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THE FUNDAMENTAL PRINCIPLE

Do you read imperfectly? Can you observe then that
when you look at the first word, or the first letter, of a
sentence you do not see best where you are looking ; that
you see other words, or other letters, just as well as or
better than the one you are looking at? Do you observe
also that the harder you try to see the worse you see?

Now close your eyes and rest them, remembering some
color, like black or white, that you can remember per-
fectly. Keep them closed until they feel rested, or until
the feeling of strain has been completely relieved. Now
open them and look at the first word or letter of a sen-
tence for a fraction of a second. If you have been able
to relax, partially or completely, you will have a flash
of improved or clear vision, and the area seen best will
be smaller.

After opening the eyes for this fraction of a second,
close them again quickly, still remembering the color,
and keep them closed until they again feel rested. Then
again open them for a fraction of a second. Continue
this alternate resting of the eyes and flashing of the
letters for a time, and you may soon find that you can
keep your eyes open longer than a fraction of a second
without losing the improved vision.

If your trouble is with distant instead of near vision,
use the same method with distant letters.

In this way you can demonstrate for yourself the fun-
damental principle of the cure of imperfect sight by treat-
ment without glasses.

If you fail, ask someone with perfect sight to help you.

FERDINAND VON ARLT
(1812-1887)

Distinguished Austrian ophthalmologist, Professor of Dis-
eases of the Eye at Vienna, who believed for a time that accom-
modation was produced by an elongation of the visual axis, but
finally accepted the conclusions of Cramer and Helmholtz.

The Cure of Imperfect Sight

by Treatment Without

Glasses

Wx. H. BATES, M.D.

CENTRAL FIXATION PUBLISHING CO.

210 MADISON AVENUE, NEW YORK CITY

BURR PRINTING HOUSE
NEW YORK

On a tomb in the Church of Santa Maria Maggiore in
Florence ivas found an inscription which read: "Here lies
Salvino degli Armati, Inventor of Spectacles. May God
pardon him his sins."

Nuova Enciclopedia Italiana, Sixth Edition.

TO THE MEMORY

OF THE

PIONEERS OF OPHTHALMOLOGY
THIS BOOK IS GRATEFULLY DEDICATED

PREFACE

This book aims to be a collection of facts and not of
theories and insofar as it is, I do not fear successful
contradiction. When explanations have been offered it
has been done with considerable trepidation, because I
have never been able to formulate a theory that would
withstand the test of the facts either in my possession at
the time, or accumulated later. The same is true of the
theories of every other man, for a theory is only a guess,
and you cannot guess or imagine the truth. No one has
ever satisfactorily answered the question, "Why?" as
most scientific men are well aware, and I did not feel
that I could do better than others who had tried and
failed. One cannot even draw conclusions safely from
facts, because a conclusion is very much like a theory,
and may be disproved or modified by facts accumulated
later. In the science of ophthalmology, theories, often
stated as facts, have served to obscure the truth and
throttle investigation for more than a hundred years.
The explanations of the phenomena of sight put forward
by Young, von Graefe, Helmholtz and Bonders have
caused us to ignore or explain away a multitude of facts
which otherwise would have led to the discovery of the
truth about errors of refraction and the consequent pre-
vention of an incalculable amount of human misery.

In presenting my experimental work to the public, I
desire to acknowledge my indebtedness to Mrs. E. C.
Lierman, whose co-operation during four years of ardu-
ous labor and prolonged failure made it possible to carry

vii

viii Preface

the work to a successful issue. I would be glad, further,
to acknowledge my debt to others who aided me with
suggestions, or more direct assistance, but am unable to
do so, as they have requested me not to mention their
names in this connection.

As there has been a considerable demand for the book
from the laity, an effort has been made to present the
subject in such a way as to be intelligible to persons
unfamiliar with ophthalmology.

CONTENTS

PAGE

Preface vii

CHAPTER I
Introductory 1

Prevalence of errors of refraction — Believed to be
incurable and practically unpreventable — The eye re-
garded as a blunder of Nature — Facts which seem to
justify this conclusion — Failure of all efforts to prevent
the development of eye defects — Futility of prevailing
methods of treatment — Conflict of facts with the theory
of incurability of errors of refraction — These facts com-
monly explained away or ignored — The author unable
to ignore them, or to accept current explanations —
Finally forced to reject accepted theories.

CHAPTER II
Simultaneous Retinoscopy 17

Retinoscppy the source of much of the information
presented in this book — What the retinoscope is — Its
possibilities not realized — Commonly used only under
artificial conditions — Used by the author under the con-
ditions of life on human beings and the lower animals —
Thus many new facts were discovered — Conflict of these
facts with accepted theories — Resulting investigations.

CHAPTER III

Evidence For the Accepted Theory of Accommo-
dation 23

Development of the theory — Behavior of the lens in
accommodation as noted by Helmholtz — General ac-
ceptance of these observations as facts — Abandonment
by Arlt of the true explanation of accommodation —
Inability of Helmholtz to explain satisfactorily the sup-
posed change of form in the lens — Question still unset-
tled— Apparent accommodation in lenseless eyes — Curi-
ous and unscientific theories advanced to account for it
— Voluntary production of astigmatism — Impossibility
of reconciling it with the theory of an inextensible
eyeball.

Contents

CHAPTER IV PAGE

The Truth About Accommodation As Demonstrated
By Experiments on the Eye Muscles of Fish,
Cats, Dogs, Rabbits and Other Animals . . 38

Disputed function of the external muscles of the eye-
ball— Once regarded as possible factors in accommoda-
tion—This idea dismissed after supposed demonstra-
tion that accommodation depends upon the lens — Au-
thor's experiments demonstrate that accommodation
depends wholly upon these muscles — Accommodation
prevented and produced at will by their manipulation —
Also errors of refraction — The oblique muscles 9f ac-
commodation— The recti concerned in the production of
hypermetropia and astigmatism — No accommodation
with one oblique cut, paralyzed, or absent— Paralysis of
accommodation in experimental animals accomplished
only by injection of atropine deep into the orbit, so as
to reach the oblique muscles — Accommodation un-
affected by removal of the lens — Fourth cranial nerve
supplying superior oblique muscle a nerve of accom-
modation— Sources of error believed to have been elimi-
nated in experiments.

CHAPTER V

The Truth About Accommodation As Demonstrated
By a Study of Images Reflected From the
Cornea, Iris, Lens and Sclera 54

Technique of Helmholtz defective — Image obtained
by his method on the front of the lens not sufficiently
distinct or stable to be measured — Failure of author to
get reliable image with various sources of light — Suc-
cess with 1,000-watt lamp, diaphragm and condenser —
Image photographed — Images on cornea, iris, lens and
sclera also photographed — Results confirmed earlier
observations — Eyeball changes its shape during accom-
modation— Lens does not — Strain to see at near-point
produces hypermetropia — Strain to see at distance my-
opia— Method of obtaining the corneal image.

CHAPTER VI
The Truth About Accommodation As Demonstrated

By Clinical Observations 69

Results of experimental work confirmed by clinical
observations — Atropine supposed to prevent accommo-
dation— Conflict of facts with this theory — Normal ac-
commodation observed in eyes under influence of atro-

Contents xi

pine for long periods — Evidence of these cases against
accepted theories overwhelming — Cases of accommo-
dation in lenseless eyes observed by author — Reality of
the apparent act of accommodation demonstrated by the
retinoscope — Evidence from the cure of presbyopia —
Harmony of all clinical observations with views of
accommodation and errors of refraction presented in
this book.

CHAPTER VII
The Variability of the Refraction of the Eye . . 75

Refractive states supposed to be permanent — Retino-
scope demonstrates the contrary — Normal sight never
continuous — Refractive errors always changing — Condi-
tions which produce errors of refraction — Variability of
refractive states the cause of many accidents — Also of
much statistical confusion.

CHAPTER VIII
What Glasses Do to Us 81

The sins of Salvino degli Armati reputed inventor of
spectacles — How glasses harm the eyes — Sight never
improved by them to normal — Always resented at first
by the eye — Objects of vision distorted by them — Disa-
greeable sensatoins produced — Field of vision con-
tracted— Difficulty of keeping the glass clean — Reflec-
tion of light from lenses annoying and dangerous —
Inconvenience of glasses to physically active persons —
Effect on personal appearance — No muscular strain re-
lieved by them — Apparent benefits often due to mental
suggestion — Fortunate that many patients refuse to
wear them — At best an unsatisfactory substitute for
normal sight.

CHAPTER IX
Cause and Cure of Errors of Refraction ... 89

All abnormal action of external muscles of the eyeball
accompanied by a strain to see — With relief of this
strain all errors of refraction disappear — Myopia (or
lessening of hypermetropia) associated with strain to
see at the distance — Hypermetropia (or lessening of
myopia) associated with strain to see at the near-point
— Facts easily demonstrated by retinoscope — Effect of
strain at the near-point accounts for apparent loss of
accommodation in the lenseless eye — Mental origin of
eyestrain — Accounts for effect of civilization on the eye
— Lower animals affected as man is — Remedy to get rid

xii Contents

PAGE

of mental strain — Temporary relaxation easy — Perma-
nent relaxation may be difficult — Eyes not rested by
sleep or tired by use— Rested only by resting the mind
— Time required for a cure.

CHAPTER X
Strain 106

Foundation of the strain to see — Act of seeing passive
— Same true of action of all sensory nerves — Their effi-
ciency impaired when made the subject of effort — The
mind the source of all such efforts brought to bear upon
the eye — Mental strain of any kind produces eyestrain —
This strain takes many forms — Results in production of
many abnormal conditions — Circulation disturbed by
strain — Normal circulation restored by mental control —
Thus errors of refraction and other abnormal conditions
are cured.

CHAPTER XI
Central Fixation 114

'The center of sight — The eye normally sees one part
of everything it looks at best — Central fixation lost in all
abnormal conditions of the eye — Cause of mental strain
— With central fixation the eye is perfectly at rest — Can
be used indefinitely without fatigue— Open and quiet —
No wrinkles or dark circles around it — Visual axes par-
allel— With eccentric fixation the contrary is the case —
Eccentric fixation cured by any method that relieves
strain — Limits of vision determined by central fixation —
Organic diseases relieved or cured by it — No limit can
be set to its possibilities — Relation to general efficiency
and general health.

CHAPTER XII
Palming 123

Relaxation with the eyes shut — With light excluded
by palms of the hands (palming) — Evidence of complete
relaxation in palming— Of incomplete relaxation— Diffi-
culties of palming — How dealt with— Futility of effort-
All the sensory nerves relaxed by successful palming —
Pain relieved in all parts of the body— Patients who
succeed at once are quickly cured— A minority not
helped and should try other methods.

Contents xiii

CHAPTER XIII PAGH

Memory As an Aid to Vision 136

Memory a test of relaxation — Memory of black most
suitable for the purpose — Application of this fact to
treatment of functional eye troubles — Sensation not a
reliable index of strain — Memory of black is — Enables
the patient to avoid conditions that produce strain —
Conditions favorable to memory — Retention of mem-
ory under unfavorable conditions — Quick cures by its
aid — A great help to other mental processes — Tests of a
perfect memory.

CHAPTER XIV
Imagination As an Aid to Vision 148

Retinal impressions interpreted by the mind — Memory
or imagination normally used as an aid to sight — In im-
perfect sight the mind adds imperfections to the imper-
fect retinal image — Only a small part of the phenomena
of refractive errors accounted for by the inaccuracy of
the focus — Difference between the photographic picture
when the camera is out of focus and the visual impres-
sions of the mind when the eye is out of focus — Patients
helped by understanding of this fact — Dependence of
imagination upon memory — Coincidence of both wkh
sight — Perfect imagination dependent upon relaxation —
Therefore imagination cures— Method of using it for
this purpose — Remarkable cures effected by it.

CHAPTER XV
Shifting and Swinging 159

Apparent movement of objects regarded with normal
vision — Due to unconscious shifting of the eye — Impos-
sibility of fixing a point for an appreciable length of
time — lowering of vision by attempt to do so — Incon-
spicuousness of normal shifting— Its incredible rapidity
— Staring an important factor in the production of im-
perfect sight — Tendency to stare corrected by conscious
shifting and realization of apparent movement resulting
from it — Conditions of success with shifting — The uni-
versal swing — Methods of shifting — Cures effected by
this means.

CHAPTER XVI

The Illusions of Imperfect and of Normal Sight . .172

Normal and abnormal illusions — Illusions of color —
Of size— Of form— Of number— Of location — Of non-
existent objects — Of complementary colors — Of the

xiv Contents

color of the sun — Blind spots — Twinkling stars — Cause
of illusions of imperfect sight — Voluntary production of
illusions — Illusions of central fixation — Normal illu-
sions of color — Illusions produced by shifting — The up«
right position of objects regarded an illusion.

CHAPTER XVII

Vision Under Adverse Conditions a Benefit to the
Eye 183

Erroneous ideas of ocular hygiene — Conditions suppos-
edly injurious may be a benefit to the eye — No foun-
dation for universal fear of the light — Temporary dis-
comfort but no permanent injury from it — Benefits of
sun-gazing — Of looking at a strong electric light — Not
light but darkness a danger to the eye — Sudden con-
trasts of light may be beneficial — Advantages of the
movies — Benefits of reading fine print — Reading in mov-
ing vehicles — In a recumbent posture — Vision under diffi-
cult conditions good mental training.

CHAPTER XVIII
Optimums and Pessimums 198

All objects not seen equally well when sight is imper-
fect— The eye has its optimums and pessimums — Some
easily accounted for — Others unaccountable — Familiar
objects optimums — Unfamiliar objects pessimums — Ex-
amples of unaccountable optimums and pessimums —
Variability of optimums and pessimums — Test card usu-
ally a pessimum — Pessimums which the patient is not
conscious of seeing — Pessimums associated with a strain
to see — How pessimums may become optimums.

CHAPTER XIX

The Relief of Pain and Other Symptoms by the Aid
of the Memory 202

No pain felt when the memory is perfect — All the
senses improved — Efficiency of the mind increased —
Operations performed without anaesthetics — Organic
disorders relieved — Facts not fully explained, but at-
tested by numerous proofs — Possible relationship of the
principle involved to cures of Faith Curists and Chris-
tian Scientists.

Contents xv

CHAPTER XX PAGE

Presbyopia: Its Cause and Cure 210

Failure of near vision as age advances — Supposed
normality of this phenomenon — Near-points expected
at different ages — Many do not fit this schedule — Some
never become presbyopic — Some retain normal vision
for some objects while presbyopic for others — First and
second of these classes of cases explained away or ig-
nored— Third not heretofore observed — Presbyopia both
preventable and curable — Due to a strain to see at the
near-point — No necessary connection with age — Lens
may flatten and lose refractive power with advancing
years, but not necessarily — Temporary increase of pres-
byopia by strain at the near-point — Temporary relief by
closing the eyes or palming — Permanent relief by per-
manent relief of strain — How the author cured himself —
Other cures — Danger of putting on glasses at the pres-
byopic age — Prevention of presbyopia.

CHAPTER XXI

Squint and Amblyopia : Their Cause . . . .221

Definition of squint — Theories as to its cause — Failure
of these theories to fit the facts — Failure of operative
treatment — St?'-e of the vision not an important factor —
Amblyopia ex anopsia — Association with squint not in-
variable— Supposed incurability — Spontaneous recovery
— Curious forms of double vision in squint — Invariable
association of squint and amblyopia with strain — Invari-
able relief following relief of strain — Voluntary produc-
tion of squint by strain.

CHAPTER XXII
Squint and Amblyopia: Their Cure .... 227

Squint and amblyopia purely functional troubles —
Cured by any method that relieves strain — Relaxation
sometimes gained by voluntary increase of squint, or
production of other kinds — Remarkable cure effected in
this way — Strain relieved when patient is able to look
more nearly in the proper direction — Proper use of a
squinting eye encouraged by covering the good eye —
Children cured by use of atropine in one or both eyes —
Examples of cases cured by eye education.

xvi Contents

CHAPTER XXIII PAGE

Floating Specks: Their Cause and Cure . . . 236

Floating specks a common phenomenon of imperfect
sight — Their appearance and behavior — Theories as to
their origin — A fruitful field for the patent-medicine
business — Examples of the needless alarm they have
caused — May be seen at times by any one — Simply an
illusion caused by mental strain — This strain easily re-
lieved— Illustrative cases.

CHAPTER XXIV
Home Treatment 242

Many persons can cure themselves of defective sight —
Only necessary to follow a few simple directions — How
to test the sight — Children who have not worn glasses
cured by reading the Snellen test card every day— Adults
of the same class also benefited in a short time — Cases
of adults and children who have worn glasses more dim-
cult — Glasses must be discarded — How to make a test
card — Need of a teacher in difficult cases — Qualifica-
tions of such teachers — Duty of parents.

CHAPTER XXV
Correspondence Treatment 246

Correspondence treatment usually regarded as quackery
— Impossible in the case of most diseases — Errors of
refraction, not being diseases, admit of such treatment —
Glasses successfully fitted by mail — Less room for fail-
ure in correspondence treatment of imperfect sight with-
out glasses — Personal treatment more satisfactory, but
not always available — Examples of cases cured by cor-
respondence— Need for the co-operation of local practi-
tioners in such treatment.

CHAPTER XXVI

The Prevention of Myopia in Schools: Methods
That Failed . 251

A much debated question— Literature on the subject
voluminous and unreliable — All that is certainly known
— Studies of Cohn — Confirmation of his observations by
other investigators in America and Europe — Increase of
myopia during school life unanimously attributed to near
work — Inadequacy of this theory — Failure of preventive
measures based upon it— New difficulties — The appeal
to heredity — To natural adaptation — Objections to these
views — Why all preventive measures have failed.

Contents xvii

CHAPTER XXVII PAGE

The Prevention and Cure of Myopia and Other
Errors of Refraction in Schools : A Method That
Succeeded 259

Production of eyestrain by unfamiliar objects — Relief
by familiar objects — Facts furnish the means of prevent-
ing and curing errors of refraction in schools — By this
means children often gain normal vision with incredible
rapidity — Results in schools of Grand Forks, N. D.;
New York, and other cities — Improvement in mentality
of children as eyesight improved — Reformation of tru-
ants and incorrigibles — Hypermetropia and astigmatism
prevented and cured — Method succeeded best when
teachers did not wear glasses — Success would be greater
still under a more rational educational system — Preva-
lence of defective sight in American children — Its results
— Practically all cases preventable and curable — Inex-
pensiveness of method recommended — Imposes no addi-
tional burden on the teachers — Cannot possibly hurt the
children — Directions for its use.

CHAPTER XXVIII
The Story of Emily 270

Cure of defective eyesight by cured patients — Cures
of fellow students, parents and friends by school chil- t
dren — Remarkable record of Emily — An illustration of
the benefits to be expected from the author's method
of preventing and curing imperfect sight in school chil-
dren.

CHAPTER XXIX

Mind and Vision 274

Poor sight one of the most fruitful causes of retarda-
tion in schools — More involved in it than inability to see
— The result of an abnormal condition of the mind —
This cannot be changed by glasses — Memory among
faculties impaired when vision is impaired — Memory of
primitive man may have been due to the same cause as
his keen vision — A modern example of primitive memory
combined with primitive keenness of vision — Corre-
spondence between differences in the faculty of memory
and differences in visual acuity — Memory and eyesight
of children spoiled by the same causes — Both dependent
upon interest — Illustrative cases — All the mental facul-
ties improved when vision becomes normal — Examples
of such improvement — Relief of symptoms of insanity
by eye education— Facts indicate a close relation be-
tween the problems of vision and those of education.

xviii Contents

CHAPTER XXX

Normal Sight and the Relief of Pain for Soldiers and

Sailors 284

Growth of militarism in the United States — Demand
for universal military training — Lack of suitable mate-
rial for such training— Defective eyesight greatest im-
pediment to the raising of an efficient army — None more
easily removed — Plan for correcting defects of vision
submitted to Surgeon General during the war — Not
acted upon — Now presented to the public with some
modifications — First requisite eye education in schools
and colleges — Eye education in training camps and at
the front also needed, even for those whose sight is
normal — How school system might be modified for mili-
tary and naval use — Soldiers should not be allowed to
wear glasses — Importance of eye training to aviators —
Eye training for the relief of pain.

CHAPTER XXXI
Letters from Patients 290

Army officer cures himself — A teacher's experiences —
Mental effects of central fixation — Relief after twenty-
five years — Search for myopia cure rewarded — Facts
versus theories — Cataract relieved by central fixation.

CHAPTER XXXII
Reason and Authority 304

Inaccessibility of average mind to reason — Facts dis-
credited if contrary to authority — Patients discredit their
own experience under this influence — Cure of cataract
ignored by medical profession — Expulsion of author
from N. Y. Post Graduate Medical School for curing
myopia — Man not a reasoning being — Consequences to
the world.

LIST OF ILLUSTRATIONS

Portrait of Ferdinand von Arlt Frontispiece

FIG. PAGE

1. Patagonians 2

2. African Pigmies 3

3. Moros from the Philippines 6

4. Diagram of the hypermetropic, emmetropic and myopic
eyeballs 11

5. The eye as a camera 13

6. Mexican Indians 15

7. Ainus, the aboriginal inhabitants of Japan 16

8. The usual method of using the retinoscope 18

9. Diagrams of the images of Purkinje 24

10. Diagram by which Helmholtz illustrated his theory of
accommodation ." 27

11. Portrait of Thomas Young 28

12. Portrait of Hermann Ludwig Ferdinand von Helmholtz 31

13. Demonstration upon the eye of a rabbit that the infe-
rior oblique muscle is an essential factor in accommoda-
tion 40

14. Demonstration upon the eye of a carp that the superior
oblique muscle is essential to accommodation 41

15. Demonstration upon the eye of a rabbit that the produc-
tion of refractive errors is dependent upon the action of
the external muscles 42

16. Demonstration upon the eye of a fish that the produc-
tion of myopic and hypermetropic refraction is depend-
ent upon the action of the extrinsic muscles 43

17. Production and relief of mixed astigmatism in the eye

of a carp 45

18. Demonstration upon the eyeball of a rabbit that the
obliques lengthen the visual axis in myopia 46

19. Demonstration upon the eye of a carp that the recti
shorten the visual axis in hypermetropia 47

20. Lens pushed out of the axis of vision 48

21. Rabbit with lens removed 49

22. Experiment upon the eye of a cat, demonstrating that
the fourth nerve, which supplies only the superior
oblique muscle, is just as much a nerve of accommoda-
tion as the third, and that the superior oblique muscle
which it supplies is a muscle of accommodation 50-51

23. Pithing a fish preparatory to operating upon its eyes . . 52

24. Arrangements for photographing images reflected from
the eyeball 55

xix

xx List of Illustrations

25. Arrangements for holding the head of the subject
steady while images were being photographed 56

26. Image of electric filament on the front of the lens 57

27. Images of the electric filament reflected simultaneously
from the cornea and lens 58

28. Image of electric filament upon the cornea 60

29. Image of electric filament on the front of the sclera 62

30. Images on the side of the sclera 63

31. Multiple images upon the front of the lens 64

32. Reflection of the electric filament from the iris 65

33. Demonstrating that the back of the lens does not change
during accommodation 67

34. Straining to see at the near-point produces hyperme-
tropia 90

35. Myopia produced by unconscious strain to see at the
distance is increased by conscious strain 91

36. Immediate production of myopia and myopic astigmat-
ism in eyes previously normal by strain to see at the
distance 92-93

37. Myopic astigmatism comes and goes according as the
subject looks at distant objects with or without strain. . 94

38. Patient who has had the lens of the right eye removed
for cataract produces changes in the refraction of this
eye by strain 96-97

39. A family group strikingly illustrating the effect of the
mind upon the vision 99

40. Myopes who never went to school, or read in the Sub-
way 100

41. One of the many thousands of patients cured of errors

of refraction by the methods presented in this book 104

42. Palming 125

43. Patient with atrophy of the optic nerve gets flashes of
improved vision after palming 127

44. Paralysis of the seventh nerve cured by palming 131

45. Glaucoma cured by palming 133

46. Woman with normal vision looking directly at the sun 187

47. Woman aged 37— child aged 4, both looking directly

at the sun without discomfort 189

48. Focussing the rays of the sun upon the eye of a patient

by means of a burning glass 191

49. Specimen of diamond type 195

50. Photographic type reduction 195

51. Operating without anaesthetics 204

52. Neuralgia relieved by palming and the memory of black. 207

53. Voluntary production of squint by strain to see 223

54. Case of divergent vertical squint cured by eye education 230

55. Temporary cure of squint by memory of a black period. 232

56. Face-rest designed by Kallmann, a German optician 254

THE CURE OF IMPERFECT SIGHT BY
TREATMENT WITHOUT GLASSES

CHAPTER I
INTRODUCTORY

MOST writers on ophthalmology appear to be-
lieve that the last word about problems of
refraction has been spoken, and from their
viewpoint the last word is a very depressing one. Prac-
tically everyone in these days suffers from some form
of refractive error. Yet we are told that for these ills,
which are not only so inconvenient, but often so distress-
ing and dangerous, there is not only no cure, and no
palliative save those optic crutches known as eyeglasses,
but, under modern conditions of life, practically no
prevention.

It is a well-known fact that the human body is not a
perfect mechanism. Nature, in the evolution of the
human tenement, has been guilty of some maladjust-
ments. She has left, for instance, some troublesome bits
of scaffolding, like the vermiform appendix, behind. But
nowhere is she supposed to have blundered so badly as
in the construction of the eye. With one accord ophthal-
mologists tell us that the visual organ of man was never
intended for the uses to which it is now put. Eons be-
fore there were any schools or printing presses, electric
lights or moving pictures, its evolution was complete.
In those days it served the needs of the human animal
perfectly. Man was a hunter, a herdsman, a farmer, a
fighter. He needed, we are told, mainly distant vision;

Introductory

and since the eye at rest is adjusted for distant vision,
sight is supposed to have been ordinarily as passive as
the perception of sound, requiring no muscular action
whatever. Near vision, it is assumed, was the exception,

fte. "-^.V 'w~

ST- ' I .

Fig. 1. Patagonians

The sight of this primitive pair and of the following groups of
primitive people was tested at the World's Fair in St. Louis and
found to be normal. The unaccustomed experience of having
their pictures taken, however, has evidently so disturbed them
that they were all, probably, myopic when they faced the camera,
(see Chapter IX.)

necessitating a muscular adjustment of such short dura-
tion that it was accomplished without placing any appre-
ciable burden upon the mechanism of accommodation.
The fact that primitive woman was a seamstress, an em-
broiderer, a weaver, an artist in all sorts of fine and beau-
tiful work, appears to have been generally forgotten. Yet

New Demands Upon the Eye

women living under primitive conditions have just as
good eyesight as the men.

When man learned how to communicate his thoughts
to others by means of written and printed forms, there
came some undeniably new demands upon the eye, af-

Fig. 2. African Pigmies

They had normal vision when tested, but their expressions
show that they could not have had it when photographed.

fecting at first only a few people, but gradually including
more and more, until now, in the more advanced coun-
tries, the great mass of the population is subjected to
their influence. A few hundred years ago even princes
were not taught to read and write. Now we compel
everyone to go to school, whether he wishes to or not,

Introductory

even the babies being sent to kindergarten. A generation
or so ago books were scarce and expensive. To-day, by
means of libraries of all sorts, stationary and traveling,
they have been brought within the reach of practically
everyone. The modern newspaper, with its endless col-
umns of badly printed reading matter, was made possible
only by the discovery of the art of manufacturing paper
from wood, which is a thing of yesterday. The -tallow
candle has been but lately displaced by the various forms
of artificial lighting, which tempt most of us to prolong
our vocations and avocations into hours when primitive
man was forced to rest, and within the last couple of
decades has come the moving picture to complete the
supposedly destructive process.

Was it reasonable to expect that Nature should have
provided for all these developments, and produced an
organ that could respond to the new demands? It is the
accepted belief of ophthalmology to-day that she could
not and did not,1 and that, while the processes of civiliza-
tion depend upon the sense of sight more than upon any
other, the visual organ is but imperfectly fitted for its
tasks.

There are a great number of facts which seem to jus-
tify this conclusion. While primitive man appears to have
suffered little from defects of vision, it is safe to say that

1 The unnatural strain of accommodating the eyes to close work (for
which they were not intended) leads to myopia in a large proportion of
growing children. — Rosenau: Preventive Medicine and Hygiene, third edition,
1917, p. 1093.

The compulsion of fate as well as an error of evolution has brought it
about that the unaided eye must persistently struggle against the astonishing
difficulties and errors inevitable in its structure, function and circumstance. —
Gould: The Cause, Nature and Consequences of Eyestrain, Pop. Sci. Monthly,
Dec., 1905.

With the invention of writing and then with the invention of the print-
ing-press a new element was introduced, and one evidently not provided for
by the process of evolution. The human eye which had been evolved for dis-
tant vision is being forced to perform a new part, one for which it had not
been evolved, and for which it is poorly adapted. The difficulty is being
daily augmented.— Scott : The Sacrifice of the Eyes of School Children, Pop.
Sci. Monthly, Oct., 1907.

Military Visual Standards

of persons over twenty-one living under civilized condi-
tions nine out of every ten have imperfect sight, and as
the age increases the proportion increases, until at forty
it is almost impossible to find a person free from visual
defects. Voluminous statistics are available to prove
these assertions, but the visual standards of the modern
army 1 are all the evidence that is required.

In Germany, Austria, France and Italy the vision with
glasses determines acceptance or rejection for military
service, and in all these countries more than six diopters2
of myopia are allowed, although a person so handicapped
cannot, without glasses, see anything clearly at more
than six inches from his eyes. In the German Army a
recruit for general service is required — or was required
under the former government — to have a corrected vision
of 6/12 in one eye. That is, he must be able to read
with this eye at six metres the line normally read at
twelve metres. In other words, he is considered fit for
military service if the vision of one eye can be brought
up to one-half normal with glasses. The vision in the
other eye may be minimal, and in the Landsturm one
eye may be blind. Incongruous as the eyeglass seems
upon the soldier, military authorities upon the European
continent have come to the conclusion that a man with
6/12 vision wearing glasses is more serviceable than a
man with 6/24 vision (one-quarter normal) without
them.

In Great Britain it was formerly uncorrected vision
that determined acceptance or rejection for military ser-
vice. This was probably due to the fact that previous to
the recent war the British Army was used chiefly for

1 Ford : Details of Military Medical Administration, published with the
approval of the Surgeon General, U. S. Army, second revised edition, 1918,
pp. 498-499.

2 A diopter is the focussing power necessary to bring parallel rays to a
focus at one metre.

Introductory

foreign service, at such distances from its base that there
might have been difficulty in providing glasses. The
standard at the beginning of the war was 6/24 (uncor-
rected) for the better eye and 6/60 (uncorrected) for the

Fig. 3 — Moros from the Philippines

With sight ordinarily normal all were probably myopic when
photographed except the one at the upper left whose eyes are
shut.

poorer, which was required to be the left. Later, owing
to the difficulty of securing enough men with even this
moderate degree of visual acuity, recruits were accepted
whose vision in the right eye could be brought up to 6/12
by correction, provided the vision of one eye was 6/24
without correction.1

1 Tr. Ophth. Soc. U. Kingdom, vol. xxxviii, 1918, pp. 130-131.

Lowering of American Standards 7

Up to 1908 the United States required normal vision
in recruits for its military service. In that year Ban-
nister and Shaw made some experiments from which
they concluded that a perfectly sharp image of the target
was not necessary for good shooting, and that, therefore,
a visual acuity of 20/40 (the equivalent in feet of 6/12
in metres), or even 20/70, in the aiming eye only, was
sufficient to make an efficient soldier. This conclusion
was not accepted without protest, but normal vision had
become so rare that it probably seemed to those in au-
thority that there was no use insisting upon it; and
the visual standard for admission to the Army was
accordingly lowered to 20/40 for the better eye and
20/100 for the poorer, while it was further provided that
a recruit might be accepted when unable with the better
eye to read all the letters on the 20/40 line, provided he
could read some of the letters on the 20/30 line.1

In the first enrollment of troops for the European war
it is a matter of common knowledge that these very low
standards were found to be too high and were interpreted
with great liberality. Later they were lowered so that
men might be "unconditionally accepted for general mili-
tary service" with a vision of 20/100 in each eye without
glasses, provided that the sight of one eye could be
brought up to 20/40 with glasses, while for limited ser-
vice 20/200 in each eye was sufficient, provided the vision
of one eye might be brought up to 20/40 with glasses.2
Yet 21.68 per cent of all rejections in the first draft, 13
per cent more than for any other single cause, were for

1 Harvard: Manual of Military Hygiene for the Military Services of the
United States, published under the authority and with the approval of the
Surgeon General, U. S. Army, third revised edition, 1917, p. 195.

2 Standards of Physical Examination for the Use of Local Boards, District
Boards, and Medical Advisory Boards under the Selective Service Regula-
tions, issued through the office of the Provost Marshal General, 1918.

8 Introductory

eye defects,1 while under the revised standards these de-
fects still constituted one of three leading causes of re-
jection. They were responsible for 10.65 per cent of the
rejections, while defects of the bones and joints and of
the heart and blood-vessels ran, respectively, about two
and two and a half per cent higher.2

For more than a hundred years the medical profession
has been seeking for some method of checking the rav-
ages of civilization upon the human eye. The Germans,
to whom the matter was one of vital military importance,
have spent millions of dollars in carrying out the sugges-
tions of experts, but without avail; and it is now ad-
mitted by most students of the subject that the methods
which were once confidently advocated as reliable safe-
guards for the eyesight of our children have accom-
plished little or nothing. Some take a more cheerful
view of the matter, but their conclusions are hardly borne
out by the army standards just quoted.

For the prevailing method of treatment, by means of
compensating lenses, very little was ever claimed except
that these contrivances neutralized the effects of the
various conditions for which they were prescribed, as a
crutch enables a lame man to walk. It has also been
believed that they sometimes checked the progress of
these conditions ; but every ophthalmologist now knows
that their usefulness for this purpose, if any, is very lim-
ited. In the case of myopia3 (shortsight), Dr. Sidler-
Huguenin of Zurich, in a striking paper recently pub-

1 Report of the Provost Marshal General to the Secretary of War on the
First Draft under the Selective Service Act, 1917.

2 Second Report of the Provost Marshal General to the Secretary of War
on the Operations of the Selective Service System to December 20, 1918.

3 From the Greek myein, to close, and ops, the eye ; literally a condition
in which the subject closes the eye, or blinks.

Present Methods of Treatment Futile 9

lished,1 expresses the opinion that glasses and all
methods now at our command are "of but little avail"
in preventing either the progress of the error of refrac-
tion, or the development of the very serious complica-
tions with which it is often associated.

These conclusions are based on the study of thousands
of cases in Dr. Huguenin's private practice and in the
clinic of the University of Zurich, and regarding one
group of patients, persons connected with the local edu-
cational institutions, he states that the failure took place
in spite of the fact that they followed his instructions for
years "with the greatest energy and pertinacity," some-
times even changing their professions.

I have been studying the refraction of the human eye
for more than thirty years, and my observations fully
confirm the foregoing conclusions as to the uselessness
of all the methods heretofore employed for the preven-
tion and treatment of errors of refraction. I was very
early led to suspect, however, that the problem was by
no means an unsolvable one.

Every ophthalmologist of any experience knows that
the theory of the incurability of errors of refraction does
not fit the observed facts. Not infrequently such cases
recover spontaneously, or change from one form to an-
other. It has long been the custom either to ignore these
troublesome facts, or to explain them away, and fortu-
nately for those who consider it necessary to bolster up
the old theories at all costs, the role attributed to the
lens in accommodation offers, in the majority of cases,
a plausible method of explanation. According to this

1 Archiv. f. Augenh, vol. Ixxix, 1915, translated in Arch. Ophth., vol.
xlv, No. 6, Nov., 1916.

10 Introductory

theory, which most of us learned at school, the eye
changes its focus for vision at different distances by alter-
ing the curvature of the lens; and in seeking for an
explanation for the inconstancy of the theoretically con-
stant error of refraction the theorists hit upon the very
ingenious idea of attributing to the lens a capacity for
changing its curvature, not only for the purpose of nor-
mal accommodation, but to cover up or to produce ac-
commodative errors. In hypermetropia1 — commonly but
improperly called farsight, although the patient with
such a defect can see clearly neither at the distance nor
the nearpoint — the eyeball is too short from the front
backward, and all rays of light, both the convergent ones
coming from near objects, and the parallel ones coming
from distant objects, are focussed behind the retina, in-
stead of upon it. In myopia it is too long, and while
the divergent rays from near objects come to a point
upon the retina, the parallel ones from distant objects
do not reach it. Both these conditions are supposed to
be permanent, the one congenital, the other acquired.
When, therefore, persons who at one time appear to
have hypermetropia, or myopia, appear at other times
not to have them, or to have them in lesser degrees, it is
not permissible to suppose that there has been a change
in the shape of the eyeball. Therefore, in the case of the
disappearance or lessening of hypermetropia, we are
asked to believe that the eye, in the act of vision, both
at the near-point and at the distance, increases the curva-
ture of the lens sufficiently to compensate, in whole or
in part, for the flatness of the eyeball. In myopia, on the

1 From the Greek hyper, over, metron. measure, and ops, the eye.

An Ingenious Theory

contrary, we are told that the eye actually goes out of
its way to produce the condition, or to make an existing
condition worse. In other words, the so-called "ciliary

Fig. 4. Diagram of the Hypermetropic, Emmetropic and
Myopic Eyeballs

H, hypermetropia ; E, emmetropia; M, myopia; Ax, optic axis.
Note that in hypermetropia and myopia the rays, instead of
coming to a focus, form a round spot upon the retina.

muscle," believed to control the shape of the lens, is
credited with a capacity for getting into a more or less
continuous state of contraction, thus keeping the lens
continuously in a state of convexity which, according

12 Introductory

to the theory, it ought to assume only for vision at the
near-point. These curious performances may seem un-
natural to the lay mind; but ophthalmologists believe
the tendency to indulge in them to be so ingrained in
the constitution of the organ of vision that, in the fittir
of glasses, it is customary to instill atropine — the "drop
with which everyone who has ever visited an oculist
familiar — into the eye, for the purpose of paralyzing i,
ciliary muscle and thus, by preventing any change o.
curvature in the lens, bringing out "latent hyperme-
tropia" and getting rid of "apparent myopia."

