tions by means of which satisfactory filtration is produced. We
are somewhat in the position that general surgeons occupied when aseptic
methods first became prevalent. We do not usually compare the statistics
of early aseptic days with those of the pre-antiseptic period, and I do
not think we ought to compare the statistics of myotic treatment with
ordinary iridectomy any longer, but that we should wait until we can
make a comparison between the results of prolonged myosis and those of
an improved modern technic which establishes a permanent filtration. In
the meantime the patients who will not or cannot submit to operation
must be reckoned with. Doubtless many patients with chronic glaucoma can
be satisfactorily managed with myotic treatment, although personally I
have always advocated operation when this could be performed, but it
cannot always be performed. This rule should guide us, namely, to begin
with a comparatively weak solution of the selected drug, for example, as
Posey has advocated a tenth of a grain of salicylate of eserin to the
ounce, and the strength gradually increased so that at the end of some
months the patient is using a solution 1 grain to the ounce; or if the
pilocarpin is preferred, solutions in double these strengths. It is my
own belief, and that of many who have studied this subject, that if,
without eserin irritation, a myosis can be maintained, and if the
treatment can be begun early enough, the chances of preserving vision
and the field of vision are good. I believe that the two most important
instillations during the twenty-four hours of the number necessary to
maintain this myosis are on retiring and if possible in the very early
morning, some time between two and four o'clock. Most patients can be
taught to wake themselves at the proper period of time, and are little
inconvenienced by this disturbance of their sleep. I believe that eserin
irritation is most successfully avoided, not by preparations of the
myotics in combination with the antiseptics, for example, tricresol,
which has been so much advocated, but by ordering very small quantities
of the solution, insisting that it shall be frequently renewed and
sterilized at each preparation, and that a half an hour after its
instillation, during the day time at least, the eye shall be thoroughly
flushed with some mild antiseptic solution, for example, boric acid and
sodium chlorid. Whether the action of the eserin on the choroidal
circula