disease did appear and become epidemic in other towns and villages. Fernandina, Gainesville, Enterprise, Macclenny, etc., were all infected. Were no efforts made at these places to control the disease? There were. But, wet, filthy and undrained, they presented conditions favorable for its spread, and it did spread. A case was carried to Callahan, Fla., one to Blackshear, Ga., one to Uptonville, Ga., but here it did not spread. It is claimed that isolation prevented its spread, but these places were clean, dry and healthy.

Again, it appeared in Jackson, Miss. There, it is said, it was not imported. "We see the disease breaking out afresh, after a long period of hibernation." (J. B. Hamilton, North American Review, January, 1889, page 57.) The people there believed that it was due to the upturning of the soil.

Decatur, Ala., where little attention was paid to sanitation, had its epidemic, and Dr. Hamilton says it must have originated from the baggage of a person from an infected city left in the house of Mr. Spencer! (Ibid.)

Does it not appear from all this that internal quarantine is as futile as maritime, to arrest the spread of yellow fever? Does it not seem that, cordon or no cordon, it affects all places within its influence which are in a condition to propagate it, and spares those which are dry and healthy?

There is nothing in the history of yellow fever which would lead any scientific man, familiar with it from practice, to believe that it is contagious, or that its spread could be prevented by quarantine, maritime or internal.

All the scientific research of the past quarter of a century has failed to discover the immediate palpable cause of yellow fever. The germ is as much an enigma as it ever was, and, although the microbe has been pictured again and again by enthusiastic microscopists, we have not advanced one step beyond where we were in 1860.

But, are we without the means of prevention? The physicians who have recorded the conditions attending yellow fever epidemics, have spent their time and labor in vain, if they have not proven that yellow fever is a preventable disease, and that the means for its prevention are easily within our reach. Drainage and cleanliness have been recognized from far back in the study of medical science as the fundamental principle in the prevention of all epidemic diseases. Experience has proven that these two measures by themselves will prevent yellow fever. Drainage and cleanliness can surely be effectually enforced throughout Georgia by a State Board of Health, if we give to that Board the power which many think we should confer on the General Government. And I now ask of you: Will you entrust this important task in the hands of the General Government, or to Georgians, true to their own manhood and to their own State?

CORRECTING THE WHOLE ERROR OF REFRACTION, AND THE NECESSITY FOR THE USE OF A MYDRIATIC.

BY R. O. COTTER, M. D., MACON, GA.

While the specialty of Ophthalmology is yet in its early youth, this subject of the correction of errors of refraction, if not actually in its swaddling clothes, is at least a vexata questio. It is remarkable how teachers of Ophthalmology differ pointblank in their views concerning the matter of fitting glasses for ametropia. I say ametropia, because I do not wish to include in this paper presbyopia, which is simply the need of glasses for advancing age. Some will claim that it is possible by means of the opthalmoscope alone, to measure refraction, without paralyzing the accommodation. Practically, it is just about as easy to do this as it is to catch a bird by simply throwing salt on its tail. Others admit the necessity for the use of the mydriatic, but many of these disagree as to how much, or if the total error should be corrected.

I can certainly say that the most glaring errors which I have encountered have been in patients who have previously been in the hands of oculists who pretended to fit them for glasses without using a mydriatic. It seems hardly necessary to argue the impossibility of getting at, by means of the ophthalmoscope alone, the true state of the refraction of an eye whose ever varying muscle of accommodation must undoubtedly vitiate any attempt to measure its refraction. Of course I do not mean that we should not verify (after the use of atropine) our work, with the ophthalmoscope. To leave it aside we would be liable to make serious errors, and possibly overlook ambly(81)

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opia, etc. So thoroughly am I convinced of the absolute necessity of using a mydriatic, believing as I do that there is without its use such a serious element of doubt about this most difficult and delicate work, that I have adopted its employment as my rule, invariable and positive. That I have driven away possible patients who would not submit to it, there is no doubt whatever. Yet it would be a short sighted policy, to say the least of it, which would permit any oculist to let this influence him in such a matter. As to fitting the whole error: If a patient's total hypermetrophia is 1-20, why should we give him a glass which corrects only 1-36, 1-48, or less. Common sense ought to dictate that when we have to deal with an ametropic eye we should ascertain (by completely paralyzing the accommodation) just what the total error is. Then we should, with a fully correcting glass, bring the eye up to a condition of normal refraction (emmetropia); then the ciliary muscle will have just the normal amount of focussing to perform. When I use the term mydriatic, I do not mean a one or a two grain solution of atropia, which simply dilates the pupil, and only partially paralyzes the accommodation. I use a four grain to the ounce solution, and drop it in the eye sufficiently often to make the muscle thoroughly passive. If I had no other reason, there is one special class of cases in which I would especially insist upon the free use of atropine. These are young hypermetropes who from excessive use of their eyes have brought on spasm of the ciliary muscle. When their vision is tested they have apparent myopia. They will accept(concave) glasses, when if we paralyze their accommodation they will require + (convex) glasses. If their parents object to the use of glasses, or we, for any reason, think it advisable to not prescribe glasses for them, there is no better treatment than the enforced rest which thorough atropinization brings about for the tired and irritated muscle.

I am more and more convinced, by daily observation, that very many cases of real myopia begin in this way among children, who are hypermetropic. Their myopia apparent only, at first, has by over use of the eye and ciliary spasm, become a real myopia at last. At the present, I am rather opposed to prescribing glasses for young near-sighted persons, yet I feel that the oculist who does not do all he can to call the attention of the profession to the very great importance of having many of the errors of refraction in young persons scientifically corrected, does not do his duty. Upon no subject perhaps are the laity so grievously ignorant. They are too willing to allow this important and most difficult of the oculist's work to be done in a haphazard way by opticians and itinerant spectacle peddlers. Many a young person with normal eyes, except for some easily remediable error of focus, is handicapped and pushed to the wall in the battle of life.

Of the very many cases in which the whole error was corrected, I have kept up very carefully with some seventy or eighty. In these seventy or eighty I have only in two cases found it necessary to afterwards modify the strength of the glass. The following cases are perfectly fair samples of those to be found in my case book. As a rule I find it best to fit the whole error, though of course there are cases, for instance, where the patient's range of accommodation is considerable, where common sense plainly indicates a modification of the rule.

CASE 1. Miss E., age 16. Her eyes ache severely whenever she studies. Conjunctivæ, congested and suffused. Retinæ congested-not as a disease per se, however, but simply as a symptom. Her mother had about decided that it was useless for her to attempt to continue her studies. Vision appears

as if she were myopic. Right 20-40, L. 20-40, she accepts-Cylindrical glasses, axis at 180°. Under atropia the