THE OCULIST, THE OPTICIAN, AND THE PUBLIC. By L. WEBSTER FOX, M.D., and GEORGE M. GOULD, A.B., PHILADELPHIA. \_Reprinted from the Philadelphia Medical Times for December 25, i886l\ IT has in all civilized countries been found not only conducive to the pub- lic good, but also necessary to the public welfare, to limit the traffic in drugs to such persons as have pursued a special course of study fitting them to dispense the materia medica intelligently, and who are in other respects qualified to deal wisely in matters which are of so highly important and deli- cate a character. It is our conviction that the business of supplying the community with spectacles is, in its way, and to a degree, a function of as profound importance to the community at large; that at present this office is shamelessly prostituted to money-making ; and that similar legal restrictions should be set about it as have been found benefi- cial in the case of drug-selling. Our con- tention is that the optician should be placed on precisely the same legal stand- ing as the druggist,—that is, he should by education, both general and technical, and by the restriction of his duty to his legiti- mate function, be placed before the com- munity with a guarantee by the proper authority that he is qualified to do what he pretends to do, and that he shall not pretend to do what is wholly beyond and outside his province. Just as the druggist qua druggist is not a physician, so should the optician not pretend by his practice to be an oculist. If the professions of medicine and phar- macy are distinct, it is beyond all cavil that the profession of ophthalmology is quite as different from that of manufac- turing and selling optical instruments. We speak thus strongly because the rea- son for the faith that is in us is derived from the memory of a long series of cases where irreparable injury and years of suf- fering have been the result of the common foolish habit of sufferers from eye-troubles relying on the optician—respectable or quack—to do the work they should have been legally protected from seeking or getting, or, yet more correctly, from being deceived in the getting. In our hospital practice, especially, these cases continually occur, but in the best private practice also we meet with them constantly. Such instances had at last grown so striking and frequent that we began inquiring if our experience was ex- ceptional, or if that of other physicians was at all similar to our own. We asked a half-dozen of our friends what their ex- perience had been, and, with their con- sent, we publish the following excerpta: Dr. Swan M. Burnett, of Washington, D.C., says, “I am sure a great deal of damage has been thus done. I know an optician who fits people with glasses with which they can see both far and near. Some of these people I have seen, and I have found that he adapts one eye to dis- tant vision and the other to near! It must be a very vigorous person who can stand that long.” Dr. Henry Dickson Bruns, of the edito- rial staff of the New Orleans Medical and Surgical Journal, says of the better class of opticians, “ Having a good knowledge of physical optics, they soon come to be- lieve that they understand the whole sci- ence and art of ‘ refraction.’ Hence their lamentable mistakes.” Dr. D. B. St. John Roosa, of New York, writes us, “Like yourselves, I have seen some bad results from the custom of certain opticians prescribing spectacles. When they do, they generally make a muss of it. I have known them to pre- scribe glasses for glaucoma, for myopia when the patient was hypermetropic, etc.” Dr. D. Webster, of New York, says, “ I heartily join you in your protest against the prescribing of spectacles by opticians. I consider it on a par with counter-pre- THE OCULIST, THE OPTICIAN, AND THE PUBLIC. 2 scribing of medicines by apothecaries. There are a number of peripatetic venders of spectacles who go about through the country telling the unwary that they are students of Dr. C. R. Agnew and personal friends of his, and that they are endorsed by him. Some of these men impose upon the credulity of those who might easily be better informed, and obtain from them almost fabulous sums of money for spec- tacles that are of very little value. . . . Although I have, as every one who has much to do with examining eyes and fit- ting them with glasses must have, seen cases like those you refer to, where the eyes have undoubtedly been injured by wearing absurdly wrong glasses, yet our cases are not so indexed that I can readily look up their records; therefore I hope you will be content with generalization.” Dr. Dudley S. Reynolds, of Louisville, Kentucky, editor of Progress, kindly sends us a valuable and interesting list of cases. We regret that we cannot quote the de- tails. We give synopses of the more im- portant. A law-student came to him “ wearing —, prescribed by an itinerant optician. Study had become impossible, owing to severe headaches, photophobia, and sun- dry distressing neurotic symptoms. Rest under a mydriatic gave relief, and a proper correction of his mixed astigmatism en- abled him to resume his studies with a per- fect reinstatement of health. A poor young woman bought several pairs of high minus spherical glasses from a jeweller, who undertook to refract her eyes with a machine “just such as used by distinguished oculists.” After great ocu- lar injury from the spectacles, she was found to be highly astigmatic. Proper cor- rection relieved her of the intense ciliary neuralgia from which she had suffered, and arrested the progress of the posterior sta- phyloma and of the amblyopia. Dr. Reynolds further says, “ I fully re- alize the importance of exposing as far as possible the dangerous practice of travel- ling spectacle-peddlers and common jewel- lers attempting to adjust glasses for the cor- rection of optical defects. My note-books are full of such cases, and I know of no evil which more urgently demands the general attention of both the public and the profession. I might cite other cases almost equally striking which resulted from attempts to determine and correct refrac- tion by the aid of the ophthalmoscope alone.” We had intended citing a number of our own cases in detail, but are warned that our limited space forbids, and we must with regret omit them. We willingly give way to the unexpectedly full replies our friends have so courteously sent us, and are only sorry we felt compelled to curtail these so much. We cannot leave the subject, however, without referring to a recent case. It was that of a lady past 55, who relied on the optician to fit her with “old age” spectacles. Her dimness of vision, however, was only temporarily benefited by the spectacles, and they were soon changed by the obliging dealer. But there was before long a dimness of vision, and again a change. Finally, after many changes,—we forget how many,—and when the precious time of possible relief had been wasted, the patient came under ob- servation with atypical glaucoma chronica, wholly beyond cure. No astigmatic cor- rection had been added to the presbyopic glasses; and, if not absolutely induced, it is far more than probable that the glau- coma had been increased and its progress hastened by the irritation resulting from the glasses. At least,—and this is the most important,—the patient’s reliance on the optician cost her the terrible penalty. Had the law directed her to a physician, as it does in other forms of illness, no such result would have taken place. No optician ever thinks for a moment of any but refractive errors, and, of course, not of the remote bearings of a supposed cor- rection of these. Indeed, it may be added that perhaps many oculists are far from properly appreciating the persistently inti- mate co-relations of the errors of refrac- tion (with their correction) and general ocular and cerebral disorders. So that it is no exaggeration to say that in writing a prescription for glasses, the judgment must be guided by a multitude of considerations that only the physician plus the ophthal- mologist can for a moment be supposed to consider and estimate aright. How far soever from perfection the oculist may be critically adjudged, there can be no question that the peddler, the jeweller, and often the optician are yet farther from it, and that some legal process of culling and gleaning in this field would be a great benefit to the community. 1304 Walnut Street.