426 OPHTHALMOLOGY 



is medical art and science in the strictest sense of the term, one 

 indeed requiring the highest intellectual qualities and hence their 

 claim can never be allowed; the profession must therefore now wage a 

 hundred year war which it might have prevented against an enemy 

 which it might have made a friend and ally. 



What are the relations of the new and old ophthalmology? They 

 are most intimate sociologically and clinically. In a word, the scien- 

 tific correction of ametropia prevents almost all inflammatory 

 and surgical diseases of the eyes, - - I should say about nine tenths 

 of them. It will not, of course, prevent the few ocular results of 

 systemic disease, such as albuminuric and diabetic retinitis, optic 

 neuritis, toxic amblyopias, etc., but such things are uncommon, 

 and not seldom the systemic trouble had its individual ground- 

 ing in morbid ocular function. The greater proportion of ocular 

 diseases are those of the extrinsic muscles; inflammations of the 

 lids, conjunctiva, cornea, and iris; glaucoma; high and increasing 

 myopia; and cataract. 



As to the external muscles, there is now an almost exceptionless 

 agreement that heterophoria is due to uncorrected or miscorrected 

 refraction anomalies, and that the plunge made into tenotomies, 

 graduate, undergraduate, or postgraduate, was into a blind alley of 

 error and waste which has done irreparable harm to true ophthal- 

 mology by making the professional and lay world suspicious and 

 even contemptuous. The heterophoric trouble is innervational in 

 nature and refractional in origin. 



As to strabismus, the same truth is at last becoming manifest 

 and admitted. A recent English book, Browne and Stevenson, 

 on the Squint of Children, is a striking proof. Get glasses on the 

 child early enough and there will be no squint. Even when the 

 fatal delay has been negligently permitted, the operation does not 

 do away with the necessity for the spectacles, and there are some 

 of us "extremists" who contend that the operation is of little or 

 no good even at the late date. 



With the exception of relatively few cases, due to trauma, in- 

 fections, malnutrition, etc., blepharites, conjunctivites, and keratites, 

 are of eye-strain origin. When one sees a few thousand cases of 

 spontaneous recovery after the patients get proper glasses, the truth 

 needs no further mention. 



As to iritis and glaucoma, did any skilled refractionist ever see 

 these diseases appear in eyes which for years previously had been 

 outfitted with right correcting lenses? It may be that such cases 

 occur, but observation shows that the eye which is morbidized by 

 eye-strain has such low resisting power that only a slight inciting 

 cause is needed to develop the otherwise powerless hint. 



Concerning retinal and choroidal diseases it is also a truism that 



