Reprint from American Journal of Ophthalmology, Jan., 1893. 
OPHTHALMOMETRY IN THE UNITED STATES 
AND ITS CHAMPIONSHIP. 
To the Editor of the American Journal of Ophthalmology : 
Sir.-It is a matter of small concern probably to the pro- 
fession at large as to who shall have the honor of being the 
champion of ophthalmometry in this country. It seems, how- 
ever, that it is a matter of a good deal of concern among a set 
of oculists in New York and they do not seem backward about 
making themselves heard in regard to it. 
Dr. Davis, in a communication in the New York Medi- 
cal Journal for December 24, 1892, is very decidedly of 
the opinion that it belongs to Dr. D. B. St. John Roosa, of 
New York, and he has stated without reserve the reasons for 
the faith that is in him. Other people have other preferences 
in the matter of championship, and one or two have happened 
to mention, casually, in some papers they have written on the 
subject of ophthalmometry, that I myself did some work 
with the instrument several years ago, and that I did not hesi- 
tate to say on several occasions, in print, how very good an in- 
strument I regarded it, and how very important it was in work- 
ing out astigmatism. Hine illce lacrymce. 
My first statement to that effect was made in an article on 
"Ophthalmometry with the Ophthalmometer of Javal and 
Schicetz," etc., in Knapp's Archives, 1885, Nos. 2 and 3. I said 
there, after a constant use of the instrument for six months, 
that "I consider it the most practical of all the instruments of 
precision we have in the diagnosis of astigmatism." It would 
appear further, that even at that remote period, the instrument 
had been removed (by me at least) from the limbo of being a 2 
mere "scientific toy," for I say that "I could hardly imagine a 
practicing oculist who could not manipulate the instrument 
with success, certainly to the extent of detecting an astigmat- 
ism of 0.5 D." 
This article, it is true, was not published in the daily papers, 
nor in a popular monthly magazine, but in the Archives of Oph- 
thalmology, which is, or should be, on the table of every prac- 
ticing oculist in this country, and it was intended to reach those 
whom it most concerned. I said other things about the in- 
strument which were intended to be complimentary and at the 
same time truthful and demonstrable. My teachers, Mr. 
Editor, had always tried to impress upon my mind the fact 
that unrestrained enthusiasm was a bad thing for science-a 
sort of boomerang, which came back at inopportune moments 
and caused you to dodge ungracefully; and I have never been 
sorry when I have heeded their wise council. 
I chanced to publish a "Treatise on zlstigmatism" about two 
years after that (in 1887), and in giving what I believe is the 
first description of the instrument in English, I felt warranted 
in saying, among other things, from my further experience, 
"that in my estimation it must be regarded as the most import- 
ant, practical and exact means of diagnosis given to our science 
since the invention of the ophthalmoscope" (page 124). Dr. 
Davis looks upon this in the light of "faint praise." Que 
voulez vous? I did not print it in red letters, nor' yet in capi- 
tals or italics. There are some things, Mr. Editor,-particu- 
larly very patent facts-which I prefer to leave, without 
marked insistance, to the intelligent comprehension of the 
reader. 
If my information is correct, this was two years before the 
appearance of the "New Model," and while the ophthalmome- 
ter was still, according to Dr. Davis, "a descredited instru- 
ment." Later (in 1888), I read before the American Ophthal- 
mological Society a paper containing "An analysis of the re- 
fraction of 576 healthy human corneae examined with the 
ophthalmometer of Javal and Schicetz." In this I showed how 
all but a very small proportion of astigmatism was corneal and 3 
how invaluable a means for its detection was the ingenious 
apparatus of Javal. This paper was published in the Transac- 
tions of that year. Subsequently to this I have published, at 
various times and in sundry places, other papers on the same 
subject, giving the results of my experience with the instru- 
ment and always speaking of it in great praise and in thank- 
fulness to its clever inventor who has become my personal 
friend. 
Now it is possible that none of these communications during 
this period reached the eye of either Dr. Roosa or Dr. Davis. 
Life in the great metropolis is carried on under so great a pres- 
sure that it sometimes happens that concentrated attention to 
matters of local moment prevent some of our New York brothers 
from having a knowledge of the unimportant and insignificant 
things that come from the outside. But I am a little sorry that 
neither Dr. Roosa nor Dr. Davis happened upon these papers, 
for if they had read them at the time with an open mind they 
might have been led to a knowledge of the great value of the 
ophthalmometer and have begun its use several years ago and 
given their patients the benefit of its employment, the lack of 
which must be a source of great sorrow to them now. 
