cartilage, do not suffer if food is withdrawn while the symptoms are acute.

Class IV-Babies who have always had a hard time digesting the various foods given them, who have frequent attacks of diarrhoea and vomiting, whose general condition is not good and whose resistance is far below normal. These babies are anæmic, their extremities are cold, the fontanelle is depressed and the level of the abdomen is below the level of the ensiform cartilage, the whole picture indicating a most serious condition in which the caloric value of a substitute food is a most important matter. In these cases routine treatment is impossible and the indications are to remove the cause and at the same time maintain strength. The withdrawal of all food is usually disastrous. In these cases a relatively strong food is indicated and whey, fat free milk, either plain or peptonized, solution of dextrin by rectum, and the cereal foods, are to be considered.

Each year we receive at the Babies Hospital patients who have been dieted too long. As shown in Dr. Goodrich's paper, it is not always necessary to wait for normal movements before beginning food. In these cases, the caloric value of food should be constantly kept in mind.

DR. CHARLES A. GOODRICH (Hartford), closing the discussion on his paper: In answer to the remarks concerning the advisability of giving food to babies acutely ill with some other disease than acute enteric infection, I would say that I perhaps feel a little more the need of an early attempt to do this than has been suggested in the discussion. A good many children that are acutely ill from other maladies than digestive disorders will be able to digest food at a much earlier period than it is usually given to them, provided that we know what kind of food to use. That is a matter that requires a good deal of consideration; and so, though these classes of maladies have been mentioned, and while I agree in the main that the children that have been exhausted are the ones that require especially these heat-values, yet I feel a little more inclined to the early feeding of the acutely ill, in order to prevent their getting into too low a condition of nutrition.

The Relation of the Medical Profession to Opticians.

HENRY W. RING, M.D., NEW HAVEN.

In many states so-called optometry laws have been passed and examining boards of optometrists have been legalized and are assuming in their examination of students prerogatives of the medical profession.

Attempts were made by the opticians to have passed similar laws in Connecticut by the legislatures of 1909 and 1911. They have not so far been successful.

In the passage of these laws throughout the United States the help of the medical profession has been solicited with no small degree of success.

The common manner of seeking the endorsement of unsuspecting physicians is by sending out postals and reply cards before the meeting of the legislature. The wording of the post cards apparently seemed innocent and harmless and in Wisconsin out of eleven thousand reply cards sent out to the physicians, ten thousand and fifty replies endorsed the proposition that the opticians should be licensed.

This aid to opticians on the part of practicing physicians is obtained largely through their misapprehension of the possible and actual evils to which patients may be subjected, and it seems appropriate and timely that the real facts about the present status of opticians and optometry laws should be more clearly understood and appreciated by the medical profession at large.

The inherent desire in human nature to get something for nothing is well understood, and the obvious reason why so many people seek and obtain medical advice from druggists and opticians is to save a physician's fee. They usually get what they pay for, and I hardly expect to be a factor in interfering with constitutional rights in this respect, but I do think they should not be encouraged in this tendency by the medical profession. A physician would not dream of recommending a

patient to seek advice from a druggist for relief for the various aches and pains to which human flesh is heir, and yet very many send patients to opticians for examination and treatment of the eyes, forgetting that the opticians bear the same relation to the ophthalmologist as the druggist to the general practitioner. One form of ocular treatment may be correcting lenses, and the proper business of the optician is to fill the oculist's prescription in this respect-a business which provides a field for the most careful, delicate and skillful work. There is room for the dispensing optician just as there is room for the dispensing chemist, but you are all well aware that very few opticians confine their work to this field. Admitting that glasses are often fitted with sufficient accuracy by them, this is their one form of treatment, and their lack of knowledge in the use of the ophthalmoscope and other lack of training renders them incompetent to recognize disease of the eyes, and thus much valuable time is lost and real dangers may exist in many cases that need skilled observation and treatment. This is illustrated not infrequently in the practice of all oculists, and if proof were needed there is in the possession of a special committee of the New York Ophthalmological Society to investigate this subject, a large number of cases of serious diseases of the eyes treated by opticians with glasses, such as glaucoma, cataract, albuminuric retinitis, sarcoma of the choroid, optic neuritis, toxic amblyopia, choked disc from cerebral tumor-autopsy, optic nerve atrophy, foreign body within the eye, and many others. In practically all these cases there was no indication that the real trouble was suspected.