The interference of the lens, however, is believed tc
account for only moderate degrees of variation in errors
of refraction, and that only during the earlier years of
life. For the higher ones, or those that occur after forty-
five years of age, when the lens is supposed to have lost
its elasticity to a greater or less degree, no plausible
explanation has ever been devised. The disappearance
of astigmatism,1 or changes in its character, present an
even more baffling problem. Due in most cases to an
unsymmetrical change in the curvature of the cornea,
and resulting in failure to bring the light rays to a focus
at any point, the eye is supposed to possess only a limited
power of overcoming this condition ; and yet astigmatism
comes and goes with as much facility as do other errors
of refraction. It is well known, too, that it can be pro-
duced voluntarily. Some persons can produce as much
as three diopters. I myself can produce one and a half.

Examining 30,000 pairs of eyes a year at the New York
Eye and Ear Infirmary and other institutions, I observed

1 From the Greek a, without, and stigma, a point.

Orthodox Explanations Fail

many cases in which errors of refraction either recov-
ered spontaneously, or changed their form, and I was
unable either to ignore them, or to satisfy myself with

Fig. 5. The Eye As a Camera

The photographic apparatus; D, diaphragm made of circular
overlapping plates of metal by means of which the opening
through which the rays of light enter the chamber can be en-
larged or contracted; L, lens; R, sensitive plate (the retina of
the eye ; AB, object to be photographed; ab, image on the sen-
sitive plate.

The eye: C, cornea where the rays of light undergo a first re-
fraction; D, iris (the diaphragm of the camera); L, lens, where
the light rays are again refracted; R, retina of the normal eye;
AB, objjct of vision; ab, image in the normal or emmetropic
eye; a' b', image in the hypermetropic eye; a" b", image in the
myopic eye. Note that in a' b' and a" b", the rays are spread out
upon the retina instead of being brought to a focus as in ab, the
result being the formation of a blurred image.

14 Introductory

the orthodox explanations, even where such explana-
tions were available. It seemed to me that if a state-
ment is a truth it must always be a truth. There can
be no exceptions. If errors of refraction are incurable,
they should not recover, or change their form, spon-
taneously.

In the course of time I discovered that myopia and
hypermetropia, like astigmatism, could be produced at
will; that myopia was not, as we have so long believed,
associated with the use of the eyes at the near-point,
but with a strain to see distant objects, strain at the
near-point being associated with hypermetropia; that
no error of refraction was ever a constant condition ; and
that the lower degrees of refractive error were curable,
while higher degrees could be improved.

In seeking for light upon these problems I examined
tens of thousands of eyes, and the more facts I accumu-
lated the more difficult it became to reconcile them with
the accepted views. Finally, about half a dozen years
ago, I undertook a series of observations upon the eyes
of human beings and the lower animals the results of
which convinced both myself and others that the lens
is not a factor in accommodation, and that the ad-
justment necessary for vision at different distances is
affected in the eye, precisely as it is in the camera, by a
change in the length of the organ, this alteration being
brought about by the action of the muscles on the out-
side of the globe. Equally convincing was the demon-
stration that errors of refraction, including presbyopia,
are due, not to an organic change in the shape of the
eyeball, or in the constitution of the lens, but to a func-
tional and therefore curable derangement in the action
of the extrinsic muscles.

The Compulsion of Facts

In making these statements I am well aware that I
am controverting the practically undisputed teaching of
ophthalmological science for the better part of a century ;

Fig. 6. Mexican Indians

With normal sight when tested all the members of this primi-
tive group are now either squinting or staring.

but I have been driven to the conclusions which they
embody by the facts, and that so slowly that I am now
surprised at my own blindness. At the time I was improv-
ing high degrees of myopia; but I wanted to be con-
servative, and I differentiated between functional myopia,

Introductory

which I was able to cure, or improve, and organic myopia,
which, in deference to the orthodox tradition, I accepted
as incurable.

Fig. 7. Ainus, the Aboriginal Inhabitants of Japan
All show signs of temporary imperfect sight

CHAPTER II
SIMULTANEOUS RETINOSCOPY

MUCH of my information about the eyes has
been obtained by means of simultaneous reti-
noscopy. The retinoscope is an instrument
used to measure the refraction of the eye. It throws a
beam of light into the pupil by reflection from a mirror,
the light being either outside the instrument — above and
behind the subject — or arranged within it by means of an
electric battery. On looking through the sight-hole one
sees a larger or smaller part of the pupil filled with light,
which in normal human eyes is a reddish yellow, because
this is the color of the retina, but which is green in a
cat's eye, and might be white if the retina were diseased.
Unless the eye is exactly focussed at the point from
which it is being observed, one sees also a dark shadow
at the edge of the pupil, and it is the behavior of this
shadow when the mirror is moved in various directions
which reveals the refractive condition of the eye. If the
instrument is used at a distance of six feet or more, and
the shadow moves in a direction opposite to the move-
ment of the mirror, the eye is myopic. If it moves in
the same direction as the mirror, the eye is either hyper-
metropic or normal; but in the case of hypermetropia
the movement is more pronounced than in that of nor-
mality, and an expert can usually tell the difference be-
tween the two states merely by the nature of the move-

bfl

•g s

Possibilities of Retinoscopy 19

ment. In astigmatism the movement is different in
different meridians. To determine the degree of the
error, or to distinguish accurately between hyperme-
tropia and normality, or between the different kinds of
astigmatism, it is usually necessary to place a glass
before the eye of the subject. If the mirror is concave
instead of plane, the movements described will be re-
versed; but the plane mirror is the one most commonly
used.

This exceedingly useful instrument has possibilities
which have not been generally realized by the medical
profession. Most ophthalmologists depend upon the
Snellen1 test card, supplemented by trial lenses, to deter-
mine whether the vision is normal or not, and to deter-
mine the degree of any abnormality that may exist. This
is a slow, awkward and unreliable method of testing the
vision, and absolutely unavailable for the study of the
refraction of the lower animals, of infants, and of adult
human beings under the conditions of life.

The test card and trial lenses can be used only under
certain favorable conditions, but the retinoscope can be
used anywhere. It is a little easier to use it in a dim
light than in a bright one, but it may be used in any
light, even with the strong light of the sun shining di-
rectly into the eye. It may also be used under many
other unfavorable conditions.

It takes a considerable time, varying from minutes
to hours, to measure the refraction with the Snellen test
card and trial lenses. With the retinoscope, however,
it can be determined in a fraction of a second. By the

1 Herman Snellen (1835-1908). Celebrated Dutch ophthalmologist, pro-
fessor of ophthalmology in the University of Utrecht and director of the
Netherlandic Eye Hospital. The present standards of visual acuity were
proposed by him, and his test types became the model for those now in use.

20 Simultaneous Eetinoscopy

former method would be impossible, for instance, to get
any information about the refraction of a baseball player
at the moment he swings for the ball, at the moment he
strikes it, and at the moment after he strikes it. But
with the retinoscope it is quite easy to determine whether
his vision is normal, or whether he is myopic, hyper-
metropic, or astigmatic, when he does these things; and
if any errors of refraction are noted, one can guess their
degree pretty accurately by the rapidity of the movement
of the shadow.

With the Snellen test card and trial lenses conclu-
sions must be drawn from the patient's statements as
to what he sees ; but the patient often becomes so wor-
ried and confused during the examination that he does
not know what he sees, or whether different glasses
make his sight better or worse; and, moreover, visual
acuity is not reliable evidence of the state of the refrac-
tion. One patient with two diopters of myopia may see
twice as much as another with the same error of refrac-
tion. The evidence of the test card is, in fact, entirely
subjective; that of the retinoscope is entirely objective,
depending in no way upon the statements of the patient.

In short, while the testing of the refraction by means
of the Snellen test card and trial lenses requires con-
siderable time, and can be done only under certain arti-
ficial conditions, with results that are not always re-
liable, the retinoscope can be used under all sorts of
normal and abnormal conditions on the eyes both of
human beings and the lower animals; and the results,
when it is used properly, can always be depended upon.
This means that it must not be brought nearer to the
eye than six feet; otherwise the subject will be made
nervous, the refraction, for reasons which will be ex-

Retinoscope Reveals New Facts 21

plained later, will be changed, and no reliable observa-
tions will be possible. In the case of animals it is often
necessary to use it at a much greater distance.

For thirty years I have been using the retinoscope
to study the refraction of the eye. With it I have ex-
amined the eyes of tens of thousands of school children,
hundreds of infants and thousands of animals, including
cats, dogs, rabbits, horses, cows, birds, turtles, reptiles
and fish. I have used it when the subjects were at rest
and when they were in motion — also when I myself was
in motion; when they were asleep and when they were
awake or even under ether and chloroform. I have used
it in the daytime and at night, when the subjects were
comfortable and when they were excited; when they
were trying to see and when they were not ; when they
were lying and when they were telling the truth; when
the eyelids were partly closed, shutting off part of the
area of the pupil, when the pupil was dilated, and also
when it was contracted to a pin-point ; when the eye was
oscillating from side to side, from above downward and
in other directions. In this way I discovered many facts
which had not previously been known, and which I was
quite unable to reconcile with the orthodox teachings on
the subject. This led me to undertake the series of
experiments already alluded to. The results were in
entire harmony with my previous observations, and left
me no choice but to reject the entire body of orthodox
teaching about accommodation and errors of refraction.
But before describing these experiments I must crave
the reader's patience while I present a resume of the
evidence upon which the accepted views of accommoda-
tion are based. This evidence, it seems to me, is as

22 Simultaneous Eetinoscopy

strong an argument as any I could offer against the
doctrine that the lens is the agent of accommodation,
while an understanding of the subject is necessary to
an understanding of my experiments.

CHAPTER III

EVIDENCE FOR THE ACCEPTED THEORY OF
ACCOMMODATION

THE power of the eye to change its focus for
vision at different distances has puzzled the
scientific mind ever since Kepler1 tried to ex-
plain it by supposing a change in the position of the
crystalline lens. Later on every imaginable hypothesis
was advanced to account for it. The idea of Kepler had
many supporters. So also had the idea that the change
of focus was effected by a lengthening of the eyeball.
Some believed that the contractive power of the pupil
was sufficient to account for the phenomenon, until the
fact was established, by the operation for the removal of
the iris, that the eye accommodated perfectly without
this part of the visual mechanism. Some, dissatisfied
with all these theories, discarded them all, and boldly
asserted that no change of focus took place,2 a view which
was conclusively disproven when the invention of the
ophthalmoscope made it possible to see the interior of
the eye.

The idea that the change of focus might be brought
about by a change in the form of the lens appears to
have been first advanced, according to Landolt,3 by the

1 Johannes Kepler (1571-1630). German theologian, astronomer and phys-
icist. Many facts of physiological optics were either discovered, or first
clearly stated, by him.

2 Bonders : On the Anomalies of Accommodation and Refraction of the
Eye. English translation by Moore, 1864, p. 10. Frans Cornelis Bonders
(1818-1889) was professor of physiology and ophthalmology at the University
of Utrecht, and is ranked as one of the greatest ophthalmologists of all time.

8 Edmund Landolt (1846-) Swiss ophthalmologist who settled in Paris in
1874, founding an eye clinic which has attracted many students.

24 Accepted Theory of Accommodation

Jesuit, Scheiner (1619). Later it was put forward by
Descartes (1637). But the first definite evidence in sup-
port of the theory was presented by Dr. Thomas Young
in a paper read before the Royal Society in 1800.1 "He
adduced reasons," says Donders, "which, properly under-

lit

Fig. 9. Diagrams of the Images of Purkinje

No. 1 — Images of a candle: a, on the cornea; b, on the front
of the lens; c, on the back of the lens.

No. 2. — Images of lights shining through rectangular openings
in a screen while the eye is at rest (R) and during accommoda-
tion (A): a, on the cornea; b, on the front of the lens; c, on the
back of the lens (after Helmholtz).

Note that in No. 2, A, the central images are smaller and have
approached each other, a change which, if actually took place,
would indicate an increase of curvature in the front of the lens
during accommodation.

stood, should be taken as positive proofs."2 At the time,
however, they attracted little attention.

About half a century later it occurred to Maximilian
Langenbeck3 to seek light on the problem by the aid of

1 On the Mechanism of the Eye, Phil. Tr. Roy. Soc., London, 1801.

2 On the Anomalies of Accommodation and Refraction of the Eye, pp. 10-11.
5 Maximilian Adolf Langenbeck (1818-1877). Professor of anatomy, surgery

and ophthalmology at Gottingen, from 1846 to 1851. Later settled in Hanover.

Studies of the Images of Purkinje 25

what are known as the images of Purkinje.1 If a small
bright light, usually a candle, is held in front of and a
little to one side of the eye, three images are seen: one
bright and upright; another large, but less bright, and
also upright; and a third small, bright and inverted.
The first comes from the cornea, the transparent cover-
ing of the iris and pupil, and the other two from the
lens, the upright one from the front and the inverted
one from the back. The corneal reflection was known
to the ancients, although its origin was not discovered
till later; but the two reflections from the lens were first
observed in 1823 by Purkinje; whence the trio of images
is now associated with his name. Langenbeck examined
these images with the naked eye, and reached the con-
clusion that during accommodation the middle one be-
came smaller than when the eye was at rest. And since
an image reflected from a convex surface is diminished
in proportion to the convexity of that surface, he con-
cluded that the front of the lens became more convex
when the eye adjusted itself for near vision. Bonders
repeated the experiments of Langenbeck, but was un-
able to make any satisfactory observations. He pre-
dicted, however, that if the images were examined with
a magnifier they would "show with certainty" whether
the form of the lens changed during accommodation.
Cramer,2 acting on this suggestion, examined the images
as magnified from ten to twenty times, and thus con-
vinced himself that the one reflected from the front of
the lens became considerably smaller during accommoda-
tion.

1 Johannes Evangelista von Purkinje (1787-1869). Professor of physiology
at Breslau and Prague, and the discoverer of many important physiological
facts.

'Antonie C. Cramer (1822-1855). Dutch ophthalmologist.

26 Accepted Theory of Accommodation

Subsequently Helmholtz, working independently, made
a similar observation, but by a somewhat different
method. Like Bonders, he found the image obtained
by the ordinary methods on the front of the lens very
unsatisfactory, and in his "Handbook of Physiological
Optics" he describes it as being "usually so blurred that
the form of the flame cannot be definitely distinguished."1
So he placed two lights, or one doubled by reflection
from a mirror, behind a screen in which were two small
rectangular openings, the whole being so arranged that
the lights shining through the openings of the screen
formed two images on each of the reflecting surfaces.
During accommodation, it seemed to him that the two
images on the front of the lens became smaller and ap-
proached each other, while on the return of the eye to a
state of rest they grew larger again and separated. This
change, he said, could be seen "easily and distinctly."2
The observations of Helmholtz regarding the behavior
of the lens in accommodation, published about the mid-
dle of the last century, were soon accepted as facts, and
have ever since been stated as such in every text-book
dealing with the subject.

"We may say," writes Landolt, "that the discovery of
the part played by the crystalline lens in the act of accom-
modation is one of the finest achievements of medical
physiology, and the theory of its working is certainly
one of the most firmly established; for not only have
"savans" furnished lucid and mathematical proofs of its
correctness, but all other theories which have been ad-
vanced as explaining accommodation have been easily

1 Handbuch der physiologischen Optik, edited by Nagel, 1909-11, vol. i,
p. 121.

2 Ibid, vol. i, p. 122.

Observations of Helmholtz Accepted 27

and entirely overthrown The fact that the eye is

accommodated for near vision by an increase in the
curvature of its crystalline lens, is, then, incontestably
proved."1

Fig. 10.

Diagram by Which Helmholtz Illustrated His Theory
of Accommodation

R is supposed to be the resting state of the lens, in which it is
adjusted for distant vision. In A the suspensory ligament is sup-
posed to have been relaxed through the contraction of the ciliary
muscle, permitting the lens to bulge forward by virtue of its
own elasticity.

"The question was decided," says Tscherning, "by the
observation of the changes of the images of Purkinje dur-
ing accommodation, which prove that accommodation is
effected by an increase of curvature of the anterior sur-
face of the crystalline lens."2

1 The Refraction and Accommodation of the Eye and their Anomalies,
authorized translation by Culver, 1886, p. 151.

* Physiologic Optics, authorized translation by Weiland, 1904, p. 163.
Marius Hans Erik Tscherning (1854 — ) is a Danish ophthalmologist who
for twenty-five years was co-director and director of the ophthalmological
laboratory of the Sorbonne. Later he became professor of ophthalmology in
the University of Copenhagen.

Fig. 11. Thomas Young (1773-1829)

English physician and man of science who was the first to
present a serious argument in support of the view that accom-
modation is brought about by the agency of the lens.

Scientific Credulity 29

"The greatest thinkers," says Cohn, "have mastered
a host of difficulties in discovering this arrangement, and
it is only in very recent times that its processes have
been clearly and perfectly set forth in the works of
Sanson, Helmholtz, Brticke, Hensen and Volckers."1

Huxley refers to the observations of Helmholtz as the
"facts of adjustment with which all explanations of that
process must accord,"2 and Bonders calls his theory the
"true principle of accommodation."3

Arlt, who had advanced the elongation theory and be-
lieved that no other was possible, at first opposed the
conclusions of Cramer and Helmholtz,4 but later accepted
them.5

Yet in examining the evidence for the theory we can
only wonder at the scientific credulity which could base
such an important department of medical practice as the
treatment of the eye upon such a mass of contradictions.
Helmholtz, while apparently convinced of the correct-
ness of his observations indicating a change of form in
the lens during accommodation, felt himself unable to
speak with certainty of the means by which the sup-
posed change was effected,6 and strangely enough the
question is still being debated. Finding, as he states,
"absolutely nothing but the ciliary muscle to which ac-
commodation could be attributed,"7 Helmholtz concluded
that the changes which he thought he had observed in
the curvature of the lens must be effected by the action
of this muscle; but he was unable to offer any satisfac-

1 The Hygiene of the Eye in Schools, English translation edited by
Turnbull, 1886, p. 23. Hermann Cohn (1838-1906) was professor of ophthal-
mology in the University of Breslau, and is known chiefly for his con-
tributions to ocular hygiene.

2 Lessons in Elementary Physiology, sixth edition, 1872, p. 231.

3 On the Anomalies of Accommodation and Refraction of the Eye, p. 13.

4 Krankheiten des Auges, 1853-56, vol. iii, p. 219, et seq.

5 Ueber die Ursachen und die Entstehung der Kurzsichtigkeit, 1876. Vor-
wort.

8 Handbuch der physiologischen Optik, vol. i, pp. 124 and 145.
t Ibid, vol. i, p. 144.

30 Accepted Theory of Accommodation

tory theory of the way it operated to produce these re-
sults and he explicitly stated that the one he suggested
possessed only the character of probability. Some of his
disciples, "more loyal than the king," as Tscherning has
pointed out, "have proclaimed as certain what he him-
self with much reserve explained as probable,"1 but there
has been no such unanimity of acceptance in this case as
in that of the observations regarding the behavior of the
images reflected from the lens. No one except the pres-
ent writer, so far as I am aware, has ventured to question
that the ciliary muscle is the agent of accommodation ;
but as to the mode of its operation there is generally
felt to be much need for more light. Since the lens is
not a factor in accommodation, it is not strange that no
one was able to find out how it changed its curvature.
It is strange, however, that these difficulties have not
in any way disturbed the universal belief that the lens
does change.

When the lens has been removed for cataract the pa-
tient usually appears to lose his power of accommodation,
and not only has to wear a glass to replace the lost part,
but has to put on a stronger glass for reading. A minor-
ity of these cases, however, after they become accus-
tomed to the new condition, become able to see at the
near-point without any change in their glasses. The
existence of these two classes of cases has been a great
stumbling block to ophthalmology. The first and more
numerous appeared to support the theory of the agency
of the lens in accommodation; but the second was hard
to explain away, and constituted at one time, as Dr.
Thomas Young observed, the "grand objection" to this
idea. A number of these cases of apparent change of focus

Physiologic Optics, p. 166.

Herman Ludwig Ferdinand von Helmholtz (1821-1894)

whose observations regarding the behavior of images reflected
from the front of the lens are supposed to have demonstrated
that the curvature of this body changes during accommodation

32 Accepted Theory of Accommodation

in the lensless eye having been reported to the Royal So-
ciety by competent observers, Dr. Young, before bringing
forward his theory of accommodation, took the trouble
to examine some of them, and considered himself justi-
fied in concluding that an error of observation had been
made. While convinced, however, that in such eyes the
"actual focal distance is totally unchangeable," he char-
acterized his own evidence in support of this view as
only "tolerably satisfactory." At a later period Bonders
made some investigations from which he concluded that
"in aphakia1 not the slightest trace of accommodative
power remains."2 Holmholtz expressed similar views,
and von Graefe, although he observed a "slight resid-
uum" of accommodative power in lensless eyes, did not
consider it sufficient to discredit the theory of Cramer
and Helmholtz. It might be due, he said, to the accom-
modative action of the iris, and possibly also to a length-
ening of the visual axis through the action of the external
muscles.3

For nearly three-quarters of a century the opinions of
these masters have echoed through ophthalmological
literature. Yet it is to-day a perfectly well-known and
undisputed fact that many persons, after the removal of
the lens for cataract, are able to see perfectly at different
distances without any change in their glasses. Every
ophthalmologist of any experience has seen cases of this
kind, and many of them have been reported in the litera-
ture.

In 1872, Professor Forster of Breslau, reported4 a

1 Absence of the lens.

2 On the Anomalies of Accommodation and Refraction of the Eye, p. 320.

3 Archiv. f. Ophth., 1855, vol. ii, part 1, p. 187 et seq. Albrecht von Graefe
(1828-1870) was professor of ophthalmology in the University of Berlin, and
is ranked with Bonders and Arlt as one of the greatest ophthalmologists of
the nineteenth century.

* Klin. Montasbl. f. Augenh., Erlangen, 1872, vol. x, p. 39, et seq.

Not To Be Deputed 33

series of twenty-two cases of apparent accommodation
in eyes from which the lens -had been removed for cata-
ract. The subjects ranged in age from eleven to seventy-
four years, and the younger ones had more accommoda-
tive power than the elder. A year later Woinow of
Moscow1 reported eleven cases, the subjects being from
twelve to sixty years of age. In 1869 and 1870, respec-
tively, Loring reported2 to the New York Ophthalmo-
logical Society and the American Ophthalmological So-
ciety the case of a young woman of eighteen who, without
any change in her glasses, read the twenty line on the
Snellen test card at twenty feet and also read diamond
type at from five inches to twenty. On October 8, 1894,
a patient of Dr. A. E. Davis who appeared to accommo-
date perfectly without a lens consented to go before the
New York Ophthalmological Society. "The members,"
Dr. Davis reports,3 "were divided in their opinion as to
how the patient was able to accommodate for the near-
point with his distance glasses on"; but the fact that he
could see at this point without any change in his glasses
was not to be disputed.

The patient was a chef, forty-two years old, and on
January 27, 1894, Dr. Davis had removed a black cataract
from his right eye, supplying him at the same time with
the usual outfit of glasses, one to replace the lens, for
distant vision, and a stronger one for reading. In Octo-
ber he returned, not because his eye was not doing well,
but because he was afraid he might be "straining" it.
He had discarded his reading glasses after a few weeks,
and had since been using only his distance glasses. Dr.

1 Archiv. f. Ophth., 1873, vol. xix, part 3, p. 107.

a Flint: Physiology of Man, 1875, vol. v, pp. 110-111.

8 Davis : Accommodation in the Lensless Eye, Reports of the Manhattan
Eye and Ear Hospital, Jan., 1895. The article gives a review of the whole
subject.

34 Accepted Theory of Accommodation

Davis doubted the truth of his statements, never having
seen such a case before, but found them, upon investiga-
tion, to be quite correct. With his lensless eye and a
convex glass of eleven and a half diopters, the patient
read the ten line on the test card at twenty feet, and
with the same glass, and without any change in its posi-
tion, he read fine print at from fourteen to eighteen
inches. Dr. Davis then presented the case to the Oph-
thalmological Society but, as has been stated, he ob-
tained no light from that source. Four months later,
February 4, 1895, the patient still read 20/10 at the dis-
tance and his range at the near point had increased so
that he read diamond type at from eight to twenty-two
and a half inches. Dr. Davis subjected him to numerous
tests, and though unable to find any explanation for his
strange performances, he made some interesting obser-
vations. The results of the tests by which Donders
satisfied himself that the lensless eye possessed no ac-
commodative power were quite different from those re-
ported by the Dutch authority, and Dr. Davis therefore
concluded that these tests were "wholly inadequate to
decide the question at issue." During accommodation
the ophthalmometer1 showed that the corneal curvature
was changed and that the cornea moved forward a little.
Under scopolamine, a drug sometimes used instead of
atropine to paralyze the ciliary muscle (1/10 per cent
solution every five minutes for thirty-five minutes, fol-
lowed by a wait of half an hour), these changes took
place as before; they also took place when the lids were
held up. With the possible influence of lid pressure and
of the ciliary muscle eliminated, therefore, Dr. Davis
felt himself bound to conclude that the changes "must

An instrument for measuring the curvature of the cornea.

Another Puzzling Case 35

have been produced by the action of the external mus-
cles." Under scopolamine, also, the man's accommoda-
tion was only slightly affected, the range at the near
point being reduced only two and a half inches.

The ophthalmometer further showed the patient to
have absolutely no astigmatism. It had showed the
same thing about three months after the operation, but
three and a half weeks after it he had four and a half
diopters.

Seeking further light upon the subject Dr. Davis now
subjected to similar tests a case which had previously
been reported by Webster in the "Archives of Pediat
rics."1 The patient had been brought to Dr. Webster at
the age of ten with double congenital cataract. The left
lens had been absorbed as the result of successive needl
ings, leaving only an opaque membrane, the lens capsule,
while the right, which had not been interfered with, was
sufficiently transparent around the edge to admit of useful
vision. Dr. Webster made an opening in the membrane
filling the pupil of the left eye, after which the vision of
this eye, with a glass to replace the lens, was about
equal to the vision of the right eye without a glass. Foi
this reason Dr. Webster did not think it necessary tc
give the patient distance glasses, and supplied him with
reading glasses only — plane glass for the right eye and
convex 16D for the left. On March 14, 1893, he returned
and stated that he had been wearing his reading glasses
all the time. With this glass it was found that he could
read the twenty line of the test card at twenty feet, and
read diamond type easily at fourteen inches. Subse
quently the right lens was removed, after which no ac-
commodation was observed in this eye. Two years later

Nov.. 1893, p. 932.

36 Accepted Theory of Accommodation

March 16, 1895, he was seen by Dr. Davis, who found
that the left eye now had an accommodative range of
from ten to eighteen inches. In this case no change was
observed in the cornea. The results of the Donders tests
were similar to those of the earlier case, and under
scopolamine the eye accommodated as before, but not
quite so easily. No accommodation was observed in
the right eye.

These and similar cases have been the cause of great
embarrassment to those who feel called upon to reconcile
them with the accepted theories. With the retinoscope
the lensless eye can be seen to accommodate; but the
theory of Helmholtz has dominated the ophthalmological
mind so strongly that even the evidence of objective tests
was not believed. The apparent act of accommodation
was said not to be real, and many theories, very curious
and unscientific, have been advanced to account for it.
Davis is of the opinion that "the slight change in the
curvature of the cornea, and its slight advancement ob-
served in some cases, may, in those cases, account for
some of the accommodative power present, but it is such
a small factor that it may be elminated entirely, since in
some of the most marked cases of accommodation in
aphakial eyes no such changes have been observed."

The voluntary production of astigmatism is another
stumbling block to the supporters of the accepted theo-
ries, as it involves a change in the shape of the cornea,
and such a change is not compatible with the idea of an
"inextensible"1 eyeball. It seems to have given them less
trouble, however, than the accommodation of the lensless

1 Inasmuch as the eye is inextensible, it cannot adapt itself for the per-
ception of objects situated at different distances by increasing the length
of its axis, but only by increasing the refractive power of its lens. — De
Schweinitz: Diseases of the Eye, eighth edition, 1916, pp. 35-36.

Voluntary Production of Astigmatism 37

eye, because fewer of these cases have been observed and
still fewer have been allowed to get into the literature.
Some interesting facts regarding one have fortunately
been given by Davis, who investigated it in connection
with the corneal changes noted in the lensless eye. The
case was that of a house surgeon at the Manhattan Eye
and Ear Hospital, Dr. C. H. Johnson. Ordinarily this
gentleman had half a diopter of astigmatism in each eye ;
but he could, at will, increase this to two diopters in the
right eye and one and a half in the left. He did this many
times, in the presence of a number of members of the
hospital staff, and also did it when the upper lids were
held up, showing that the pressure of the lids had nothing
to do with the phenomenon. Later he went to Louisville,
and here Dr. J. M. Ray, at the suggestion of Dr. Davis,
tested his ability to produce astigmatism under the influ-
ence of scopolamine (four instillations, 1/5 per cent solu-
tion). While the eyes were under the influence of the
drug the astigmatism still seemed to increase, according
to the evidence of the ophthalmometer, to one and a half
diopters in the right eye and one in the left. From these
facts, the influence of the lids and of the ciliary muscle
having been eliminated, Dr. Davis concluded that the
change in the cornea was "brought about mainly by the
external muscles." What explanation others offer for
such phenomena I do not know.

CHAPTER IV

THE TRUTH ABOUT ACCOMMODATION AS DEMON-
STRATED BY EXPERIMENTS ON THE EYE MUS-
CLES OF FISH, CATS, DOGS, RABBITS AND OTHER
ANIMALS

THE function of the muscles on the outside of
the eyeball, apart from that of turning the globe
in its socket, has been a matter of much dis-
pute; but after the supposed demonstration by Helm-
holtz that accommodation depends upon a change in
the curvature of the lens, the possibility of their being
concerned in the adjustment of the eye for vision at
different distances, or in the production of errors of re-
fraction, was dismissed as no longer worthy of serious
consideration. "Before physiologists were acquainted
with the changes in the dioptic system,"1 says Bonders,
"they often attached importance to the external muscles
in the production of accommodation. Now that we
know that accommodation depends on a change of form
in the lens this opinion seems scarcely to need refuta-
tion." He states positively that "many instances occur
where the accommodation is wholly destroyed by paraly-
sis, without the external muscles being the least im-
peded in their action," and also that "some cases are on
record of paralysis of all or nearly all of the muscles of
the eye, and of deficiency of the same, without diminu-
tion of the power of accommodation."2

If Bonders had not considered the question settled, he

1 The refractive system.

2 On the Anomalies of Accommodation and Refraction of the Eye, p. 22.

The External Muscles of the Eyeball 39

might have inquired more carefully into these cases, and
if he had, he might have been less dogmatic in his state-
ments ; for, as has been pointed out in the preceding chap-
ter, there are plenty of indications that the contrary is
the case. In my own experiments upon the extrinsic eye
muscles of fish, rabbits, cats, dogs and other animals, the
demonstration seemed to be complete that in the eyes of
these animals accommodation depends wholly upon the
action of the extrinsic muscles and not at all upon the
agency of the lens. By the manipulation of these muscles
I was able to produce or prevent accommodation at will,
to produce myopia, hypermetropia and astigmatism, or to
prevent these conditions. Full details of these experi-
ments will be found in the "Bulletin of the New York
Zoological Society" for November, 1914, and in the "New
York Medical Journal" for May 8, 1915; and May 18,
1918; but for the benefit of those who have not the time
or inclination to read these papers, their contents are
summarized below.

There are six muscles on the outside of the eyeball,
four known as the "recti" and two as the "obliques." The
obliques form an almost complete belt around the middle
of the eyeball, and are known, according to their position,
as "superior" and "inferior." The recti are attached to the
sclerotic, or outer coat of the eyeball, near the front, and
pass directly over the top, bottom and sides of the globe
to the back of the orbit, where they are attached to the
bone round the edges of the hole through which the optic
nerve passes. According to their position, they are
known as the "superior," "inferior," "internal" and "ex-
ternal" recti. The obliques are the muscles of accommo-
dation ; the recti are concerned in the production of hyper-
metropia and astigmatism.

40 Accommodation: Experiments on Animals

In some cases one of the obliques is absent or rudi-
mentary, but when two of these muscles were present and
active, accommodation, as measured by the objective test

Fig. 13. Demonstration Upon the Eye of a Rabbit that the
Inferior Oblique Muscle is an Essential Factor in Accommo-
dation

No. 1. — The inferior ob-
lique muscle has been ex-
posed and two sutures are
attached to it. Electrical
stimulation of the eyeball
produces accommodation,
as demonstrated by simul-
taneous retinoscopy.

No. 2.— The muscle has
been cut. Electrical stim-
ulation produces no ac-
commodation.

No. 3.— The muscle has
been sewed together. Elec-
trical stimulation produces
normal accommodation.

of retinoscopy, was always produced by electrical stimu-
lation either of the eyeball, or of the nerves of accommo-
dation near their origin in the brain. It was also pro-

Oblique Muscles Inactive: No Accommodation 41

Fig. 14. Demonstration Upon the Eye of a Carp That the
Superior Oblique Muscle Is Essential to Accommodation.

No. 1.— The superior oblique is lifted from the eyeball by two
sutures, and the retinoscope shows no error of refraction. No. 2.
— Electrical stimulation produces accommodation, as determined
by the retinoscope. No. 3. — The muscle has been cut. Stimula-
tion of the eyeball with electricity fails to produce accommoda-
tion. No. 4.— The divided muscle has been reunited by tying
the sutures. Accommodation follows electrical stimulation as
before.

42 Accommodation: Experiments on Animals

duced by any manipulation of the obliques whereby their
pull was increased. This was done by a tucking opera-
tion of one or both muscles, or by an advancement of the

Fig. 15. Demonstration Upon the Eye of a Rabbit That the
Production of the Refractive Errors Is Dependent Upon the
Action of the External Muscles. The String Is Fastened
to the Insertion of the Superior Oblique and Rectus Muscles

No. 1. — Backward pull.
Myopia is produced.

No. 2. — Forward pull.
Hypermetropia is p r o -
duced.

No. 3. — Upward pull in
the plane of the iris.
Mixed astigmatism is pro-
duced.

point at which they are attached to the sclerotic. When
one or more of the recti had been cut; the effect of opera-
tions increasing the pull of the obliques was intensified.

The Extrinsic Muscles in Refractive Errors 43

After one or both of the obliques had been cut across,
or after they had been paralyzed by the injection of atro-
pine deep into the orbit, accommodation could never be

Fig. 16. Demonstration Upon the Eye of a Fish That the
Production of Myopic and Hypermetropic Refraction Is
Dependent Upon the Action of the Extrinsic Muscles.

Suture tied to the insertion of the superior rectus muscle. By
means of strong traction upon the suture the eyeball is turned
in its socket, and by tying the thread to a pair of fixation forceps
which grasp the lower jaw, it is maintained in this position. A
high degree of mixed astigmatism as produced, as demonstrated
by simultaneous retinoscopy. When the superior oblique is di-
vided the myopic part of the astigmatism disappears, and when
the inferior rectus is cut the hypermetropic part disappears, and
the eye becomes normal — adjusted for distant vision — although
the same amount of traction is maintained. It is evident that
these muscles are essential factors in the production of myopia
and hypermetropia.

44 Accommodation: Experiments on Animals

produced by electrical stimulation; but after the effects
of the atropine had passed away, or a divided muscle had
been sewed together, accommodation followed electrical
stimulation just as usual. Again when one oblique muscle
was absent, as was found to be the case in a dogfish, a
shark and a few perch, or rudimentary, as in all cats ob-
served, a few fish and an occasional rabbit, accommoda-
tion could not be produced by electrical stimulation. But
when the rudimentary muscle was strengthened by ad-
vancement, or the absent one was replaced by a suture
which supplied the necessary countertraction, accommo-
dation could always be produced by electrical stimulation.

After one or both of the oblique muscles had been cut,
and while two or more of "the recti were present and
active,1 electrical stimulation of the eyeball, or of the
nerves of accommodation, always produced hyperme-
tropia, while by the manipulation of one of the recti,
usually the inferior or the superior, so as to strengthen
its pull, the same result could be produced. The
paralyzing of the recti by atropine, or the cutting of one
or more of them, prevented the production of hyperme-
tropic refraction by electrical stimulation; but after the
effects of the atropine had passed away, or after a divided
muscle had been sewed together, hypermetropia was pro-
duced as usual by electrical stimulation.

It should be emphasized that in order to paralyze either
the recti muscles, or the obliques, it was found necessary
to inject the atropine far back behind the eyeball with a
hypodermic needle. This drug is supposed to paralyze
the accommodation when dropped into the eyes of human

1 In many animals, notably in rabbits, the internal and external recti are
either absent or rudimentary, so that, practically, in such cases, there are
only two recti. just as there are only two obliques. In others, as in many
fish, the internal rectus is negligible.

Production of Astigmatism

beings or animals, but in all of my experiments it was
found that when used in this way it had very little effect
upon the power of the eye to change its focus.

Astigmatism was usually produced in combination

Fig. 17.

No. 1.— Production of mixed astigmatism in the eye of a carp
by pulling strings attached to the conjunctiva in opposite direc-
tions. Note the oval shape of the front of the eyeball.

No. 2.— With the cutting of the strings the eyeball returns to
its normal shafe, and the refraction becomes normal.