It must be admitted however, that Dr. Davis now, for the 
first time, concedes the priority of first description and first use 
oi the ophthalmometer to the Barbarian outside the walls, and 
hinges the whole of his argument for the championship on the 
fact that the Greek has chosen to make it his own (in the usual 
way), has set the stamp of his approval upon it and has an- 
nounced the fact with a flourish of trumpets of no uncertain 
sound, putting no limitations upon the instrument either 
possible or actual-in political parlance, "claiming every 
thing." 
Proselytes and new converts are always most vociferous in 
their praises of the new found Gods. 
Ideas of what it takes to constitute a championship may be 
widely different. It is largely, it must be confessed, too, a 
matter of taste. One conception would be to strip to the 
waist a la Prof. John L. Sullivan, "wade in" and "put a head 4 
on" any one who refuses to recognize the omnipotence of the 
ophthalmometer, and Dr. Roosa as its Prophet. 
This would seem to be Dr. Davis' idea. 
Another plan is to set forth the actual value of the instru- 
ment in a calm and deliberate manner, paying due regard to 
what it can do and what it cannot do; "nothing extenuate nor 
set down aught in malice." True science has a negative as 
well as a positive side, and Truth is comprehended between 
the two. This latter method, which in my humble efforts I 
have tried to follow has also been used by Drs. De Schweinitz, 
Eaton, Koller, Noyes, Valk, Woodward, and some others who 
have written and spoken upon the ophthalmometer in this 
country, and to these men is due in a large measufe the pres- 
ent proper esteem in which the instrument is held in America. 
The championship of ophthalmometery in America does not 
belong to any one man. I distinctly repudiate it for myself 
in any limited or personal sense; and I have not allowed any of 
my pupils or assistants to claim it for me. I only claim that I 
knew a good thing when I saw it, and hastened to tell my fel- 
low-workers how very valuable I deemed it and asked them to 
try it for themselves. 
But if we are to have a champion (and Dr. Davis seems to 
think we must), we would probably come nearer a choice if we 
left it to the best authority on the ophthalmometer, we 
have-none other than the inventor of the instrument-Dr. 
Javal himself. 
He has spoken on the subject, for in his Memoirss d'ophthal- 
mometrie, published in Paris, in 1891, in the preface, on page 
vi, we find the following which, in deference to my modesty, I 
trust you will allow me to quote in the original: 
"En parcourant ce volume on s'apersevra bientot que 1'oph- 
thalmometrie clinique doit son progres en Amerique a M. Swan 
M. Burnett, que s'en est fait le premier champion." 
But perhaps Dr. Davis is not willing to recognize Dr. Javal 
as an authority on championships. However, I fear that, con- 
sidering we have no higher court of appeal, we shall have to 
let it rest at this. 5 
And I should be glad to allow the whole matter to pass out 
of sight at this closure of the case, were it not that among the 
many mis-statements and misrepresentations in Dr. Davis' let- 
ter there are two or three of such quality and magnitude that 
I cannot permit them to go by without a protest and a flat 
denial, partly from scientific and partly from personal reasons. 
I do not allude to the attempt to associate in the same cate- 
gory Dr. Landolt, who is not an advocate or a friend of the 
instrument, and myself who am both, by garbled extracts from 
our writings. This is so clumsily done that its animus is ap- 
parent upon the face of it, and it is a sufficient answer to itself. 
But when he goes on further and says that "in fact Burnett, in 
his first paper on ophthalmometry, gave drawings made from 
measurements of the cornea by the disc of Placido; in some 
respects he claimed it to be superior to the ophthalmometer," 
the long suffering of the Barbarian even must give way. I 
will quote, Mr. Editor, exactly what I did say, and what can 
be found on page 171 of that paper: "No other form of kera- 
toscopy can be compared to it (the ophthalmometer) for pre- 
cision and accuracy. I have used Placido's disc and Wecker's 
Squares, but must confess that I found them worthless in reg- 
ular astigmatism." The.statement of Dr. Davis is wholely the 
product of his fertile imagination. The drawings referred to 
were of a case of keratoconus of remarkable regularity which 
could be shown graphically only by means of the keratoscopic 
drawings. The measurements of the ophthalmometer, which 
furnished a clue to the regular astigmatism associated with it, 
are given, however, with laudatory praises of the instrument 
without the aid of which it could not have been done. 
