less contagious and infectious diseases, and that we do have will be easier controlled. Don't allow the lady to be the judge of an efficient nurse; let it be done from a scientific standpoint, or from no other. The State, as a responsible party, can not license an inefficient nurse; it must look into the fitness of an applicant. It should require fitness in a preliminary education, and require all graduates to be from a well-equipped hospital with a training-school in conjunction with it, and requiring a three years' course of study and bedside training. Unless we do take some steps in this line, our State will soon be overrun with badly trained and uneducated individuals who have been driven from other States by such a law because they were unfit for the vocation. In the prevention of disease and the spread of diseases a well-trained nurse will prove her value as a philanthropic worker in any community in addition to what she would accomplish every day in correcting unsanitary conditions. I ask for discussion, and for my part I would suggest that a committee be appointed from this Association to act in conjunction with an auxiliary body composed of business men, lawyers and ministers, as this is a matter that should interest every one within the State's bounds, and as a whole to draft a bill to go before the next term of the Georgia legislature, and in drawing up such bill it might be well to get the views of a few States who have already such laws, among them New York, New Jersey, Virginia and North Carolina, who will assist and cooperate very materially.

The temple of efficiency is not a mass of disjointed facts, and no responsibility should be tolerated without a solid foundation, and without the natural connection between its different parts clearly discernable. From ruling a kingdom down to weeding an onion row it is quits as important to know how to do what needs doing as it is to have stores of knowledge concerning the things to be done.

DISCUSSION OF PAPER BY DR. ELDER.

Dr. Hull: The relation of the nurse to the medical profession is such that we must repose considerable confidence in them, and I have had some experience which has been very disastrous, and which shows to my mind very clearly that something should be done. I remember one nurse who charted everything ordered by the physician, but who afterward owned up that she had failed to give it. We expelled two nurses from the school in Atlanta, and yet they are registered for private nursing, and when you telephone to Atlanta for a nurse, you may get one of these nurses who are incompetent. I think some law should be passed requiring some standard of registration so that the physician and patient can be protected.

Dr. Shorter: I move that this matter be referred to the Committee on Legislation for their consideration. Motion carried.

Dr. Elder: There is a law in some States requiring nurses to stand an examination, and there are nurses here in Georgia who have been expelled from these schools, and they come here to us to do nursing. I know of three nurses who have been driven from adjoining States for their inefficiency.

EYE-STRAIN THE IMPORTANCE OF ITS DETECTION AND CORRECTION IN ALL GENERAL NERVOUS DERANGEMENTS.

BY ARTHUR G. HOBBS, M.D., ATLANTA.

It is not every man who is endowed with the special faculty of doing well surgical operations on the eyeball, or its muscular appendages, who can also do as well the refrac tion and muscular tests that oculists are daily called upon to do. The last, the correction of refractory errors and muscular incoordinations, requires a special capacity, of ten very distinct from the first. The one is suggestive of a mechanical turn of mind, presupposing, of course, a thorough knowledge of the anatomy, physiology, and pathology of the parts involved, together with an up-to-date knowledge of antiseptic methods in surgical operations. But it is quite another proposition, a mathematical and not a physical (a surgical) one, that is presented to the oculist or, it may be, to the family physician first when the patient's eyes reveal no apparent lesion; when all the symptoms are subjective and as a rule involve the general nervous system as a reflex result, with the eyes as the cause.

In such cases the other side of the consultant inust be brought out, but unfortunately, when his mechanical or surgical side predominates, he is more than likely, in spite of himself, to look first for a surgical, and not for a refractive or a mathematical solution of the problem.

The mathematicai mind, with an optical training, will

as naturally look first to the other side, to see if the desired result can not be better reached without surgical intervention. That is, by correcting the refractive error, which is probably slight, and at the same time, and with the same lenses, correct the muscular incoordination, which is usually the complication, when general nervous symptoms are prominent. Hence in eyestrain with its systemic reflexes. we must not lose sight of the fact that in each case a choice must be made between one or the other means, yet possibly we may have to resort to both in some cases. But in no case can we afford to forget our own predilections (and the most of us have them) if we would consult our patient's good.

For example: I am personally convinced that "heterophoria," a term applied to slight muscular incoordination, can and should be, in most cases, corrected either by acentering or decentering the lenses that neutralize the accompanying refractive error, or by adding to them the necessary prisms. I mean, of course, in those cases where the muscular aberration is so slight as to suggest only the partial clipping of one of the seven pairs of muscles that govern the movements of the eyeballs. It is usually only one, but possibly both of the internal recti muscles.

As some lens, either a refractive or a prismatic, is as a rule prescribed even after partial tenotomies for the cor rection of eyestrain, why should it not be done from the mathematical standpoint at first, when the refraction or muscular deviation is slight?

I have done these partial tenotomies a limited number of times, though probably not as adroitly as my friend Dr. Stevens, of New York, has done his many.

I have also seen Landolt, of Paris, manage these cases in his private clinic almost exclusively from the refractive standpoint.

On the other hand, Galezosky, of Paris, in whose private clinic I have seen eyestrains under his direct management,

has a tendency to surgery first, and afterwards the lens almost invariably. But Sir Anderson Critchett, of London, whom I have also seen do these graduated tenotomies for eyestrains, like Landolt and Ranney, prefers the mathematical means when possible.

It is not necessary to make the patient believe that a surgical procedure is always necessary in these cases. The surgical effect, as a means to the end may, in some cases of a psychical character, reach it more surely when the nerve reflexes assume a certain phase, but I think that this would apply only to exceptional cases. Yet is it not a fact, that most oculists know mechanics surgery best, and prefer it to the complications of refraction tests, especially when the astigmatism is out of the rule? Still there must be some who do know refraction as well as they know surgery, and the ideal oculist should be the one who knows both alike, yet it is probable that the latter is in the minority.

That eyestrain is at the bottom of many, very many, of the constitutional nervous symptoms that are daily met with is ceasing to be a doubt during the last decade. The question is now becoming how to detect and correct these slight errors as well as to be sure of the part they do, or do not, play in the general nervous panorama.

While in eyestrains that are so palpably, so plainly, associated with general nervous phenomena, we feel almost confident now, that we can relieve the last if we can succeed in relieving the first, that is when we relieve the cause its nervous sequelae disappear. But we are not yet so accustomed to these good results that so oftentimes follow as not to be a little surprised at each of our successes. Especially is this the case in old and long-continued sick headaches, considered incurable for so many years, when such cases give way, and so often disappear entirely as a result of neutralizing an eyestrain. And then when we find that this strain is sometimes the causative factor in chorea and