46 Accommodation: Experiments on Animals

with myopic or hypermetropic refraction. It was also
produced by various manipulations of both the oblique
and recti muscles. Mixed astigmatism, which is a com-
bination of myopic with hypermetropic refraction, was

Fig. 18. Demonstration Upon the Eyeball of a Rabbit That the
Obliques Lengthen the Visual Axis in Myopia

R, rest. The eyeball is of normal length and emmetropic — that
is, perfectly adjusted for distant vision. My, myopia. The pull
of the oblique muscles has been strengthened by advancement,
and the retinoscope shows that myopia has been produced. It
can easily be noted that the eyeball is longer. It was impossible
to avoid some movement of the head between the taking of the
two pictures as a result of the manipulation of the strings, but
the rule shows that the focus of the camera was not appreciably
changed by such movements.

always produced by traction on the insertion of the supe-
rior or inferior rectus in a direction parallel to the plane
of the iris, so long as both obliques were present and
active : but if either or both of the obliques had been cut,

The Recti in Hypermetropia

the myopic part of the astigmatism disappeared. Simi-
larly after the superior or the inferior rectus had been
cut the hypermetropic part of the astigmatism disap-
peared. Advancement of the two obliques, with ad-
vancement of the superior and inferior recti, always pro-
duced mixed astigmatism.

Fig. 19. Demonstration Upon the Eye of a Carp That the
Recti Shorten the Visual Axis in Hypermetropia

R, rest. The eyeball is of normal length and emmetropic.
Hy, hypermetropia. The pull of the external and internal recti
has been strengthened by advancement, and the retinoscope
shows that hypermetropia has been produced. It may easily be
noted that the eyeball is shorter. The rule shows that the focus
of the camera was not appreciably changed between the taking
of the two pictures.

Eyes from which the lens had been removed, or in
which it had been pushed out of the axis of vision, re-
sponded to electrical stimulation precisely as did the
normal eye, so long as the muscles were active; but

48 Accommodation: Experiments on Animals

when they had been paralyzed by the injection of atro-
pine deep into the orbit, electrical stimulation had no
effect on the refraction.

Fig:. 20. Lens Pushed Out of the Axis of Vision

In this experiment on the eye of a carp the lens was pushed
out of the axis of vision. Accommodation took place after this
displacement just as it did before. Note the point of the knife
in the pupil in front of the lens.

In one experiment the lens was removed from the right
eye of a rabbit, the refraction of each eye having first
been tested by retinoscopy and found to be normal. The
wound was then allowed to heal. Thereafter, for a

Accommodation in Aphakia

period extending from one month to two years, electrical
stimulation always produced accommodation in the lens-
less eye precisely to the same extent as in the eye which

Fig. 21. Rabbit With Lens Removed

The animal was exhibited at a meeting of the Ophthalmologi-
cal Section of the American Medical Association, held in Atlan-
tic City, and was examined by a number of ophthalmologists
present, all of whom testified that electrical stimulation of the
eyeball produced accommodation, or myopic refraction, precisely
as in the normal eye.

had a lens. The same experiment with the same result
was performed on a number of other rabbits, on dogs
and on fish. The obvious conclusion is that the lens is
not a factor in accommodation.

50 Accommodation: Experiments on Animals

In most text-books on physiology it is stated that ac-
commodation is controlled by the third cranial nerve,
which supplies all the muscles of the eyeball except the
superior oblique and the external rectus; but the fourth
cranial nerve, which supplies only the superior oblique,
was found in these experiments to be just as much a
nerve of accommodation as the third. When either the
third or the fourth nerve was stimulated with electricity
near its point of origin in the brain accommodation al-

Fig. 22. Experiment Upon the Eye of a Cat Demonstrating
That the Fourth Nerve, Which Supplies Only the Superior
Oblique Muscle, Is Just as Much a Nerve of Accommodation
As the Third, and That the Superior Oblique Muscle Which
It Supplies Is a Muscle of Accommodation.

No. 1. — Both nerves have been exposed near their origin in
the brain, and a strip of black paper has been inserted beneath
each to render it visible. The fourth nerve is the smaller one.
The superior oblique muscle has been advanced by a tucking
operation, as this muscle is always rudimentary in cats, and
unless its pull is strengthened, accommodation cannot be pro-
duced in these animals. Stimulation of either or both nerves by
the faradic current produced accommodation.

No. 2. — When the fourth nerve was covered with cotton
soaked in a normal salt solution, the application of the faradic
current to the cotton produced accommodation. When the cot-
ton was soaked in a one per cent solution of atropine sulphate
in a normal salt solution, such application produced no accom-
modation, but stimulation of the third nerve did produce it.

The Role of the Fourth Nerve 51

No. 3. — When the third nerve was covered with cotton soaked
in a normal salt solution, the application of the faradic current
to the cotton produced accommodation. When the cotton was
soaked with atropine sulphate in a normal salt solution, such
application produced no accommodation, but the stimulation of
the fourth nerve did produce it.

No. 4. — When both nerves were covered with cotton soaked
in atropine sulphate in a normal salt solution, the application of
electricity to the cotton produced no accommodation. Wnen *he
parts had been washed with a warm salt solution electrical stim-
ulation of either nerve always produced accommodation. The
nerves were alternately covered with the atropine-soaked cotton
and then washed with the warm saline solution for an hour, the
electricity being applied in each condition with invariably the
same result. Accommodation could never be produced by elec-
trical stimulation when the nerves were paralyzed with the
atropine, but always resulted from the stimulation of either or
both when they had been washed with the salt solution. The
experiment was performed with the same results on many rab-
bits and dogs.

ways resulted in the normal eye. When the origin of
either nerve was covered with a small wad of cotton
soaked in a two per cent solution of atropine sulphate
in a normal salt solution, stimulation of that nerve pro-
duced no accommodation, while stimulation of the un-
paralyzed nerve did produce it. When the origin of
both nerves was covered with cotton soaked in atropine,
accommodation could not be produced by electrical stim-
ulation of either or both. When the cotton was removed
and the nerves washed with normal salt solution, elec-

52 Accommodation: Experiments on Animals

trical stimulation of either or both produced accommoda-
tion just as before the atropine had been applied. This
experiment, which was performed repeatedly for more

Fig. 23. Pithing a Fish Preparatory to Operating Upon
Its Eyes

The object of this operation is to secure greater relaxation of
the muscles of the eyes and head, which would work for hours,
without external stimulus, if the brain cells were not destroyed
by the probe.

than an hour by alternately applying and removing the
atropine, not only demonstrated clearly what had not
been known before, namely, that the fourth nerve is a
nerve of accommodation, but also demonstrated that the

No Room for Doubt 53

superior oblique muscle which is supplied by it is an im-
portant factor in accommodation. It was further found
that when the action of the oblique muscles was pre-
vented by dividing them, the stimulation of the third
nerve produced, not accommodation, but hypermetropia.
In all the experiments all sources of error are believed
to have been eliminated. They were all repeated many
times and always with the same result. They seemed,
therefore, to leave no room for doubt that neither the
lens nor any muscle inside the eyeball has anything to
do with accommodation, but that the process whereby
the eye adjusts itself for vision at different distances is
entirely controlled by the action of the muscles on the
outside of the globe.

CHAPTER V

THE TRUTH ABOUT ACCOMMODATION AS DEMON-
STRATED BY A STUDY OF IMAGES REFLECTED
FROM THE LENS, CORNEA, IRIS AND SCLERA

AS the conclusions in which the experiments de-
scribed in the preceding chapter pointed were
diametrically opposed to those reached by Helm-
holtz in his study of the images reflected from the front
of the lens, I determined to repeat the experiments of
the German investigator and find out, if possible, why
his results were so different from my own. I devoted
four years to this work, and was able to demonstrate
that Helmholtz had erred through a defective technique,
the image obtained by his method being so variable and
uncertain that it lends itself to the support of almost
any theory.

I worked for a year or more with the technique of
Helmholtz, but was unable to obtain an image from the
front of the lens which was sufficiently clear or distinct
to be measured or photographed. With a naked candle
as the source of light a clear and distinct image could be
obtained on the cornea; on the back of the lens it was
quite clear; but on the front of the lens it was very im-
perfect. Not only was it blurred, just as Helmholtz
stated, but without any ascertainable cause it varied
greatly in size and intensity. At times no reflection
could be obtained at all, regardless of the angle of the
light to the eye of the subject, or of the eye of the ob-
server to that of the subject. With a diaphragm I got

How the Focus Was Changed

Fig. 24. — Arrangements for Photographing Images Reflected

From the Eyeball

CM, concave mirror in which the subject may observe the
images reflected from various parts of her eye; C, condenser; D,
diaphragm; L, 1000-watt lamp; F, forehead rest; MP, bar which
the subject grasps with her teeth for the purpose of holding her
head steady; P, plane mirror upon which is pasted a letter of
diamond type and in which is reflected a Snellen test card twenty
feet behind the subject (the mirror is just above the letter P);
CAM, camera; Pr, perimeter used to measure the angle of the
light to the eye; R, plane mirror reflecting light from the 1000-
watt lamp upon the eye, which otherwise would be in total dark-
ness except for the part from which the highly condensed image
of the filament is reflected; B, blue glass screen used to modify
the light reflected from the mirror R. When the subject read the
bottom line of the Snellen test card reflected in the mirror P,
her eye was at rest, and when she saw the letter of diamond type
distinctly it was accommodated ten diopters, as demonstrated by
the retinoscope.

56 Accommodation: Study of Images

Fig. 25. Arrangements for Holding the Head of the Subject
Steady While Images Were Being Photographed

CM, concave mirror; F, forehead rest; C, condenser, MP,
mouthpiece; Pr, perimeter.

a clearer and more constant image, but it still was not
sufficiently reliable to be measured. To Helmholtz the
indistinct image of a naked flame seemed to show an
appreciable change, while the images obtained by the
aid of the diaphragm showed it more clearly; but I was

Inconstancy of Candle Image 57

unable, either with a diaphragm or without it, to obtain
images which I considered sufficiently distinct to be
reliable.

Men who had been teaching and demonstrating Helm-
holtz's theory repeated his experiments for my benefit;
but the images which they obtained on the front of the
lens did not seem to me any better than my own. After

Fig. 26. Image of Electric Filament on the Front of the Lens

R, rest; A, accommodation. Under the magnifying glass no
change can be observed in the size of the two images. The
image at the right looks larger only because it is more distinct.
To support the theory of Helmholz it ought to be the smaller.
The comet's tail at the left of the two images is an accidental
reflection from the cornea. The spot of light beneath is a reflec-
tion from the light used to illuminate the eye while the photo-
graphs were being taken. It took two years to get these pictures.

studying these images almost daily for more than a year
I was unable to make any reliable observation regarding
the effect of accommodation upon them. In fact, it
seemed that an infinite number of appearances might be
obtained on the front of the lens when a candle was used
as the source of illumination. At times the image be-
came smaller during accommodation and seemed to sus-
tain the theory of Helmholtz; but just as frequently it
became larger. At other times it was impossible to tell
what it did.

58 Accommodation: Study of Images

With a thirty-watt lamp, a fifty-watt lamp, a 250-watt
lamp and a 1000-watt lamp, there was no improvement.
The light of the sun reflected from the front of the lens
produced an image just as cloudy and uncertain as the
reflections from other sources of illumination, and just
as variable in shape, intensity and size. To sum it all
up, I was convinced that the anterior surface of the lens

Fig. 27. Images of the Electric Filament Reflected Simul-
taneously From the Cornea and Lens

R, rest; A, accommodation. The size of the images in both
pictures is the same. The corneal image is so small that it has
not been noticeably altered by the slight change that takes place
in the cornea during accommodation. In A both images have
changed their position and the end of the reflection from the
lens has been cut off by the iris, but its width remains the same.
The white spot between the two images of the filament is a
reflection from the lamp used to illuminate the eye. Note that
in A more of the sclera is visible, owing to the elongation of the
eyeball during accommodation.

was a very poor reflector of light, and that no reliable
images could be obtained from it by the means described.
After a year or more of failure I began to work at an
aquarium on the eyes of fish. It was a long story of
failure. Finally I became able, with the aid of a strong
light — 1000 watts — a diaphragm with a small opening
and a condenser, to obtain, after some difficulty, a clear

Image on the Lens Photographed 59

and distinct image from the cornea of fish. This image
was sufficiently distinct to be measured, and after many
months a satisfactory photograph was obtained. Then
the work was resumed on the eyes of human beings.
The strong light, combined with the diaphragm and con-
denser, the use of which was suggested by their use to
improve the illumination of a glass slide under the mi-
croscope, proved to be a decided improvement over the
method of Helmholtz, and by means of this technique
an image was at last obtained on the front of the lens
which was sufficiently clear and distinct to be photo-
graphed. This was the first time, so far as published
records show, that an image of any kind was ever pho-
tographed from the front of the lens. Professional pho-
tographers whom I consulted with a view to securing
their assistance assured me that the thing could not be
done, and declined to attempt it. I was therefore obliged
to learn photography, of which I have previously known
nothing, myself, and I then found that so far as the
image obtained by the method of Helmholtz is concerned
the professionals were right.

The experiments were continued until, after almost
four years of constant labor, I obtained satisfactory pic-
tures before and after accommodation and during the
production of myopia and hypermetropia, not only of
images on any surface at will without reflections from
the iris, cornea, the front of the sclera (white of the eye)
and the side of the sclera. I also became able to obtain
images on any surface at will without reflections from
the other parts. Before these results were obtained, how-
every, many difficulties had still to be overcome.

Complicating reflections were a perpetual source of
trouble. Reflections from surrounding objects were easily

60 Accommodation: Study of Images

prevented ; but those from the sides of the globe of the
electric light were difficult to deal with, and it was use-
less to try to obtain images on the front of the lens until
they had been eliminated, or reduced to a minimum, by

Fig. 28. Image of Electric Filament Upon the Cornea

R, rest ; A, accommodation. The image is smaller in A, but
the change is so slight as to be scarcely noticeable, showing that
the alteration in the shape of the cornea during accommodation
is very slight. For this reason the ophthalmometer, with its
small image, has been thought to demonstrate that the cornea
did not change during accommodation.

a proper adjustment of the light. The same apparent
adjustment did not, however, always give similar results.
Sometimes there would be no reflections for days; then
would come a day when, with the light apparently at the
same angle, they would reappear.

With some adjustments of the light multiple images
were seen reflected from the front of the lens. Some-
times these images were arranged in a horizontal line,
sometimes in a vertical one and sometimes at angles of

Unexplained Difficulties 61

different degrees, while their distance from each other
also varied. Usually there were three of them; some-
times there were more; and sometimes there were only
two. Occasionally they were all of the same size, but
usually they varied, there being apparently no limit to
their possibilities of change in this and other respects.
Some of them were photographed, indicating that they
were real reflections. Changes in the distance of the
diaphragm from the light and from the condenser, and
alterations in the size and shape of its opening, appeared
to make no difference. Different adjustments of the con-
denser were equally without effect. Changes in the
angle at which the light was adjusted sometimes lessened
the number of images and sometimes increased them,
until at last an angle was found at which but one image
was seen. The images appear, in fact, to have been
caused by reflections from the globe of the electric light.
Even after the light had been so adjusted as to elimi-
nate reflections it was often difficult, or impossible, to
get a clear and distinct image of the electric filament
upon the front of the lens. One could, rearrange the
condenser and the diaphragm and change the axis of
fixation, and still the image would be clouded or ob-
scured and its outline distorted. The cause of the diffi-
culty appeared to be that the light was not adjusted at
the best angle for the purpose and it was not always
possible to determine the exact axis at which a clear,
distinct image would be produced. As in the case of the
reflections from the sides of the globe, it seemed to vary
without a known cause. This was true, however: that
there were angles of the axis of the globe which gave
better images than others, and that what these angles
were could not be determined with exactness. I have

62 Accommodation: Study of Images

labored with the light for two or three hours without
finding the right angle. At other times the axis would
remain unchanged for days, giving always a clear, dis-
tinct image.

Fig. 29. Image of Electric Filament on the Front of the Sclera

R, rest; A, accommodation. During accommodation the front
of the sclera becomes more convex, because the eyeball has
elongated, just as a camera is elongated when it is focussed upon
a near object. The spot of light on the cornea is an accidental
reflection.

The results of these experiments confirmed the conclu-
sions drawn from the previous ones, namely, that accom-
modation is due to a lengthening of the eyeball, and not
to a change in the curvature of the lens. They also con-
firmed, in a striking manner, my earlier conclusions as to
the conditions under which myopia and hypermetropia
are produced.1

The images photographed from the front of the lens
did not show any change in size or form during accom-
modation. The image on the back of the lens also re-
mained unchanged, as observed through the telescope
of the ophthalmometer; but as there is no dispute about
its behavior during accommodation, it was not photo-
graphed. Images photographed from the iris before

1 Bates: The Cause of Myopia, N. Y. Med. Jour., March 16, 1912.

No Change in Iris Image

63<*

and during accommodation were also the same in size
and form, as was to be expected from the character of
the lens images. If the lens changed during accommo-
dation, the iris, which rests upon it, would change also.

Fig. 30. Images on the Side of the Sclera

R, rest; A, accommodation. The image in A is the larger,
indicating a flattening of the side of the sclera as the eyeball
elongates. My, Myopia. The eye is straining to see at the dis-
tance and the image is larger, indicating that the eyeball has
elongated, resulting in a flattening of the side of the sclera. Hy,
Hypermetropia. The eye is straining to see at two inches. The
image is the smallest of the series, indicating that the eyeball
has become shorter than in any of the other pictures, and the
side of the sclera more convex. The two lower pictures confirm
the author's previous observations that farsight is produced when
the eye strains to see near objects and nearsight when it strains
to see distant objects.

64 Accommodation: Study of Images

The images photographed from the cornea and from
the front and side of the sclera showed, however, a series

Fig. 31. Multiple Images Upon the Front of the Lens

This picture illustrates one of the difficulties that had to be
overcome in photographing images reflected from various parts
of the eyeball. Unless the light was adjusted at precisely the
right angle the filament was multiplied by reflection from the
sides of the globe. Usually the image was doubled, sometimes
it was tripled, as shown in the picture, and sometimes it was
quadrupled. Often days of labor were required to eliminate
these reflections, and for reasons that were not definitely deter-
mined the same adjustment did not always give the same results.
Sometimes all would go well for days, and then, without any
apparent reason, the multiple images would return.

of four well-marked changes, according to whether the
vision was normal or accompanied by a strain. During
accommodation the images from (the cornea were smaller
than when the eye was at rest, indicating elongation of
the eyeball and a consequent increase in the convexity of
the cornea. But when an unsuccessful effort was made
to see at the near-point, the image became larger, indi-
cating that the cornea had become less convex, a condi-

A Series of Four Changes 65

tion which one would expect when the optic axis was
shortened, as in hypermetropia. When a strain was
made to see at a distance the image was smaller than
when the eye was at rest, again indicating elongation
of the eyeball and increased convexity of the cornea.

The images photographed from the front of the sclera
showed the same series of changes as the cornea! images,
but those obtained from the side of the sclera were found
to have changed in exactly the opposite manner, being
larger where the former were smaller and vice versa, a

Fig. 32. Reflection of the Electric Filament From the Iris

This picture is shown to illustrate the fact that it is possible
to get a reflection from any reflecting surface of the eyeball
without reflections from the other parts, although these may
be exposed. This is done by changing the angle of the light to the
eye. In No. 1 observations of the eye at the time the picture
was taken demonstrated that the image was from the iris, not
from the cornea, and the fact is also apparent in the picture.
(Compare the image with the corneal reflection in Fig. 28.) In
No. 2, where the image overlaps the margin of the pupil, the fact
that the reflection is from the iris is manifest from the circum-
stance that only part of the filament is seen. If it were from
the cornea, the whole of it would be reflected. Note in this picture
that there is no reflection from the lens. The images on the iris
did not change their size or shape during accommodation, dem-
onstrating again that the lens, upon which the iris rests, does
not change its shape when the eye adjusts itself for near vision.

66 Accommodation: Study of Images

difference which one would naturally expect from the
fact that when the front of the sclera becomes more
convex the sides must become flatter.

When an effort was made to see at a distance the
image reflected from the side of the sclera was larger
than the image obtained when the eye was at rest, indi-
cating that this part of the sclera had become less con-
vex or flatter, because of elongation of the eyeball. The
image obtained during normal accommodation was also
larger than when the eye was at rest, indicating again
a flattening of the side of the sclera. The image ob-
tained, however, when an effort was made to see near
was much smaller than any of the other images, indi-
cating that the sclera had become more convex at the
side, a condition which one would expect when the eye-
ball was shortened, as in hypermetropia.

The most pronounced of the changes were noted in
the images reflected from the front of the sclera. Those
on the side of the sclera were less marked, and, owing to
the difficulty of photographing a white image on a white
background, could not always be readily seen on the pho-
tographs. They were always plainly apparent, however,
to the observer, and still more so to the subject, who
regarded them in a concave mirror. The alterations in
the size of the corneal image were so slight that they did
not show at all in the photographs, except when the
image was large, a fact which explains why the ophthal-
mometer, with its small image, has been thought to show
that the cornea did not change during accommodation.
They were always apparent, however, to the subject and
observer.

The corneal image was one of the easiest of the series
to produce and the experiment is one which almost any-

No Change in Back of Lens 67

Fig. 33. Demonstrating That the Back of the Lens Does Not
Change During Accommodation

The filament of an electric light (L) is shining into the eye of
the subject (S), and the reflection on the back of the lens can be
seen by the observer (O) in the telescope (T). The subject
holds in her hand, at a distance of four inches, a mirror on which
is pasted a small letter, and in which is reflected a Snellen test
card hung above and behind her head at a distance of twenty
feet. The retinoscope reveals that when she looks at the reflec-
tion of the test card and reads the bottom line the eye is at rest,
and that when she looks at the letter pasted on the mirror it
accommodates. The image on the lens does not change during
these changes of focus. The telescope is the telescope of the
ophthalmometer, the prisms having been removed. As there
is no dispute about the behavior of the back of the lens during
accommodation this image was not photographed.

68 Accommodation: Study of Images

one can repeat, the only apparatus required being a
fifty candlepower lamp — an ordinary electric globe — and
a concave mirror fastened to a rod which moves back
and forth in a groove so that the distance of the mirror
from the eye can be altered at will. A plane mirror might
also be used; but the concave glass is better, because it
magnifies the image. The mirror should be so arranged
that it reflects the image of the electric filament on the
cornea, and so that the eye of the subject can see this
reflection by looking straight ahead. The image in the
mirror is used as the point of fixation, and the distance
at which the eye focuses is altered by altering the dis-
tance of the mirror from the eye. The light can be placed
within an inch or two of the eye, as the heat is not great
enough to interfere with the experiment. The closer it
is the larger the image, and according to whether it is
adjusted vertically, horizontally, or at an angle, the clear-
ness of the reflection may vary. A blue glass screen can
be used, if desired, to lessen the discomfort of the light.
If the left eye is used by the subject — and in all the ex-
periments it was found to be the more convenient for
the purpose — the source of light should be placed to the
left of that eye and as much as possible to the front of
it, at an angle of about forty-five degrees. For absolute
accuracy the light and the head of the subject should be
held immovable, but for demonstration this is not essen-
tial. Simply holding the bulb in his hand the subject
can demonstrate that the image changes according to
whether the eye is at rest, accommodating normally for
near vision, or straining to see at a near or a distant
point.

In the original report were described possible sources
of error and the means taken to eliminate them.

CHAPTER VI

THE TRUTH ABOUT ACCOMMODATION AS DEMON-
STRATED BY CLINICAL OBSERVATIONS

THE testimony of the experiments described in
the preceding chapters to the effect that the lens
is not a factor in accommodation is confirmed
by numerous observations on the eyes of adults and
children, with normal vision, errors of refraction, or
amblyopia, and on the eyes of adults after the removal
of the lens for cataract.

It has already been pointed out that the instillation of
atropine into the eye is supposed to prevent accommoda-
tion by paralyzing the muscle credited with controlling
the shape of the lens. 1 hat it has this effect is stated in
every text-book on the subject,1 and the drug is daily
used in the fitting of glasses for the purpose of eliminat-
ing the supposed influence of the lens upon refractive
states.

In about nine cases out of ten the conditions resulting
from the instillation of atropine into the eye fit the theory
upon which its use is based; but in the tenth case they
do not, and every ophthalmologist of any experience has
noted some of these tenth cases. Many of them are re-
ported in the literature, and many of them have come
under my own observation. According to the theory,

1 Certain substances have the power of producing a dilation of the pupil
(mydriasis), and hence are termed mydriatics. At the same time they act
upon the ciliary body, diminishing and, when applied in sufficient strength,
completely paralyzing the power of accommodation, thus rendering the eye
for some time unalterably focussed for the farthest point. — Herman Snellen,
Jr.: Mydriatics and Myotics, System of Diseases of the Eye, edited by
Morris and Oliver, 1897-1900, vpl. ii, p. 30.

70 Accommodation: Clinical Observations

atropine ought to bring out latent hypermetropia in eyes
either apparently normal, or manifestly hypermetropic,
provided, of course, the patient is of the age during which
the lens is supposed to retain its elasticity. The fact is
that it sometimes produces myopia, or changes hyper-
metropia into myopia, and that it will produce both
myopia and hypermetropia in persons over seventy years
of age, when the lens is supposed to be as hard as a
stone, as well as in cases in which the lens is hard with
incipient cataract. Patients with eyes apparently nor-
mal will, after the use of atropine, develop hypermetropic
astigmatism, or myopic astigmatism, or compound my-
opic astigmatism, or mixed astigmatism.1 In other cases
the drug will not interfere with the accommodation, or
alter the refraction in any way. Furthermore, when the
vision has been lowered by atropine the subjects have
often become able, simply by resting their eyes, to read
diamond type at six inches. Yet atropine is supposed to
rest the eyes by affording relief to an overworked muscle.

In the treatment of squint and amblyopia I have often
used atropine in the better eye for more than a year, in
order to encourage the use of the amblyopic eye; and at
the end of this time, while still under the influence of
atropine, such eyes have become able in a few hours, or
less, to read diamond type at six inches (see Chapter
XXII). The following are examples of many similar
cases that might be cited:

A boy of ten had hypermetropia in both eyes, that of

1 In simple hypermetropic astigmatism one principal meridian is normal
and the other, at right angles to it, is flatter. In simple myopic astigmatism
the contrary is the case ; one principal meridian is normal and the other, at
right angles to it, more convex. In mixed astigmatism one principal meridian
is too flat, the other too convex. In compound hypermetropic astigmatism
both principal meridians are flatter than normal, one more so than the other.
In compound myopic astigmatism both are more convex than normal, one
more so than the other.

Atr opine Fails to Paralyze Accommodation 71

the left or better eye amounting to three diopters. When
atropine was instilled into this eye the hypermetropia
was increased to four and a half diopters, and the vision
lowered to 20/200. With a convex glass of four and a
half diopters the patient obtained normal vision for the
distance, and with the addition of another convex glass
of four diopters he was able to read diamond type at ten
inches (best). The atropine was used for a year, the
pupil being dilated continually to the maximum. Mean-
time the right eye was being treated by methods to be
described later. Usually in such cases the eye which is
not being specifically treated improves to some extent
with the others, but in this case it did not. At the end
of the year the vision of the right eye had become nor-
mal; but that of the left eye remained precisely what it
was at the beginning, being still 20/200 without glasses
for the distance, while reading without glasses was im-
possible and the degree of the hypermetropia had not
changed. Still under the influence of the atropine and
still with the pupil dilated to the maximum, this eye was
now treated separately; and in half an hour its vision
had become normal both for the distance and the near-
point, diamond type being read at six inches, all without
glasses. According to the accepted theories, the ciliary
muscle of this eye must not only have been completely
paralyzed at the time, but must have been in a state of
complete paralysis for a year. Yet the eye not only
overcame four and a half diopters of hypermetropia, but
added six diopters of accommodation, making a total of
ten and a half. It remains for those who adhere to the
accepted theories to say how such facts can be reconciled
with them.

Equally, if not more remarkable, was the case of a

72 Accommodation: Clinical Observations

little girl of six who had two and a half diopters of hyper-
metropia in her right or better eye, and six in the other,
with one diopter of astigmatism. With the better eye
under the influence of atropine and the pupil dilated to
the maximum, both eyes were treated together for more
than a year, and at the end of that time, the right being
still under the influence of the atropine, both became
able to read diamond type at six inches, the right doing
it better, if anything, than the left. Thus, in spite of the
atropine, the right eye not only overcame two and a half
diopters of hypermetropia, but added six diopters of ac-
commodation, making a total of eight and a half. In
order to eliminate all possibility of latent hypermetropia
in the left eye — which in the beginning had six diopters
— the atropine was now used in this eye and discontinued
in the other, the eye education being continued as before.
Under the influence of the drug there was a slight return
of the hypermetropia; but the vision quickly became
normal again, and although the atropine was used daily
for more than a year, the pupil being continually dilated
to the maximum, it remained so, diamond type being
read at six inches without glasses during the whole
period. It is difficult for me to conceive how the ciliary
muscle could have had anything to do with the ability
of this patient to accommodate after atropine had been
used in each eye separately for a year or more at a time.
According to the current theory, atropine paralyzes
the ciliary muscle and thus, by preventing a change of
curvature in the lens, prevents accommodation. When
accommodation occurs, therefore, after the prolonged use
of atropine, it is evident that it must be due to some
factor or factors other than the lens and the ciliary
muscle. The evidence of such cases against the accepted

Aphakia and Presbyopia 73

theories is, in fact, overwhelming; and according to
these theories the other factors cited in this chapter are
equally inexplicable. All of these facts, however, are in
entire accord with the results of my experiments on the
eye muscles of animals and my observations regarding
the behavior of images reflected from various parts of
the eyeball. They strikingly confirm, too, the testimony
of the experiments with atropine, which showed that the
accommodation could not be paralyzed completely and
permanently unless the atropine was injected deep into
the orbit, so as to reach the oblique muscles, the real
muscles of accommodation, while hypermetropia could
not be prevented when the eyeball was stimulated with
electricity without a similar use of atropine, resulting
in the paralysis of the recti muscles.

As has already been noted, the fact that after the
removal of the lens for cataract the eye often appears
to accommodate just as well as it did before is well
known. Many of these cases have come under my own
observation. Such patients have not only read diamond
type with only their distance glasses on, at thirteen and
ten inches and at a less distance, but one man was able
to read without any glass at all. In all these cases the
retinoscope demonstrated that the apparent act of accom-
modation was real, being accomplished, not by the "in-
terpretation of circles of diffusion," or by any of the other
methods by which this inconvenient phenomenon is com-
monly explained, but by an accurate adjustment of the
focus to the distances concerned.

The cure of presbyopia (see Chapter XX) must also
be added to the clinical testimony against the accepted
theory of accommodation. On the theory that the lens
is a factor in accommodation such cures would be mani-

74 Accommodation: Clinical Observations

festly impossible. The fact that rest of the eyes improves
the sight in presbyopia has been noted by others, and
has been attributed to the supposed fact that the rested
ciliary muscle is able for a brief period to influence the
hardened lens ; but while it is conceivable that this might
happen in the early stages of the condition and for a few
moments, it is not conceivable that permanent relief
should be obtained by this means, or that lenses which
are, as the saying goes, as "hard as a stone," should be
influenced, even momentarily.

A truth is strengthened by an accumulation of facts.
A working hypothesis is proved not to be a truth if a
single fact is not in harmony with it. The accepted
theories of accommodation and of the cause of errors of
refraction require that a multitude of facts shall be ex-
plained away. During more than thirty years of clinical
experience, I have not observed a single fact that was
not in harmony with the belief that the lens and the
ciliary muscle have nothing to do with accommodation,
and that the changes in the shape of the eyeball upon
which errors of refraction depend are not permanent.
My clinical observations have of themselves been suffi-
cient to demonstrate this fact. They have also been suf-
ficient to show how errors of refraction can be produced
at will, and how they may be cured, temporarily in a few
minutes, and permanently by continued treatment.

CHAPTER VII

THE VARIABILITY OF THE REFRACTION OF
THE EYE

THE theory that errors of refraction are due to
permanent deformations of the eyeball leads nat-
urally to the conclusion, not only that errors of
refraction are permanent states, but that normal refrac-
tion is also a continuous condition. As this theory is
almost universally accepted as a fact, therefore, it is not
surprising to find that the normal eye is generally re-
garded as a perfect machine which is always in good
working order. No matter whether the object regarded
is strange or familiar, whether the light is good or im-
perfect, whether the surroundings are pleasant or dis-
agreeable, even under conditions of nerve strain or bodily
disease, the normal eye is expected to have normal re-
fraction and normal sight all the time. It is true that
the facts do not harmonize with this view, but they are
conveniently attributed to the perversity of the ciliary
muscle, or if that explanation will not work, ignored
altogether.

When we understand, however, how the shape of the
eyeball is controlled by the external muscles, and how it
responds instantaneously to their action, it is easy to see
that no refractive state, whether it is normal or abnormal,
can be permanent. This conclusion is confirmed by the
retinoscope, and I had observed the facts long before the
experiments described in the preceding chapters had
offered a satisfactory explanation for it. During thirty
years devoted to the study of refraction, I have found

76 Variability of the Refraction of the Eye

few people who could maintain perfect sight for more
than a few minutes at a time, even under the most favor-
able conditions; and often I have seen the refraction
change half a dozen times or more in a second, the varia-
tions ranging all the way from twenty diopters of myopia
to normal.

Similarly I have found no eyes with continuous or
unchanging errors of refraction, all persons with errors
of refraction having, at frequent intervals during the day
and night, moments of normal vision, when their myopia,
hypermetropia, or astigmatism, wholly disappears. The
form of the error also changes, myopia even changing
into hypermetropia, and one form of astigmatism into
another.

Of twenty thousand school children examined in one
year, more than half had normal eyes, with sight which
was perfect at times; but not one of them had perfect
sight in each eye at all times of the day. Their sight
might be good in the morning and imperfect in the
afternoon, or imperfect in the morning and perfect in
the afternoon. Many children could read one Snellen
test card with perfect sight, while unable to see a differ-
ent one perfectly. Many could also read some letters of
the alphabet perfectly, while unable to distinguish other
letters of the same size under similar conditions. The
degree of this imperfect sight varied within wide limits,
from one-third to one-tenth, or less. Its duration was
also variable. Under some conditions it might continue
for only a few minutes, or less; under others it might
prevent the subject from seeing the blackboard for days,
weeks, or even longer. Frequently all the pupils in a
classroom were affected to this extent.

Among babies a similar condition was noted. Most

Changing Refraction of Infants 77

investigators have found babies hypermetropic. A few
have found them myopic. My own observations indicate
that the refraction of infants is continually changing.
One child was examined under atropine on four success-
sive days, beginning two hours after birth. A three per
cent solution of atropine was instilled into both eyes,
the pupil was dilated to the maximum, and other physio-
logical symptoms of the use of atropine were noted. The
first examination showed a condition of mixed astigma-
tism. On the second day there was compound hyper-
metropic astigmatism, and on the third compound myopic
astigmatism. On the fourth one eye was normal and
the other showed simple myopia. Similar variations
were noted in many other cases.

What is true of children and infants is equally true
of adults of all ages. Persons over seventy years of age
have suffered losses of vision of variable degree and
intensity, and in such cases the retinoscope always in-
dicated an error of refraction. A man eighty years old,
with normal eyes and ordinarily normal sight, had
periods of imperfect sight which would last from a few
minutes to half an hour or longer. Retinoscopy at such
times always indicated myopia of four diopters or more.

During sleep the refractive condition of the eye is
rarely, if ever, normal. Persons whose refraction is nor-
mal when they are awake will produce myopia, hyperme-
tropia and astigmatism when they are asleep, or, if they
have errors of refraction when they are awake, they will
be increased during sleep. This is why people waken in
the morning with eyes more tired than at any other time,
or even with severe headaches. When the subject is
under ether or chloroform, or unconscious from any other
cause, errors of refraction are also produced or increased.

78 Variability of the Refraction of the Eye

When the eye regards an unfamiliar object an error of
refraction is always produced. Hence the proverbial
fatigue caused by viewing pictures, or other objects, in
a museum. Children with normal eyes who can read per-
fectly small letters a quarter of an inch high at ten feet
always have trouble in reading strange writing on the
blackboard, athough the letters may be two inches high.
A strange map, or any map, has the same effect. I have
never seen a child, or a teacher, who could look at a map
at the distance without becoming nearsighted. German
type has been accused of being responsible for much of
the poor sight once supposed to be peculiarly a German
malady; but if a German child attempts to read Roman
print, it will at once become temporarily hypermetropic.
German print, or Greek or Chinese characters, will have
the same effect on a child, or other person, accustomed
to Roman letters. Cohn repudiated the idea that Ger-
man lettering was trying to the eyes.1 On the contrary,
he always found it "pleasant, after a long reading of the
monotonous Roman print, to return 'to our beloved Ger-
man.' " Because the German characters were more
familiar to him than any others he found them restful to
his eyes. "Use," as he truly observed, "has much to do
with the matter." Children learning to read, write, draw,
or sew, always suffer from defective vision, because of
the unfamiliarity of the lines or objects with which they
are working.

A sudden exposure to strong light, or rapid or sudden
changes of light, are likely to produce imperfect sight in
the normal eye, continuing in some cases for weeks and
months (see Chapter XVII).

1 Eyes and School Books, Pop. Sci. Monthly, May, 1881, translated from
Deutsche Rundschau.

Causes of Defective Vision in Normal Eyes 79

Noise is also a frequent cause of defective vision in the
normal eye. All persons see imperfectly when they hear
an unexpected loud noise. Familiar sounds do not lower
the vision, but unfamiliar ones always do. Country chil-
dren from quiet schools may suffer from defective vision
for a long time after moving to a noisy city. In school
they cannot do well with their work, because their sight
is impaired. It is, of course, a gross injustice for teachers
and others to scold, punish, or humiliate such children.

Under conditions of mental or physical discomfort,
such as pain, cough, fever, discomfort from heat or cold,
depression, anger, or anxiety, errors of refraction are
always produced in the normal eye, or increased in the
eye in which they already exist.

The variability of the refraction of the eye is respon-
sible for many otherwise unaccountable accidents. When
people are struck down in the street by automobiles, or
trolley cars, it is often due to the fact that they were
suffering from temporary loss of sight. Collisions on
railroads or at sea, disasters in military operations, avia-
tion accidents, etc., often occur because some responsible
person suffered temporary loss of sight.