Moreover, when he says that "Dr. Roosa took a discredited 
instrument and brought it into wide use and good repute," 
there is an implied imputation and slur upon some of our best 
workers and most esteemed practitioners for which there can 
be no defense. Who brought it into discredit? Dr. Roosa's 
use of the instrument began three years ago or less, but if 
either he or Dr. Davis had taken the trouble to walk a few 
blocks to the office of Dr. Noyes in New York,' even so far 6 
back as in 1885, they would have found that he was doing some 
very creditable work with it indeed, even with the old model, 
as good work as has been done with the new model anywhere 
to-day. Indeed, I am of the opinion that Dr. Noyes was the 
first on the Atlantic coast to use the ophthalmometer regu- 
larly, certainly as early as any; as Dr. Martinache, I have been 
told, was the first to use it on the Pacific coast. Dr. Noyes' 
first public advocacy of the instrument, was, I think, in 1888, 
but he has since that time never allowed an opportunity to 
pass without stating in forcible language his high appreciation 
of the ophthalmometer as a practical instrument. Certainly 
Dr. Noyes' advocacy of the ophthalmometer cannot be consid- 
ered "discreditable" nor can that of Dr. Koller, who imported 
his enthusiasm for it with him from Europe, whence he came 
in 1887. 
It may be well to communicate, just here, some facts which 
may prove important information for some who are really in 
search of it, and that is that the scientific principles of the oph- 
thalmometer are precisely the same in the new and in the old 
model. If any one understands the one he understands the 
other; and though Dr. Davis seems to know that I have never 
used the new model, I have to inform.him that I have not only 
used it but have instructed a number of novices in its employ- 
ment. Furthermore, I have no hesitation in saying that in 
some particulars (for instance in the matter of getting the me- 
ridians exactly), the older form is the better, and in this opin- 
ion I am backed by one near the throne at Paris; and some in 
this country who have used both models would be glad to get 
one of the old if they could. The change to the new model 
was not wholly a matter of scientific necessity, as some of us 
happen to know. 
But the real claim to a championship is, I suppose, set 
forth in the closing paragraph: "It was Dr. Roosa who took 
the perfected instrument and by his unceasing advocacy of it, 
both in writing and teaching, demonstrated its great practica- 
bility not only in cases of aphakia, but in all cases of refraction!' 
Italics his. The only thing that we can infer from this is that 7 
Dr. Roosa holds that the instrument is practicable for the de- 
tection and diagnosis of hypermetropia, myopia and general 
astigmatism as well as corneal astigmatism; certainly that can 
be the only signification of "all cases of refraction." 
I do not think that any one who has any knowledge of phy- 
siological optics or of the principles of the ophthalmometer 
will dispute with Dr. Roosa for the championship of that claim. 
If he can do all which that claim implies we will willingly and 
gladly crown him King of Ophthalmometrists, and hasten to 
make pilgrimages to New York to sit at his feet and learn. 
But we must bring this already too long communication to a 
close, though in doing so I would ask you to allow me to point 
the moral which should adorn any tale worth the telling, and 
it is this: 
Firstly. Let the ophthalmological Youth first make himself 
familiar with the facts and then not tamper with them over- 
much. 
Secondly. Let him not presume too greatly on the ignor- 
ance, stupidity or forbearance of the Barbarian. 
I am, sir, yours most truly, 
Swan M. Burnett. 
Washington, December 28, 1892. 
OPHTHALMOMETRY IN AMERICA. 
[We reprint in the following the letter referred to by Dr. Bur- 
nett in order to afford the reader an intelligent understanding.] 
To the Editor of the New York Medical Journal: 
Sin.- In the New York Medical Journal for November 19th, 
under the heading of Ophthalmometry in America, you have 
published the introductory historical remarks of a lecture on 
Corneal Astigmatism, presented at a meeting of the Philadel- 
phia County Medical Society, on October 26th, by Dr. G. E. 
de Schweinitz, of Philadelphia. In these remarks Dr. Swan 
M. Burnett, of Washington, is characterized as the "champion 8 
of ophthalmometry in America." It is with all that candor 
and fairmindedness due one professional brother from another 
that I am obliged to dissent from the claim made by Dr. de 
Schweinitz, and to ask you to allow me to give my reasons for 
so doing. 
While undoubtedly to Dr. Burnett belongs the honor of 
having first used the ophthalmometer (old model, he never 
having used the new model so far as my knowledge goes; at 
least, he has given no description of it), and also of having first 
written upon the subject of ophthalmometry in America, he 
has by no means and in no sense been its champion, nor did he 
popularize the instrument as it now is. The honor of the 
championship of ophthalmometry belongs to another man-to 
D. B. St. John Roosa. As everybody knows, a champion for 
anything is one who contends for it, not one who simply de- 
scribes it. The latter is what Dr. Burnett did for the ophthal- 
mometer. It was faint praise he gave it. Never did he claim 
that its use surpassed other methods of measuring astigmatism, 
especially the astigmatism of the eye as a whole. Dr. de 
Schweinitz's words themselves constitute Dr. Roosa the cham- 
pion when he describes what he has written in behalf of the 
ophthalmometer as "an earnest advocacy of its employment- 
an advocacy that has never ceased, and has never been couched 
in words of an uncertain tone." 