Even in their attempts to prescribe correcting lenses belladonna is not used, and it is the almost universal conviction of oculists that thorough and accurate results in the large majority of younger persons can only be obtained by the temporary paralysis of accommodation by this drug.

Since the activity of the opticians of recent years to change their title to "optometrists", which is simply a trademark manufactured for a specific purpose and saturated with commercialism, and to be legalized by state laws to practice ophthalmology,

the danger to patients should be more keenly appreciated by, at least, the medical profession and past indifference be changed to active opposition. Every state passing optometry laws and making legalized board of examiners is simply adding so many more fake doctors to the community, for this is proving to be the practical result.

There are many so-called optical colleges, and correspondence schools where diplomas are supplied for sums ranging from $7.50 to $50, and the subjects advertised to be taught include ophthalmology, anatomy, histology, embryology, pathology, chemistry, physics, physiology, hygiene, optometry and mathematics.

Here are some of the titles of papers read at an annual meeting of the American Association of Opticians, viz.: "Monocular Amblyopia Due to Congenital Corneal Asymmetry"; "The Eye in Comparative Anatomy"; "Some Diseases Essential for the Optometrist to Recognize"; "Mechanism of Accommodation"; "Illumination of the Eye by Direct and Oblique methods", and "The Eye in Relation to Health." During this last lecture it is stated a free clinic will be held demonstrating the effect of lenses in cases of stammering, partial deafness, St. Vitus' dance, and shaking palsy.

The President of the Association in 1907 said: Optometry is rapidly becoming an advanced profession. Its practice involves specializing because of the wide range of knowledge essential to its successful practice. Mathematical and mechanical ability coupled with good judgment, training in physics, anatomy of the eye, nerve reflexes and sufficient study to recognize diseases and refer them to the medical specialist for treatment, are but part of the mental equipment."

This certainly seems to indicate the need of medical training on the part of these men.

The eye is an integral portion of the body, and is subject not only to diseases peculiar to itself, but frequently participates in, and gives evidence of, affections of the cerebrospinal, cardiovascular, respiratory, renal and digestive systems, as well as those of the genital organs, the liver, accessory organs of nutrition or ductless glands, accessory nasal sinuses, blood, etc.

Anyone who is unacquainted with this relationship and its effects evidently is unfitted to examine an eye for the purpose of correcting its defects, no matter whether this correction requires optical, surgical or medicinal therapeutics. He who is medically untrained is liable to fail to recognize, on the one hand, for example, glaucoma, or on the other hand an albuminuric retinitis. In the first instance he endangers the patient's eyesight, in the second his life.

It therefore follows that a proper understanding of ocular therapeutics and of the adaptation of lenses for ocular disorders requires the skill of one who is medically trained in the best sense of that term.

The measurement of errors of refraction, anomalies of accommodation and of ocular motility, with or without the use of drugs, is not a simple mechanical procedure, but represents one of the most important therapeutic measures in the practice of medicine, and must not be lightly undertaken by any one who is uninformed in the matter I have described.

The American Medical Association, having a membership of over 30,000 in January, 1909, went on record, through its Legislative Committee and National Legislative Council, as opposing "optometry" by passing resolutions to this effect. Also the American Ophthalmological Society at Washington, May 4, 1910, and the section on Ophthalmology of the American Medical Association, memorialized the House of Delegates with a petition which was unanimously passed, part of which was as follows, viz:

The section prays: "That the House of Delegates express its disapproval of ophthalmologists serving with opticians on boards examining men who have not taken medical courses endorsed by the Association of American Medical Colleges and considers the acceptance of such appointment by ophthalmologists as contrary to the spirit of the code of ethics of the American Medical Association."

"That the House of Delegates urge on all members of the American Medical Association, first, that legal recognition of the optician to diagnose the condition of the eye is an infringement on medical practice laws, and therefore should not be sanctioned