To this cause must also be ascribed, in a large degree,
the confusion which every student of the subject has
noted in the statistics which have been collected regard-
ing the occurrence of errors of refraction. So far as I
am aware it has never been taken into account by any
investigator of the subject; yet the result in any such
investigation must be largely determined by the condi-
tions under which it is made. It is possible to take the
best eyes in the world and test them so that the subject
will not be able to get into the Army. Again, the test

80 Variability of the Refraction of the Eye

may be so made that eyes which are apparently much
below normal at the beginning, may in the few minutes
required for the test, acquire normal vision and become
able to read the test card perfectly.

CHAPTER VIII
WHAT GLASSES DO TO US

THE Florentines were doubtless mistaken in sup-
posing that their fellow citizen (see page v) was
the inventor of the lenses now so commonly
worn to correct errors of refraction. There has been much
discussion as to the origin of these devices, but they are
generally believed to have been known at a period much
earlier than that of Salvino degli Armati. The Romans
at least must have known something of the art of supple-
menting the powers of the eye, for Pliny tells us that
Nero used to watch the games in the Colosseum through
a concave gem set in a ring for that purpose. If, how-
ever, his contemporaries believed that Salvino of the
Armati was the first to produce these aids to vision, they
might well pray for the pardon of his sins; for while it
is true that eyeglasses have brought to some people im-
proved vision and relief from pain and discomfort, they
have been to others simply an added torture, they always
do more or less harm, and at their best they never im-
prove the vision to normal.

That glasses cannot improve the sight to normal can
be very simply demonstrated by looking at any color
through a strong convex or concave glass. It will be
noted that the color is always less intense than when
seen with the naked eye; and since the perception of
form depends upon the perception of color, it follows
that both color and form must be less distinctly seen
with glasses than without them. Even plane glass low-
ers the vision both for color and form, as everyone knows
who has ever looked out of a window. Women who
wear glasses for minor defects of vision often observe

82 What Glasses Do To Us

that they are made more or less color-blind by them, and
in a shop one may note that they remove them when
they want to match samples. If the sight is seriously
defective, the color may be seen better with glasses than
without them.

That glasses must injure the eye is evident from the
facts given in the preceding chapter. One cannot see
through them unless one produces the degree of refrac-
tive error which they are designed to correct. But re-
fractive errors, in the eye which is left to itself, are never
constant. If one secures good vision by the aid of con-
cave, or convex, or astigmatic lenses, therefore, it means
that one is maintaining constantly a degree of refractive
error which otherwise would not be maintained con-
stantly. It is only to be expected that this should make
the condition worse, and it is a matter of common expe-
rience that it does. After people once begin to wear
glasses their strength, in most cases, has to be steadily
increased in order to maintain the degree of visual acuity
secured by the aid of the first pair. Persons with pres-
byopia who put on glasses because they cannot read fine
print too often find that after they have worn them for
a time they cannot, without their aid, read the larger
print that was perfectly plain to them before. A person
with myopia of 20/70 who puts on glasses giving him a
vision of 20/20 may find that in a week's time his unaided
vision has declined to 20/200, and we have the testimony
of Dr. Sidler-Huguenin, of Zurich,1 that of the thousands
of myopes treated by him the majority grew steadily
worse, in spite of all the skill he could apply to the fit-
ting of glasses for them. When people break their
glasses and go without them for a week or two, they

1 Archiv. f. Augenh., vol. Ixxix, 1915, translated in Arch. Ophth., vol.
xlv, Nov. 6, 1916.

The Eye Resents Glasses 83

frequently observe that their sight has improved. As a
matter of fact the sight always improves, to a greater or
less degree, when glasses are discarded, although the
fact may not always be noted.

That the human eye resents glasses is a fact which no
one would attempt to deny. Every oculist knows that
patients have to "get used" to them, and that sometimes
they never succeed in doing so. Patients with high de-
grees of myopia and hypermetropia have great difficulty
in accustoming themselves to the full correction, and
often are never able to do so. The strong concave
glasses required by myopes of high degree make all
objects seem much smaller than they really are, while
convex glasses enlarge them. These are unpleasantnesses
that cannot be overcome. Patients with high degrees of
astigmatism suffer some very disagreeable sensations
when they first put on glasses, for which reason they are
warned by one of the "Conservation of Vision" leaflets
published by the Council on Health and Public Instruc-
tion of the American Medical Association to "get used
to them at home before venturing where a misstep might
cause a serious accident."1 Usually these difficulties are
overcome, but often they are not, and it sometimes hap-
pens that those who get on fairly well with their glasses
in the daytime never succeed in getting used to them
at night.

All glasses contract the field of vision to a greater or
less degree. Even with very weak glasses patients are
unable to see distinctly unless they look through the
center of the lenses, with the frames at right angles to
the line of vision; and not only is their vision lowered
if they fail to do this, but annoying nervous symptoms,

1 Lancaster: Wearing Glasses, p. 15.

84 What Glasses Do To Us

such as dizziness and headache, are sometimes produced.
Therefore they are unable to turn their eyes freely in
different directions. It is true that glasses are now
ground in such a way that it is theoretically possible to
look through them at any angle, but practically they
seldom accomplish the desired result.

The difficulty of keeping the glass clear is one of the
minor discomforts of glasses, but nevertheless a most
annoying one. On damp and rainy days the atmosphere
clouds them. On hot days the perspiration from the
body may have a similar effect. On cold days they are
often clouded by the moisture of the breath. Every day
they are so subject to contamination by dust and moist-
ure and the touch of the fingers incident to unavoidable
handling that it is seldom they afford an absolutely un-
obstructed view of the objects regarded.

Reflections of strong light from eyeglasses are often
very annoying, and in the street may be very dangerous.

Soldiers, sailors, athletes, workmen and children have
great difficulty with glasses because of the activity of
their lives, which not only leads to the breaking of the
lenses, but often throws them out of focus, particularly
in the case of eyeglasses worn for astigmatism.

The fact that glasses are very disfiguring may seem a
matter unworthy of consideration in a medical publica-
tion; but mental discomfort does not improve either the
general health or the vision, and while we have gone so
far toward making a virtue of what we conceive to be
necessity that some of us have actually come to consider
glasses becoming, huge round lenses in ugly tortoise-
shell frames being positively fashionable at the present
time, there are still some unperverted minds to which
the wearing of glasses is mental torture and the sight
of them upon others far from agreeable. Most human

Glasses to Relieve Strain 85

beings are, unfortunately, ugly enough without putting
glasses upon them, and to disfigure any of the really
beautiful faces that we have with such contrivances is
surely as bad as putting an import tax upon art. As for
putting glasses upon a child it is enough to make the
angels weep.

Up to a generation ago glasses were used only as an
aid to defective sight, but they are now prescribed for
large numbers of persons who can see as well or better
without them. As explained in Chapter I, the hyperme-
tropic eye is believed to be capable of correcting its own
difficulties to some extent by altering the curvature of
the lens, through the activity of the ciliary muscle. The
eye with simple myopia is not credited with this capac-
ity, because an increase in the convexity of the lens,
which is supposed to be all that is accomplished by ac-
commodative effort, would only increase the difficulty;
but myopia is usually accompanied by astigmatism, and
this, it is believed, can be overcome, in part, by alterations
in the curvature of the lens. Thus we are led by the
theory to the conclusion that an eye in which any error
of refraction exists is practically never free, while open,
from abnormal accommodative efforts. In other words, it
is assumed that the supposed muscle of accommodation
has to bear, not only the normal burden of changing the
focus of the eye for vision at different distances, but the
additional burden of compensating for refractive errors.
Such adjustments, if they actually took place, would
naturally impose a severe strain upon the nervous sys-
tem, and it is to relieve this strain — which is believed to
be the cause of a host of functional nervous troubles —
quite as much as to improve the sight, that glasses are
prescribed.

It has been demonstrated, however, that the lens is not

86 What Glasses Do To Us

a factor, either in the production of accommodation, or in
the correction of errors of refraction. Therefore under
no circumstances can there be a strain of the ciliary
muscle to be relieved. It has also been demonstrated
that when the vision is normal no error of refraction is
present, and the extrinsic muscles of the eyeball are at
rest. Therefore there can be no strain of the extrinsic
muscles to be relieved in these cases. When a strain of
these muscles does exist, glasses may correct its effects
upon the refraction, jut the strain itself they cannot
relieve. On the contrary, as has been shown, they must
make it worse. Nevertheless persons with normal vision
who wear glasses for the relief of a supposed muscular
strain are often benefited by them. This is a striking
illustration of the effect of mental suggestion, and plane
glass, if it could inspire the same faith, would produce
the same result. In fact, many patients have told me
that they had been relieved of various discomforts by
glasses which I found to be simply plane glass. One
of these patients was an optician who had fitted the
glasses himself and was under no illusions whatever
about them; yet he assured me that when he didn't wear
them he got headaches.

Some patients are so responsive to mental suggestion
that you can relieve their discomfort, or improve their
sight, with almost any glasses you like to put on them.
I have seen people with hypermetropia wearing myopic
glasses with a great deal of comfort, and people with no
astigmatism getting much satisfaction from glasses de-
signed for the correction of this defect.

Landolt mentions the case of a patient who had for
years worn prisms for insufficiency of the internal recti,
and who found them absolutely indispensable for work,
although the apices were toward the nose. The prescrip-

Effects of Mental Suggestion 87

tion, which the patient was able to produce, called for
prisms adjusted in the usual manner, with the apices
toward the temples ; but the optician had made a mistake
which, owing to the patient's satisfaction with the result,
had never been discovered. Landolt explained the case
by "the slight effect of weak prisms and the great power
of imagination" j1 and doubtless the benefit derived from
the glasses was real, resulting from the patient's great
faith in the specialist — described as "one of the most
competent of ophthalmologists" — who prescribed them.

Some patients will even imagine that they see better
with glasses that markedly lower the vision. A number
of years ago a patient for whom I had prescribed glasses
consulted an ophthalmologist whose reputation was
much greater than my own, and who gave him another
pair of glasses and spoke slightingly of the ones that
I had prescribed. The patient returned to me and told
me how much better he could see with the second pair
of glasses than he did with the first. I tested his vision
with the new glasses, and found that while mine had
given him a vision of 20/20 those of my colleague enabled
him to see only 20/40. The simple fact was that he had
been hypnotized by a great reputation into thinking he
could see better when he actually saw worse ; and it was
hard to convince him that he was wrong, although he
had to admit that when he looked at the test card he
could see only half as much with the new glasses as
with the old ones.

When glasses do not relieve headaches and other ner-
vous symptoms it is assumed to be because they were
not properly fitted, and some practitioners and their
patients exhibit an astounding degree of patience and

1 Anomalies of the Motor Apparatus of the Eye, System of Diseases of the
Eye, voL iv, pp. 154-155.

88 What Glasses Do To Us

perseverance in their joint attempts to arrive at the
proper prescription. A patient who suffered from severe
pains at the base of his brain was fitted sixty times by
one specialist alone, and had besides visited many other
eye and nerve specialists in this country and in Europe.
He was relieved of the pain in five minutes by the meth-
ods presented in this book, while his vision, at the same
time, became temporarily normal.

It is fortunate that many people for whom glasses
have been prescribed refuse to wear them, thus escaping
not only much discomfort but much injury to their eyes.
Others, having less independence of mind, or a larger
share of the martyr's spirit, or having been more badly
frightened by the oculists, submit to an amount of un-
necessary torture which is scarcely conceivable. One
such patient wore glasses for twenty-five years, although
they did not prevent her from suffering continual misery
and lowered her vision to such an extent that she had
to look over the tops when she wanted to see anything
at a distance. Her oculist assured her that she might
expect the most serious consequences if she did not wear
the glasses, and was very severe about her practice of
looking over instead of through them.

As refractive abnormalities are continually changing,
not only from day to day and from hour to hour, but
from minute to minute, even under the influence of atro-
pine, the accurate fitting of glasses is, of course, impos-
sible. In some cases these fluctuations are so extreme,
or the patient so unresponsive to mental suggestion, that
no relief whatever is obtained from correcting lenses,
which necessarily become under such circumstances an
added discomfort. At their best it cannot be maintained
that glasses are anything more than a very unsatisfactory
substitute for normal vision.

CHAPTER IX
THE CAUSE AND CURE OF ERRORS OF REFRACTION

IT has been demonstrated in thousands of cases that
all abnormal action of the external muscles of the
eyeball is accompanied by a strain or effort to see,
and that with the relief of this strain the action of the
muscles becomes normal and all errors of refraction dis-
appear. The eye may be blind, it may be suffering from
atrophy of the optic nerve, from cataract, or disease of
the retina; but so long as it does not try to see, the ex-
ternal muscles act normally and there is no error of re-
fraction. This fact furnishes us with the means by which
all these conditions, so long held to be incurable, may
be cured.

It has also been demonstrated that for every error of
refraction there is a different kind of strain. The study
of images reflected from various parts of the eyeball
confirmed what had previously been observed, namely,
that myopia (or a lessening of hypermetropia) is always
associated with a strain to see at the distance, while
hypermetropia (or a lessening of myopia) is always asso-
ciated with a strain to see at the near-point ; and the fact
can be verified in a few minutes by anyone who knows
how to use a retinoscope, provided only that the instru-
ment is not brought nearer to the subject than six feet.

In an eye with previously normal vision a strain to see
near objects always results in the temporary production
of hypermetropia in one or all meridians. That is, the
eye either becomes entirely hypermetropic, or some form

90 Cause and Cure of Errors of Refraction

Fig. 34.

Patient reading fine
print in a good light
at thirteen inches, the
object of vision being
placed above the eye
so as to be out of the
line of the camera.
Simultaneous retino-
scopy indicated that
the eye was focused at
thirteen inches. The
glass was used with
the retinoscope to de-
termine the amount of
the refraction.

Straining to See at the Near-Point Produces
Hypermetropia

When the room was
darkened the patient
failed to read the
fine print at thirteen
inches and the retino-
scope indicated that
the eye was focused
at a greater distance.
When a conscious
strain of considerable
degree was made to
see, the eye became
hypermetropic.

Voluntary Increase of Refractive Error 91

Fig. 35 Myopia Produced by
unconscious Strain to See at
the Distance is Increased by
Conscious Strain.

No. 1. — Normal vision.

No. 2. — Same subject four
years later with myopia. Note
the strained expression.

No. 3. — Myopia increased by
conscious effort to see a distant
object.

92 Cause and Cure of Errors of Refraction

Fig. 36. Immediate Produc-
tion of Myopia and Myopic
Astigmatism in Eyes Pre-
viously Normal by Strain
to See at the Distance

Boy reading the Snellen
test card with normal vision.
Note the absence of facial
strain.

The same boy trying to
see a picture at twenty feet.
The effort, manifested by
staring, produces compound
myopic astigmatism, as re-
vealed by the retinoscope.

Emmetropia at the Near-Point

of astigmatism is produced of which hypermetropia
forms a part. In the hypermetropic eye the hyperme-
tropia is increased in one or all meridians. When the
myopic eye strains to see a near object the myopia is
lessened and emmetropia1 may be produced, the eye
being focussed for parallel rays while still trying to see
at the near-point. In some cases the emmetropia may
even pass over into hypermetropia in one or all merid-
ians. All these changes are accompanied by evidences
of increasing strain, in the form of eccentric fixation

(see Chapter XI) and
lowered vision ; but,
strange to say, pain and
fatigue are usually re-
lieved to a marked de-
gree. If, on the contrary,
the eye with previously
normal vision strains to
see at the distance, tem-
porary myopia is always
produced in one or all
meridians, and if the eye
is already myopic, the
myopia is increased. If
the hypermetropic eye
strains to see a distant
object, pain and fatigue
may be produced or in-
creased; but the hyper-

The same boy making himself
myopic voluntarily by partly
closing the eyelids and making
a conscious effort to read the
test card at ten feet.

metropia and the eccen-

1 Emmetropia (from the Greek emmetros, in measure, and ops, the eye) is
that condition of the eye in which it is focussed for parallel rays. This con-
stitutes normal vision at the distance, but is an error of refraction when it
occurs at the near-point.

94 Cause and Cure of Errors of Refraction

trie fixation are lessened and the vision improves. This
interesting result, it will be noted, is the exact contrary
of what we get when the myope strains to see at the
near-point. In some cases the hypermetropia is com-
pletely relieved, and emmetropia is produced, with a
complete disappearance of all evidences of strain. This
condition may then pass over into myopia, with an
increase of strain as the myopia increases.

In other words the eye which strains to see at the near-
point becomes flatter than it was before, in one or all
meridians. If it was elongated to start with, it may pass

Fig. 37. Myopic Astigmatism comes and Goes According as the
Subject Looks at Distant Objects With or Without Strain

No. L— Patient regarding the Snellen test card at ten feet
without effort and reading the bottom line with normal vision.

No. 2. — The same patient making an effort to see a picture at
twenty feet. The retinoscope indicated compound myopic astig-
matism.

Strain in Lensless Eyes 95

from this condition through emmetropia, in which it is
spherical, to hypermetropia, in which it is flattened; and
if these changes take place unsymmetrically, astigma-
tism will be produced in connection with the other con-
ditions. The eye which strains to see at the distance, on
the contrary, becomes longer than it was before in one
or all meridians, and may pass from the flattened condi-
tion of hypermetropia, through emmetropia, to the elon-
gated condition of myopia. If these changes take place
unsymmetrically, astigmatism will again be produced in
connection with the other conditions.

What has been said of the normal eye applies equally
to eyes from which the lens has been removed. This
operation produces usually a condition of hypermetro-
pia; but when there has previously been a condition of
high myopia the removal of the lens may not be suffi-
cient to correct it, and the eye may still remain myopic.
In the first case a strain to see at the distance lessens
the hypermetropia, and a strain to see at the near-point
increases it; in the second a strain to see at the distance
increases the myopia, and a strain to see at the near-
point lessens it. For a longer or shorter period after
the removal of the lens many aphakic eyes strain to see
at the near-point, producing so much hypermetropia that
the patient cannot read ordinary print, and the power of
accommodation appears to have been completely lost.
Later, when the patient becomes accustomed to the sit-
uation, this strain is often relieved, and the eye becomes
able to focus accurately upon near objects. Some rare
cases have also been observed in which a measure of
good vision both for distance and the near-point was
obtained without glasses, the eyeball elongating suffi-
ciently to compensate, to some degree, for the loss of
the lens.

96 Cause and Cure of Errors of Refraction

Fig. 38. This Patient Had Had the Lens of the Right Eye
Removed for Cataract and Was Wearing an Artificial Eye
in the Left Socket. The Removal of the Lens created a
Condition of Hypermetropia Which Was Corrected by a Con
vex Glass of Ten Diopters.

Should Have Been Impossible 97

No. 1. — The patient is reading the Snellen test card at twenty
feet with normal vision. No. 2. — She is straining to see the test
card at the same distance, and her hypermetropia is lessened by
two diopters so that her glass now overcorrects it and she cannot
see the card perfectly. No. 3.— With a convex reading glass of
thirteen diopters the right eye is focussed accurately at thirteen
inches. No. 4. — The patient is straining to see at the same dis-
tance and her hypermetropia is so increased that in order to
read she would require a glass of fifteen diopters. On the basis
of the accepted theory that the power of accommodation is
wholly destroyed by the removal of the lens these changes in
the refraction would have been impossible. The experiment was
repeated several times and it was found that the error of refrac-
tion produced by straining to see varied, being sometimes more
and sometimes less than two diopters.

98 Cause and Cure of Errors of Refraction

The phenomena associated with strain in the human
eye have also been observed in the eyes of the lower
animals. I have made many dogs myopic by inducing
them to strain to see a distant object. One very nervous
dog, with normal refraction, as demonstrated by the ret-
inoscope, was allowed to smell a piece of meat. He
became very much excited, pricked up his ears, arched
his eyebrows and wagged his tail. The meat was then
removed to a distance of twenty feet. The dog looked
disappointed, but didn't lose interest. While he was
watching the meat it was dropped into a box. A worried
look came into his eyes. He strained to see what had
become of it, and the retinoscope showed that he had
become myopic. This experiment, it should be added,
would succeed only with an animal possessing two active
oblique muscles. Animals in which one of these muscles
is absent or rudimentary are unable to elongate the eye-
ball under any circumstances.

Primarily the strain to see is a strain of the mind, and,
as in all cases in which there is a strain of the mind,
there is a loss of mental control. Anatomically the
results of straining to see at a distance may be the same
as those of regarding an object at the near point without
strain; but in one case the eye does what the mind de-
sires ; and in the other it does not.

These facts appear sufficiently to explain why visual
acuity declines as civilization advances. Under the con-
ditions of civilized life men's minds are under a continual
strain. They have more things to worry them than un-
civilized man had, and they are not obliged to keep cool
and collected in order that they may see and do other
things upon which existence depends. If he allowed
himself to get nervous, primitive man was promptly

Relation of Civilization to Vision

eliminated; but civilized man survives and transmits his
mental characteristics to posterity. The lower animals
when subjected to civilized conditions respond to them
in precisely the same way as do human creatures. I
have examined many domestic and menagerie animals,
and have found them, in many cases, myopic, although
they neither read, nor write, nor sew, nor set type.
A decline in visual acuity at the distance, however, is

Fig. 39. A Family Group Strikingly Illustrating the Effect
of the Mind Upon the Vision

No. 1.— Girl of four with normal eyes. No. 2.— The child's
mother with myopia. No. 3 — The same girl at nine with myopia.
Note that her expression has completely changed, and is now
exactly like her mother's. Nos. 4, 5 and 6. — The girl's brother
at two, six and eight. His eyes are normal in all three pictures.
The girl has either inherited her mother's disposition to take
things hard, or has been injuriously effected by her personality
of strain. The boy has escaped both influences. In view of the
prevailing theories about the relation of heredity to myopia, this
picture is particularly interesting.

100 Cause and Cure of Errors of Refraction

no more a peculiarity of civilization than is a similar
decline at the near-point. Myopes, although they see
better at the near-point than they do at the distance,
never see as well as does the eye with normal sight;

Fig. 40. Myopes Who Never Went to School, or Read in the

Subway

No. 1.— Myopic elephant in the Central Park Zoo, New York,
thirty-nine years old. Young elephants and other young animals
were found to have normal vision.

No. 2.— Cape buffalo with myopia, Central Park Zoo.

No. 3.— Myopic monkey, also in the Central Park Zoo.

No. 4.— Pet dog with myopia which progressed from year to

Relaxation Cures 101

and in hypermetropia, which is more common than
myopia, the sight is worse at the near-point than at the
distance.

The remedy is not to avoid either near work or dis-
tant vision, but to get rid of the mental strain which
underlies the imperfect functioning of the eye at both
points; and it has been demonstrated in thousands of
cases that this can always be done.

Fortunately, all persons are able to relax under certain
conditions at will. In all uncomplicated errors of refrac-
tion the strain to see can be relieved, temporarily, by
having the patient look at a blank wall without trying
to see. To secure permanent relaxation sometimes re-
quires considerable time and much ingenuity. The same
method cannot be used with everyone. The ways in
which people strain to see are infinite, and the methods
used to relieve the strain must be almost equally varied.
Whatever the method that brings most relief, however,
the end is always the same, namely relaxation. By con-
stant repetition and frequent demonstration and by all
means possible, the fact must be impressed upon the
patient that perfect sight can be obtained only by relax-
ation. Nothing else matters.

Most people, when told that rest, or relaxation, will
cure their eye troubles, ask why sleep does not do so.
The answer to this question was given in Chapter VII.
The eyes are rarely, if ever, completely relaxed in sleep,
and if they are under a strain when the subject is awake,
that strain will certainly be continued during sleep, to
a greater or less degree, just as a strain of other parts
of the body is continued.

The idea that it rests the eyes not to use them is also
erroneous. The eyes were made to see with, and if when

102 Cause and Cure of Errors of Refraction

they are open they do not see, it is because they are
under such a strain and have such a great error of refrac-
tion that they cannot see. Near vision, although accom-
plished by a muscular act, is no more a strain on them
than is distant vision, although accomplished without
the intervention of the muscles. The use of the muscles
does not necessarily produce fatigue. Some men can
run for hours without becoming tired. Many birds sup-
port themselves upon one foot during sleep, the toes
tightly clasping the swaying bough and the muscles re-
maining unfatigued by the apparent strain. Fabre tells
of an insect which hung back downward for ten months
from the roof of its wire cage, and in that position per-
formed all the functions of life, even to mating and lay-
ing its eggs. Those who fear the effect of civilization,
with its numerous demands for near vision, upon the
eye may take courage from the example of this marvel-
ous little animal which, in a state of nature, hangs by
its feet only at intervals, but in captivity can do it for
ten months on end, the whole of its life's span, appar-
ently without inconvenience or fatigue.1

The fact is that when the mind is at rest nothing can
tire the eyes, and when the mind is under a strain noth-
ing can rest them. Anything that rests the mind will
benefit the eyes. Almost everyone has observed that the
eyes tire less quickly when reading an interesting book
than when perusing something tiresome or difficult to
comprehend. A schoolboy can sit up all night reading
a novel without even thinking of his eyes, but if he tried
to sit up all night studying his lessons he would soon
find them getting very tired. A child whose vision was

1 The Wonders of Instinct, English translation by de Mattos and Miall,
1918, pp. 36-38.

Time Required for a Cure 103

ordinarily so acute that she could see the moons of Jupi-
ter with the naked eye became myopic when asked to
do a sum in mental arithmetic, mathematics being a sub-
ject which was extremely distasteful to her. Sometimes
the conditions which produce mental relaxation are very
curious. One patient, for instance, was able to correct
her error of refraction when she looked at the test card
with her body bent over at an angle of about forty-five
degrees, and the relaxation continued after she had as-
sumed the upright position. Although the position was
an unfavorable one, she had somehow got the idea that
it improved her sight, and therefore it did so.

The time required to effect a permanent cure varies
greatly with different individuals. In some cases five,
ten, or fifteen minutes is sufficient, and I believe the time
is coming when it will be possible to cure everyone
quickly. It is only a question of accumulating more
facts, and presenting these facts in such a way that the
patient can grasp them quickly. At present, however,
it is often necessary to continue the treatment for weeks
and months, although the error of refraction may be no
greater nor of longer -duration than in those cases that
are cured quickly. In most cases, too, the treatment
must be continued for a few minutes every day to pre-
vent relapse. Because a familiar object tends to relax
the strain to see, the daily reading of the Snellen test
card is usually sufficient for this purpose. It is also use-
ful, particularly when the vision at the near point 'is
imperfect, to read fine print every day as close to the
eyes as it can be done. When a cure is complete it is
always permanent; but complete cures, which mean the
attainment, not of what is ordinarily called normal sight,
but of a measure of telescopic and microscopic vision,

104 Cause and Cure of Errors of Refraction

are very rare. Even in these cases, too, the treatment
can be continued with benefit; for it is impossible to
place limits to the visual powers of man, and no matter
how good the sight, it is always possible to improve it.
Daily practice of the art of vision is also necessary to

Fig. 41.— One of Many Thousands of Patients Cured of Errors
of Refraction by the Methods Presented in This Book

No. L— Man of thirty-six, 1902, wearing glasses for myopia.
Note the appearance of effort in his eyes. He was relieved in
1904 by means of exercises in distant vision and obtained normal
sight without glasses.

No. 2. — The same man five years later. No relapse.

prevent those visual lapses to which every eye is liable,
no matter how good its sight may ordinarily be. It is
true that no system of training will provide an absolute
safeguard against such lapses in all circumstances; but
the daily reading of small distant, familiar letters will
do much to lessen the tendency to strain when disturb-
ing circumstances arise, and all persons upon whose eye-
sight the safety of others depends should be required
to do this.

Generally persons who have never worn glasses are

Cures at All Ages 105

more easily cured than those who have, and glasses
should be discarded at the beginning of the treatment.
When this cannot be done without too great discomfort,
or when the patient has to continue his work during the
treatment and cannot do so without glasses, their use
must be permitted for a time ; but this always delays the
cure. Persons of all ages have been benefited by this
treatment of errors of refraction by relaxation; but chil-
dren usually, though not invariably, respond much more
quickly than adults. If they are under twelve years of
age, or even under sixteen, and have never worn glasses,
they are usually cured in a few days, weeks, or months,
and always within a year, simply by reading the Snellen
test card every day.

CHAPTER X

STRAIN

TEMPORARY conditions may contribute to the
strain to see which results in the production
of errors of refraction; but its foundation lies
in wrong habits of thought. In attempting to relieve it
the physician has continually to struggle against the
idea that to do anything well requires effort. This idea
is drilled into us from our cradles. The whole educa-
tional system is based upon it; and in spite of the won-
derful results attained by Montessori through the total
elimination of every species of compulsion in the edu-
cational process, educators who call themselves modern
still cling to the club, under various disguises, as a neces-
sary auxiliary to the process of imparting knowledge.

It is as natural for the eye to see as it is for the mind
to acquire knowledge, and any effort in either case is not
only useless, but defeats the end in view. You may force
a few facts into a child's mind by various kinds of com-
pulsion, but you cannot make it learn anything. The
facts remain, if they remain at all, as dead lumber in the
brain. They contribute nothing to the vital processes of
thought; and because they were not acquired naturally
and not assimilated, they destroy the natural impulse of
the mind toward the acquisition of knowledge, and by
the time the child leaves school or college, as the case
may be, it not only knows nothing but is, in the majority
of cases, no longer capable of learning.

In the same way you may temporarily improve the
sight by effort, but you cannot improve it to normal, and

106

When the Eye Tries to See 107

if the effort is allowed to become continuous, the sight
will steadily deteriorate and may eventually be destroyed.
Very seldom is the impairment or destruction of vision
due to any fault in the construction of the eye. Of two
equally good pairs of eyes one will retain perfect sight
to the end of life, and the other will lose it in the kinder-
garten, simply because one looks at things without effort
and the other does not.

The eye with normal sight never tries to see. If for
any reason, such as the dimness of the light, or the dis-
tance of the object, it cannot see a particular point, it
shifts to another. It never tries to bring out the point
by staring at it, as the eye with imperfect sight is con-
stantly doing.

Whenever the eye tries to see, it at once ceases to
have normal vision. A person may look at the stars with
normal vision; but if he tries to count the stars in any
particular constellation, he will probably become my-
opic, because the attempt to do these things usually
results in an effort to see. A patient was able to look
at the letter K on the Snellen test card with normal
vision, but when asked to count its twenty-seven corners
he lost it completely.

It obviously requires a strain to fail to see at the dis-
tance, because the eye at rest is adjusted for distant
vision. If one does anything when one wants to see at
the distance, one must do the wrong thing. The shape
of the eyeball cannot be altered during distant vision
without strain. It is equally a strain to fail to see at the
near-point, because when the muscles respond to the
mind's desire they do it without strain. Only by an
effort can one prevent the eye from elongating at the
near-point.

108 Strain

The eye possesses perfect vision only when it is abso-
lutely at rest. Any movement, either in the organ or the
object of vision, produces an error of refraction. With
the retinoscope it can be demonstrated that even the
necessary movements of the eyeball produce a slight
error of refraction, and the moving pictures have given
us a practical demonstration of the fact that it is impos-
sible to see a moving object perfectly. When the move-
ment of the object of vision is sufficiently slow, the
resulting impairment of vision is so slight as to be in-
appreciable, just as the errors of refraction produced
by slight movements of the eyeball are inappreciable;
but when objects move very rapidly they can be seen
only as a blur. For this reason it has been found neces-
sary to arrange the machinery for exhibiting moving
pictures in such a way that each picture is halted for
a twenty-fourth of a second, and screened while it is
moving into place. Moving pictures, accordingly, are
never seen in motion.

The act of seeing is passive. Things are seen, just as
they are felt, or heard, or tasted, without effort or voli-
tion on the part of the subject. When sight is perfect
the letters on the test card are waiting, perfectly black
and perfectly distinct, to be recognized. They do not
have to be sought; they are there. In imperfect sight
they are sought and chased. The eye goes after them.
An effort is made to see them.

The muscles of the body are supposed never to be at
rest. The blood-vessels, with their muscular coats, are
never at rest. Even in sleep thought does not cease. But
the normal condition of the nerves of sense — of hearing,
sight, taste, smell and touch — is one of rest. They can
be acted upon; they cannot act. The optic nerve, the

Mental Strain Reflected in the Eye 109

retina and the visual centers of the brain are as passive
as the finger-nail. They have nothing whatever in their
structure that makes it possible for them to do anything,
and when they are the subject of effort from outside
sources their efficiency is always impaired.

The mind is the source of all such efforts from outside
sources brought to bear upon the eye. Every thought
of effort in the mind, of whatever sort, transmits a
motor impulse to the eye ; and every such impulse causes
a deviation from the normal in the shape of the eyeball
and lessens the sensitiveness of the center of sight. If
one wants to have perfect sight, therefore, one must
have no thought of effort in the mind. Mental strain
of any kind always produces a conscious or unconscious
eyestrain and if the strain takes the form of an effort
to see, an error of refraction is always produced. A
schoolboy was able to read the bottom line of the Snellen
test card at ten feet, but when the teacher told him to
mind what he was about he could not see the big C.1
Many children can see perfectly so long as their mothers
are around ; but if the mother goes out of the room, they
may at once become myopic, because of the strain pro-
duced by fear. Unfamiliar objects produce eyestrain and
a consequent error of refraction, because they first pro-
duce mental strain. A person may have good vision
when he is telling the truth ; but if he states what is not
true, even with no intent to deceive, or if he imagines
what is not true, an error of refraction will be produced,
because it is impossible to state or imagine what is not
true without an effort.

I may claim to have discovered that telling lies is bad

1 In this case and others to be mentioned later, the large letter at the
top of the card read by the eye with normal vision at two hundred feet,
was a "C."

110 Strain

for the eyes, and whatever bearing this circumstance
may have upon the universality of defects of vision, the
fact can easily be demonstrated. If a patient can read
all the small letters on the bottom line of the test card,
and either deliberately or carelessly miscalls any of them,
the retinoscope will indicate an error of refraction. In
numerous cases patients have been asked to state their
ages incorrectly, or to try to imagine that they were a
year older or a year younger than they actually were,
and in every case when they did this the retinoscope
indicated an error of refraction. A patient twenty-five
years old had no error of refraction when he looked at
a blank wall without trying to see ; but if he said he was
twenty-six or if someone else said he was twenty-six,
or if he tried to imagine that he was twenty-six, he be-
came myopic. The same thing happened when he stated
or tried to imagine that he was twenty-four. When he
stated or remembered the truth his vision was normal,
but when he stated or imagined an error he had an error
of refraction.

Two little girl patients arrived one after the other one
day, and the first accused the second of having stopped
at Huyler's for an ice cream soda, which she had been
instructed not to do, being somewhat too much addicted
to sweets. The second denied the charge, and the first,
who had used the retinoscope and knew what it did to
people who told lies, said :

"Do take the retinoscope and find out."

I followed the suggestion, and having thrown the light
into the second child's eyes, I asked:

"Did you go to Huyler's?"

"Yes," was the response, and the retinoscope indicated
no error of refraction.

Different Kinds of Strain 111

"Did you have an ice-cream soda?"

"No," said the child ; but the telltale shadow moved in
a direction opposite to that of the mirror, showing that
she had become myopic and was not telling the truth.

The child blushed when I told her this and acknowl-
edged that the retinoscope was right; for she had heard
of the ways of the uncanny instrument before and did
not know what else it might do to her if she said any-
thing more that was not true.

So sensitive is this test that if the subject, whether his
vision is ordinarily normal or not, pronounces the initials
of his name correctly while looking at a blank surface
without trying to see, there will be no error of refrac-
tion; but if he miscalls one initial, even without any
consciousness of effort, and with full knowledge that he
is deceiving no one, myopia will be produced.

Mental strain may produce many different kinds of
eyestrain. According to the statement of most author-
ities there is only one kind of eyestrain,' an indefinite
thing resulting from so-called over-use of the eyes, or an
effort to overcome a wrong shape of the eyeball. It can
be demonstrated, however, that there is not only a differ-
ent strain for each different error of refraction, but a
different strain for most abnormal conditions of the eye.
The strain that produces an error of refraction is not the
same as the strain that produces a squint, or a cataract,1
or glaucoma,2 or amblyopia.3 or inflammation of the con-
junctiva4 or of the margin of the lids, or disease of the
optic nerve or retina. All these conditions may exist

1 An opacity of the lens.

2 A condition in which the eyeball becomes abnormally hard.

8 A condition in which there is a decline of vision without apparent cause.
4 A membrane covering the inner surface of the eyelid and the visible
part of the white of the eye.

112 Strain

with only a slight error of refraction, and while the relief
of one strain usually means the relief of any others that
may coexist with it, it sometimes happens that the strain
associated with such conditions as cataract and glau-
coma is relieved without the complete relief of the strain
that causes the error of refraction. Even the pain that
so often accompanies errors of refraction is never caused
by the same strain that causes these errors. Some my-
opes cannot read without pain or discomfort, but most
of them suffer no inconvenience. When the hyperme-
trope regards an object at the distance the hyperme-
tropia is lessened, but pain and discomfort may be in-
creased. While there are many strains, however, there
is only one cure for all of them, namely, relaxation.

The health of the eye depends upon the blood, and
circulation is very largely influenced by thought. When
thought is normal — that is, not attended by any excite-
ment or strain — the circulation in the brain is normal,
the supply of blood to the optic nerve and the visual
centers is normal, and the vision is perfect. When
thought is abnormal the circulation is disturbed, the
supply of blood to the optic nerve and visual centers is
altered, and the vision lowered. We can consciously
think thoughts which disturb the circulation and lower
the visual power ; we can also consciously think thoughts
that will restore normal circulation, and thereby cure,
not only all errors of refraction, but many other abnor-
mal conditions of the eyes. We cannot by any amount
of effort make ourselves see, but by learning to control
our thoughts we can accomplish that end indirectly.

