ORDINARY people are in the habit of regarding with some misgivings the constantly increasing use of spectacles. In earlier days, these rather unsightly lenses were reserved mainly for old age ; and it is not without sadness that the uninitiated see innocent schoolgirls and sturdy schoolboys disfigured with these appendages. We had learned to speak with some compassion of the spectacled German nation as having fallen, perhaps by excessive tobacco-smoking and overstudy, into a state of possibly hereditary debility of sight, usually associated with the “slippered pantaloon ; ” so that the picture of a whole schoolful of children carrying the “ satchel,” with “ spectacles on nose,” seems incongruously to mix the symbols of the extremes of the seven ages. But we must learn to correct these old-world notions.
Mr. Williamson, the president of the ophthalmological section at the annual meeting of the British Medical Association, recently held at Newcastle, looks forward with hopeful satisfaction to a time when, as an evidence of increasing knowledge among the people and advancing civilization, we may ultimately reach a position in which “ a man who goes about with his eyes naked will be so rare that the sight of him will almost raise a blush.”The prejudice against glasses is still so strong that in some cases and in some public services a man may not wear them at work, even when they give him perfect sight. But this prejudice is lessening, and many people are inclined to think that the more men learn of the complexity of the mechanism of the eye as it is now studied and understood, and the more they recognize the wide distribution of its various and multitudinous defects, and the accuracy with which these can, in each individual, be gauged and remedied, the more quickly it will happen that every person will have his eyes examined, tested, and reported upon early in life.
The new school of physicists and physiologists had prepared us for this. It used to be the way of the anatomist to lecture on the perfection of the eye and the hand as marvels of mechanism. These were the themes of Bell, Owen, and Acland in the days of the Bridgewater treatises. But the anatomists of the next generation began to see that there are in the human body rudimentary, vestigial, and superfluous parts — organs such as the tonsil, or the male mamma, or the cæcal appendix — to which it is difficult to assign a function ; and further, that there were useless complexities observable in the comparison of the human hand with the seal’s flapper, which betrayed imperfection, from the old and limited conception of design in creation. The transformations of type visible in the morphological changes of the embryo led to the recognition of developmental transitions represented in each individual of each species, which went hand in hand with the observations and deductions of Darwin ; so that when physiologists such as Helmholtz came to investigate the function and construction of the eye, we were able to accept without shock their statement that the eye, wonderful optical instrument as it is, is far from being perfect, when examined in detail in the individual. In truth, the eyes of any man or child are rarely in such perfect correspondence as to be pairs in a rigidly physical sense. Nor is it other than an exception to find individuals whose eyes each possess perfectly accurate focusing power on the retina, precisely accurate curvature, vertical and horizontal, of the transparent cornea, and truly accordant and correct powers of refraction.
The methods of testing the defects of vision have, in the last two decades, been brought to a standard of accuracy and refinement previously unknown. Thus, many troubles, disabilities, and maladies hitherto suffered in patience, or treated incorrectly and in vain, are now traced to defects of the vision, and are quickly remedied by the use of appropriate glasses, concave, convex, cylindrical, or prismatic. The schoolboy’s headache, the seamstress’s browache, the convergent squint of childhood, so far as they are the results of faulty refraction, are beginning to be erased from the catalogue of human woes. On the other hand, many who, without sufficient relief, were wearing glasses which were either injurious or inadequate or useless for defects of the interior of the eye, for which such mechanical devices are unsuitable, now obtain complete and permanent relief in virtue of the fuller insight into the refraction and structure of the eye afforded by the ophthalmoscopic investigation by which modern science precedes, guides, and supplements the choice of glasses.
A great deal of harm is done, and still more good is left undone, by the gimlet-eyed jeweler or optician who, in ignorance, or in yet more dangerous halfknowledge, fits glasses by specious “ advertisement of certain kinds of glasses superior to any others ; ” the man who babbles about “flints,” or boasts a set of German " trial glasses ” with achromatic lenses. He commonly will “ fit” a customer from his trial frame with just enough accuracy to give some assistance in many cases, and some relief in others. But in many instances he will maltreat cases of disease by yielding in interested ignorance to the belief of the patient that all he requires is “ a pair of spectacles,” and in a large proportion — especially of children and adolescents — he will pass over all the more subtle defects which permanently affect the near and distant future of the eye as a life servant. He does so — and this is a matter of daily observation among practicing ophthalmological physicians and surgeons — because the only complete examination of the refraction of the eye which can be made with a due appreciation of the physiological meaning, precise character, and the consequences of such defects is that made by the study through the ophthalmoscopic mirror of the interior structure of the eye, and the calculation by the same marvelously beautiful and simple instrument of the refraction of the imperfect eye.