The instrument-the old model-when first shown by Javal 
and Schiotz in 1881, in London, and later when used in 
America, seems to have been regarded by those who saw it, 
and even by those who used it, as a scientific toy. Certainly 
but little more value was given it than to the disc of Placido or 
the squares of De Wecker. In fact, Burnett, in his first paper 
on ophthalmometry, gave drawings made from measurements 
of the cornea by the disc of Placido. In some respects he 
claimed it to be superior to the ophthalmometer. Two years 
later, in his Treatise on Astigmatism, when describing the 
ophthalmometer, in one paragraph he declares "the value of this 
keratometer in the diagnosis of astigmatism can hardly be over- 
estimated," while in the preceding paragraph he says: "As it 9 
is not possible with this instrument to examine with any degree 
of accuracy the lenticular surfaces, and as these form important 
elements in the general optical condition'of the eye, the appa- 
ratus is of limited advantage in obtaining the refraction of the 
eye as a whole, except in cases of aphakia. Its usefulness for 
estimating general ametropia is still further diminished by the 
fact, which the instrument itself has done so much to establish, 
that the conditions of myopia and hypermetropia are not due, 
except in rare instances, to variations in the refracting surfaces 
of the eye, but to changes in the antero-posterior diameter of 
the eyeball." 
This paragraph certainly shows lack of faith in the instru- 
ment except in cases of aphakia, and in this respect Burnett's 
opinion coincides with that of Landolt, who does not use the 
ophthalmometer at all, I believe, and has just as little faith in 
it, except in cases of aphakia, as Burnett, as is shown by a quo- 
tation from him (Landolt) made by Dr. F. B. Eaton, of Port- 
land, Oregon, in a recent article,1 as follows: "These instru- 
ments may render service when the dioptric system of the eye 
is reduced to the cornea alone, in aphakia. But in an immense 
majority of cases the determination of the curvature of the 
cornea is far from sufficient to acquaint us with the amount of 
astigmatism." Then Dr. Eaton goes on to say himself: "Later 
clinical experience of many observers proves that the above 
statement is incorrect, for, on the contrary, it is known now 
that in the great great majority of cases all but one-half of one 
diopter of the astigmatism is caused by unequal corneal 
curvature." 
If this is so, as it certainly is, then it is unfortunate for Bur- 
nett, as a champion, that, in regard to "obtaining the refraction 
of the eye as a whole" with this instrument, his opinion and 
his words are nearly identical with those of Landolt, who is 
anything but a champion. Compare quotations from each. 
Burnett: "The apparatus is of limited advantage in obtaing 
the refraction of the eyes as a whole, except in cases of aphakia." 
'Medical Record, Nov. 12, 1892, p. 573. 10 
Landolt: "These instruments may render service when the di- 
optric system of the eye is reduced to the cornea alone, in 
aphakia." 
The honor of having championed and popularized the oph- 
thalmometer in America belongs to Dr. Roosa. It was intro- 
duced to the profession by those to whom we shall always be 
ready to give honor. But, as they themselves did not believe in 
the value of the instrument except in a yery limited way-much 
below what Javal and Schiotz claimed for it-it is no wonder 
that the introduction was forgotten and the instrument generally 
consigned to the limbo of obscurity. It was scarcely noticed by 
oculists in general. It was taken for granted from the method 
of its introduction that it was not at all an essential instrument, 
as is now claimed. 
Dr. Roosa took a discredited instrument and brought in into 
wide use and good repute. No one, I think, will, or can for 
that matter, claim that the old instrument was in any sense a 
popular one in America, it being only in the offices, so far as I 
can learn, of not more than six oculists-certainly not more than 
twelve-and in some of these offices was put aside in the lum- 
ber room. That the new modeled instrument could have been 
popularized from a description of the old is out of the question. 
I doubt very much if the new instrument could be used at all 
from the description of the old, and I am sure it could not be 
accurately employed. 
It was Roosa who took the perfected instrument, and by his 
unceasing advocacy of it, both in writing and in teaching, dem- 
onstrated its great practicability, not only in cases of aphakia, 
but in all cases of refraction, 
December I, 1892. *A. E. Davis, M. D.