You can teach people how to produce any error of
refraction, how to produce a squint, how to see two
images of an object, one above another, or side by side,

As Quick as Thought 113

or at any desired angle from one another, simply by
teaching them how to think in a particular way. When
the disturbing thought is replaced by one that relaxes,
the squint disappears, the double vision and the errors
of refraction are corrected; and this is as true of abnor-
malties of long standing as of those produced volun-
tarily. No matter what their degree or their duration
their cure is accomplished just as soon as the patient
is able to secure mental control. The cause of any error
of refraction, of a squint, or of any other functional dis-
turbance of the eye, is simply a thought — a wrong
thought — and the cure is as quick as the thought that
relaxes. In a fraction of a second the highest degrees
of refractive error may be corrected, a squint may disap-
pear, or the blindness of amblyopia may be relieved. If
the relaxation is only momentary, the correction is mo-
mentary. When it becomes permanent, the correction
is permanent.

This relaxation cannot, however, be obtained by any
sort of effort. It is fundamental that patients should
understand this; for so long as they think, consciously
or unconsciously, that relief from strain may be obtained
by another strain their cure will be delayed.

CHAPTER XI
CENTRAL FIXATION

THE eye is a miniature camera, corresponding in
many ways very exactly to the inanimate ma-
chine used in photography. In one respect,
however, there is a great difference between the two
instruments. The sensitive plate of the camera is equally
sensitive in every part; but the retina has a point of
maximum sensitiveness, and every other part is less sen-
sitive in proportion as it is removed from that point.
This point of maximum sensitiveness is called the "fovea
centralis," literally the "central pit."

The retina, although it is an extremely delicate mem-
brane, varying in thickness from one-eightieth of an inch
to less than half that amount, is highly complex. It is
composed of nine layers, only one of which is supposed
to be capable of receiving visual impressions. This layer
is composed of minute rodlike and conical bodies which
vary in form and are distributed very differently in its
different parts. In the center of the retina is a small
circular elevation known, from the yellow color which it
assumes in death and sometimes also in life, as the "mac-
ula lutea," literally the "yellow spot." In the center of
this spot is the fovea, a deep depression of darker color.
In the center of this depression there are no rods, and the
cones are elongated and pressed very closely together.
The other layers, on the contrary, become here extremely
thin, or disappear altogether, so that the cones are cov-
ered with barely perceptible traces of them. Beyond the
center of the fovea the cones become thicker and fewer

114

An Invariable Symptom of Imperfect Sight 115

and are interspersed with rods, the number of which in-
creases toward the margin of the retina. The precise
function of these rods and cones is not clear; but it is a
fact that the center of the fovea, where all elements ex-
cept the cones and their associated cells practically dis-
appear, is the seat of the most acute vision. As we
withdraw from this spot, the acuteness of the visual
perceptions rapidly decreases. The eye with normal
vision, therefore, sees one part of everything it looks at
best, and everything else worse, in proportion as it is
removed from the point of maximum vision ; and it is an
invariable symptom of all abnormal conditions of the
eyes, both functional and organic, that this central fixa-
tion is lost.

These conditions are due to the fact that when the
sight is normal the sensitiveness of the fovea is normal,
but when the sight is imperfect, from whatever cause,
the sensitiveness of the fovea is lowered, so that the eye
sees equally well, or even better, with other parts of
the retina. Contrary to what is generally believed, the
part seen best when the sight is normal is extremely
small. .The text-books say that at twenty feet an area
having a diameter of half an inch can be seen with maxi-
mum vision, but anyone who tries at this distance to see
every part of even the smallest letters of the Snellen
test card — the diameter of which may be less than a
quarter of an inch — equally well at one time will imme-
diately become myopic. The fact is that the nearer the
point of maximum vision approaches a mathematical
point, which has no area, the better the sight.

The cause of this loss of function in the center of sight
is mental strain; and as all abnormal conditions of the
eyes, organic as well as functional, are accompanied by

116 Central Fixation

mental strain, all such conditions must necessarily be ac-
companied by loss of central fixation. When the mind
is under a strain the eye usually goes more or less blind.
The center of sight goes blind first, partially or com-
pletely, according to the degree of the strain, and if the
strain is great enough the whole or the greater part of
the retina may be involved. When the vision of the
center of sight has been suppressed, partially or com-
pletely, the patient can no longer see the point which he
is looking at best, but sees objects not regarded directly
as well, or better, because the sensitiveness of the retina
has now become approximately equal in every part, or
is even better in the outer part than in the center. There-
fore in all cases of defective vision the patient is unable
to see best where he is looking.

This condition is sometimes so extreme that the pa-
tient may look as far away from an object as it is possible
to see it, and yet see it just as well as when looking di-
rectly at it. In one case it had gone so far that the patient
could see only with the edge of the retina on the nasal
side. In other words, she could not see her fingers in
front of her face, but could see them if held at the outer
side of her eye. She had only a slight error of refraction,
showing that while every error of refraction is accom-
panied by eccentric fixation, the strain which causes the
one condition is different from that which produces the
other. The patient had been examined by specialists in
this country and Europe, who attributed her blindness
to disease of the optic nerve or brain; but the fact that
vision was restored by relaxation demonstrated that the
condition had been due simply to mental strain.

Eccentric fixation, even in its lesser degrees, is so un-
natural that great discomfort, or even pain, can be pro-
duced in a few seconds by trying to see every part of an

When the Eye Possesses Central Fixation 117

area three or four inches in extent at twenty feet, or
even less, or an area of an inch or less at the near-point,
equally well at one time, while at the same time the
retinoscope will demonstrate that an error of refraction
has been produced. This strain, when it is habitual,
leads to all sorts of abnormal conditions and is, in fact,
at the bottom of most eye troubles, both functional and
organic. The discomfort and pain may be absent, how-
ever, in the chronic condition, and it is an encouraging
symptom when the patient begins to experience them.

When the eye possesses central fixation it not only
possesses perfect sight, but it is perfectly at rest and
can be used indefinitely without fatigue. It is open and
quiet; no nervous movements are observable; and when
it regards a point at the distance the visual axes are
parallel. In other words, there are no muscular insuffi-
ciencies. This fact is not generally known. The text-
books state that muscular insufficiencies occur in eyes
having normal sight, but I have never seen such a case.
The muscles of the face and of the whole body are also
at rest, and when the condition is habitual there are no
wrinkles or dark circles around the eyes.

In most cases of eccentric fixation, on the contrary, the
eye quickly tires, and its appearance, with that of the
face, is expressive of effort or strain. The ophthalmo-
scope1 reveals that the eyeball moves at irregular inter-
vals, from side to side, vertically or in other directions.
These movements are often so extensive as to be mani-
fest by ordinary inspection, and are sometimes suffi-
ciently marked to resemble nystagmus.2 Nervous move-

1 A shorter movement can be noted when the observer watches the optic
nerve with the ophthalmoscope than when he views merely the exterior of
the eye.

2 A condition in which there is a conspicuous and more or less rhythmic
movement of the eyeball from side to side.

118 Central Fixation

ments of the eyelids may also be noted, either by ordi-
nary inspection, or by lightly touching the lid of one eye
while the other regards an object either at the near-point
or the distance. The visual axes are never parallel, and
the deviation from the normal may become so marked as
to constitute the condition of squint. Redness of the
conjunctiva and of the margins of the lids, wrinkles
around the eyes, dark circles beneath them and tearing
are other symptoms of eccentric fixation.

Eccentric fixation is a symptom of strain, and is re-
lieved by any method that relieves strain; but in some
cases the patient is cured just as soon as he is able to
demonstrate the facts of central fixation. When he comes
to realize, through actual demonstration of the fact, that
he does not see best where he is looking, and that when
he looks a sufficient distance away from a point he can
see it worse than when he looks directly at it, he becomes
able, in some way, to reduce the distance to which he
has to look in order to see worse, until he can look
directly at the top of a small letter and see the bot-
tom worse, or look at the bottom and see the top
worse. The smaller the letter regarded in this way, or
the shorter the distance the patient has to look away
from a letter in order to see the opposite part indistinctly,
the greater the relaxation and the better the sight. When
it becomes possible to look at the bottom of a letter and
see the top worse, or to look at the top and see the bot-
tom worse, it becomes possible to see the letter perfectly
black and distinct. At first such vision may come only
in flashes. The letter will come out distinctly for a
moment and then disappear. But gradually, if the prac-
tice is continued, central fixation will become habitual.

Most patients can readily look at the bottom of the

The Use of Strong Lights 119

big C and see the top worse; but in some cases it is not
only impossible for them to do this, but impossible for
them to let go of the large letters at any distance at which
they can be seen. In these extreme cases it sometimes
requires considerable ingenuity, first to demonstrate to
the patient that he does not see best where he is looking,
and then to help him to see an object worse when he
looks away from it than when he looks directly at it.
The use of a strong light as one of the points of fixation,
or of two lights five or ten feet apart, has been found
helpful, the patient when he looks away from the light
being able to see it less bright more readily than he can
see a black letter worse when he looks away from it.
It then becomes easier for him to see the letter worse
when he looks away from it. This method was success-
ful in the following case :

A patient with vision of 3/200, when she looked at a
point a few feet away from the big C, said she saw the
letter better than when she looked directly at it. Her
attention was called to the fact that her eyes soon became
tired and that her vision soon failed when she saw things
in this way. Then she was directed to look at a bright
object about three feet away from the card, and this at-
tracted her attention to such an extent that she became
able to see the large letter on the test card worse, after
which she was able to look back at it and see it better.
It was demonstrated to her that she could do one of two
things: look away and see the letter better than she did
before, or look away and see it worse. She then became
able to see it worse all the time when she looked three
feet away from it. Next she became able to shorten the
distance successively to two feet, one foot, and six inches,
with a constant improvement in vision; and finally she

120 Central Fixation

became able to look at the bottom of the letter and see
the top worse, or look at the top and see the bottom
worse. With practice she became able to look at the
smaller letters in the same way, and finally she became
able to read the ten line at twenty feet. By the same
method also she became able to read diamond type, first
at twelve inches and then at three inches. By these
simple measures alone she became able, in short, to see
best where she was looking, and her cure was complete.

The highest degrees of eccentric fixation occur in the
high degrees of myopia, and in these cases, since the
sight is best at the near-point, the patient is benefited
by practicing seeing worse at this point. The distance
can then be gradually extended until it becomes possible
to do the same thing at twenty feet. One patient with
a high degree of myopia said that the farther she looked
away from an electric light the better she saw it, but
by alternately looking at the light at the near-point and
looking away from it she became able, in a short time,
to see it brighter when she looked directly at it than
when she looked away from it. Later she became able
to do the same thing at twenty feet, and then she expe-
rienced a wonderful feeling of relief. No words, she
said, could adequately describe it. Every nerve seemed
to be relaxed, and a feeling of comfort and rest perme-
ated her whole body. Afterward her progress was rapid.
She soon became able to look at one part of the smallest
letters on the card and see the rest worse, and then she
became able to read the letters at twenty feet.

On the principle that a burnt child dreads the fire,
some patients are benefited by consciously making their
sight worse. When they learn, by actual demonstration
of the facts, just how their visual defects are produced,
they unconsciously avoid the unconscious strain which

Possibilities Cannot Be Limited 121

causes them. When the degree of eccentric fixation is
not too extreme to be increased, therefore, it is a benefit
to patients to teach them how to increase it. When a
patient has consciously lowered his vision and produced
discomfort and even pain by trying to see the big C,
or a whole line of letters, equally well at one time, he
becomes better able to correct the unconscious effort of
the eye to see all parts of a smaller area equally well at
one time.

In learning to see best where he is looking it is usually
best for the patient to think of the point not directly re-
garded as being seen less distinctly than the point he is
looking at, instead of thinking of the point fixed as being
seen best, as the latter practice has a tendency, in most
cases, to intensify the strain under which the eye is al-
ready laboring. One part of an object is seen best only
when the mind is content to see the greater part of it
indistinctly, and as the degree of relaxation increases the
area of the part seen worse increases, until that seen best
becomes merely a point.

The limits of vision depend upon the degree of central
fixation. A person may be able to read a sign half a mile
away when he sees the letters all alike, but when taught
to see one letter best he will be able to read smaller let-
ters that he didn't know were there. The remarkable
vision of savages, who can see with the naked eye ob-
jects for which most civilized persons require a telescope,
is a matter of central fixation. Some people can see the
rings of Saturn, or the moons of Jupiter, with the naked
eye. It is not because of any superiority in the structure
of their eyes, but because they have attained a higher
degree of central fixation than most civilized persons do.

Not only do all errors of refraction and all functional

122 Central Fixation

disturbances of the eye disappear when it sees by central
fixation, but many organic conditions are relieved or
cured. I am unable to set any limits to its possibilities.
I would not have ventured to predict that glaucoma, in-
cipient cataract and syphilitic iritis could be cured by cen-
tral fixation; but it is a fact that these conditions have
disappeared when central fixation was attained. Relief
was often obtained in a few minutes, and, in rare cases,
this relief was permanent. Usually, however, a perma-
nent cure required more prolonged treatment. Inflam-
matory conditions of all kinds, including inflammation
of the cornea, iris, conjunctiva, the various coats of the
eyeball and even the optic nerve itself, have been bene-
fited by central fixation after other methods had failed.
Infections, as well as diseases caused by protein poison-
ing and the poisons of typhoid fever, influenza, syphilis
and gonorrhoea, have also been benefited by it. Even
with a foreign body in the eye there is no redness and
no pain so long as central fixation is retained.

Since central fixation is impossible without mental con-
trol, central fixaton of the eye means central fixation of
the mind. It means, therefore, health in all parts of the
body, for all the operations of the physical mechanism
depend upon the mind. Not only the sight, but all the
other senses — touch, taste, hearing and smell — are bene-
fited by central fixation. All the vital processes — digest-
tion, assimilation, elimination, etc. — are improved by it.
The symptoms of functional and organic diseases are
relieved. The efficiency of the mind is enormously in-
creased. The benefits of central fixation already ob-
served are, in short, so great that the subject merits
further investigation.

CHAPTER XII
PALMING

ALL the methods used in the cure of errors of re-
fraction are simply different ways of obtaining
relaxation, and most patients, though by no
means all, find it easiest to relax with their eyes shut.
This usually lessens the strain to see, and in such cases is
followed by a temporary or more lasting improvement
in vision.

Most patients are benefited merely by closing the eyes ;
and by alternately resting them for a few minutes or
longer in this way and then opening them and looking
at the Snellen test card for a second or less, flashes of
improved vision are, as a rule, very quickly obtained.
Some temporarily obtain almost normal vision by this
means; and in rare cases a complete cure has been
effected, sometimes in less than an hour.

But since some light comes through the closed eyelids,
a still greater degree of relaxation can be obtained, in
all but a few exceptional cases, by excluding it. This
is done by covering the closed eyes with the palms of
the hands (the fingers being crossed upon the forehead)
in such a way as to avoid pressure on the eyeballs. So
efficacious is this practice, which I have called "palming,"
as a means of relieving strain, that we all instinctively
resort to it at times, and from it most patients are able
to get a considerable degree of relaxation.

But even with the eyes closed and covered in such
a way as to exclude all the light, the visual centers of

123

124 P aiming

the brain may still be disturbed, the eye may still strain
to see; and instead of seeing a field so black that it
is impossible to remember, imagine, or see anything
blacker, as one ought normally to do when the optic
nerve is not subject to the stimulation of light, the
patients will see illusions of lights and colors ranging
all the way from an imperfect black to kaleidoscopic
appearances so vivid that they seem to be actually seen
with the eyes. The worse the condition of the eyesight,
as a rule, the more numerous, vivid and persistent these
appearances are. Yet some persons with very imperfect
sight are able to palm almost perfectly from the begin-
ning, and are, therefore, very quickly cured. Any dis-
turbance of mind or body, such as fatigue, hunger, anger,
worry or depression, also makes it difficult for patients
to see black when they palm, persons who can see it
perfectly under ordinary conditions being often unable
to do so without assistance when they are ill or in pain.
It is impossible to see a perfect black unless the eye-
sight is perfect, because only when the eyesight is perfect
is the mind at rest; but some patients can without diffi-
culty approximate such a black nearly enough to improve
their eyesight, and as the eyesight improves the deepness
of the black increases. Patients who fail to see even an
approximate black when they palm state that instead of
black they see streaks or floating clouds of gray, flashes
of light, patches of red, blue, green, yellow, etc. Some-
times instead of an immovable black, clouds of black will
be seen moving across the field. In other cases the black
will be seen for a few seconds and then some other color
will take its place. The different ways in which patients
can fail to see black when their eyes are closed and cov-
ered are, in fact, very numerous and often very peculiar.

Vivid Colors Seen When Palming 125

Some patients have been so impressed with the vivid-
ness of the colors which they imagined they saw that
no amount of argument could, or did, convince them
that they did not actually see them with their eyes. If

Fig. 42. Palming

This is one of the most effective methods of obtaining relaxa-
tion of all the sensory nerves.

other people saw bright lights or colors, with their eyes
closed and covered, they admitted that these things would
be illusions; but what they themselves saw under the
same conditions was reality. They would not believe,
until they had themselves demonstrated the truth, that

126 Palming

their illusions were due to an imagination beyond their
control.

Successful palming in these more difficult cases usually
involves the practice of all the methods for improving the
sight described in succeeding chapters. For reasons
which will be explained in the following chapter, the
majority of such patients may be greatly helped by the
memory of a black object. They are directed to look
at such an object at the distance at which the color can
be seen best, close the eyes and remember the color,
and repeat until the memory appears to be equal to the
sight. Then they are instructed, while still holding the
memory of the black, to cover the closed eyes with the
palms of the hands in the manner just described. If
the memory of the black is perfect, the whole background
will be black. If it is not, or if it does not become so in
the course of a few seconds, the eyes are opened and the
black object regarded again.

Many patients become able by this method to see black
almost perfectly for a short time ; but most of them, even
those whose eyes are not very bad, have great difficulty
in seeing it continuously. Being unable to remember
black for more than from three to five seconds, they can-
not see black for a longer time than this. Such patients
are helped by central fixation. When they have become
able to see one part of a black object darker than the
whole, they are able to remember the smaller area for a
longer time than they could the larger one, and thus be-
come able to see black for a longer period when they
palm. They are also benefited by mental shifting (see
Chapter XV) from one black object to another, or from
one part of a black object to another. It is impossible to
see, remember, or imagine anything, even for as much as

Mental Shifting

127

a second, without shifting from one part to another, or
to some other object and back again; and the attempt
to do so always produces strain. Those who think they
are remembering a black object continuously are uncon-
sciously comparing it with something not so black, or

Fig. 43

Patient with atrophy of the optic nerve gets flashes of im-
proved vision after palming.

else its color and its position are constantly changing. It
is impossible to remember even such a simple thing as
a period perfectly black and stationary for more than a
fraction of a second. When shifting is not done uncon-
sciously patients must be encouraged to do it consciously.
They may be directed, for instance, to remember suc-
cessively a black hat, a black shoe, a black velvet dress,
a black plush curtain, or a fold in the black dress or the

128 Palming

black curtain, holding each one not more than a fraction
of a second. Many persons have been benefited by re-
membering all the letters of the alphabet in turn perfectly
black. Others prefer to shift from one small black object,
such as a period or a small letter, to another, or to swing
such an object in a manner to be described later (see
Chapter XV).

In some cases the following method has proved suc-
cessful: When the patient sees what he thinks is a per-
fect black, let him remember a piece of starch on this
background, and on the starch the letter F as black as
the background. Then let him let go of the starch and re-
member only the F, one part best, on the black back-
ground. In a short time the whole field may become as
black as the blacker part of the F. The process can be re-
peated many times with a constant increase of blackness
in the field.

In one case a patient who saw grey so vividly when
she palmed that she was positive she saw it with her
eyes, instead of merely imagining it, was able to oblit-
erate nearly all of it by first imagining a black C on the
grey field, then two black C's, and finally a multitude of
overlapping C's.

It is impossible to remember black perfectly when it
is not seen perfectly. If one sees it imperfectly, the best
one can do is to remember it imperfectly. All persons,
without exception, who can see or read diamond type at
the near-point, no matter how great their myopia may be,
or how much the interior of the eye may be diseased,
become able, as a rule, to see black with their eyes closed
and covered more readily than patients with hyperme-
tropia or astigmatism; because, while myopes cannot
see anything perfectly, even at the near-point, they see

Imperfect Memory Useful 129

better at that point than persons with hypermetropia or
astigmatism do at any distance. Persons with high de-
grees of myopia, however, often find palming very diffi-
cult, since they not only see black very imperfectly, but,
because of the effort they are making to see, cannot re-
member it more than one or two seconds. Any other con-
dition of the eye which prevents the patient from seeing
black perfectly also makes palming difficult. In some
cases black is never seen as black, appearing to be grey,
yellow, brown, or even bright red. In such cases it is
usually best for the patient to improve his sight by other
methods before trying to palm. Blind persons usually
have more trouble in seeing black than those who can see,
but may be helped by the memory of a black object fa-
miliar to them before they lost their sight. A blind
painter who saw grey continually when he first tried to
palm became able at last to see black by the aid of the
memory of black paint. He had no perception of light
whatever and was in terrible pain ; but when he succeeded
in seeing black the pain vanished, and when he opened
his eyes he saw light.

Even the imperfect memory of black is useful, for by
its aid a still blacker black can be both remembered and
seen; and this brings still further improvement. For
instance, let the patient regard a letter on the Snellen
test card at the distance at which the color is seen best,
then close his eyes and remember it. If the palming
produces relaxation, it will be possible to imagine a deeper
shade of black than was seen, and by remembering this
black when again regarding the letter it can be seen
blacker than it was at first. A still deeper black can then
be imagined, and this deeper black can, in turn, be trans-
ferred to the letter on the test card. By continuing this

130 Palming

process a perfect perception of black, and hence perfect
sight, are sometimes very quickly obtained. The deeper
the shade of black obtained with the eyes closed, the more
easily it can be remembered when regarding the letters
on the test card.

The longer some people palm the greater the relaxation
they obtain and the darker the shade of black they are
able both to remember and see. Others are able to palm
successfully for short periods, but begin to strain if they
keep it up too long.

It is impossible to succeed by effort, or by attempting
to "concentrate" on the black. As popularly understood,
concentration means to do or think one thing only; but
this is impossible, and an attempt to do the impossible
is a strain which defeats its own end. The human mind
is not capable of thinking of one thing only. It can
think of one thing best, and is only at rest when it does
so ; but it cannot think of one thing only. A patient who
tried to see black only and to ignore the kaleidoscopic
colors which intruded themselves upon her field of vision,
becoming worse and worse the more they were ignored,
actually went into convulsions from the strain, and was
attended every day for a month by her family physician
before she was able to resume the treatment. This pa-
tient was advised to stop palming, and, with her eyes
open, to recall as many colors as possible, remembering
each one as perfectly as possible. By thus taking the
bull by the horns and consciously making the mind wan-
der more than it did unconsciously, she became able, in
some way, to palm for short periods.

Some particular kinds of black objects may be found
to be more easily remembered than others. Black plush
of a high grade for instance, proved to be an optimum

Optimum Blacks

131

(see Chapter XVIII) with many persons as compared
with black velvet, silk, broadcloth, ink and the letters
on the Snellen test card, although no blacker than these
other blacks. A familiar black object can often be re-
membered more easily by the patient than those that

Fig. 44

No. 1. — Owing to paralysis of the seventh nerve on the right
side, resulting from a mastoid operation on the right ear, the
patient is unable to close her lips.

No. 2.— After palming and remembering a perfectly black pe-
riod she became able not only to close the lips, but to whistle.
The cure was permanent.

are less so. A dressmaker, for instance, was able to re-
member a thread of black silk when she could not remem-
ber any other black object.

132 Palming

When a black letter is regarded before palming the
patient will usually remember not only the blackness of
the letter, but the white background as well. If the mem-
ory of the black is held for a few seconds, however, the
background usually fades away and the whole field be-
comes black.

Patients often say that they remember black perfectly
when they do not. One can usually tell whether or not
this is the case by noting the effect of palming upon the
vision. If there is no improvement in the sight when
the eyes are opened, it can be demonstrated, by bringing
the black closer to the patient, that it has not been re-
membered perfectly.

Although black is, as a rule, the easiest color to re-
member, for reasons explained in the next chapter, the
following method sometimes succeeds when the memory
of black fails: Remember a variety of colors — bright
red, yellow, green, blue, purple, white especially — all in
the most intense shade possible. Do not attempt to hold
any of them more than a second. Keep this up for
five or ten minutes. Then remember a piece of starch
about half an inch in diameter as white as possible. Note
the color of the background. Usually it will be a shade
of black. If it is, note whether it is possible to remember
anything blacker, or to see anything blacker with the
eyes open. In ail cases when the white starch is remem-
bered perfectly the background will be so black that it
will be impossible to remember anything blacker with
the eyes closed, or to see anything blacker with them
open.

When palming is successful it is one of the best meth-
ods I know of for securing relaxation of all the sensory
nerves, including those of sight. When perfect relaxa-

When Palming Is Successful

133

tion is gained in this way, as indicated by the ability to
see a perfect black, it is completely retained when the
eyes are opened, and the patient is permanently cured.
At the same time pain in the eyes and head, and even in
other parts of the body, is permanently relieved. Such
cases are very rare, but they do occur. With a lesser

X ^

L-*- 1

Fig 45

Fig. 1. — Patient with absolute glaucoma of the right eye. He
had suffered agonizing pain for six months and had no percep-
tion of light. He was photographed when testing the tension
of his eyeball, which he found to be perfectly hard.

Fig. 2.— The patient is palming and remembering a perfectly
black period. After half an hour the eyeball became soft, the
pain ceased, and the patient became able to see the light. After
three years there was no return of the glaucoma.

degree of relaxation much of it is lost when the eyes are
opened, and what is retained is not held permanently. In
other words, the greater the degree of the relaxation pro-
duced by palming the more of it is retained when the

1 34 Palming

eyes are opened and the longer it lasts. If you palm
perfectly, you retain, when you open your eyes, all of the
relaxation that you gain, and you do not lose it again. If
you palm imperfectly, you retain only part of what you
gain and retain it only temporarily — it may be only for a
few moments. Even the smallest degree of relaxation
is useful, however, for by means of it a still greater de-
gree may be obtained.

Patients who succeed with palming from the begin-
ning are to be congratulated, for they are always cured
very quickly. A very remarkable case of this kind was
that of a man nearly seventy years of age with com-
pound hypermetropic astigmatism and presbyopia, com-
plicated by incipient cataract. For more than forty years
he had worn glasses to improve his distant vision, and
for twenty years he had worn them for reading and desk
work. Because of the cloudiness of the lens, he had now
become unable to see well enough to do his work, even
with glasses ; and the other physicians whom he had con-
sulted had given him no hope of relief except by opera-
tion when the cataract was ripe. When he found palming
helped him, he asked:

"Can I do that too much?"

"No," he was told. "Palming is simply a means of
resting your eyes, and you cannot rest them too much."

A few days later he returned and said:

"Doctor, it was tedious, very tedious ; but I did it."

"What was tedious?" I asked.

"Palming," he replied. "I did it continuously for
twenty hours."

"But you couldn't have kept it up for twenty hours
continuously," I said incredulously. "You must have
stopped to eat."

Tedious But Worth While 135

And then he related that from four o'clock in the morn-
ing until twelve at night he had eaten nothing, only drink-
ing large quantities of water, and had devoted practically
all of the time to palming. It must have been tedious, as
he said, but it was also worth while. When he looked at
the test card, without glasses, he read the bottom line at
twenty feet. He also read fine print at six inches and at
twenty. The cloudiness of the lens had become much
less, and in the center had entirely disappeared. Two
years later there had been no relapse.

Although the majority of patients are helped by palm-
ing, a minority are unable to see black, and only increase
their strain by trying to get relaxation in this way. In
most cases it is possible, by using some or all of the
various methods outlined in this chapter, to enable the
patient to palm successfully ; but if much difficulty is ex-
perienced, it is usually better and more expeditious to
drop the method until the sight has been improved by
other means. The patient may then become able to see
black when he palms, but some never succeed in doing
it until they are cured.

CHAPTER XIII
MEMORY AS AN AID TO VISION

WHEN the mind is able to remember perfectly
any phenomenon of the senses, it is always
perfectly relaxed. The sight is normal, if the
eyes are open; and when they are closed and covered so
as to exclude all the light, one sees a perfectly black field
— that is nothing at all. If you can remember the tick-
ing of a watch, or an odor or a taste perfectly, your mind
is perfectly at rest, and you will see a perfect black when
your eyes are closed and covered. If your memory of a
sensation of touch could be equal to the reality, you would
see nothing but black when the light was excluded from
your eyes. If you were to remember a bar of music per-
fectly when your eyes were closed and covered, you
would see nothing but black. But in the case of any of
these phenomena it is not easy to test the correctness
of the memory, and the same is true of colors other than
black. All other colors, including white, are altered by
the amount of light to which they are exposed, and are
seldom seen as perfectly as it is possible for the normal
eye to see them. But when the sight is normal, black
is just as black in a dim light as in a bright one. It is
also just as black at the distance as at the near-point,
while a small area is just as black as a large one, and,
in fact, appears blacker. Black is, moreover, more readily

136

Memory a Measure of Relaxation 137

available than any other color. There is nothing blacker
than printer's ink, and that is practically ubiquitous. By
means of the memory of black, therefore, it is possible to
measure accurately one's own relaxation. If the color is
remembered perfectly, one is perfectly relaxed. If it is
remembered almost perfectly, one's relaxation is almost
perfect. If it cannot be remembered at all, one has very
little or no relaxation.

By means of simultaneous retinoscopy, these facts can
be readily demonstrated. An absolutely perfect memory
is very rare, so much so that it need hardly be taken into
consideration ; but a practically perfect memory, or what
might be called normal, is attainable by every one under
certain conditions. With such a memory of black, the
retinoscope shows that all errors of refraction are cor-
rected. If the memory is less than normal, the contrary
will be the case. If it fluctuates, the shadow of the retino-
scope will fluctuate. The testimony of the retinoscope is,
in fact, more reliable than the statements of the patient.
Patients often believe and state that they remember black
perfectly, or normally, when the retinoscope indicates
an error of refraction ; but in such cases it can usually be
demonstrated by bringing the test card to the point at
which the black letters can be seen best, that the memory
is not equal to the sight. That the color cannot be re-
membered perfectly when the eyes and mind are under
a strain, the reader can easily demonstrate by trying to
remember it when making a conscious effort to see — by
staring, partly closing the eyes, frowning, etc. — or while
trying to see all the letters of a line equally well at one
time. It will be found that it either cannot be remem-
bered at all under these conditions, or that it is remem-
bered very imperfectly.

138 Memory as an Aid to Vision

When the two eyes of a patient are different, it has
been found that the difference can be exactly measured
by the length of time a black period can be remembered,
while looking at the Snellen test card, with both eyes
open, and with the better eye closed. A patient with
normal vision in the right eye and half-normal vision
in the left could, when looking at the test card with
both eyes open, remember a period for twenty seconds
continuously; but with the better eye closed, it could
be remembered only ten seconds. A patient with half-
normal vision in the right eye and one-quarter normal
in the left could remember a period twelve seconds with
both eyes open, and only six seconds with the better eye
closed. A third patient, with normal sight in the right
eye and vision of one-tenth in the left, could remember
a period twenty seconds with both eyes open, and only
two seconds when the better eye was closed. In other
words, if the right eye is better than the left, the memory
is better when the right eye is open than when only the
left eye is open, the difference being in exact proportion
to the difference in the vision of the two eyes.

In the treatment of functional eye troubles this rela-
tionship between relaxation and memory is of great prac-
tical importance. The sensations of the eye and of the
mind supply very little information as to the strain to
which both are being subjected, those who strain most
often suffering the least discomfort; but by means of
his ability to remember black the patient can always
know whether he is straining or not, and is able, there-
fore, to avoid the conditions that produce strain. What-
ever method of improving his sight the patient is using,
he is advised to carry with him constantly the mem-
ory of a small area of black, such as a period, so that

Not Attainable by Effort 139

he may recognize and avoid the conditions that pro-
duce strain, and in some cases patients have obtained a
complete cure in a very short time by this means alone.
One advantage of the method is that it does not require a
test card, for at any hour of the day or night, what-
ever the patient may be doing, he can always place him-
self in the conditions favorable to the perfect memory of
a period.

The condition of mind in which a black period can
be remembered cannot be attained by any sort of effort.
The memory is not the cause of the relaxation, but must
be preceded by it. It is obtained only during moments
of relaxation, and retained only as long as the causes
of strain are avoided; but how this is accomplished can-
not be fully explained, just as many other psychological
phenomena cannot be explained. We only know that
under certain conditions that might be called favorable
a degree of relaxation sufficient for the memory of a
black period is possible, and that, by persistently seek-
ing these conditions, the patient becomes able to increase
the degree of the relaxation and prolong its duration,
and finally becomes able to retain it under unfavorable
conditions.

For most patients palming provides the most favor-
able conditions for the memory of black. When the
strain to see is lessened by the exclusion of the light,
the patient usually becomes able to remember a black
object for a few seconds or longer, and this period of
relaxation can be prolonged in one of two ways. Either
the patient can open his eyes and look at a black object
by central fixation at the distance at which it can be
seen best, and at which the eyes are, therefore, most
relaxed, or he can shift mentally from one black object to

140 Memory as an Aid to Vision

another, or from one part of a black object to another.
By these means, and perhaps also through other influ-
ences that are not clearly understood, most patients be-
come able, sooner or later, to remember black for an in-
definite length of time with their eyes closed and covered.

With the eyes open and looking at a blank surface with-
out trying consciously to see, the unconscious strain is
lessened so that the patient becomes able to remember
a black period, and all errors of refraction, as demon-
strated by the retinoscope, are corrected. This result
has been found to be invariable, and so long as the sur-
face remains blank and the patient does not begin to
remember or imagine things seen imperfectly, the mem-
ory and the vision may be retained. But if, with the
improved vision, details upon the surface begin to come
out, or if the patient begins to think of the test card,
which he has seen imperfectly, the strain to see will re-
turn and the period will be lost.

When looking at a surface on which there is nothing
particular to see, distance makes no difference to the
memory, because the patient can always look at such
a surface, no matter where it is, without straining to
see it. When looking at letters, or other details, how-
ever, the memory is best at the point at which the pa-
tient's sight is best, because at that point the eyes and
mind are more relaxed than when the same letters or ob-
jects are regarded at distances at which the vision is not
so good. By practicing central fixation at the most favor-
able distance, therefore, and using any other means of
improving the vision which are found effectual, the mem-
ory of the period may be improved, in some cases, very
rapidly.

If the relaxation gained under these favorable condi-

Improved Sight a Disturbing Influence 141

tions is perfect, the patient will be able to retain it when
the mind is conscious of the impressions of sight at un-
favorable distances. Such cases are, however, very rare.
Usually the degree of relaxation gained is markedly im-
perfect, and is, therefore, lost to a greater or less degree
when the conditions are unfavorable, as when letters or
objects are being regarded at unfavorable distances. So
disturbing are the impressions of sight under these cir-
cumstances, that just as soon as details begin to come
out at distances at which they have not previously been
seen, the patient usually loses his relaxation, and with it
the memory of the period. In fact, the strain to see may
even return before he has had time to become conscious
of the image on his retina, as the following case strik-
ingly illustrates :

A woman of fifty-five who had myopia of fifteen
diopters, complicated with other conditions which made
it impossible for her to see the big C at more than one
foot, or to go about, either in her house or on the street,
without an attendant, became able, when she looked at
a green wall without trying to see it, to remember a
perfectly black period and to see a small area of the
wall-paper at the distance as well as she could at the
near-point. When she had come close to the wall, she
was asked to put her hand on the door-knob, which she
did without hesitation. "But I don't see the knob,"
she hastened to explain. As a matter of fact she had
seen it long enough to put her hand on it; but as soon
as the idea of seeing it was suggested to her she lost
the memory of the period, and with it her improved
vision, and when she again tried to find the knob she
could not do so.

When a period is remembered perfectly while a let-

142 Memory as an Aid to Vision

ter on the Snellen test card is being regarded, the let-
ter improves, with or without the consciousness of the
patient; because it is impossible to strain and relax at
the same time, and if one relaxes sufficiently to remem-
ber the period, one must also relax sufficiently to see the
letter, consciously or unconsciously. Letters on either
side of the one regarded, or on the lines above and below
it, also improve. When the patient is conscious of see-
ing the letters, this is very distracting, and usually
causes him, at first, to forget the period ; while with some
patients, as already noted, the strain may return even
before the letters are consciously recognized.

Thus patients find themselves on the horns of a
dilemma. The relaxation indicated by the memory of a
period improves their sight, and the things they see
with this improved vision cause them to lose their re-
laxation and their memory. It is very remarkable to me
how the difficulty is ever overcome, but some patients
are able to do it in five minutes or half an hour. With
others the process is long and tedious.

There are various ways of helping patients to deal with
this situation. One is to direct them to remember the
period while looking a little to one side of the test card,
say a foot or more; then to look a little nearer to it, and
finally to look between the lines. In this way they may
become able to see the letters in the eccentric field with-
out losing the period; and when they can do this they
may become able to go a step farther, and look directly
at a letter without losing control of their memory. If
they cannot do it, they are told to look at only one part
of a letter — usually the bottom — or to see or imagine the
period as part of the letter, while noting that the rest
of the letter is less black and less distinct than the part

Dodging Improved Sight 143

directly regarded. When they can do this they become
able to remember the period better than when the letter
is seen all alike. If the letter is seen all alike, the perfect
memory of the period is always lost. The next step is
to ask the patient to note whether the bottom of the
letter is straight, curved, or open, without losing the
period on the bottom. When he can do this, he is asked
to do the same with the sides and top of the letter, still
holding the period on the bottom. Usually when the
parts can be observed separately in this way, the whole
letter can be seen without losing the memory of the
period; but it occasionally happens that this is not the
case, and further practice is needed before the patient can
become conscious of all sides of the letter at once without
losing the period. This may require moments, hours,
days, or months. In one case the following method suc-
ceeded :

The patient, a man with fifteen diopters of myopia,
was so much disturbed by what he saw when his vision
had been improved by the memory of a period that he
was directed to look away from the Snellen test card,
or whatever object he was regarding, when he found the
letters or other details coming out; and for about a
week he went around persistently dodging his improved
sight. As his memory improved, it became more and
more difficult for him to do this, and at the end of the
week it was impossible. When he looked at the bottom
line at a distance of twenty feet he remembered the
period perfectly, and when asked if he could see the
letters, he replied :

"I cannot help but see them."

