is it the man of the family who is the most opposed to 
bespectacled servants and nurses. Indeed I have usually found 
that it is the women themselves, who in this, as in some other 
matters, make the hardships and injustices against their own 
sex all the rqore poignant. In one similar case however, the 
male must bear the blame alone. Instead of preferring to be 
shaved by a man who can see accurately by the aid of glasses 
there are many long-eared fellows who increase the danger they 
run of being cut, by refusing to allow their barbers to wear 
spectacles. Their stupidity is of the same kind as that of the 
railway superintendents. 3 
A little glimpse into an amusing condition of the public mind 
as to facts and appearances was given me by the confession of 
an artist, an excellent painter, who derived a not inconsiderable 
annual income by painting “ black-and-blue” eyes so that the 
ecchymoses were entirely concealed,—the patients (clerks, etc.) 
thus avoiding loss of position or time, or at least escaping 
irritating guying by friends. 
The presence of skin-diseases is one of the most frequent 
causes of much concealed trouble and loss of employment. 
Skill and character cannot compensate for disfiguring dermal 
evidences of disease in the face. The public will not consider 
that the patient is probably the double victim of parental sin 
and of popular prejudice. Whether the doctor calls it eczema, 
or by a much worse name, is all one. The employer may give 
the poor sufferer two weeks to get rid of it, but after that—! 
One of the most pathetic and tragic instances of suffering, and 
worse than mere suffering I have ever known was caused by an 
unconquerable affection of the skin of a part of the face of an 
otherwise lovely woman. It finally actually wrecked her life 
and happiness. If one great college-president does not succumb 
to a huge naevus matemus, a hundred less sturdy persons will 
be conquered by a mother’s mark, bottle-nose, or pigmentary 
mole. Happily our art is progressively giving relief to many 
afflicted with such diseases. If it could discover some easier 
method of eradicating misplaced hair than by the slow electric 
method, thousands would be relieved of an annoyance that 
makes their lives full of chagrin. 
Surgery is now able to transform much downright tragedy 
into happiness. A snip of a pair of scissors, or a bit of helpful 
advice as to muscular habits, etc., have made many miserable 
stutterers free-speakers. One of the most brilliant examples I 
have seen was that whereby a harelip patient was transformed 
from a melancholic, dirty, doless wretch, into an active, bright, 
and useful man. An artistic surgeon is able by plastic opera- 
tions to do away with the deformities of faces that make trage- 
dies of the lives of their owners. There are thousands of such 
sufferers to-day whose lives might be brightened and elevated. 
The surgeon has of course in nearly every operation to consider 4 
the results of his work as regards the subsequent sightliness. 
Volumes might be written on the subject, and yet others on the 
beneficence of orthopedic surgery in restoring to normal looks as 
well as to useful work, the deformed, the ungainly, and the re- 
pulsive products of disease. Surely also prosthetic dentistry and 
surgery, have not been inspired solely or even chiefly by motives 
of utility. The ingenuity and money expended in these things 
is beyond calculation. 
An artificial eye has been described as a thing everybody else 
can see through except the patient. And yet one who has not 
investigated the subject has no adequate conception of the 
capital and skill required in this great industry. 
You all know Pascal’s famous remark about Cleopatra’s nose, 
and the history of the world. Many people’s noses have been 
so short that they had none at all, two zeros representing the 
condition. I have known but one instance in which the loss of 
the nose did not result in isolating and bestializing the unfortu- 
nate being. In one of the suburbs of Philadelphia, there is a 
woman, wholly hairless and noseless, and yet this hideous 
creature—believe it who can,—has been thrice married. I am 
told that, quite naturally enough, she is at present a widow. 
Whether “ grass,” or “ sod,” my informant did not say. The 
Italians have competitive contests in nasal beauty, and a dozen 
or two types of admired noses are distinctly classified, and prizes 
given accordingly to the proud owners. But the noseless man 
is worthy of profound pity in any land. My friend the late Dr. 
Parker, of St. Bouis, once rescued one such from living death by 
dissecting away the nail and fleshy parts of two distal phalanges 
of the man’s little finger, and binding it fast in the opened flaps 
of the skin of the boneless nose until it had united ; he then 
completed the rhinoplasty by amputating the finger and drawing 
the skin over this natural-artificial “ridge-pole,” giving the face 
a normal appearance. A patient of mine was changed from de- 
spair and ruin by an artificial nose, constructed by my friend Dr. 
