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OF REFRACTION, THE 
INFLUENCE OF EYE- 
STRAIN, ETC. 




BY 



GEORGE M. GOULD, M.D- 

PHILADELPHIA 



Reprint from the Medical Record 
July 21, igo6 



WILLIAM WOOD & COMPANY 



NEW YORK 




“FITTING GLASSES,” THE DIAGNOSIS OF ER- 
RORS OF REFRACTION, THE INFLUENCE 
OF EYESTRAIN, ETC. 

To THE Editor of the Medical Record: 

Sir; — F earing that the many erroneous statements made 
in the article of Dr. A. Edward Davis, in your issue of 
June 30, 1906, may mislead the incautious, I beg for space 
to point out what seem to me the more important. With 
one exception almost every position taken is in part or 
wholly wrong, so that the hackneyed story of the diction- 
ary definition again applies: The crawfish is not red, 

it is not a fish, and it does not walk backward. Many 
considerations compel too great brevity on my part: 

1. The very title of the article is inaccurate. By all 
oculists and opticians it is common to speak of “the fitting 
of glasses” as a part of the optician’s art, having nothing 
to do with the diagnosis of errors of refraction, with eye- 
strain, or with its systemic effects. 

2. The epitome of the history of the discovery of glasses, 
of astigmatism, and of other refractive errors, of the 
theory of physical and physiologic optics, is made up of 
many sins of omission and commission; it has been fre- 
quently done, and better done, than here, and was not at 
all necessary to introduce the real subject. 

3. The ophthalmoscope is made much of as a method of 
diagnosing refraction errors, but is of no use to those who 
value scientific precision in such work. It has had al- 
most no influence in “placing the subject of refraction 
on a sound basis. ” 

4. The ophthalmometer is credited with even a greater 
role in “the science and art of fitting glasses. ” All skilled 
oculists are agreed that at best it is only an aid, never solel}’’ 
to be relied on. I myself find it of no use whatever. The 
article confesses this, unwittingly, of course, in the state- 
ment that it will, “as a rule, ” give the astigmatism to with- 
in an error of 0.50 D. Within that error, however, lie 
the work and success of the careful refractionist. 

Copyright, William Wood & Company 



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Relief of eyestrain and its systematic effects depend 
precisely upon eliminating this astigmatism of 0.50 D. 
It is perfectly plain why those who do not eliminate this 
small degree of astigmatic error jest at the “extremists” 
and “exaggerators, ” and the “eyestrain faddists.” The 
“hpbbyrider” who does correct the neglected 0.50 D. and 
less of astigmatism cures the reflexes of his patients, and, 
natupally enough, emphasizes the truth. 

5. Retinoscopy is the most accurate and trustworthy ob- 
jective method of diagnosing errors of refraction, 
article I criticise discourages the method, because it re- 
quires carefulness, time, and conscientiousness on the part 
of the oculist. But what is the oculist “here for”? 

6. The epitome of the history of the discovery of reflex 
ocular neuroses is all wrong, even as to the dates and 
references. It is a sorry jumble of inaccuracies and mis- 
statements. It seems designed only to deny and ridicule 
the theory of the very existence of systemic diseases due 
to eyestrain. It ends with a quotation from the Prophet 
of the god. Ophthalmometer, that “the belief in any mor- 
bid constitutional condition” due to eyestrain is nonsense. 
Although this is surpassingly frank and brave, it is itself 
most amusing nonsense. Hundreds of capable oculists and 
general practitioners smilingly demur to the ignominious 
implication. The quotations from Fisher, Sachs, Dana, 
and others are in these times delightfully funny. One 
bopt'S they will be repeated many times in the future, 
because getting such “scientists” on record is a great 
desideratum. When the ‘ ‘ flop ’ ' comes it will thus perforce 
be all the more evident and mirth-provoking. 

7. Rxce.ssive space is given to the summary of Dr. 
Howe’s charming article. Unfortunately, neither the 
quoter nor the “collective investigator” gives the names 
of those who reply to the qiiestionnaire. The names of 
those who scorned to reply to such an absurd “investiga- 
tion” are also wisely and equally omitted. Were it not 
that so many are put on record, the whole pother has not 
the value of the paper on which it was tabulated. If your 
contributor knew several things about it, even he would 
Realize how much less valuable it is than that blank 
foolscap page. 

8. Your contributor’s article has another indirect merit: 
jt exposes the ‘ ‘ science ’ ’ and ‘ ‘ art ’ ’ of many who are doing 
refraction work. Its chief motive appears to be to deny 
fhe advisability of the use of cycloplegia in the diagnosis 
of refractioir errors. But all who know, know most cer- 



tainly that there can be no accuracy in such work without 
what the author calls a score of times, cyclopegia. This is 
the crowning proof of the author’s supreme abandonment 
of all reserve : he makes the unblushing plea that refraction 
as practiced nowadays, ‘ ‘ comes nearer to being an exact 
science than any other branch of medicine. ” In fact and 
in truth, we all know it to be the most inexact. The 
author himself forgetfully admits and reemphasizes the 
truth that few or no oculists do agree in their diagnoses 
and prescriptions. 

9. Patients go to opticians, it is said, chiefly because the 
bad oculists persist in using “cyclopegics. ” I should say 
it IS because they don’t use them, and because the optician 
can do as good work {gratis, too) as oculists do who do 
not use drops, ” and who scorn 0.50 D. (and often much 
more) of astigmatism. Your contributor is in naive in- 
nocence that modern ophthalmology does not disable a 
patieirt ten days, ” nor “three days, ’’ not even one day. 
in eighty minutes after a patient enters the office he may 

e completely cycloplegicized, accurately refracted, and 
the ac^mmodation and pupils wholly normalized. 

10. One of the most inexcusable blunders made by 
your contributor is the exasperating mixings-up and in- 
aiscnminations in crediting men with service in bringing 
about progress m the science and art of refraction. Men 

honored for work they did not raise a 
who labored mightily are wholly 
reform ■ heroes of discoveries and 

desffi^ have always scorned and still 

espise refraction; who cure by taking all glasses off • ’’ 

SaS; very Recently kt 

least sent their patients to the optician to be refracted • 
who to-day would “not bother aboSt a httle 

George M. Gould, M.D. 

Philadelphia. 



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