Some patients retard their recovery by decorating the
scenery with periods as they go about during the day,

144 Memory as an Aid to Vision

instead of simply remembering a period in their minds.
This does them no good, but is, on the contrary, a cause
of strain. The period can be imagined perfectly and with
benefit as forming part of a black letter on the test card,
because this merely means imagining that one sees one
part of the black letter best; but it cannot be imagined
perfectly on any surface which is not black, and to
attempt to imagine it on such surfaces defeats the end
in view.

The smaller the area of black which the patient is able
to remember, the greater is the degree of relaxation
indicated; but some patients find it easier, at first, to
remember a somewhat larger area, such as one of the
letters on the Snellen test card with one part blacker
than the rest. They may begin with the big C, then
proceed to the smaller letters, and finally get to a period.
It is then found that this small area is remembered more
easily than the larger ones, and that its black is more
intense. Instead of a period, some patients find it easier
to remember a colon, with one period blacker than the
other, or a collection of periods, with one blacker than
all the others, or the dot over an i or j. Others, again,
prefer a comma to a period. In the beginning most
patients find it helpful to shift consciously from one of
these black areas to another, or from one part of such
an area to another, and to realize the swing, or pulsation,
produced by such shifting (see Chapter XV) ; but when
the memory becomes perfect, one object may be held
continuously, without conscious shifting, while the swing
is realized only when attention is directed to the matter.

Although black is, as a rule, the best color to remem-
ber, some patients are bored or depressed by it, and
prefer to remember white or some other color. A

A Help to Other Mental Processes 145

familiar object, or one with pleasant associations, is
often easier to remember than one which has no par-
ticular interest. One patient was cured by the memory
of a yellow buttercup, and another was able to remem-
ber the opal of her ring when she could not remember
a period. Whatever the patient finds easiest to remem-
ber is the best to remember, because the memory can
never be perfect unless it is easy.

When the memory of the period becomes habitual, it
is not only not a burden, but is a great help to other
mental processes. Then mind, when it remembers one
thing better than all other things, possesses central fixa-
tion, and its efficiency is thereby increased, just as the
efficiency of the eye is increased by central fixation. In
other words, the mind attains its greatest efficiency when
it is at rest, and it is never at rest unless one thing is
remembered better than all other things. When the
mind is in such a condition that a period is remembered
perfectly, the memory for other things is improved.

A high-school girl reports that when she was unable
to remember the answer to a question in an examination,
she remembered the period, and the answer came to her.
When I cannot remember the name of a patient, I re-
member a period — and, behold, I have it! A musician
who had perfect sight and could remember a period per-
fectly, had a perfect memory for music; but a musician
with imperfect sight who could not remember a period
could play nothing without his notes, only gaining that
power when his sight and visual memory had become
normal. In some exceptional cases, the strain to see
letters on the Snellen test card has been so terrific that
patients have said that they not only could not remem-

146 Memory as an Aid to Vision

her a period while they were looking at them, but could
not remember even their own names.

Patients may measure the accuracy of their memory
of the period, not only by comparing it with the sight,
but by the following tests :

When the memory of the period is perfect it is instan-
taneous. If a few seconds or longer are necessary to
obtain the memory, it is never perfect.

A perfect memory is not only instantaneous, but con-
tinuous.

When the period is remembered perfectly perfect sight
comes instantaneously. If good vision is obtained only
after a second or two, it can always be demonstrated
that the memory of the period is imperfect and the
sight also.

The memory of a period is a test of relaxation. It
is the evidence by which the patient knows that his eyes
and mind are at rest. It may be compared to the steam-
gauge of an engine, which has nothing to do with the
machinery, but is of great importance in giving infor-
mation as to the ability of the mechanism to do its
work. When the period is black one knows that the
engine of the eye is in good working order. When the
period fades, or is lost, one knows that it is out of order,
until a cure is effected. Then one does not need a period,
or any other aid to vision, just as the engineer does not
need a steam-gauge when the engine is going properly.
One patient who had gained telescopic and microscopic
vision by the methods presented in this book said, in
answer to an inquiry from some one interested in inves-
tigating the treatment of errors of refraction without
glasses, that he had not only done nothing to prevent
a relapse, but had even forgotten how he was cured.

The Period no Longer Needed 147

The reply was unsatisfactory to the inquirer, but is
quoted to illustrate the fact that when a patient is cured
he does not need to do anything consciously in order to
stay cured, although the treatment can always be con-
tinued with benefit, since even supernormal vision can
be improved.

CHAPTER XIV
IMAGINATION AS AN AID TO VISION

WE see very largely with the mind, and only
partly with the eyes. The phenomena of
vision depend upon the mind's interpreta-
tion of the impression upon the retina. What we see
is not that impression, but our own interpretation of it.
Our impressions of size, color, form and location can be
demonstrated to depend upon the interpretation by the
mind of the retinal picture. The moon looks smaller at
the zenith than it does at the horizon, though the optical
angle is the same and the impression on the retina may
be the same, because at the horizon the mind uncon-
sciously compares the picture with the pictures of sur-
rounding objects, while at the zenith there is nothing to
compare it with. The figure of a man on a high build-
ing, or on the topmast of a vessel, looks small to the
landsman; but to the sailor it appears to be of ordinary
size, because he is accustomed to seeing the human figure
in such positions.

Persons with normal vision use their memory, or
imagination, as an aid to sight; and when the sight is
imperfect it can be demonstrated, not only that the eye
itself is at fault, but that the memory and imagination
are impaired, so that the mind adds imperfections to the
imperfect retinal image. No two persons with normal
sight will get the same visual impressions from the same
object; for their interpretations of the retinal picture
will differ as much as their individualities differ, and

148

The Mind Out of Focus 149

when the sight is imperfect the interpretation is far more
variable. It reflects, in fact, the loss of mental control
which is responsible for the error of refraction. When
the eye is out of focus, in short, the mind is also out
of focus.

According to the accepted view most of the abnor-
malities of vision produced when there is an error of
refraction in the eye are sufficiently accounted for by
the existence of that error. Some are supposed to be
due to diseases of the brain or retina. Multiple images
are attributed to astigmatism, though only two can be
legitimately accounted for in this way, while some pa-
tients state that they see half a dozen or more, and many
persons with astigmatism do not see any. It can easily
be demonstrated, however, that the inaccuracy of the
focus accounts for only a small part of these results;
and since they can all be corrected in a few seconds
through the correction, by relaxation, of the error of
refraction, it is evident that they cannot be due to any
organic disease.

If we compare the picture on the glass screen of the
camera when the camera is out of focus with the visual
impressions of the mind when the eye is out of focus,
there will be found to be a great difference between
them. When the camera is out of focus it turns black
into grey, and blurs the outlines of the picture; but it
produces these results uniformly and constantly. On
the screen of the camera an imperfect picture of a black
letter would be equally imperfect in all parts, and the
same adjustment of the focus would always produce the
same picture. But when the eye is out of focus the
imperfect picture which the patient imagines that he
sees is always changing, whether the focus changes or

150 Imagination as an Aid to Vision

not. There will be more grey on one part than on
another, and both the shade and the position of the grey
may vary within wide limits in a very short space of
time. One part of the letter may appear grey and the
rest black. Certain outlines may be seen better than
others, the vertical lines, perhaps, appearing black and
the diagonal grey, and vice versa. Again, the black
may be changed into brown, yellow, green, or even red,
transmutations impossible to the camera. Or there may
be spots of color, or of black, on the grey, or on the
white openings. There may also be spots of white, or
of color, on the black.

When the camera is out of focus the picture which
it produces of any object is always slightly larger than
the image produced when the focus is correct; but when
the eye is out of focus the picture which the mind sees
may be either larger or smaller than it normally would
be. To one patient the big C at ten feet appeared smaller
than at either twenty feet or four inches. To some it
appears larger than it actually is at twenty feet, and to
others it seems smaller.

When the human eye is out of focus the form of the
objects regarded by the patient frequently appears to be
distorted, while their location may also appear to change.
The image may be doubled, tripled, or still further mul-
tiplied, and while one object, or part of an object may
be multiplied other objects or parts of objects in the
field of vision may remain single. The location of these
multiple images is sometimes constant and at others
subject to continual change. Nothing like this could
happen when the camera is out of focus.

If two cameras are out of focus to the same degree,
they will take two imperfect pictures exactly alike. If

How Imagination Cures 151

two eyes are out of focus to the same degree, similar
impressions will be made upon the retina of each; but
the impressions made upon the mind may be totally un-
like, whether the eyes belong to the same person or to
different persons. If the normal eye looks at an object
through glasses that change its refraction, the greyness
and blurring produced are uniform and constant; but
when the eye has an error of refraction equivalent to
that produced by the glasses, these phenomena are non-
uniform and variable.

It is fundamental that the patient should understand
that these aberrations of vision — which are treated
more fully in a later chapter — are illusions, and not due
to a fault of the eyes. When he knows that a thing is
an illusion he is less likely to see it again. When he
becomes convinced that what he sees is imaginary it
helps to bring the imagination under control; and since
a perfect imagination is impossible without perfect re-
laxation, a perfect imagination not only corrects the
false interpretation of the retinal image, but corrects
the error of refraction.

Imagination is closely allied to memory, although dis-
tinct from it. Imagination depends upon the memory,
because a thing can be imagined only as well as it can
be remembered. You cannot imagine a sunset unless
you have seen one; and if you attempt to imagine a
blue sun, which you have never seen, you will be-
come myopic, as indicated by simultaneous retinoscopy.
Neither imagination nor memory can be perfect unless
the mind is perfectly relaxed. Therefore when the
imagination and memory are perfect, the sight is per-
fect. Imagination, memory and sight are, in fact, coin-
cident. When one is perfect, all are perfect, and when

152 Imagination as an Aid to Vision

one is imperfect, all are imperfect. If you imagine a
letter perfectly, you will see the letter and other letters
in its neighborhood will come out more distinctly, be-
cause it is impossible for you to relax and imagine you
see a perfect letter and at the same time strain and
actually see an imperfect one. If you imagine a perfect
period on the bottom of a letter, you will see the letter
perfectly, because you cannot take the mental picture of
a perfect period and put it on an imperfect letter. It is
possible, however, as pointed out in the preceding chap-
ter, for sight to be unconscious. In some cases patients
may imagine the period perfectly, as demonstrated by
the retinoscope, without being conscious of seeing the
letter; and it is often some time before they are able to
be conscious of it without losing the period.

When one treats patients who are willing to believe
that the letters can be imagined, and who are content
to imagine without trying to see, or compare what they
see with what they imagine, which always brings back
the strain, very remarkable results are sometimes ob-
tained by the aid of the imagination. Some patients at
once become able to read all the letters on the bottom
line of the test card after they become able to imagine
that they see one letter perfectly black and distinct. The
majority, however, are so distracted by what they see
when their vision has been improved by their imagina-
tion that they lose the latter. It is one thing to be able
to imagine perfect sight of a letter, and another to be
able to see the letter and other letters without losing
control of the imagination.

In myopia the following method is often successful :

First look at a letter at the point at which it is seen

best. Then close the eyes and remember it. Repeat

Patients Who Succeed 153

until the memory is almost as good as the sight at the
near-point. With the test card at a distance of twenty
feet, look at a blank surface a foot or more to one side
of it, and again remember the letter. Do the same at
six inches and at three inches. At the last point note
the appearance of the letters on the card — that is, in the
eccentric field. If the memory is still perfect, they will
appear to be a dim black, not grey, and those nearest
the point of fixation will appear blacker than those more
distant. Gradually reduce the distance between the point
of fixation and the letter until able to look straight at it
and imagine that it is seen as well as it is remembered.
Occasionally it is well during the practice to close and
cover the eyes and remember the letter, or a period,
perfectly black. The rest and mental control gained in
this way are a help in gaining control when one looks
at the test card.

Patients who succeed with this method are not con-
scious while imagining a perfect letter, of seeing, at the
same time, an imperfect one, and are not distracted when
their vision is improved by their imagination. Many
patients can remember perfectly with their eyes closed,
or when they are looking at a place where they cannot
see the letter; but just as soon as they look at it they
begin to strain and lose control of their memory. There-
fore, as the imagination depends upon the memory, they
cannot imagine that they see the letter. In such cases
it has been my custom to proceed somewhat in the man-
ner described in the preceding chapter. I begin by saying
to the patient:

"Can you imagine a black period on the bottom of
this letter, and at the same time, while imagining the
period perfectly, are you able to imagine that you see
the letter?

154 Imagination as an Aid to Vision

Sometimes they are able to do this, but usually they
are not. In that case they are asked to imagine part
of the letter, usually the bottom. When they have be-
come able to imagine this part straight, curved, or open,
as the case may be, they become able to imagine the
sides and top, while still holding the period on the bot-
tom. But even after they have done this, they may
still not be able to imagine the whole letter without
losing the period. One may have to coax them along
by bringing the card up a little closer, then moving it
farther away; for when looking at a surface where there
is anything to see, the imagination improves in propor-
tion as one approaches the point where the sight is best,
because at that point the eyes are most relaxed. When
there is nothing particular to see, the distance makes
no difference, because no effort is being made to see.

To encourage patients to imagine they see the letter
it seems helpful to keep saying to them over and over
again:

"Of course you do not see the letter. I am not ask-
ing you to see it. I am just asking you to imagine
that you see it perfectly black and perfectly distinct."

When patients become able to see a known letter by
the aid of their imagination, they become able to apply
the same method to an unknown letter ; for just as soon
as any part of a letter, such as an area equal to a period,
can be imagined to be perfectly black, the whole letter
is seen to be black, although the visual perception of this
fact may not, at first, last long enough for the patient
to become conscious of it.

In trying to distinguish unknown letters, the patient
discovers that it is impossible to imagine perfectly un-
less one imagines the truth; for if a letter, or any part

One Way of Imagining Perfectly 155

of a letter, is imagined to be other than it is, the mental
picture is foggy and inconstant, just like a letter which
is seen imperfectly.

The ways in which the imagination can be interfered
with are very numerous. There is one way of imagining
perfectly and an infinite number of ways of imagining
imperfectly. The right way is easy. The mental pic-
ture of the thing imagined comes as quick as thought,
and can be held more or less continuously. The wrong
way is difficult. The picture comes slowly, and is both
variable and discontinuous. This can be demonstrated
to the patient by asking him first to imagine or remember
a black letter as perfectly as possible with the eyes
closed, and then to imagine the same letter imperfectly.
The first he can usually do easily; but it will be found
very difficult to imagine a black letter with clear out-
lines to be grey, with fuzzy edges and clouded openings,
and impossible to form a mental picture of it that will
remain constant for an appreciable length of time. The
letter will vary in color, shape and location in the visual
field, precisely as a letter does when it is seen imper-
fectly; and just as the strain of imperfect sight pro-
duces discomfort and pain, the effort to imagine im-
perfectly will sometimes produce pain. The more nearly
perfect the mental picture of the letter, on the contrary,
the more easily and quickly it comes and the more con-
stant it is.

Some very dramatic cures have been effected by means
of the imagination. One patient, a physician, who had
worn glasses for forty years and who could not without
them see the big C at twenty feet, was cured in fifteen
minutes simply by imagining that he saw the letters
black. When asked to describe the big C with unaided

156 Imagination as an Aid to Vision

vision he said it looked grey to him, and that the open-
ing was obscured by a grey cloud to such an extent
that he had to guess that it had an opening. He was
told that the letter was black, perfectly black, and that
the opening was perfectly white, with no grey cloud;
and the card was brought close to him so that he could
see that this was so. When he again regarded the let-
ter at the distance, he remembered its blackness so
vividly that he was able to imagine that he saw it just
as black as he had seen it at the near-point, with the
opening perfectly white; and therefore he saw the let-
ter on the card perfectly black and distinct. In the same
way he became able to read the seventy line; and so he
went down the card, until in about five minutes he be-
came able to read at twenty feet the line which the
normal eye is supposed to read at ten feet. Next dia-
mond type was given to him to read. The letters ap-
peared grey to him, and he could not read them. His
attention was called to the fact that the letters were
really black, and immediately he imagined that he saw
them black and became able to read them at ten inches.

The explanation of this remarkable occurrence is
simply relaxation. All the nerves of the patient's body
were relaxed when he imagined that he saw the letters
black, and when he became conscious of seeing the let-
ters on the card, he still retained control of his imagina-
tion. Therefore he did not begin to strain again, and
actually saw the letters as black as he imagined them.

The patient not only had no relapse, but continued
to improve. About a year later I visited him in his
office and asked him how he was getting on. He re-
plied that his sight was perfect, both for distance and
the near-point. He could see the motor cars on the

Too Good To Be True 157

other side of the Hudson River and the people in them,
and he could read the names of boats on the river which
other people could make out only with a telescope. At
the same time he had no difficulty in reading the news-
papers, and to prove the latter part of this statement,
he picked up a newspaper and read a few sentences
aloud. I was astonished, and asked him how he did it.

"I did what you told me to do," he said.

"What did I tell you to do?" I asked.

"You told me to read the Snellen test card every day,
which I have done, and to read fine print every day in
a dim light, which I have also done."

Another patient, who had a high degree of myopia
complicated with atrophy of the optic nerve, and who
had been discouraged by many physicians, was bene-
fited so wonderfully and rapidly by the aid of his imagi-
nation that one day while in the office he lost control
of himself completely, and raising a test card which he
held in his hand, he threw it across the room.

"It is too good to be true," he exclaimed; "I cannot
believe it. The possibility of being cured and the fear
of disappointment are more than I can stand."

He was calmed down with some difficulty and encour-
aged to continue. Later he became able to read the
small letters on the test card with normal vision. He
was then given fine print to read. When he looked at
the diamond type, he at once said that it was impossible
for him to read it. However, he was told to follow the
same procedure that had benefited his distance sight.
That is, he was to imagine a period on one part of the
small letters while holding the type at six inches. After
testing his memory of the period a number of times, he
became able to imagine he saw a period perfectly black

158 Imagination as an Aid to Vision

on one of the small letters. Then he lost control of
his nerves again, and on being asked, "What is the
trouble?" he said:

"I am beginning to read the fine print, and I am so
overwhelmed that I lose my self-control."

In another case, that of a woman with high myopia
complicated with incipient cataract, the vision improved
in a few days from 3/200 to 20/50. Instead of going
gradually down the card, a jump was made from the
fifty line to the ten line. The card was brought up close
to her, and she was asked to look at the letter O at three
inches, the distance at which she saw it best, to imagine
that she saw a period on the bottom of it and that the
bottom was the blackest part. When she was able to
do this at the near-point, the distance was gradually in-
creased until she became able to see the O at three feet.
Then I placed the card at ten feet and she exclaimed:

"Oh, doctor, it is impossible! The letter is too small.
It is too great a thing for me to do. Let me try a larger
letter first."

Nevertheless she became able in fifteen minutes to
read the small O on the ten line at twenty-feet.

CHAPTER XV

SHIFTING AND SWINGING

WHEN the eye with normal vision regards a
letter either at the near-point or at the dis-
tance, the letter may appear to pulsate, or
to move in various directions, from side to side, up and
down, or obliquely. When it looks from one letter to
another on the Snellen test card, or from one side of a
letter to another, not only the letter, but the whole line
of letters and the whole card, may appear to move from
side to side. This apparent movement is due to the
shifting of the eye, and is always in a direction con-
trary to its movement. If one looks at the top of a
letter, the letter is below the line of vision, and, therefore,
appears to move downward. If one looks at the bottom,
the letter is above the line of vision and appears to move
upward. If one looks to the left of the letter, it is to
the right of the line of vision and appears to move to
the right. If one looks to the right, it is to the left of the
line of vision and appears to move to the left.

Persons with normal vision are rarely conscious of this
illusion, and may have difficulty in demonstrating it ; but
in every case that has come under my observation they
have always become able, in a longer or shorter time, to
do so. When the sight is imperfect the letters may re-
main stationary, or even move in the same direction as
the eye.

It is impossible for the eye to fix a point longer than
a fraction of a second. If it tries to do so, it begins to

159

160 Shifting and Swinging

strain and the vision is lowered. This can readily be
demonstrated by trying to hold one part of a letter for
an appreciable length of time. No matter how good the
sight, it will begin to blur, or even disappear, very
quickly, and sometimes the effort to hold it will produce
pain. In the case of a few exceptional people a point
may appear to be held for a considerable length of
time; the subjects themselves may think that they are
holding it ; but this is only because the eye shifts uncon-
sciously, the movements being so rapid that objects
seem to be seen all alike simultaneously.

The shifting of the eye with normal vision is usually
not conspicuous, but by direct examination with the oph-
thalmoscope it can always be demonstrated. If one eye
is examined with this instrument while the other is re-
garding a small area straight ahead, the eye being ex-
amined, which follows the movements of the other, is
seen to move in various directions, from side to side,
up and down in an orbit which is usually variable. If
the vision is normal these movements are extremely
rapid and unaccompanied by any appearance of effort.
The shifting of the eye with imperfect sight, on the
contrary, is slower, its excursions are wider, and the
movements are jerky and made with apparent effort.

It can also be demonstrated that the eye is capable of
shifting with a rapidity which the ophthalmoscope can-
not measure. The normal eye can read fourteen letters
on the bottom line of a Snellen test card, at a distance
of ten or fifteen feet, in a dim light, so rapidly that they
seem to be seen all at once. Yet it can be demonstrated
that in order to recognize the letters under these condi-
tions it is necessary to make about four shifts to each
letter. At the near-point, even though one part of the

Rapidity of Eye's Motion 161

letter is seen best, the rest may be seen well enough
to be recognized; but at the distance it is impossible
to recognize the letters unless one shifts from the top
to the bottom and from side to side. One must also shift
from one letter to another, making about seventy shifts
in a fraction of a second.

A line of small letters on the Snellen test card may be
less than a foot long by a quarter of an inch in height;
and if it requires seventy shifts to a fraction of a second
to see it apparently all at once, it must require many
thousands to see an area of the size of the screen of a
moving picture, with all its detail of people, animals,
houses, or trees, while to see sixteen such areas to a
second, as is done in viewing moving pictures, must
require a rapidity of shifting that can scarcely be real-
ized. Yet it is admitted that the present rate of taking
and projecting moving pictures is too slow. The results
would be more satisfactory, authorities say, if the rate
were raised to twenty, twenty-two, or twenty-four a
second.

The human eye and mind are not only capable of this
rapidity of action, and that without effort or strain, but
it is only when the eye is able to shift thus rapidly that
eye and mind are at rest, and the efficiency of both at
their maximum. It is true that every motion of the eye
produces an error of refraction ; but when the movement
is short, this is very slight, and usually the shifts are
so rapid that the error does not last long enough to be
detected by the retinoscope, its existence being demon-
strable only by reducing the rapidity of the movements
to less than four or five a second. The period during
which the eye is at rest is much longer than that during

162 Shifting and Swinging

which an error of refraction is produced. Hence, when
the eye shifts normally no error of refraction is mani-
fest. The more rapid the unconscious shifting of the
eye, the better the vision; but if one tries to be con-
scious of a too rapid shift, a strain will be produced.

Perfect sight is impossible without continual shifting,
and such shifting is a striking illustration of the mental
control necessary for normal vision. It requires perfect
mental control to think of thousands of things in a frac-
tion of a second; and each point of fixation has to be
thought of separately, because it is impossible to think
of two things, or of two parts of one thing, perfectly at
the same time. The eye with imperfect sight tries to
accomplish the impossible by looking fixedly at one point
for an appreciable length of time; that is, by staring.
When it looks at a strange letter and does not see it, it
keeps on looking at it in an effort to see it better. Such
efforts always fail, and are an important factor in the
production of imperfect sight.

One of the best methods of improving the sight, there-
fore, is to imitate consciously the unconscious shifting
of normal vision and to realize the apparent motion pro-
duced by such shifting. Whether one has imperfect or
normal sight, conscious shifting and swinging are a great
help and advantage to the eye; for not only may imper-
fect sight be improved in this way, but normal sight
may be improved also. When the sight is imperfect,
shifting, if done properly, rests the eye as much as palm-
ing, and always lessens or corrects the error of refraction.

The eye with normal sight never attempts to hold a
point more than a fraction of a second, and when it
shifts, as explained in the chapter on "Central Fixation,"
it always sees the previous point of fixation worse.
When it ceases to shift rapidly and to see the point

The Shift That Rests 163

shifted from worse, the sight ceases to be normal, the
swing being either prevented or lengthened, or (occa-
sionally) reversed. These facts are the keynote of the
treatment by shifting.

In order to see the previous point of fixation worse,
the eye with imperfect sight has to look farther away
from it than does the eye with normal sight. If it shifts
only a quarter of an inch, for instance, it may see the
previous point of fixation as well as or better than be-
fore; and instead of being rested by such a shift, its
strain will be increased, there will be no swing, and
the vision will be lowered. At a couple of inches it may
be able to let go of the first point; and if neither point
is held more than a fraction of a second, it will be rested
by such a shift and the illusion of swinging may be
produced. The shorter the shift the greater the benefit;
but even a very long shift — as much as three feet or
more — is a help to those who cannot accomplish a
shorter one. When the patient is capable of a short
shift, on the contrary, the long shift lowers the vision.
The swing is an evidence that the shifting is being done
properly, and when it occurs the vision is always im-
proved. It is possible to shift without improvement;
but it is impossible to produce the illusion of a swing
without improvement, and when this can be done with
a long shift, the movement can gradually be shortened
until the patient can shift from the top to the bottom of
the smallest letter, on the Snellen test card or elsewhere,
and maintain the swing. Later he may become able to
be conscious of the swinging of the letters without con-
scious shifting.

No matter how imperfect the sight, it is always pos-
sible to shift and produce a swing, so long as the pre-

164 Shifting and Swinging

vious point of fixation is seen worse. Even diplopia
and polyopia1 do not prevent swinging with some im-
provement of vision. Usually the eye with imperfect
vision is able to shift from one side of the card to the
other, or from a point above the card to a point below
it, and observe that in the first case the card appears
to move from side to side, while in the second it appears
to move up and down.

When patients are suffering from high degrees of
eccentric fixation, it may be necessary, in order to help
them to see worse when they shift, to use some of
the methods described in the chapter on "Central Fixa-
tion." Usually, however, patients who cannot see worse
when they shift at the distance can do it readily at the
near-point, as the sight is best at that point, not only in
myopia, but often in hypermetropia as well. When the
swing can be produced at the near point, the distance
can be gradually increased until the same thing can be
done at twenty feet.

After resting the eyes by closing or palming, shifting
and swinging are often more successful. By this method
of alternately resting the eyes and then shifting, persons
with very imperfect sight have sometimes obtained a
temporary or permanent cure in a few weeks.

Shifting may be done slowly or rapidly, according to
the state of the vision. At the beginning the patient
will be likely to strain if he shifts too rapidly ; and then
the point shifted from will not be seen worse, and there
will be no swing. As improvement is made, the speed
can be increased. It is usually impossible, however, to
realize the swing if the shifting is more rapid than
two or three times a second.

1 Double and multiple vision.

Imagination Helps 165

A mental picture of a letter can, as a rule, be made to
swing precisely as can a letter on the test card. Occa-
sionally one meets a patient with whom the reverse is
true ; but for most patients the mental swing is easier at
first than visual swinging; and when they become able
to swing in this way, it becomes easier for them to swing
the letters on the test card. By alternating mental with
visual swinging and shifting, rapid progress is some-
times made. As relaxation becomes more perfect, the
mental swing can be shortened, until it becomes possible
to conceive and swing a letter the size of a period in a
newspaper. This is easier, when it can be done, than
swinging a larger letter, and many patients have derived
great benefit from it.

All persons, no matter how great their error of refrac-
tion, when they shift and swing successfully, correct it
partially or completely, as demonstrated by the retino-
scope, for at least a fraction of a second. This time may
be so short that the patient is not conscious of improved
vision; but it is possible for him to imagine it, and then
it becomes easier to maintain the relaxation long enough
to be conscious of the improved sight. For instance,
the patient, after looking away from the card, may look
back to the big C, and for a fraction of a second the
error of refraction may be lessened or corrected, as dem-
onstrated by the retinoscope. Yet he may not be con-
scious of improved vision. By imagining that the C is
seen better, however, the moment of relaxation may be
sufficiently prolonged to be realized.

When swinging, either mental or visual, is success-
ful, the patient may become conscious of a feeling of
relaxation which is manifested as a sensation of univer-
sal swinging. This sensation communicates itself to any

166 Shifting and Swinging

object of which the patient is conscious. The motion
may be imagined in any part of the body to which the
attention is directed. It may be communicated to the
chair in which the patient is sitting, or to any object in
the room, or elsewhere, which is remembered. The
building, the city, the whole world, in fact, may appear
to be swinging. When the patient becomes conscious
of this universal swinging, he loses the memory of the
object with which it started; but so long as he is able
to maintain the movement in a direction contrary to the
original movement of the eyes, or the movement imag-
ined by the mind, relaxation is maintained. If the direc-
tion is changed, however, strain results. To imagine
the universal swing with the eyes closed is easy, and
some patients soon become able to do it with the eyes
open. Later the feeling of relaxation which accompanies
the swing may be realized without consciousness of the
latter; but the swing can always be produced when the
patient thinks of it.

There is but one cause of failure to produce a swing,
and that is strain. Some people try to make the letters
swing by effort. Such efforts always fail. The eyes
selves. The eye can shift voluntarily. This is a mus-
cular act resulting from a motor impulse. But the
Swing comes of its own accord when the shifting is
normal. It does not produce relaxation, but is an evi-
dence of it; and while of no value in itself is, like the
period, very valuable as an indication that relaxation is
being maintained.

The following methods of shifting have been found
useful in various cases :

One Cause of Failure 167

No. l—

(a) Regard a letter.

(b) Shift to a letter on the same line far enough

away so that the first is seen worse.

(d) Look at the letters alternately for a few sec-

onds, seeing worse the one not regarded.

When successful, both letters improve and appear to
move from side to side in a direction opposite to the
movement of the eye.

No. 2—

(a) Look at a large letter.

(b) Look at a smaller one a long distance away

from it. The large one is then seen worse.

(d) Repeat half a dozen times.

When successful, both letters improve, and the card
appears to move up and down.

No. 3—

Shifting by the above methods enables the patient to
see one letter on a line better than the other letters,
and, usually, to distinguish it in flashes. In order to
see the letter continuously it is necessary to become able
to shift from the top to the bottom, or from the bottom
to the top, seeing worse the part not directly regarded,
and producing the illusion of a vertical swing.

(a) Look at a point far enough above the top of

the letter to see the bottom, or the whole
letter worse.

(b) Look at a point far enough below the bottom

to see the top, or the whole letter, worse.

**:-.::

168 Shifting and Swinging

If successful, the letter will appear to move up and
down, and the vision will improve. The shift can then
be shortened until it becomes possible to shift between
the top and the bottom of the letter and maintain the
swing. The letter is now seen continuously. If the
method fails, rest the eyes, palm, and try again.

One may also practice by shifting from one side of
the letter to a point beyond the other side, or from one
corner to a point beyond the other corner.

No. 4—

(a) Regard a letter at the distance at which it is

seen best. In myopia this will be at the
near-point, a foot or less from the face.
Shift from the top to the bottom until able
to see each worse alternately, when the let-
ter will appear blacker than before, 'and an
illusion of swinging will be produced.

(b) Now close the eyes, and shift from the top

to the bottom of the letter mentally.

do the same. Compare the ability to shift
and swing mentally with the ability to do
the same visually at the near-point.

(d) Then regard the letter at the distance, and

shift from the top to the bottom. If success-
ful, the letter will improve, and an illusion
of swinging will be produced.

No. 5—

Some patients, particularly children, are able to see
better when one points to the letters. In other cases

Pointing to the Letters 169

this is a distraction. When the method is found success-
ful one can proceed as follows :

(a) Place the tip of the finger three or four inches

below the letter. Let the patient regard the
letter, and shift to the tip of the finger, see-
ing the letter worse.

(b) Reduce the distance between the finger and

the letter, first to two or three inches, then
to one or two, and finally to half an inch,
proceeding each time as in (a).

If successful, the patient will become able to look
from the top to the bottom of the letter, seeing each
worse alternately, and producing the illusion of swing-
ing. It will then be possible to see the letter contin-
uously.

No. 6—

When the vision is imperfect it often happens that,
when the patient looks at a small letter, some of the
larger letters on the upper lines, or the big C at the top,
look blacker than the letter regarded. This makes it
impossible to see the smaller letters perfectly. To cor-
rect this eccentric fixation regard the letter which is seen
best, and shift to the smaller letter. If successful, the
small letter, after a few movements, will appear blacker
than the larger one. If not successful after a few trials,
rest the eyes by closing and palming, and try again.
One may also shift from the large letter to a point some
distance below the small letter, gradually approaching
the latter as the vision improves.

No. 7—

Shifting from a card at three or five feet to one at ten
or twenty feet often proves helpful, as the unconscious

170 Shifting and Swinging

memory of the letter seen at the near-point helps to
bring out the one at the distance.

Different people will find these various methods of
shifting more or less satisfactory. If any method does
not succeed, it should be abandoned after one or two
trials and something else tried. It is a mistake to con-
tinue the practice of any method which does not yield
prompt results. The cause of the failure is strain, and
it does no good to continue the strain.

When it is not possible to practice with the Snellen
test card, other objects may be utilized. One can shift,
for instance, from one window of a distant building to
another, or from one part of a window to another part
of the same window, from one auto to another, or from
one part of an auto to another part, producing, in each
case, the illusion that the objects are moving in a direc-
tion contrary to the movement of the eye. When talk-
ing to people, one can shift from one person to another,
or from one part of the face to another part. When
reading a book, or newspaper, one can shift consciously
from one word or letter to another, or from one part of
a letter to another.

Shifting and swinging, as they give the patient some-
thing definite to do, are often more successful than other
methods of obtaining relaxation, and in some cases re-
markable results have been obtained simply by demon-
strating to the patient that staring lowers the vision
and shifting improves it. One patient, a girl of sixteen
with progressive myopia, obtained very prompt relief by
shifting. She came to the office wearing a pair of glasses
tinted a pale yellow, with shades at the sides; and in
spite of this protection she was so annoyed by the light
that her eyes were almost closed, and she had great

Cured by Shifting

difficulty in finding her way about the room. Her vision
without glasses was 3/200. All reading had been for-
bidden, playing the piano from the notes was not al-
lowed, and she had been obliged to give up the idea
of going to college. The sensitiveness to light was re-
lieved in a few minutes by focussing the light of the
sun upon the upper part of the eyeball when she looked
far down, by means of a burning glass (see Chapter
XVII). The patient was then seated before a Snellen
test card and directed to look away from it, rest her
eyes, and then look at the big C. For a fraction of a
second her vision was improved, and by frequent demon-
strations she was made to realize that any effort to see
the letters always lowered the vision. By alternately
looking away, and then looking back at the letters for
a fraction of a second, her vision improved so rapidly
that in the course of half an hour it was almost normal
for the distance. Then diamond type was given her to
read. The attempt to read it at once brought on a severe
pain. She was directed to proceed as she had in reading
the Snellen test card; and in a few minutes, by alter-
nately looking away and then looking at the first letter
of each word in turn, she became able to read without
fatigue, discomfort, or pain. She left the office without
her glasses, and was able to see her way without diffi-
culty. Other patients have been benefited as promptly
by this simple method.

CHAPTER XVI

THE ILLUSIONS OF IMPERFECT AND
OF NORMAL EYESIGHT

PERSONS with imperfect sight always have illu-
sions of vision; so do persons with normal sight.
But while the illusions of normal sight are an
evidence of relaxation, the illusions of imperfect sight
are an evidence of strain. Some persons with errors of
refraction have few illusions, others have many; because
the strain which causes the error of refraction is not
the same strain that is responsible for the illusions.

The illusions of imperfect sight may relate to the
color, size, location and form of the objects regarded.
They may include appearances of things that have no ex-
istence at all, and various other curious and interesting
manifestations.

ILLUSIONS OF COLOR

When a patient regards a black letter and believes it
to be grey, yellow, brown, blue, or green, he is suffering
from an illusion of color. This phenomenon differs from
color-blindness. The color-blind person is unable to
differentiate between different colors, usually blue and
green, and his inability to do so is constant. The person
suffering from an illusion of color does not see the false
colors constantly or uniformly. When he looks at the
Snellen test card the black letters may appear to him at
one time to be grey; but at another moment they may
appear to be a shade of yellow, blue, or brown. Some

172

Vagaries of Color and Size 173

patients always see the black letters red; to others, they
appear red only occasionally. Although the letters are
all of the same color, some may see the large letters
black and the small ones yellow or blue. Usually the
large letters are seen darker than the small ones, what-
ever color they appear to be. Often different colors
appear in the same letter, part of it seeming to be black,
perhaps, and the rest grey or some other color. Spots
of black, or of color, may appear on the white; and
spots of white, or of color, on the black.

ILLUSIONS OF SIZE

Large letters may appear small, or small letters large.
One letter may appear to be of normal size, while another
of the same size and at the same distance may appear
larger or smaller than normal. Or a letter may appear
to be of normal size at the near-point and at the distance,
and only half that size at the middle distance. When a
person can judge the size of a letter correctly at all
distances up to twenty feet his vision is normal. If the
size appears different to him at different distances, he is
suffering from an illusion of size. At great distances
the judgment of size is always imperfect, because the
sight at such distances is imperfect, even though perfect
at ordinary distances. The stars appear to be dots, be-
cause the eye does not possess perfect vision for objects
at such distances. A candle seen half a mile away ap-
pears smaller than at the near-point; but seen through
a telescope giving perfect vision at that distance it will
be the same as at the near-point. With improved vision
the ability to judge size improves.

The correction of an error of refraction by glasses
seldom enables the patient to judge size as correctly as

174 Illusions of Imperfect and Normal Sight

the normal eye does, and the ability to do this may differ
very greatly in persons having the same error of refrac-
tion. A person with ten diopters of myopia corrected
by glasses may (rarely) be able to judge the sizes of
objects correctly. Another person, with the same degree
of myopia and the same glasses, may see them only one-
half or one-third their normal size. This indicates that
errors of refraction have very little to do with incorrect
perceptions of size.