Gaskill. We are gathering the literature of the subject for 
future publication. There have been quite a number of cases. 
The chief difficulty is to fasten the nose without irritating the 
nasal passages or the skin. In our case we had the bridge of 5 
heavy spectacle frames riveted through the artificial nose, and 
thus secured the gutta-percha substitute by the “hold” of the 
temple-pieces behind the ears. It was prevented from slipping 
downward toward the mouth by two bent prongs extending into 
the post-nasal cavities. I shall never forget the man’s gratitude, 
and his transformation from abject hopelessness to that of a 
bright and useful worker. Before this he could not get employ- 
ment and was an object of charity. 
Even artificial ears have been devised that remedied a dis- 
figurement which the growing and combing of hair hardly 
helped. Very few persons are conscious or ashamed of over- 
long ears, especially if they are well-furred, but no ear at all is a 
calamity. 
I hear of semiprofessional people whose specialty is massaging 
the wrinkles from the faces of those whose years are passing too 
swiftly. 
Did you know that the word wig, through several transforma- 
tions, comes from the Latin pilus? A book might be written 
(perhaps has been written) concerning the influence of the wig, 
and of baldness, in the world’s history. I am reminded of the 
long-past efforts of us schoolboys to develop a moustache by 
means of applications of grape-vine juice when I find how 
valuable is hair to the seven Sutherland sisters synchronously 
exhibiting their wealth of woman’s strength in half-a-dozen 
cities. Doubtless their reward, i. e., their pile, is far greater 
than that of the schoolboy! The nostrum-lists of infallible hair- 
restorers attests the popular belief that atrophied hair-bulbs may 
be again stimulated to functional activity. The myth of the 
search for the golden fleece is eternally young, and its priests 
are ever at hand,—likewise the fleeced ! 
In no part or specialty of the physician’s work does he come 
into so direct and constant contact with esthetic and unesthetic 
prejudice as in ophthalmology. The conscientious oculist is 
tormented by it every hour of his life. It becomes at times 
positively disgusting and maddening. His work is to stop neu- 
roses, headache, anemia, and reflexes of a hundred kinds, all of 
which are the great destroyers of health and of beauty. Eye- 
strain is the most potent of all causes of “crowsfeet,” and of 6 
pinched and suffering faces, and yet every second woman prefers 
the homeliness and the evidences of years not yet arrived, to 
what she considers the hideousness of glasses,—at least of 
spectacles,—and eye-glasses are often as helpless and as harmful 
as no lenses at all. I know one woman whose little remnant of 
mind is discarded because of her silly pride. Rather than wear 
glasses, she has given up all reading, writing, sewing, music, 
all occupation whatever, except calling, and gossiping, and 
theater-going. I know another who has turned her hnmp into 
a hysteric’s hospital for part of the year, and for the rest ot it she 
trundles her poor husband to watering places, and impoverishes 
him in paying doctor-bills. I have known women to hide from 
consciousness the fact that the cause of their relapses of “nervous 
prostration” was the eve-strain they would not allow to be cured. 
Periodically they take the “rest-cure,” get a little relief until 
they return to the bedevilment of their husbands and to prepar- 
ing anew breakdown by laziness, by bad “bossing” of servants 
thereby made worse, by reading trash, etc. 
In these and a hundred other ways the physician is the accom- 
plice or the enemy of what is a false or a true estheticism. If 
he is true to his calling he is at the same time true to the spirit 
of the esthetic ideal. The oculist has a sad fight against vanity 
and fashion,—the hypocritic travesties of the genuinely beautiful. 
Back to the building of the most primitive organisms out of the 
inorganic we may trace the Divine Artist, never forgetful of His 
art however hard-pressed by the exigencies of utility and neces- 
sity. Whatever lives betrays the trace of lost beauty or the 
promise of its coming glory. Every once-living relic of the dust- 
bin shows traces and memories of the Artist-Creator. As 
physicians and surgeons we are coworkers with the great Artist, 
ever seeking to fuse into identity the converging ideals of health 
and loveliness. Disease is the death of beauty ; without health 
the esthetic ideal cannot be realized, and as teachers of hygiene 
and health, we are never to forget that fashion and vanity must 
not turn us from the sterner ideal. If these false ideals are 
powerless we shall at last find that over the face of health will 
break that grateful smile of divine symbolism men call the 
Beautiful.