fluid from the anterior chamber of the eye into the
sub-conjunctival space; in doing so it is essential to avoid as far as
possible all interference with the uveal tissue. The purpose of an
iridectomy is to avoid the danger of the iris in the neighborhood of the
wound being drawn and impacted in the trephined hole. We have found in a
large number of cases in which an iridectomy has been omitted, that the
results have been in no way inferior to those in which a piece of iris
has been removed, provided always that no subsequent iris prolapse
takes place. In pursuance of our purpose to avoid uveal tissue, we split
the cornea, and place the trephine as far forward as such splitting will
allow, and we bear on the trephine in such a way that it cuts through on
the corneal edge of the wound first. This insures establishing our
fistula in the most anterior position possible, and, therefore, as far
away as possible from the ciliary body and the angle of the chamber.

Third: The difficulties of the operation. Far too much stress has been
laid on these. Trephining is an operation which can be performed by any
surgeon who is used to ophthalmic manipulations, and who has good sight.
It is essential that he should work in a good light. The necessary
technique can be acquired from a written description. It is not for a
moment necessary that the surgeon who wishes to learn trephining should
see the originator of the operation at work. If, however, he feels
diffident at undertaking the procedure until he has seen it done by
another, there are many centers in this country where the operation is
now being successfully performed. I would mention amongst those which I
have visited New York, Minneapolis, St. Louis, Nashville, Louisville,
Detroit and Chicago. I have seen results of trephining by American
surgeons which could not be bettered anywhere.

Fourth: I am sure that everybody will recognize the difficulties of
operating during such a tour as I am now making. I have so far in the
last month performed over seventy trephinings in ten cities, and in
twice as many clinics. To adapt one's self to different clinical
methods, different assistants and different nurses is so difficult that,
as you are aware, many distinguished surgeons refuse to work out of
their own clinics. One cannot expect the results of such a tour to be on
a par with those one obtains in one's own quiet daily surroundings. I
am, however, confident that you will make a gen