ILLUSIONS OF FORM

Round letters may appear square or triangular ; straight
letters may appear curved; letters of regular form may
appear very irregular ; a round letter may appear to have
a checker-board or a cross in the center. In short, an in-
finite variety of changing forms may be seen. Illumi-
nation, distance and environment are all factors in this
form of imperfect sight. Many persons can see the form
of a letter correctly when other letters are covered, but
when the other letters are visible they cannot see it.
The indication of the position of a letter by a pointer
helps some people to see it. Others are so disturbed by
the pointer that they cannot see the letter so well.

ILLUSIONS OF NUMBER

Multiple images are frequently seen by persons with
imperfect sight, either with both eyes together, with
each eye separately, or with only one eye. The manner
in which these multiple images make their appearance
is sometimes very curious. For instance, a patient with
presbyopia read the word HAS normally with both eyes.
The word PHONES he read correctly with the left eye;

Strange Tricks of the Mind 175

but when he read it with the right eye he saw the letter
P double, the imaginary image being a little distance to
the left of the real one. The left eye, while it had normal
vision for the word PHONES, multiplied the shaft of
a pin when this object was in a vertical position (the
head remaining single), and multiplied the head when
the position was changed to the horizontal (the shaft
then remaining single). When the point of the pin was
placed below a very small letter, the point was some-
times doubled while the letter remained single. No
error of refraction can account for these phenomena.
They are tricks of the mind only. The ways in which
multiple images are arranged are endless. They are
sometimes placed vertically, sometimes horizontally or
obliquely, and sometimes in circles, triangles and other
geometrical forms. Their number, too, may vary from
two to three, four, or more. They may be stationary,
or may change their position more or less rapidly. They
also show an infinite variety of color, including a white
even whiter than that of the background.

ILLUSIONS OF LOCATION

A period following a letter on the same horizontal
level as the bottom of the letter may appear to change
its position in a great variety of curious ways. Its
distance from the letter may vary. It may even appear
on the other side of the letter. It may also appear above
or below the line. Some persons see letters arranged in
irregular order. In the case of the word AND, for
instance, the D may occupy the place of the N, or the
first letter may change places with the last. All these
things are mental illusions. The letters sometimes ap-

176 Illusions of Imperfect and Normal Sight

pear to be farther off than they really are. The small
letters, twenty feet distant, may appear to be a mile
away. Patients troubled by illusions of distance some-
times ask if the position of the card has not been changed.

ILLUSIONS OF NON-EXISTENT OBJECTS

When the eye has imperfect sight the mind not only
distorts what the eye sees, but it imagines that it sees
things that do not exist. Among illusions of this sort
are the floating specks which so often appear before the
eyes when the sight is imperfect, and even when it is
ordinarily very good. These specks are known scientifi-
cally as "muscae volitantes," or "flying flies," and al-
though they are of no real importance, being symptoms
of nothing except mental strain, they have attracted so
much attention, and usually cause so much alarm to the
patient, that they will be discussed at length in another
chapter.

ILLUSIONS OF COMPLEMENTARY COLORS

When the sight is imperfect, the subject, on looking
away from a black, white, or brightly colored object,
and closing the eyes, often imagines for a few seconds
that he sees the object in a complementary, or approxi-
mately complementary, color. If the object is black upon
a white background, a white object upon a black back-
ground will be seen. If the object is red, it may be seen
as blue ; and if it is blue, it may appear to be red. These
illusions, which are known as "after-images," may also be
seen, though less commonly, with the eyes open, upon
any background at which the subject happens to look,
and are often so vivid that they appear to be real.

The Color of the Sun 177

ILLUSIONS OF THE COLOR OF THE SUN

Persons with normal sight see the sun white, the
whitest white there is; but when the sight is imperfect
it may appear to be any color in the spectrum — red, blue,
green, purple, yellow, etc. In fact, it has even been
described by persons with imperfect vision as totally
black. The setting sun commonly appears to be red,
because of atmospheric conditions; but in many cases
these conditions are not such as to change the color,
and while this still appears to be red to persons with
imperfect vision, to persons with normal vision it ap-
pears to be white. When the redness of a red sun is an
illusion, and not due to atmosphere conditions, its im-
age on the ground glass of a camera will be white, not
red, and the rays focussed with a burning glass will also
be white. The same is true of a red moon.

BLIND SPOTS AFTER LOOKING AT THE SUN

After looking at the sun, most people see black or
colored spots which may last from a few minutes to a
year or longer, but are never permanent. These spots
are also illusions, and are not due, as is commonly sup-
posed, to any organic change in the eye. Even the total
blindness which sometimes results, temporarily, from
looking at the sun, is only an illusion.

ILLUSIONS OF TWINKLING STARS

The idea that the stars should twinkle has been em-
bodied in song and story, and is generally accepted as
part of the natural order of things ; but it can be demon-

178 Illusions of Imperfect and Normal Sight

strated that this appearance is simply an illusion of the
mind.

CAUSE OF THE ILLUSIONS OF IMPERFECT SIGHT

All the illusions of imperfect sight are the result of
a strain of the mind, and when the mind is disturbed
for any reason, illusions of all kinds are very likely to
occur. This strain is not only different from the strain
that produces the error of refraction, but it can be demon-
strated that for each and every one of these illusions
there is a different kind of strain. Alterations of color
do not necessarily affect the size or form of objects, or
produce any other illusion, and it is possible to see the
color of a letter, or of a part of a letter, perfectly, without
recognizing the letter. To change black letters into
blue, or yellow, or another color, requires a subconscious
strain to remember or imagine the colors concerned,
while to alter the form requires a subconscious strain to
see the form in question. With a little practice anyone
can learn to produce illusions of form and color by strain-
ing consciously in the same way that one strains un-
consciously; and whenever illusions are produced in this
way it will be found that eccentric fixation and an error
of refraction have also been produced.

The strain which produces polyopia is different again
from the strain which produces illusions of color, size
and form. After a few attempts most patients easily
learn to produce polyopia at will. Staring or squinting,
if the strain is great enough, will usually make one see
double. By looking above a light, or a letter, and then
trying to see it as well as when directly regarded, one
can produce an illusion of several lights, or letters, ar-
ranged vertically. If the strain is great enough, there

Conscious Production of Illusions 179

may be as many as a dozen of them. By looking to the
side of the light or letter, or looking away obliquely at
any angle, the images can be made to arrange themselves
horizontally, or obliquely at any angle.

To see objects in the wrong location, as when the first
letter of a word occupies the place of the last, requires
an ingenuity of eccentric fixation and an education of the
imagination which is unusual.

The black or colored spots seen after looking at the
sun, and the strange colors which the sun sometimes
seems to assume, are also the result of the mental strain.
When one becomes able to look at the orb of day with-
out strain, these phenomena immediately disappear.

After-images have been attributed to fatigue of the
retina, which is supposed to have been so overstimulated
by a certain color that it can no longer perceive it, and
therefore seeks relief in the hue which is complementary
to this color. If it gets tired looking at the black C on
the Snellen test card, for instance, it is supposed to seek
relief by seeing the C white. This explanation of the
phenomenon is very ingenious but scarcely plausible.
The eyes cannot see when they are closed; and if they
appear to see under these conditions, it is obvious that
the subject is suffering from a mental illusion with which
the retina has nothing to do. Neither can they see what
does not exist; and if they appear to see a white C on
a green wall where there is no such object, it is obvious
again that the subject is suffering from a mental illusion.
The after-image indicates, in fact, simply a loss of mental
control, and occurs when there is an error of refraction,
because this condition also is due to a loss of mental
control. Anyone can produce an after-image at will by
trying to see the big C all alike — that is, under a strain ;

180 Illusions of Imperfect and Normal Sight

but one can look at it indefinitely by central fixation
without any such result.

While persons with imperfect sight usually see the
stars twinkle, they do not necessarily do so. Therefore
it is evident that the strain which causes the twinkling
is different from that which causes the error of refrac-
tion. If one can look at a star without trying to see it,
it does not twinkle; and when the illusion of twinkling
has been produced, one can usually stop it by "swing-
ing" the star. On the other hand, one can start the
planets, or even the moon, to twinkling, if one strains
sufficiently to see them.

ILLUSIONS OF NORMAL SIGHT

The illusions of normal sight include all the phe-
nomena of central fixation. When the eye with normal
sight looks at a letter on the Snellen test card, it sees
the point fixed best, and everything else in the field of
vision appears less distinct. As a matter of fact, the
whole letter and all the letters may be perfectly black
and distinct, and the impression that one letter is blacker
than the others, or that one part of a letter is blacker
than the rest, is an illusion. The normal eye, however,
may shift so rapidly that it appears to see a whole line
of small letters all alike simultaneously. As a matter
of fact there is, of course, no such picture on the retina.
Each letter has not only been seen separately, but it has
been demonstrated in the chapter on "Shifting and Swing-
ing" that if the letters are seen at a distance of fifteen
or twenty feet, they could not be recognized unless about
four shifts were made on each letter. To produce the
impression of a simultaneous picture of fourteen letters,

All Vision an Illusion 181

therefore, some sixty or seventy pictures, each with some
one point more distinct than the rest, must have been
produced upon the retina. The idea that the letters are
seen all alike simultaneously is therefore, an illusion.
Here we have two different kinds of illusions. In the
first case the impression made upon the brain is in ac-
cordance with the picture on the retina, but not in
accordance with the fact. In the second the mental
impression is in accordance with the fact, but not with
the pictures upon the retina.

The normal eye usually sees the background of a
letter whiter than it really is. In looking at the letters
on the Snellen test card it sees white streaks at the
margins of the letters, and in reading fine print it sees
between the lines and the letters, and in the openings
of the letters, a white more intense than the reality.
Persons who cannot read fine print may see this illusion,
but less clearly. The more clearly it is seen, the better
the vision; and if it can be imagined consciously — it is
imagined unconsciously when the sight is normal — the
vision improves. If the lines of fine type are covered,
the streaks between them disappear. When the letters
are regarded through a magnifying glass by the eye with
normal sight, the illusion is not destroyed, but the in-
tensity of the white and black are lessened. With im-
perfect sight it may be increased to some extent by this
means, but will remain less intense than the white and
black seen by the normal eye. The facts demonstrate
that perfect sight cannot be obtained with glasses.

The illusions of movement produced by the shifting
of the eye and described in detail in the chapter on "Shift-
ing and Swinging" must also be numbered among the
illusions of normal sight, and so must the perception of

182 Illusions of Imperfect and Normal Sight

objects in an upright position. This last is the most
curious illusion of all. No matter what the position
of the head, and regardless of the fact that the image
on the retina is inverted, we always see things right
side up.

CHAPTER XVII

VISION UNDER ADVERSE CONDITIONS
A BENEFIT TO THE EYES

ACCORDING to accepted ideas of ocular hygiene,
it is important to protect the eyes from a great
variety of influences which are often very diffi-
cult to avoid, and to which most people resign them-
selves with the uneasy sense that they are thereby "ruin-
ing their eyesight." Bright lights, artificial lights, dim
lights, sudden fluctuations of light, fine print, reading in
moving vehicles, reading lying down, etc., have long been
considered "bad for the eyes," and libraries of literature
have been produced about their supposedly direful
effects. These ideas are diametrically opposed to the
truth. When the eyes are properly used, vision under
adverse conditions not only does not injure them, but
is an actual benefit, because a greater degree of relaxa-
tion is required to see under such conditions than under
more favorable ones. It is true that the conditions in
question may at first cause discomfort, even to persons
with normal vision ; but a careful study of the facts has
demonstrated that only persons with imperfect sight
suffer seriously from them, and that such persons, if
they practice central fixation, quickly become accustomed
to them and derive great benefit from them.

Although the eyes were made to react to the light, a
very general fear of the effect of this element upon the
organs of vision is entertained both by the medical pro-
fession and by the laity. Extraordinary precautions are

183

184 Adverse Conditions a Benefit to the Eyes

taken in our homes, offices and schools to temper the
light, whether natural or artificial, and to insure that it
shall not shine directly into the eyes ; smoked and amber
glasses, eye-shades, broad-brimmed hats and parasols
are commonly used to protect the organs of vision from
what is considered an excess of light; and when actual
disease is present, it is no uncommon thing for patients
to be kept for weeks, months and years in dark rooms,
or with bandages over their eyes.

The evidence on which this universal fear of the light
has been based is of the slightest. In the voluminous
literature of the subject one finds such a lack of informa-
tion that in 1910 Dr. J. Herbert Parsons of the Royal
Ophthalmic Hospital of London, addressing a meeting
of the Ophthalmological Section of the American Med-
ical Association, felt justified in saying that ophthalmol-
ogists, if they were honest with themselves, "must con-
fess to a lamentable ignorance of the conditions which
render bright light deleterious to the eyes."1 Since then,
Verhoeff and Bell have reported2 an exhaustive series of
experiments carried on at the Pathological Laboratory of
the Massachusetts Charitable Eye and Ear Infirmary,
which indicate that the danger of injury to the eye from
light radiation as such has been "very greatly exagger-
ated." That brilliant sources of light sometimes produce
unpleasant temporary symptoms cannot, of course, be
denied; but as regards definite pathological effects, or
permanent impairment of vision from exposure to light
alone, Drs. Verhoeff and Bell were unable to find, either
clinically or experimentally, anything of a positive na-
ture.

1 Jour. Am. Med. Assn., Dec. 10, 1910, p. 2028.

8 Proc. Am. Acad. Arts and Sciences. 1916, Vol. 51, No. 13.

A Danger Greatly Exaggerated 185

As for danger from the heat effects of light, they con-
sider this to be "ruled out of consideration by the imme-
diate discomfort produced by excessive heat." They
conclude, in short, that "the eye in the process of evolu-
tion has acquired the ability to take care of itself under
extreme conditions of illumination to a degree hitherto
deemed highly improbable." In their experiments, the
eyes of rabbits, monkeys and human beings were flooded
for an hour or more with light of extreme intensity, with-
out any sign of permanent injury, the resulting scoto-
mata1 disappearing within a few hours. Commercial
illuminants were found to be entirely free of danger un-
der any ordinary conditions of their use. It was even
found impossible to damage the retina with any arti-
ficial illuminant, except by exposures and intensities
enormously greater than any likely to occur outside the
laboratory. In one case an animal succumbed to heat
after an exposure of an hour and a half to a 7 50- watt
nitrogen lamp at twenty centimeters — about eight
inches; but in a second experiment, in which it was well
protected from the heat, there was no damage to the eye
whatever after an exposure of two hours. As for the
ultra-violet part of the spectrum, to which exaggerated
importance has been attached by many recent writers,
the situation was found to be much the same as with
respect to the rest of the spectrum ; that is, "while under
conceivable or realizable conditions of over-exposure, in-
jury may be done to the external eye, yet under all prac-
ticable conditions found in actual use of artificial sources
of light for illumination, the ultra-violet part of the spec-
trum may be left out as a possible source of injury."
The results of these experiments are in complete ac-

1 Blind areas.

186 Adverse Conditions a Benefit to the Eyes

cord with my own observations as to the effect of strong
light upon the eyes. In my experience such light has
never been permanently injurious. Persons with normal
sight have been able to look at the sun for an indefinite
length of time, even an hour or longer, without any
discomfort or loss of vision. Immediately afterward
they were able to read the Snellen test card with im-
proved vision, their sight having become better than
what is ordinarily considered normal. Some persons with
normal sight do suffer discomfort and loss of vision when
they look at the sun ; but in such cases the retinoscope al-
ways indicates an error of refraction, showing that this
condition is due, not to the light, but to strain. In excep-
tional cases, persons with defective sight have been able
to look at the sun, or have thought that they have looked
at it, without discomfort and without loss of vision; but,
as a rule, the strain in such eyes is enormously increased
and the vision decidedly lowered by sun-gazing, as mani-
fested by inability to read the Snellen test card. Blind
areas (scotomata) may develop in various parts of the
field — two or three or more. The sun, instead of appear-
ing perfectly white, may appear to be slate-colored, yel-
low, red, blue, or even totally black. After looking away
from the sun, patches of color of various kinds and sizes
may be seen, continuing a variable length of time, from
a few seconds to a few minutes, hours, or even months.
In fact, one patient was troubled in this way for a year
or more after looking at the sun for a few seconds. Even
total blindness lasting a few hours has been produced.
Organic changes may also be produced. Inflammation,
redness of the conjunctiva, cloudiness of the lens and of
the aqueous and vitreous humors, congestion and cloudi-
ness of the retina, optic nerve and choroid, have all re-

Ill Effects of Sun-Gazing Temporary 187

suited from sun-gazing. These effects, however, are al-
ways temporary. The scotomata, the strange colors,
even the total blindness, as explained in the preceding
chapter, are only mental illusions. No matter how much
the sight may have been impaired by sun-gazing, or how
long the impairment may have lasted, a return to normal

Fig. 46.— Woman With Normal Vision Looking Directly at the
Sun. Note That the Eyes are Wide Open and That There
Is No Sign of Discomfort.

has always occurred ; while prompt relief of all the symp-
toms mentioned has always followed the relief of eye-
strain, showing that the conditions are the result, not of
the light, but of the strain. Some persons who have
believed their eyes to have been permanently injured by
the sun have been promptly cured by central fixation, in-
dicating that their blindness had been simply functional.
By persistence in looking at the sun, a person with nor-

188 Adverse Conditions a Benefit to the Eyes

mal sight soon becomes able to do so without any loss of
vision; but persons with imperfect sight usually find it
impossible to accustom themselves to such a strong light
until their vision has been improved by other means. One
has to be very careful in recommending sun-gazing to
persons with imperfect sight; because although no per-
manent harm can result from it, great temporary dis-
comfort may be produced, with no permanent benefit. In
some rare cases, however, complete cures have been ef-
fected by this means alone.

In one of these cases, the sensitiveness of the patient,
even to ordinary daylight, was so great that an eminent
specialist had felt justified in putting a black bandage
over one eye and covering the other with a smoked glass
so dark as to be nearly opaque. She was kept in this
condition of almost total blindness for two years without
any improvement. Other treatment extending over some
months also failed to produce satisfactory results. She
was then advised to look directly at the sun. The im-
mediate result was total blindness, which lasted several
hours; but next day the vision was not only restored to
its former condition, but was improved. The sun-gazing
was repeated, and each time the blindness lasted for a
shorter period. At the end of a week the patient was
able to look directly at the sun without discomfort, and
her vision, which had been 20/200 without glasses and
20/70 with them, had improved to 20/10, twice the ac-
cepted standard for normal vision.

Patients of this class have also been greatly benefited
by focussing the rays of the sun directly upon their eyes,
marked relief being often obtained in a few minutes.

Like the sun, a strong electric light may also lower the
vision temporarily, but never does any permanent harm.

Artificial Light May Be Beneficial 189

In those exceptional cases in which the patient can be-
come accustomed to the light, it is beneficial. After
looking at a strong electric light some patients have been
able to read the Snellen test card better.

Fig. 47. Woman Aged 37, Child Aged 4, Both Looking
Directly at Sun Without Discomfort

It is not light but darkness that is dangerous to the
eye. Prolonged exclusion from the light always lowers
the vision, and may produce serious inflammatory con-
ditions. Among young children living in tenements this
is a somewhat frequent cause of ulcers upon the cornea,
which ultimately destroy the sight. The children, find-
ing their eyes sensitive to light, bury them in the pillows

190 Adverse Conditions a Benefit to the Eyes

and thus shut out the light entirely. The universal fear
of reading or doing fine work in a dim light is, however,
unfounded. So long as the light is sufficient so that one
can see without discomfort, this practice is not only
harmless, but may be beneficial.

Sudden contrasts of light are supposed to be particu-
larly harmful to the eye. The theory on which this idea
is based is summed up as follows by Fletcher B. Dress-
lar, specialist in school hygiene and sanitation of the
United States Bureau of Education:

"The muscles of the iris are automatic in their move-
ments, but rather slow. Sudden contrasts of strong light
and weak illumination are painful and likewise harmful
to the retina. For example, if the eye, adjusted to a dim
light, is suddenly turned toward a brilliantly lighted ob-
ject, the retina will receive too much light and will be
shocked before the muscles controlling the iris can react
to shut out the superabundance of light. If contrasts are
not strong, but frequently made, that is, if the eye is
called upon to function where frequent adjustments in
this way are necessary, the muscles controlling the iris
become fatigued, respond more slowly and less perfectly.
As a result, eyestrain in the ciliary muscles is produced
and the retina is over-stimulated. This is one cause of
headaches and tired eyes."1

There is no evidence whatever to support these state-
ments. Sudden fluctuations of light undoubtedly cause
discomfort to many persons, but, far from being in-
jurious, I have found them, in all cases observed, to be
actually beneficial. The pupil of the normal eye, when
it has normal sight, does not change appreciably under

n Education' edited by Monroe.

Fig. 48. Focussing the Rays of the Sun Upon the Eye of a

Patient by Means of a Burning Glass

191

192 Adverse Conditions a Benefit to the Eyes

the influence of changes of illumination ; and persons with
normal vision are not inconvenienced by such changes.
I have seen a patient look directly at the sun after com-
ing from an imperfectly lighted room, and then, return-
ing to the room, immediately pick up a newspaper and
read it. When the eye has imperfect sight, the pupil
usually contracts in the light and expands in the dark,
but it has been observed to contract to the size of a pin-
hole in the dark. Whether the contraction takes place
under the influence of light or of darkness, the cause is
the same, namely, strain. Persons with imperfect sight
suffer great inconvenience, resulting in lowered vision,
from changes in the intensity of the light; but the low-
ered vision is always temporary, and if the eye is per-
sistently exposed to these conditions, the sight is bene-
fited. Such practices as reading alternately in a bright
and a dim light, or going from a dark room to a well-
lighted one, and vice versa, are to be recommended. Even
such rapid and violent fluctuations of light as those in-
volved in the production of the moving picture are, in the
long run, beneficial to all eyes. I always advise patients
under treatment for the cure of defective vision to go to
the movies frequently and practice central fixation. They
soon become accustomed to the flickering light, and af-
terward other light and reflections cause less annoyance.
Reading is supposed to be one of the necessary evils
of civilization; but it is believed that by avoiding fine
print, and taking care to read only under certain favor-
able conditions, its deleterious influences can be mini-
mized Extensive investigations as to the effect of vari-
ous styles of print on the eyesight of school children
have been made, and detailed rules have been laid down
as to the size of the print, its shading, the distance of

Supposed Dangers of Reading 193

the letters from each other, the spaces between the lines,
the length of the lines, etc. As regards the effects of
different sorts of type on the human eye in general and
those of children in particular, Dr. A. G. Young, in his
much quoted report1 to the Maine State Board of Health
makes the following interesting observations:

Pearl, as the printers call it, is unfit for any eyes, yet the piles of Bibles and Testaments
annually printed in it tempt many eyes to self-destruction.

Agate is the type in which a boy, to the writer's knowledge, undertook to read
the Bible through . His outraged eyes broke down with asthenopia before he went
•far and could be used but little for school work the next two years.

Nonpareil is used in some papers and magazines for children, but, to spare the
eyes, all such should, and do, go on the list of forbidden reading matter in those
homes where the danger of such print is understood.

Minion is read by the healthy, normal young eye without appreciable
difficulty, but even to the sound eye the danger of strain is so great that
all books and magazines for children printed from it should be banished
from the home and school .

Brevier is much used in newspapers, but is too small for magazines or
books for young folks.

Bourgeois is much used in magazines, but should be used in
only those school books to which a brief reference is made.

Long Primer is suitable for school readers for the higher
and intermediate grades, and for text books generally.

Small Pica is still a more luxurious type, used in the
North American Review and the Forum.

Pica is a good type for books for small children.

Great Primer sho.uld be used for the
first reading book.

1 Seventh Annual Report to the Maine State Board of Health, by the
secretary, Dr. A. G. Young, 1891. p. 193.

194 Adverse Conditions a Benefit to the Eyes

All this is directly contrary to my own experience.
Children might be bored by books in excessively small
print; but I have never seen any reason for supposing
that their eyes or any other eyes, would be harmed by
such type. On the contrary, the reading of fine print,
when it can be done without discomfort, has invariably
proved to be beneficial, and the dimmer the light in
which it can be read, and the closer to the eyes it can be
held, the greater the benefit. By this means severe pain
in the eyes has been relieved in a few minutes or even
instantly. The reason is that fine print cannot be read in
a dim light and close to the eyes unless the eyes are re-
laxed, whereas large print can be read in a good light and
at ordinary reading distance although the eyes may be
under a strain. When fine print can be read under ad-
verse conditions, the reading of ordinary print under
ordinary conditions is vastly improved. In myopia it
may be a benefit to strain to see fine print, because my-
opia is always lessened when there is a strain to see near
objects, and this has sometimes counteracted the ten-
dency to strain in looking at distant objects, which is
always associated with the production of myopia. Even
straining to see print so fine that it cannot be read is a
benefit to some myopes.

Persons who wish to preserve their eyesight are fre-
quently warned not to read in moving vehicles ; but since
under modern conditions of life many persons have to
spend a large part of their time in moving vehicles, and
many of them have no other time to read, it is useless
to expect that they will ever discontinue the practice.
Fortunately the theory of its injuriousness is not borne
out by the facts. When the object regarded is moved
more or less rapidly, strain and lowered vision are, at

Benefits of Reading Fine Print 195

Seven Truths of Normal Sight

SM.'11- "<""

part °f the ietter r°-

4. Swinging: When the shifting is slow, the letters ap
pear to move from side to side, or in other directions
with a pendulum-like motion.

6. Memory is perfect. The color and background of the
letters or other objects seen, are remembered per -
fectly, instantaneously and continuously.

6. Imagination is good One may even see the white
part of letters whiter than it really is, while the black
of the fetters ^ dlstance> illumination, size, or form.

7. Rest or relaxation of the eye and mind is perfect
and can always be demonstrated.

1686 ^^ fundamentals

Fig. 49. Specimen of Diamond Type

Many patients have been greatly benefited by reading type of
this size.

Fig. 50. Photographic Type Reduction

Patients who can read photographic type reductions are in-
stantly relieved of pain and discomfort when they do so, and
those who cannot read such type may be benefited simply by
looking at it.

196 Adverse Conditions a Benefit to the Eyes

first, always produced; but this is always temporary,
and ultimately the vision is improved by the practice.

There is probably no visual habit against which we
have been more persistently warned than that of read-
ing in a recumbent posture. Many plausible reasons
have been adduced for its supposed injuriousness ; but
so delightful is the practice that few, probably, have
ever been deterred from it by fear of the consequences.
It is gratifying to be able to state, therefore, that I have
found these consequences to be benefical rather than
injurious. As in the case of the use of the eyes under
other difficult conditions, it is a good thing to be able
to read lying down, and the ability to do it improves
with practice. In an upright position, with a good light
coming over the left shoulder, one can read with the
eyes under a considerable degree of strain; but in a
recumbent posture, with the light and the angle of the
page to the eye unfavorable, one cannot read unless one
relaxes. Anyone who can read lying down without dis-
comfort is not likely to have any difficulty in reading
under ordinary conditions.

The fact is that vision under difficult conditions is
good mental training. The mind may be disturbed at
first by the unfavorable environment; but after it has
become accustomed to such environments, the mental
control, and, consequently, the eyesight are improved.
To advise against using the eyes under unfavorable con-
ditions is like telling a person who has been in bed for
a few weeks and finds it difficult to walk to refrain from
such exercise. Of course, discretion must be used in
both cases. The convalescent must not at once try to
run a Marathon, nor must the person with defective vi-
sion attempt, without some preparation, to outstare the

Discretion Must Be Used 197

sun at noonday. But just as the invalid may gradually
increase his strength until the Marathon has no terrors
for him, so may the eye with defective sight be educated
until all the rules with which we have so long allowed
ourselves to be harassed in the name of "eye hygiene"
may be disregarded, not only with safety but with benefit.

CHAPTER XVIII
OPTIMUMS AND PESSIMUMS

IN nearly all cases of imperfect sight due to errors of
refraction there is some object, or objects, which
can be regarded with normal vision. Such objects
I have called "optimums." On the other hand, there are
some objects which persons with normal eyes and ordi-
narily normal sight always see imperfectly, an error of
refraction being produced when they are regarded, as
demonstrated by the retinoscope. Such objects I have
called "pessimums." An object becomes an optimum, or a
pessimum, according to the effect it produces upon the
mind, and in some cases this effect is easily accounted for.
For many children their mother's face is an optimum,
and the face of a stranger a pessimum. A dressmaker
was always able to thread a No. 10 needle with a fine
thread of silk without glasses, although she had to put
on glasses to sew on buttons, because she could not see
the holes. She was a teacher of dressmaking, and
thought the children stupid because they could not tell
the difference between two different shades of black.
She could match colors without comparing the samples.
Yet she could not see a black line in a photographic copy
of the Bible which was no finer than a thread of silk,
and she could not remember a black period. An employee
in a cooperage factory, who had been engaged for years
in picking out defective barrels as they went rapidly past
him on an inclined plane, was able to continue his work

198

Idiosyncrasies of the Mind 199

after his sight for most other objects had become very
defective, while persons with much better sight for the
Snellen test card were unable to detect the defective bar-
rels. The familiarity of these various objects made it
possible for the subjects to look at them without strain —
that is, without trying to see them. Therefore the bar-
rels were to the cooper optimums ; while the needle's eye
and the colors of silk and fabrics were optimums to the
dressmaker. Unfamiliar objects, on the contrary, are al-
ways pessimums, as pointed out in the chapter on "The
Variability of the Refraction of the Eye."

In other cases there is no accounting for the idiosyn-
crasy of the mind which makes one object a pessimum
and another an optimum. It is also impossible to account
for the fact that an object may be an optimum for one
eye and not for the other, or an optimum at one time and
at one distance and not at others. Among these unac-
countable optimums one often finds a particular letter on
the Snellen test card. One patient, for instance, was able
to see the letter K on the forty, fifteen and ten lines, but
could see none of the other letters on these lines, although
most patients would see some of them, on account of the
simplicity of their outlines, better than they would such
a letter as K.

Pessimums may be as curious and unaccountable as
optimums. The letter V is so simple in its outlines that
many people can see it when they cannot see others on
the same line. Yet some people are unable to distinguish
it at any distance, although able to read other letters in
the same word, or on the same line of the Snellen test
card. Some people again will not only be unable to recog-
nize the letter V in a word, but also to read any word
that contains it, the pessimum lowering their sight not

200 Optimums and Pessimums

only for itself but for other objects. Some letters, or
objects, become pessimums only in particular situations.
A letter, for instance, may be a pessimum when located
at the end or at the beginning of a line or sentence, and
not in other places. When the attention of the patient
is called to the fact that a letter seen in one location
ought logically to be seen equally well in others, the
letter often ceases to be a pessimum in any situation.

A pessimum, like an optimum, may be lost and later be-
come manifest. It may vary according to the light and
distance. An object which is a pessimum in a moderate
light may not be so when the light is increased or dimin-
ished. A pessimum at twenty feet may not be one at
two feet, or thirty feet, and an object which is a pessi-
mum when directly regarded may be seen with normal
vision in the eccentric field.

For most people the Snellen test card is a pessimum.
If you can see the Snellen test card with normal vision,
you can see almost anything else in the world. Patients
who cannot see the letters on the Snellen test card can
often see other objects of the same size and at the same
distance with normal sight. When letters which are
seen imperfectly, or even letters which cannot be seen
at all, or which the patient is not conscious of seeing are
regarded, the error of refraction is increased. The pa-
tient may regard a blank white card without any error
of refraction ; but if he regards the lower part of a Snellen
test card, which appears to him to be just as blank as
the blank card, an error of refraction can always be dem-
onstrated, and if the visible letters of the card are cov-
ered, the result is the same. The pessimum may, in short,
be letters or objects which the patient is not conscious
of seeing. This phenomenon is very common. When the

How Pessimums Become Optimums 201

card is seen in the eccentric field it may have the effect
of lowering the vision for the point directly regarded.
For instance, a patient may regard an area of green wall-
paper at the distance, and see the color as well as at the
near-point; but if a Snellen test card on which the let-
ters are either seen imperfectly, or not seen at all, is
placed in the neighborhood of the area being regarded,
the retinoscope may indicate an error of refraction.
When the vision improves, the number of letters on the
card which are pessimums diminishes and the number of
optimums increases, until the whole card becomes an
optimum.

A pessimum, like an optimum, is a manifestation of the
mind. It is something associated with a strain to see,
just as an optimum is something which has no such as-
sociation. It is not caused by the error of refraction, but
always produces an error of refraction; and when the
strain has been relieved it ceases to be a pessimum and
becomes an optimum.

CHAPTER XIX

THE RELIEF OF PAIN AND OTHER SYMPTOMS BY
THE AID OF THE MEMORY

MANY years ago patients who had been cured of
imperfect sight by treatment without glasses
quite often told me that after their vision had
become perfect they were always relieved of pain, not
only in the eyes and head, but in other parts of the body,
even when the pain was apparently caused by some or-
ganic disease, or by an injury. The relief in many cases
was so striking that I investigated some thousands of
cases and found it to be a fact that persons with perfect
sight, or the memory of perfect sight — that is, of some-
thing perfectly seen — do not suffer pain in any part of
the body, while by a strain or effort to see I have pro-
duced pain in various parts of the body.

By perfect sight is not meant, necessarily, the perfect
visual perception of words, letters, or objects, of a more
or less complicated form. To see perfectly the color
alone is sufficient, and the easiest color to see perfectly
is black. But perfect sight is never continuous, careful
scientific tests having shown that it is seldom maintained
for more than a few minutes and usually not so long.
For practical purposes in the relief of pain, therefore,
the memory is more satisfactory than sight.

When black is remembered perfectly a temporary, if
not a permanent, relief of pain always results. The skin
may be pricked with a sharp instrument without caus-
ing discomfort. The lobe of the ear may be pinched be-

202

Pain of Operation Prevented 203

tween the nails of the thumb and first finger, and no pain
will be felt. At the same time the sense of touch becomes
more acute. The senses of taste, smell and hearing are
also improved, while the efficiency of the mind is in-
creased. The ability to distinguish different temperatures
is increased, but one does not suffer from heat or cold.
Organic conditions may not be changed; but all of the
functional symptoms, such as fever, weakness, and shock,
which these conditions cause, are relieved. Patients who
have learned to remember black under all circumstances
no longer dread to visit the dentist. When they remem-
ber a period the drill causes them no pain, and they are
not annoyed even by the extraction of teeth. It is pos-
sible to perform surgical operations without anaesthetics
when the patient is able to remember black perfectly.
The following are only a few of many equally striking
cases which might be given of the relief or prevention of
pain by this means :

A patient suffered from ulceration of the eyeball, oc-
curring at different times and resulting in the formation
of holes through which the fluids in the interior escaped.
These openings had to be closed by surgical operations.
At first these operations were performed under the in-
fluence of cocaine ; but the progressive disease of the eye
caused so much congestion that complete anaesthesia was
no longer attainable by the use of this drug, and ether
and chloroform were employed. As so many operations
were needed, it became desirable to get along, if possible,
without anaesthetics, and the patient's success in reliev-
ing pain by the memory of black suggested that she might
also be able to prevent the pain of operations in the same
way. Her ability to do this was tested by touching her
eyeball lightly with a blunt probe. At first she forgot the

204

The Relief of Pain

black as soon as the probe touched her eye, but later she
became able to remember it. The operation was then
successfully performed ; the patient not only felt no pain,

Fig. 51. Operating Without Anaesthetics

The patient suffered from ulceration of the eyeball resulting
in the formation of holes through which the fluids of the interior
escaped. These holes had to be closed by surgical operations,
and fourteen of these operations were performed without anaes-
thetics, because the patient was able to prevent pain by the
memory of a black period.

but her self-control was better than when cocaine had
been used. Later fourteen more operations were per-
formed under the same conditions, the patient not only

No Pain in Dentist's Chair 205

suffering no pain, but, what was more remarkable, feeling
no pain or soreness afterward. The patient stated that
if she had been operated upon by a stranger she would
probably have been so nervous that she would not have
been able to remember the black; but later she was
treated by a strange dentist, who made two extractions
and did some other work, all without causing her any
discomfort, because she was able to remember the period
perfectly.

A man who had been extremely nervous in the dentist's
chair, and had had four extractions made under gas, sur-
prised his dentist, after having learned the effect of the
memory of a period in relieving pain, by having a tooth
extracted without cocaine, gas, or chloroform. The den-
tist complimented him on his nerve and looked incredu-
lous when the patient said he had felt no pain at all.
In a second case, that of a woman, the dentist removed
the nerve from three teeth without causing the patient
any pain.

A boy of fourteen came to the eye clinic of the Harlem
Hospital, New York, with a foreign body deeply em-
bedded in his cornea. It caused him much pain, and his
mother stated that a number of physicians had been un-
able to remove it, because the child was so nervous that
he could not keep still long enough, although cocaine
had been used quite freely. The boy was told to look
at a black object, close and cover his eyes, and think of
the black object until he saw black. He was soon able
to do this, and the pain in his eye was relieved. He was
next taught to remember the black with his eyes open.
The foreign body was then removed from the cornea.
The operation was one of much difficulty and required
considerable time, but the boy felt no pain. While it was

206 The Relief of Pain

in progress he was asked if he was still remembering
black.

"You bet I am," he replied.

In the same hospital a surgeon from the accident ward
visited the eye clinic with a friend suffering from pain in
his eyes and head. The patient was benefited very quickly
by relaxation methods. The surgeon said it was unusual,
and spoke slightingly of my methods. I challenged him
to bring me a patient with pain that I could not relieve
in five minutes.

"All right," he said. "I want you to understand that I
am from Missouri."

He returned soon with a woman who had been suffer-
ing from severe pains in her head for several years. She
had been operated upon a number of times, and had been
under the care of the hospital for many months.

"You cannot help the pain in this patient's head," said
the surgeon, "because she has a brain tumor."

I doubted the existence of a brain tumor, but I said:
"Brain tumor or no brain tumor, my assistant will stop
the pain in five minutes."

