1884 Journal of the American Medical Association (JAMA)  
thanked the essayist for his very interesting and instructive paper, but protested against that portion of it which would dispense with a mydriatic in the examination of all anomalous re¬ fraction. He was fully convinced, after abundant proof in gcing over the work of others, that no man on earth has ever been able in all cases to prescribe glasses correctly without the use of a mydriatic. If he was not permitted to thoroughly examine a patient, he would not think of prescribing ; but when one
more » ... ing ; but when one has thoroughly examined his patient, then he is not ashamed to have his work go before the world. He would not accept a fee in these cases unless the pa¬ tient consented to this test. Dr. D. S. Reynolds, of Louisville, Ky., said that no accurate diagnosis of astigmatism could possibly be made without the aid of a mydriatic. He had tried it in his own and many other cases, and had found no other method reliable. Dr. S. M. Burnett-I never use a mydriatic, unless I have reason to believe there is spasm of accommo¬ dation. I am decidedly opposed to its routine em¬ ployment. to enter my protest against the use of a mydriatic. We do not correct the latent, but simply the manifest anomaly, and in cases of myopia it is entirely un¬ necessary. Dr. Shakespeare, of Philadelphia-I fully agree with the gentleman who first spoke as to the impossi¬ bility of correctness in many cases short of mydriasis ; have astigmatism myself, and find that while I now look at the texts of the essayist, they do not lead me to his conclusions. Have examined myself be¬ fore and after artificial mydriasis, and have reëxamined many others, and am fully confirmed in my be¬ lief as to the importance of this acid. Dr. S. D. Risley-Like all of the refinements brought to our aid during the last few years, I fear that this, also, will not prove of very great practical benefit; as in my own case, while looking at the tests it does not answer expectation, so will we doubtless find when we have to deal with confused or stupid persons. Very skilful opticians constantly claim ability in this direction, and yet we see how fre¬ quently they fail in their efforts. I, therefore, declare very positively in favor of the use of a mydriatic. Dr. L. Connor, of Detroit, Mich.-I first examine without, and afterwards with, a mydriatic ; always use it where I suspect muscular spasm. Dr. Young, of Iowa-In a majority of cases you get a different effect where a mydriatic has been used. Dr. R. J. McKay-If the patient first looks at test types without, then with glasses, and we also examine with the ophthalmoscope, we can usually determine the astigmatism without mydriasis. Dr. W. S. Little, in closing, said-I am a full ad¬ vocate of a mydriatic, except where there is a ten¬ dency to glaucoma, or in cases where the age of the patient renders it unnecessary.
doi:10.1001/jama.1884.02390570016001b fatcat:j2oczik7czco7jwpsfapuxhtuu