The weak point of the general practitioner in dealing with eye diseases is, unquestionably, in reaching a correct diagnosis; and this is not surprising in view of the fact that in most instances he works without the help of the ophthalmoscope, the trial case, and the various contrivances for testing the central and peri pheral visual acuteness, the muscle balance, etc., aids which the specialist in diseases of the eye always has at command, and without which even he would often be at fault. But, it must be confessed, the general practitioner's errors of diagnosis are not always limited to the class of cases in which these aids are essential.

For example, he not infrequently fails to draw a distinction between the several varieties of conjunc tivitis, and, in consequence, is led into errors in the therapeutic measures which he employs. Again, he mistakes a corneal inflammation or an iritis, with its attendant conjunctival injection, for a simple con junctivitis, with still more serious consequences; or, in order to avoid this mistake, he goes to the other extreme, and causes his patient much unnecessary inconvenience by prescribing atropin when only a mild astringent is called for. In other instances, he mis takes the photophobia, lacrimation and hyperemia of the conjunctiva due to the presence of a foreign body upon the cornea or beneath the upper lid for a com mencing ocular inflammation, and treats it accordingly, without success.

A chronic conjunctivitis or blepharitis, dependent upon an error of refraction or a muscular anomaly or secondary to disease of the lacrimal apparatus, is dealt with without reference to its primary cause and, therefore, to no effect. Still more disastrous in its results is the failure of the general practitioner to recognize promptly inflamma tory glaucoma. Not infrequently this disease is mis taken for iritis or keratitis, and atropin, the remedy distinctly contraindicated, is prescribed, or, in the quiet periods between the inflammatory outbreaks, owing to the apparent or actual loss of transparency of the crystalline lens, for cataract, which usually leads to the patient's being advised to defer any operative procedure until the supposed cataract is "ripe."

Under such circumstances, when the case ultimately comes under the observation of the ophthalmic sur geon the eye too often is absolutely blind, and nothing that he can do is of avail, at least so far as the restora tion of sight is concerned. To mistake an acute glaucomatous attack for severe 'facial neuralgia, as sometimes happens, though a most unfortunate mis take, is less reprehensible; for in neuralgia of the fifth nerve the eye upon the affected side is not infrequently injected, sensitive to the touch and photophobic, and the pain experienced in the two conditions is of much the same character.

It is with the view of helping the general practitioner to avoid such mistakes as have been enumerated and others of similar character, and, further, to enable him to recognize the probable existence of other troubles, such as refractive and muscular anomalies and dis eases of the deeper structures of the eye as to which he can hardly be expected to make a definite and exact diagnosis, and which, therefore, if he is conscientious and discreet, he will not be inclined to treat that this chapter is written. Doubtless, it would be an excellent thing if every physician were an expert ophthalmoscopist; but, however desirable, there are not many who would con tend that, for the present at least, this is practicable. As a matter of fact, the number of general practitioners at the present day who are, or who are ever likely to be, sufficiently versed in the use of the ophthalmoscope to make it of any real diagnostic value to them is, relatively, so small that it may be treated as a neg ligible quantity.

Such being the case, it is assumed throughout this work which, as has been stated, is designed solely for physicians engaged in general practice that the reader is not skilled in the use of the ophthalmoscope; and this has materially modified the treatment of several important subjects.

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