THE NEW OPHTHALMOLOGY 427 



they are usually caused by the ciliary strain of uncorrected ame- 

 tropia. The " woolly," hyperemic, and suffering retinas, the " pepper- 

 and-salt/' unhealthy maculas, the abnormal pigmentations; noted 

 ophthalmoscopically as the result of long-continued eye-strain, are 

 suggestive and characteristic. 



There is one refraction anomaly, high or malignant myopia, 

 which is the direct consequence of disease of the eyeball. Does 

 any one now doubt that this, the stretching or stretched eyeball, 

 is the result of ametropia? If so, he should go to Germany to live. 

 And why does the lens so often grow opaque in the old? Why, it 

 would be better asked, does it grow opaque toward the end of pres- 

 byopic failure? The suggestion comes that it is at least partly 

 because of the denutritive conditions set up by the severe strain of 

 presbyopia added to that of preexisting ametropia. This theory 

 derives clinical support from the fact that cataract does not arise 

 when the eye has been kept in an optically correct, healthy, and 

 physiologic condition for twenty years before the cataract age. 



And thus the good American motto, e pluribus unum, applies 

 to ophthalmology as well as to statesmanship. In these many 

 diseases of the eye there is often at last but one disease. There was 

 plainly an over-hasty recourse to surgery when the surgical disease 

 could have been prevented. As has been well said, an ancient hunger 

 for the miraculous has come down to our times and to our medical 

 science, and operation is the modern medical miracle. At last we 

 have begun to see that prevention is better than cure, and the oph- 

 thalmic surgeon is becoming the refractionist. In the same way 

 the ophthalmic therapeutist is disappearing to return immediately 

 as the preventer of disease, the keeper of good eyes good. Thera- 

 peutics is fast merging itself into prophylaxis, and the practitioner 

 of medicine is becoming the hygienist. It is a sort of benevolent 

 suicide of the old ophthalmologist for the benefit of his heir, the 

 well-insured new young man. It is fortunate that the new and the 

 old science are in reality carried on in America by the same prac- 

 titioners so that no rivalry or ill-will can take place. For a time, to 

 be sure, the dual ophthalmologist may privately discuss with his 

 conscience the question as to whether he will undertake to prevent 

 the strabismus of the little one, and the cataract of the presbyope, 

 or operate later, etc., but in this and many other similar instances 

 I do not contend that the old ophthalmologist is Mr. Hyde, although 

 I am sure that the new one is Dr. Jekyll. 



The unity of the organism and the interdependence of all func- 

 tions is the dominating and molding truth of medicine, the monism 

 of physiology, the evolution-principle of medical science and prac- 

 tice. No organ lives to itself alone; there is no function that 

 does not influence every other. This is the truth which disallows 