The more general use of spectacles so often noticed nowadays, both by children and adults, is mainly the result not of any increase of eye disease or degeneration of vision, as the praisers of past times and the croakers about modern decadence delight to tell us. It is the index of the progress of a new and practical application of physical science to the relief of a widespread and very ancient series of troubles arising from defects which have always existed, but which are now far more readily tested and remedied than they were during the lives of the last and earlier generations. The science and art of examining, discerning, and treating eye diseases are now undergoing transformation. Diseases formerly incurable, such as the rapid hardening of the eyeball and destruction of the sight by glaucoma, are now curable. The early diagnosis of the varieties of cataract and its complications, and the new methods of extraction and dressing, now restore sight to at least ninety-five per hundred patients, where thirty years ago only about fifty per cent regained vision. Squints are sometimes cured in a few days by operation, which were heretofore a lifelong disfigurement and injury to vision. Other cases are more slowly arrested and remedied without operation, by glasses. Many unnecessary and distressing operations are no longer performed.
These are among the greater and more heroic triumphs of the modern ophthalmologist ; but far beyond them in their frequency and extent, and the bulk of relief afforded and happiness conferred, are the modest achievements of the physician and ophthalmoscopist who patiently investigates and judiciously corrects the habitual and often slight, but always mischievous aberrations of the vision of young and old, who, being slightly far-sighted or near - sighted, or having asymmetrical vision, are often too insufficiently aware of their defects to call for such an examination. Mr. Williamson’s dictum is that every person — and in this he would include school-children — should have his eyes ophthalmoscopically examined, tested, and reported upon. The optician’s test will, by those who know, be unanimously and emphatically agreed to be practically useless, and often dangerous.
Obviously, then, the proposition of the lecturer at the British Medical Association has a solid basis, and much to recommend it. It must, of course, always be a matter of judgment how far the defects are minor deficiencies of “ accommodation ” by the muscular system of the eye, and how much it will be wise to leave the remedy to the efflux of time, and to trust to the process exemplified by the growth of the blacksmith’s arm. Those are considerations which every trained surgeon will not fail to bear in mind.
But, making all allowances and deductions, it is plain that the increase of the use of spectacles is not an evidence of race degeneration, any more than the increase of lunatic asylums is a proof, as is often rashly assumed, of the increase of lunacy, or the growth of railroads a testimony to our inability to walk, or the use of steamships of our inability to sail. All are the outcome of higher knowledge, greater consideration for the needs of humanity, and improved capability of assisting those needs. It is quite possible, therefore, that we may, in the coming years, see an increase both in the number and the proportion of spectacled schoolboys, and a decrease of “ naked - eyed adults.” But we shall not necessarily be going to the dogs, for all that. “ Nothing like leather ” is likely to be the comment on the extremely modern oculist who foretells all this, and who urges that every school-child should undergo a properly skilled testing of his or her vision as a part of the physical examination which ought generally to precede school life. But sensible people, and those most experienced in school life and teachings, will easily recognize the element of serious value in the recommendation, especially in relation to town children and to the young adult of sedentary occupation. It is far better to discover visual defects and to remedy them at the beginning of school life than to have the child sent home after his sight has been seriously injured, as dull of vision, or unable to get through his studies, and the subject of periodical “bilious headaches,”—matters nowadays of constant occurrence. Moreover, it is quite probable that the effect of such systematic visual testing of the school boy and girl would end by diminishing instead of increasing the frequency of the need of spectacles in the prime of adult life ; for it is in the period of youth that suitable glasses often prove curative of defects which would otherwise become fixed or aggravated in later years. The plea for the purblind schoolboy is well worth acceptance, and its importance may be admitted without involving exaggerated inference.