He took out his watch, opened it, looked at the time,
and told my assistant to go ahead. The patient was di-
rected to look at a large black letter, note its blackness,
then to cover her closed eyes with the palms of her
hands, shutting out all the light, and to remember the
blackness of the letter until she saw everything black.
In less than three minutes she said:

"I now see everything perfectly black. I feel no pain
in my head. I am completely relieved, and I thank you
very much."

The surgeon looked bewildered, and left the room
without a word.

fill

207

208 The Relief of Pain

To prevent a relapse, the patient was advised to palm
six times a day or oftener. The pain did not return, and
she came to the clinic some weeks later to express her
gratitude.

Not only does the memory of perfect sight relieve pain
and the symptoms of disease, but in some cases it pro-
duces manifest relief of the causes of these symptoms.
Coughs, colds, hay fever, rheumatism and glaucoma are
among the conditions that have been relieved in this
way.

A patient under treatment for imperfect sight from a
high degree of mixed astigmatism one day came to the
office with a severe cold. She coughed continually, and
there was a profuse discharge from both eyes and nose.
There was some fever, with a severe pain in the eyes
and head, and the patient was unable to breathe through
her nose because of the inflammatory swelling. Palming
was successful in half an hour, when the pain and dis-
charge ceased, the nose opened, and the breathing and
temperature became normal. The benefit was perma-
nent— a very unusual thing after one treatment.

A boy of four with whooping-cough was always re-
lieved by covering his eyes and remembering black. The
relapses became less frequent, and in a few weeks he had
completely recovered.

A man who suffered every summer from attacks of hay
fever, beginning in June and lasting throughout the sea-
son was completely relieved by palming for half an hour ;
and after three years there had been no relapse.

A man of sixty-five who had been under treatment for
rheumatism for six months without improvement ob-
tained temporary relief by palming, and by the time his
vision had become normal the relief of the rheumatism
was complete.

The Power of Thought 209

In many cases of glaucoma not only the pain, but the
tension which is often associated with the pain, has been
completely relieved by palming. In some cases perma-
nent relief of the tension has followed one treatment. In
others many treatments have been required.

Why the memory of black should have this effect can-
not be fully explained, just as the action of many drugs
cannot be explained; but it is evident that the body
must be less susceptible to disturbances of all kinds when
the mind is under control, and only when the mind is un-
der control can black be remembered perfectly. That pain
can be produced in any part of the body by the action of
the mind is not a new observation; and if the mind can
produce pain, it is not surprising that it should also be
able to relieve pain and the conditions which produce it.
This, doubtless, is the explanation of some of the remark-
able cures reported by Faith Curists and Christian
Scientists. Whatever the explanation, however, the facts
have been attested by numerous proofs, and are of the
greatest practical value.

With a little training, anyone with good sight can be
taught to remember black perfectly with the eyes closed
and covered, and with a little more training anyone can
learn to do it with the eyes open. When one is suffer-
ing extreme pain, however, the control of the memory
may be difficult, and the assistance of someone who un-
derstands the method may be necessary. With such
assistance it is seldom or never impossible.

CHAPTER XX
PRESBYOPIA: ITS CAUSE AND CURE

A (LONG people living under civilized conditions the
accommodative power of the eye gradually de-
clines, in most cases, until at the age of sixty or
seventy it appears to have been entirely lost, the subject
being absolutely dependent upon his glasses for vision at
the near-point. As to whether the same thing happens
among primitive people or people living under primitive
conditions, very little information is available. Bonders1
says that the power of accommodation diminishes little,
if at all, more rapidly among people who use their eyes
much at the near-point than among agriculturists, sailors
and others who use them mainly for distant vision; and
Roosa and others2 say the contrary. This is a fact how-
ever, that people who cannot read, no matter what their
age, will manifest a failure of near vision if asked to look
at printed characters, although their sight for familiar
objects at the near-point may be perfect. The fact that
such persons, at the age of forty-five or fifty, cannot dif-
ferentiate between printed characters is no warrant, there-
fore, for the conclusion that their accommodative powers
are declining. A young illiterate would do no better, and
a young student who can read Roman characters at the
near-point without difficulty always develops symptoms
of imperfect sight when he attempts to read, for the first
time, old English, Greek, or Chinese characters.

1 On the Anomalies of Accommodation and Refraction of the Eye, p. 223.

eases
iv, p

210

2 Roosa: A Clinical Manual of Diseases of the Eye, 1894, p. 537- Oliver-
System of Diseases of the Eye, vol. iv, p. 431.

Generally Accepted as Normal 211

When the accommodative power has declined to the
point at which reading and writing become difficult, the
patient is said to have "presbyopia," or, more popularly,
"old sight" ; and the condition is generally accepted, both
by the popular and the scientific mind, as one of the un-
avoidable inconveniences of old age. "Presbyopia," says
Bonders, "is the normal quality of the normal, emmetropic
eye in advanced age,"1 and similar statements might be
multiplied endlessly. De Schweinitz calls the condition
"a normal result of growing old" ;2 according to Fuchs it
is "a physiological process which every eye undergoes";3
while Roosa speaks of the change as one which "ulti-
mately affects every eye."4

The decline of accommodative power with advancing
years is commonly attributed to the hardening of the lens,
an influence which is believed to be augmented, in later
years, by a flattening of this body and a lowering of its
refractive index, together with weakness or atrophy of
the ciliary muscle; and so regular is the decline, in most
cases, that tables have been compiled showing the near-
point to be expected at various ages. From these it is
said one might almost fit glasses without testing the vi-
sion of the subject; or, conversely, one might, from a
man's glasses, judge his age within a year or two. The
following table is quoted from Jackson's chapter on "The
Dioptrics of the Eye," in Norris and Oliver's "System of
Diseases of the Eye,"5 and does not differ materially from
the tables given by Fuchs, Donders and Duane. The first

1 On the Anomalies of Accommodation and Refraction of the Eye, p. 210.

2 Diseases of the Eye, p. 148.

3 Text-book of Ophthalmology, authorized translation from the twelfth
German edition by Duane, 1919, p. 862. Ernst Fuchs (1851- ). Professor
of Ophthalmology at Vienna from 1885 to 1915. His Text-book of Ophthal-
mology has been translated into many languages.

4 A Clinical Manual of Diseases of the Eye, p. 535.
•VoL i, p. 504.

212 Presbyopia: Its Cause and Cure

column indicates the age ; the second, diopters of accom-
modative power; the third, the near-point for an em-
metropic1 eye, in inches.

Age Diopters Inches

10 14 2.81

15 12 3.28

20 10 3.94

25 8.5 4.63

30 7 5.63

35 5.5 7.16

40 4.5 8.75

45 3.5 11.25

50 2.5 15.75

55 1.5 26.25

60 .75 52.49

65 .25 157.48

70 0 0

According to these depressing figures, one must expect
at thirty to have lost no less than half of one's original
accommodative power, while at forty two-thirds of it
would be gone, and at sixty it would be practically non-
existent.

There are many people, however, who do not fit this
schedule. Many persons at forty can read fine print at
fours inches, although they ought, according to the table,
to have lost that power shortly after twenty. Worse still,
there are people who refuse to become presbyopic at all.
Oliver Wendell Holmes mentions one of these cases in
"The Autocrat of the Breakfast Table."

1 An eye which, when it is at rest, focusses parallel rays upon the retina,
is said to be emmetropic or normal.

The Dead Hand of German Science 213

"There is now living in New York State," he says, "an
old gentleman who, perceiving his sight to fail, immedi-
ately took to exercising it on the finest print, and in this
way fairly bullied Nature out of her foolish habit of tak-
ing liberties at five-and-forty, or thereabout. And now
this old gentleman performs the most extraordinary feats
with his pen, showing that his eyes must be a pair of
microscopes. I should be afraid to say how much he
writes in the compass of a half-dime — whether the
Psalms or the Gospels, or the Psalms and the Gospels, I
won't be positive."1

There are also people who regain their near vision after
having lost it for ten, fifteen, or more years ; and there are
people who, while presbyopic for some objects, have
perfect sight for others. Many dressmakers, for instance,
can thread a needle with the naked eye, and with the
retinoscope it can be demonstrated that they accurately
focus their eyes upon such objects; and yet they cannot
read or write without glasses.

So far as I am aware no one but myself has ever ob-
served the last mentioned class of cases, but the others
are known to every opththalmologist of any experience.
One hears of them at the meetings of ophthalmological
societies ; they are even reported in the medical journals ;
but such is the force of authority that when it comes to
writing books they are either ignored or explained away,
and every new treatise that comes from the press repeats
the old superstition that presbyopia is "a normal result
of growing old." We have beaten Germany; but the
dead hand of German science still oppresses our intellects
and prevents us from crediting the plainest evidence of
our senses. Some of us are so filled with repugnance for

Everyman's Library, 1908, pp. 166-167.

214 Presbyopia: Its Cause and Cure

the Hun that we can no longer endure the music of Bach,
or the language of Goethe and Schiller; but German
ophthalmology is still sacred, and no facts are allowed to
cast discredit upon it.

Fortunately for those who feel called upon to defend
the old theories, myopia postpones the advent of pres-
byopia, and a decrease in the size of the pupil, which often
takes place in old age, has some effects in facilitating vi-
sion at the near-point. Reported cases of persons reading
without glasses when over fifty-or fifty-five years of age,
therefore, can be easily disposed of by assuming that the
subjects must be myopic, or that their pupils are unusu-
ally small. If the case comes under actual observation,
the matter may not be so simple, because it may be
found that the patient, so far from being myopic, is hyper-
metropic, or emmetropic, and that the pupil is of normal
size. There is nothing to do with these cases but to ig-
nore them. Abnormal changes in the form of the lens
have also been held responsible for the retention of near
vision beyond the prescribed age, or for its restoration
after it has been lost, the swelling of the lens in incipient
cataract affording a very convenient and plausible ex-
planation for the latter class of cases. In cases of pre-
mature presbyopia "accelerated sclerosis"1 of the lens
and weakness of the ciliary muscle have been assumed ;
and if such cases as the dressmakers who can thread their
needles when they can no longer read the newspapers had
been observed, no doubt some explanation consistent
with the German viewpoint would have been found for
them.

The truth about presbyopia is that it is not "a normal
result of growing old," being both preventable and cu-

1Fuchs: Text-book of Ophthalmology, p. 905.

A Form of Hypermetropia 215

rable. It is not caused by hardening of the lens, but by a
strain to see at the near-point. It has no necessary con-
nection with age, since it occurs, in some cases, as early
as ten years, while in others it never occurs at all, al-
though the subject may live far into the so-called pres-
byopic age. It is true that the lens does harden with ad-
vancing years, just as the bones harden and the struc-
ture of the skin changes ; but since the lens is not a factor
in accommodation, this fact is immaterial, and while in
some cases the lens may become flatter, or lose some
of its refractive power with advancing years, it has been
observed to remain perfectly clear and unchanged in
shape up to the age of ninety. Since the ciliary muscle
is also not a factor in accommodation, its weakness or
atrophy can contribute nothing to the decline of accom-
modative power. Presbyopia is, in fact, simply a form of
hypermetropia in which the vision for the near-point is
chiefly affected, although the vision for the distance,
contrary to what is generally believed, is always lowered
also. The difference between the two conditions is not
always clear. A person with hypermetropia may or may
not read fine print, and a person at the presbyopic age
may read it without apparent inconvenience and yet have
imperfect sight for the distance. In both conditions the
sight at both points is lowered, although the patient may
not be aware of it.

It has been shown that when the eyes strain to see at
the near-point the focus is always pushed farther away
than it was before, in one or all meridians ; and by means
of simultaneous retinoscopy it can always be demon-
strated that when a person with presbyopia tries to read
fine print and fails, the focus is always pushed farther
away than it was before the attempt was made, indicat-

216 Presbyopia: Its Cause and Cure

ing that the failure was caused by strain. Even the
thought of making such an effort will produce strain, so
that the refraction may be changed, and pain, discomfort
and fatigue produced, before the fine print is regarded.
Furthermore, when a person with presbyopia rests the
eyes by closing them, or palming, he always becomes
able, for a few moments at least, to read fine print at
six inches, again indicating that his previous failure was
due, not to any fault of the eyes, but to a strain to see.
When the strain is permanently relieved, the presbyopia
is permanently cured, and this has happened, not in a
few cases, but in many, and at all ages, up to sixty,
seventy and eighty.

The first patient that I cured of presbyopia was myself.
Having demonstrated by means of experiments on the
eyes of animals that the lens is not a factor in accommo-
dation, I knew that presbyopia must be curable, and I
realized that I could not look for any very general ac-
ceptance of the revolutionary conclusions I had reached
so long as I wore glasses myself for a condition supposed
to be due to the loss of the accommodative power of the
lens. I was then suffering from the maximum degree of
presbyopia. I had no accommodative power whatever,
and had to have quite an outfit of glasses, because with a
glass, for instance, which enabled me to read fine print at
thirteen inches, I could not read it either at twelve inches
or at fourteen. The retinoscope showed that when
I tried to see anything at the near-point without glasses,
my eyes were focussed for the distance, and when I tried
to see anything at the distance they were focussed for the
near-point. My problem, then, was to find some way of
reversing this condition and inducing my eyes to focus
for the point I wished to see at the moment that I wished

Only One Man Who Could Cure Me 217

to see it. I consulted various eye specialists but my
language was to them like that of St. Paul to the Greeks,
namely, foolishness. "Your lens is as hard as a stone,"
they said. "No one can do anything for you." Then I
went to a nerve specialist. He used the retinoscope on
me, and confirmed my own observations as to the pe-
culiar contrariness of my accommodation ; but he had no
idea what I could do about it. He would consult some
of his colleagues, he said, and asked me to come back in
a month, which I did. Then he told me he had come to
the conclusion that there was only one man who could
cure me, and that was Dr. William H. Bates of New
York.

"Why do you say that?" I asked.

"Because you are the only man who seems to know
anything about it," he answered.

Thus thrown upon my own resources, I was fortunate
enough to find a non-medical gentleman who was willing
to do what he could to assist me, the Rev. R. B. B. Foote,
of Brooklyn. He kindly used the retinoscope through
many long and tedious hours while I studied my own
case, and tried to find some way of accommodating when
I wanted to read, instead of when I wanted to see some-
thing at the distance. One day, while looking at a pic-
ture of the Rock of Gibralter which hung on the wall, I
noted some black spots on its face. I imagined that these
spots were the openings of caves, and that there were
people in these caves moving about. When I did this
my eyes were focussed for the reading distance. Then
I looked at the same picture at the reading distance, still
imagining that the spots were caves with people in them.
The retinoscope showed that I had accommodated, and
I was able to read the lettering beside the picture. I had,

218 Presbyopia: Its Cause and Cure

in fact, been temporarily cured by the use of my imagina-
tion. Later I found that when I imagined the letters
black I was able to see them black, and when I saw them
black I was able to distinguish their form. My progress
after this was not what could be called rapid. It was
six months before I could read the newspapers with any
kind of comfort, and a year before I obtained my present
accommodative range of fourteen inches, from four inches
to eighteen; but the experience was extremely valuable,
for I had in pronounced form every symptom subse-
quently observed in other presbyopic patients.

Fortunately for the patients, it has seldom taken me as
long to cure other people as it did to cure myself. In
some cases a complete and permanent cure was effected
in a few minutes. Why, I do not know. I will never be
satisfied till I find out. A patient who had worn glasses
for presbyopia for about twenty years was cured in less
than fifteen minutes by the use of his imagination.

When asked to read diamond type, he said he could not
do so, because the letters were grey and looked all alike.
I reminded him that the type was printer's ink and that
there was nothing blacker than printer's ink. I asked
him if he had ever seen printer's ink. He replied that he
had. Did he remember how black it was? Yes. Did he
believe that these letters were as black as the ink he re-
membered? He did, and then he read the letters; and be-
cause the improvement in his vision was permanent, he
said that I had hypnotized him.

In another case a presbyope of ten years' standing was
cured just as quickly by the same method. When re-
minded that the letters which he could not read were
black, he replied that he knew they were black, but that
they looked grey.

Responsible for Much Defective Eyesight 219

"If you know they are black, and yet see them grey," I
said, "you must imagine them grey. Suppose you im-
agine that they are black. Can you do that?"

"Yes," he said, "I can imagine that they are black";
and then he proceeded to read them.

These extremely quick cures are rare. In nine cases
out of ten progress has been much slower, and it has
been necessary to resort -to all the methods of obtaining
relaxation found useful in the treatment of other errors of
refraction. In the more difficult cases of presbyopia the
patients often suffer from the same illusions of color, size,
form and number, when they try to read fine print, as do
patients with hypermetropia, astigmatism, and myopia
when they try to read the letters on the Snellen test card
at the distance. They are unable to remember or im-
agine, when trying to see at the near-point, even such a
simple thing as a small black spot, but can remember it
perfectly when they do not try to see. Their sight for
the distance is often very imperfect and always below
normal, although they may have thought it perfect; and
just as in the case of other errors of refraction, improve-
ment of the distant vision improves the vision at the
near-point. Regardless, however, of the difficulty of the
case and the age of the patient, some improvement has
always been obtained, and if the treatment was continued
long enough, the patient has been cured.

The idea that presbyopia is "a normal result of grow-
old" is responsible for much defective eyesight. When
people who have reached the presbyopic age experience
difficulty in reading, they are very likely to resort at
once to glasses, either with or without professional ad-
vice. In some cases such persons may be actually pres-
byopic ; in others the difficulty may be something tempo-

220 Presbyopia: Its Cause and Cure

rary, which they would have thought little about if they
had been younger, and which would have passed away
if Nature had been left to herself. But once the glasses
are adopted, in the great majority of cases, they produce
the condition they were designed to relieve, or, if it al-
ready existed, they make it worse, sometimes very rap-
idly, as every ophthalmologist knows. In a couple of
weeks, sometimes, the patient finds, as noted in the
chapter on "What Glasses Do to Us," that the large print
which he could read without difficulty before he got his
glasses, can no longer be read without their aid. In from
five to ten years the accommodative power of the eye is
usually gone ; and if from this point the patient does not
go on to cataract, glaucoma, or inflammation of the re-
tina, he may consider himself fortunate. Only occasion-
ally do the eyes refuse to submit to the artificial condi-
tions imposed upon them; but in such cases they may
keep up an astonishing struggle against them for long
periods. A woman of seventy, who had worn glasses for
twenty years, was still able to read diamond type and
had good vision for the distance without them. She said
the glasses tired her eyes and blurred her vision, but that
she had persisted in wearing them, in spite of a continual
temptation to throw them off, because she had been told
that it was necessary for her to do so.

If persons who find themselves getting presbyopic, or
who have arrived at the presbyopic age, would, instead
of resorting to glasses, follow the example of the gentle-
man mentioned by Dr. Holmes, and make a practice of
reading the finest print they can find, the idea that the
decline of accommodative power is "a normal result of
growing old" would soon die a natural death.

CHAPTER XXI
SQUINT AND AMBLYOPIA: THEIR CAUSE

SINCE we have two eyes, it is obvious that in the
act of sight two pictures must be formed; and in
order that these two pictures shall be fused into
one by the mind, it is necessary that there shall be per-
fect harmony of action between the two organs of vision.
In looking at a distant object the two visual axes must
be parallel, and in looking at an object at a less distance
than infinity, which for practical purposes is less than
twenty feet, they must converge to exactly the same de-
gree. The absence of this harmony of action is known
as "squint," or "strabismus," and is one of the most dis-
tressing of eye defects, not only because of the lowering of
vision involved, but because the want of symmetry in the
most expressive feature of the face which results from it
has a most unpleasant effect upon the personal appear-
ance. The condition is one which has long baffled
ophthalmological science. While the theories as to its
cause advanced in the text-books seem to fit some cases,
they leave others unexplained, and all methods of treat-
ment are admitted to be very uncertain in their results.

The idea that a lack of harmony in the movements of
the eye is due to a corresponding lack of harmony in the
strength of the muscles that turn them in their sockets
seem such a natural one that this theory was almost uni-
versally accepted at one time. Operations based upon it
once had a great vogue; but to-day they are advised, by
most authorities, only as a last resort. It is true that
many persons have been benefited by them ; but, at best,

221

222 Squint and Amblyopia: Their Cause

the correction of the squint is only approximate, and in
many cases the condition has been made worse, while a
restoration of binocular vision — the power of fusing the
two visual images into one — is scarcely even hoped for.1

The muscle theory fitted the facts so badly that when
Bonders advanced the idea that squint was a condition
growing out of refractive errors — hypermetropia being
held responsible for the production of convergent and
myopia for divergent squint — it was universally accepted.
This theory, too, proved unsatisfactory, and now medical
opinion is divided between various theories. Hansen-
Grut attributed the condition, in the great majority of
cases, to a defect, not of the muscles, but of the nerve
supply; and this idea has had many supporters. Worth
and his disciples lay stress on the lack of a so-called
fusion faculty, and have recommended the use of prisms,
or other measures, to develop it. Stevens believes that
the anomaly results from a wrong shape of the orbit,
and as it is impossible to alter this condition, advocates
operations for the purpose of neutralizing its influence.

In order to make any of these theories appear consist-
ent it is necessary to explain away a great many trouble-
some facts. The uncertain result of operations upon the
eye muscles is sufficient to cast suspicion on the theory
that the condition is due to any abnormality of the mus-
cles, and many cases of marked paralysis of one or more
muscles have been observed in which there was no squint.
Relief of paralysis, moreover, may not relieve the squint,
nor the relief of the squint the paralysis. Worth found

1 The result obtained by the operation is, as a rule, simply cosmetic.
The sight of the squinting eye is not influenced by the operation, and in
only a few instances is even binocular vision restored. — Fuchs: Text-book
of Ophthalmology, p. 795.

The result of even the most successful squint operation, in long-standing
strabismus, is merely cosmetic in the vast majority of cases. — Eversbusch:
The Diseases of Children, edited by Pfaunder and Schlossman. English
translation by Shaw and La Fetra, second edition, 1912-1914, vol. vii, p. 316.

State of Vision Not Important Factor 223

so many cases which were not benefited by training de-
signed to improve the fusion faculty that he recom-
mended operations on the muscles in such cases; while
Bonders, noting that the majority of hypermetropes did
not squint, was obliged to assume that hypermetropia

Fig. 53

No. 1 — Reading the Snellen test card with normal vision;
visual axes parallel.

No. 2 — The same patient making an effort to see the test
card; myopia and convergent squint of the left eye have been
produced.

did not cause this condition without the aid of co-oper-
ating circumstances.

That the state of the vision is not an important factor
in the production of squint is attested by a multitude of
facts. It is true, as Bonders observed, that squint is
usually associated with errors of refraction; but some
people squint with a very slight error of refraction. It
is also true that many persons with convergent squint

224 Squint and Amblyopia: Their Cause

have hypermetropia ; but many others have not. Some
persons with convergent squint have myopia. A person
may also have convergent squint with one eye normal
and one hypermetropic or myopic, or with one eye blind.
Usually the vision of the eye that turns in is less than
that of the eye which is straight; yet there are cases in
which the eye with the poorer vision is straight and the
eye with the better vision turned in. With two blind
eyes, both eyes may be straight, or one may turn in.
With one good eye and one blind eye, both eyes may be
straight. The blinder the eye, as a rule, the more marked
the squint ; but exceptions are frequent, and in rare cases
an eye with nearly normal vision may turn in persist-
ently. A squint may disappear and return again, while
convergent squint will change into divergent squint and
back again. With the same error of refraction, one per-
son will have squint and the other not. A third will
squint with a different eye. A fourth will squint first
with one eye and then with the other. In a fifth the
amount of the squint will vary. One will get well with-
out glasses, or other treatment, and another with these
things. These cures may be temporary, or permanent,
and the relapses may occur either with or without
glasses.

However slight the error of refraction, the vision of
many squinting eyes is inferior to that of the straight
eye, and for this condition, usually, no apparent or suffi-
cient cause can be found in the constitution of the eye.
There is a difference of opinion as to whether this curious
defect of vision is the result of the squint, or the squint
the result of the defect of vision ; but the predominating
opinion that it is, at least, aggravated by the squint has
been crystallized in the name given to the condition,
namely, "amblyopia ex anopsia," literally "dim-sighted-

Facts Versus Theory 225

ness from non-use" — for in order to avoid the annoyance
of double vision the mind is believed to suppress the
image of the deviating eye. There are, however, many
squinting eyes without amblyopia, while such a condition
has been found in eyes that have never squinted.

The literature of the subject is full of the impossibility
of curing amblyopia, and in popular writings persons
having the care of children are urged to have cases of
squint treated early, so that the vision of the squinting
eye may not be lost. According to Worth, not much
improvement can ordinarily be obtained in amblyopic
eyes after the age of six, while Fuchs says,1 "The function
of the retina never again becomes perfectly normal, even
if the cause of the visual disturbance is done away with."
Yet it is well known, as the translator of Fuchs points
out in an editorial comment upon the above statement,2
that if the sight of the good eye is lost at any period of
life, the vision of the amblyopic eye will often become
normal. Furthermore, an eye may be amblyopic at one
time and not at another. When the good eye is covered,
a squinting eye may be so amblyopic that it can scarcely
distinguish daylight from darkness; but when both eyes
are open, the vision of the squinting eye may be found
to be as good as that of the straight eye, if not better.
In many cases, too, the amblyopia will change from one
eye to the other.

Double vision occurs very seldom in squint, and when
it does, it often assumes very curious forms. When the
eyes turn in the image seen by the right eye should,
according to all the laws of optics, be to the right, and
the image seen by the left eye to the left. When the

1 Text-book of Ophthalmology, p. 633.

2 Cases have been reported, some surely authentic, in which an amblyopic
squinting eye has acquired good vision, either through correction of the
refraction, or because loss of sight in the good eye has compelled the use
of the amblyopic eye. — Ibid.

226 Squint and Amblyopia: Their Cause

eyes turn out, the opposite should be the case. But often
the position of the images is reversed, the image of the
right eye in convergent squint being seen to the left and
that of the left eye to the right, while in divergent squint
the opposite is the case. This condition is known as
"paradoxical diplopia." Furthermore, persons with al-
most normal vision and both eyes perfectly straight may
have both kinds of double vision.

All the theories heretofore suggested fail to explain
the foregoing facts; but it is a fact that in all cases of
squint a strain can be demonstrated, and that the relief
of the strain is in all cases followed by the cure of the
squint, as well as of the amblyopia and the error of
refraction. It is also a fact that all persons with normal
eyes can produce squint by a strain to see. It is not a
difficult thing to do, and many children derive much
amusement from the practice, while it gives their elders
unnecessary concern, for fear the temporary squint may
become permanent. To produce convergent squint is
comparatively easy. Children usually do it by straining
to see the end of the nose. The production of divergent
squint is more difficult, but with practice persons with
normal eyes become able to turn out either eye, or both,
at will. They also become able to turn either eye upward
and inward, or upward and outward, at any desired
angle. Any kind of squint can, in fact, be produced at
will by the appropriate kind of strain. Some persons
retain the power to produce voluntary squint more or
less permanently. Others quickly lose it if they do not
keep in practice. There is usually a lowering of the
vision when voluntary squint is produced, and accepted
methods of measuring the strength of the muscles seem
to show deficiencies corresponding to the nature of the
squint.

CHAPTER XXII
SQUINT AND AMBLYOPIA: THEIR CURE

THE evidence is conclusive that squint and
amblyopia, like errors of refraction, are purely
functional troubles; and since they are always
relieved by the relief of the strain with which they are
associated, it follows that any of the methods which
promote relaxation and central fixation may be employed
for their cure. As in the case of errors of refraction,
the squint disappears and the amblyopia is corrected just
as soon as the patient gains sufficient mental control to
remember a perfectly black period. In this way both
conditions can be temporarily relieved in a few seconds,
their permanent cure being a mere matter of making this
temporary state permanent.

One of the best ways of gaining mental control in
cases of squint is to learn how to increase the squint, or
produce other kinds of squint, voluntarily. In the case
illustrated, the patient had divergent vertical squint in
both eyes. When the left eye was straight the right
eye turned out and up, and when the right eye was
straight the left eye turned down and out. Both eyes
were amblyopic and there was double vision, with the
images sometimes on the same side and sometimes on
opposite sides. The patient suffered from headaches,
and having obtained no relief from glasses, or other
methods of treatment, she made up her mind to an oper-
ation and consulted Dr. Gudmund J. Gislason, of Grand
Forks, N. D., with a view to having one performed. Dr.
Gislason, puzzled to find so many muscles apparently

227

228 Squint and Amblyopia: Their Cure

at fault, asked my opinion as to which of them should
be operated upon. I showed the patient how to make her
squint worse, and recommended that Dr. Gislason treat
her by eye education without an operation. He did so,
and in less than a month the patient had learned to turn
both eyes in voluntarily. At first she did this by looking
at a pencil held over the bridge of the nose; but later
she became able to do it without the pencil, and ulti-
mately she became able to produce every kind of squint
at will. The treatment was not pleasant for her, because
the production of new kinds of squint, or the making
worse of the existing condition, gave her pain; but it
effected a complete and permanent cure both of the
squint and of the amblyopia. The same method has
proved successful with other patients.

Some patients do not know whether they are looking
straight at an object or not. These may be helped by
watching the deviating eye and directing them to look
more nearly in the proper direction. When the deviating
eye looks directly at an object, the strain to see is less,
and the vision is consequently improved. Covering the
good eye with an opaque screen, or with ground glass,
encourages a more proper use of the squinting eye, espe-
cially if the vision of that eye is imperfect.

Children of six years, or younger, can usually be cured
of squint by the use of atropine, a one per cent solution
being instilled into one or both eyes twice a day, for
many months, a year, or longer. The atropine makes it
more difficult for the child to see, and makes the sunlight
disagreeable. In order to overcome this handicap it has
to relax, and the relaxation cures the squint.

The improvement resulting from eye education in cases
of squint and amblyopia is sometimes so rapid as to be

Learning to See Worse 229

almost incredible. The following are a few of many
other examples that might be quoted :

A girl of eleven had convergent vertical squint of the
left eye. The vision of this eye at the distance was 3/200,
while at the near-point it was so imperfect that she was
unable to read. The vision of the right eye was normal
both for the near-point and the distance. She was wear-
ing glasses when she came to the office — convex 4.00
D. S. combined with convex 0.50 D. C., axis 90, for the
right eye; and convex 5.50 D. S. for the left eye — but
had obtained no benefit from them. When she looked
three feet away from the big C with the left eye, she
saw it better than when she looked directly at it; but
when asked to count my fingers held three feet away
from the card, they so attracted her attention that she
was able to see the large letter worse. The fact was
impressed upon her that she could see the card better
when she looked away from it, or she could see it worse,
at will; and she was also asked to note that when she
saw it worse her vision improved, and when she saw
it better her vision declined. After shifting from the
card to a point three feet away from it, and seeing the
former worse a few times, her vision improved to 10/200.
The ability to shift and see worse improved by practice
so rapidly that in less than ten days her vision was
normal in both eyes, and in less than two weeks it had
improved to 20/10, while diamond type was read with
each eye at from three inches to twenty inches. In less
than three weeks her vision for the distance was 20/5,
by artificial light, and she read photographic type reduc-
tions at two inches, the tests being made with both eyes
together and with each eye separately. She also read
strange test cards as readily as the familiar ones. She

230 Squint and Amblyopia: Their Cure

Fig. 54. Case of Divergent Vertical Squint Cured by
Eye Education

No. 1.— The right eye turns out and up, the left being straight.

No. 2. The patient learns to look down and out with the
left eye while the right looks straight.

No. 3. — The patient learns to turn both eyes in by looking at
a pencil held over the bridge of the nose.

No. 4. — The patient is permanently cured.

All four pictures were taken within fifteen minutes of each
other, the patient having learned to reproduce the conditions
represented at will.

Cured in Three Weeks 231

was advised to continue the treatment at home to pre-
vent a relapse, and at the end of three years none had
occurred. During the treatment at the office and practice
at home the good eye was covered with an opaque screen,
but this was not worn at other times.

A very remarkable case was that of a girl of fourteen
who had squinted from childhood. The internal rectus of
the right eye had been cut when she was two years old,
but still pulled the eye inward. The patient objected to
wearing a ground glass over her good eye, because her
friends teased her about it and she thought it made her
more conspicuous than the squint. One day she lost her
glasses in the snow; but her father, who was a man of
strong character, immediately provided another pair.
Then she announced that she was ill, and couldn't go to
school. I told the father that his daughter was hysteri-
cal, and simply imagined she was ill to avoid treatment.
He insisted that she continue, and as she did not consider
herself well enough to come to see me, I called upon her.
With the assistance of her father she was made to under-
stand that she would have to continue the treatment
until she was cured, and she at once went to work with
such energy and intelligence that in half an hour the vi-
sion of the squinting and amblyopic eye had improved
from 3/200 to 20/30. She also became able to read fine
print at twelve inches. She went back to school wearing
the ground glass over the good eye; but whenever she
wanted to see she looked over the top of it. Her father
followed her to school, and insisted that she use the
poorer eye instead of the better one. She became con-
vinced that the simplest way out of her troubles would be
to follow my instructions, and in less than a week the
squint was corrected and she had perfect vision in both

232 Squint and Amblyopia: Their Cure

eyes. At the beginning of the treatment she could not
count here fingers at three feet with the poorer eye, and
in three weeks, including all the time that she wasted,
she had perfect sight. When told that she was cured her

Fig. 55

No. 1.— Convergent squint of the right eye.
No. 2.— The patient is temporarily cured by the memory of a
black period.

main concern seemed to be to know whether she would
have to wear the ground glass any more. She was as-
sured that she would not have to do so unless there was
a relapse, but there never was any relapse.1

L>6ducation de 1>oeil dans 1'amblyopie ex anopsia, Clin. Opht., Dec.

Cured in Two Weeks 233

A girl of eight had had amblyopia and squint since
childhood. The vision of the right eye was 10/40, while
that of the left was 20/30. Glasses did not improve either
eye. The patient was seated twenty feet from a Snellen
test card and the right, or poorer eye, was covered with
an opaque screen. She was directed to look with her
better eye at the large letter on the card and to note its
clearness. Next she was told to look at a point three feet
to one side of the card, and her attention was called to the
fact that she did not then see the large letter so well. The
point of fixation was brought closer and closer to the
letter, until she appreciated the fact that her vision was
lowered when she looked only a few inches to one side
of it. When she looked at a small letter she readily rec-
ognized that an eccentric fixation of less than an inch
lowered the vision.

After she had learned to increase the amblyopia of the
better eye, this eye was covered while she was taught
how to lower the vision of the other, or poorer eye, by
increasing its eccentric fixation. This was accomplished
in a few minutes. She was told that the cause of her
defective sight was her habit of looking at objects with
a part of the retina to one side of the true center of sight.
She was advised to see by looking straight at the Snellen
card. In less than half an hour the vision of the left eye
became normal, while the right improved from 10/40 to
10/10. The cure was complete in two weeks.

The following case was unusually prolonged, because
as soon as one eye had been cured, the defect for which it
had been treated appeared in the other eye. The patient,
a child of ten, had imperfect sight in both eyes, but worse
in the right than in the left. The vision of the right eye
was restored after some weeks by eye education, when

234 Squint and Amblyopia: Their Cure

the left eye turned in and became amblyopic. The right
eye was then covered, and after a few weeks of eye edu-
cation the left became normal. The right eye then turned
in and the vision became defective. It was necessary to
educate the eyes alternately, for about a year, before both
became normal at the same time. This patient had con-
genital paralysis of the external rectus muscle in both
eyes, a condition which was apparently not relieved when
the squint and amblyopia were cured.

In the following case the patient had an attack of in-
fantile paralysis after her cure, resulting in a relapse, with
new and more serious developments, which were, how-
ever quickly cured. The patient, a girl of six, seen first
on December 11, 1914, had had divergent squint of the
left eye for three years, and had worn glasses for two
years without benefit — convex 2.50 D. S. for the right eye,
and convex 6.00 D. S. combined with convex 1.00 D. C.,
axis 90, for the left. The vision of the right eye with
glasses was 12/15 and of the left 12/200. Atropine was
prescribed for the right eye for the purpose of partially
blinding it and thus encouraging a more nearly proper
use of the squinting eye, and the usual methods of secur-
ing relaxation, such as shifting, palming, the exercise
of the memory, etc., were used. On January 13, 1915, the
vision without glasses had improved to 10/70 for the right
eye, and 10/50 for the left. On February 6, the vision of
the right eye was 10/40 and of the left 10/30. The eyes
were apparently straight, and scientific tests showed that
both were used at the same time (binocular single vi-
sion). On April 17, after about four months' treatment,
the vision of the left eye was normal, and there was bi-
nocular single vision at six inches. On May 1 the vision
of the left eye was still normal, and whereas at the be-

Accommodation Unaffected by Atr opine 235

ginning the patient had been unable to read with it at
all, even with glasses, she now read diamond type with-
out glasses at six inches.

On August 16, 1916, the patient had an attack of infan-
tile paralysis which was then epidemic. The sight of
both eyes failed, the muscles that turned the eyes in and
out were paralyzed, the eyelids twitched, and there was
double vision. Various muscles of the head, the left leg
and the left arm were also paralzyed. When she left the
hospital after five weeks the left eye was turned in, and
the vision of both eyes was so poor that she was unable
to recognize her mother. Later she developed alternate
convergent squint. On November 2 the paralysis in the
right eye subsided, and four weeks later that of the left
eye began to improve. On November 9 she returned for
treatment without any conspicuous squint, but still suf-
fering from double vision, with the images sometimes on
the same side and sometimes on opposite sides. On No-
vember 23 the eyes were straight and the vision normal.

On July 11, 1918, the eyes were still straight and the
vision normal, and there was binocular single vision at
six inches. Although atropine had been used in the right
eye every day for more than a year, and intermittently for
a much longer time, and the pupil was dilated to the
maximum, it read fine print without difficulty at six
inches, central fixation overcoming the paralyzing effect
of the drug. According to the current theory the accom-
modation should have been completely paralyzed, making
near vision quite impossible. The patient also read fine
print with the left eye as well as, or better than, with
the right eye.

CHAPTER XXIII
FLOATING SPECKS: THEIR CAUSE AND CURE

A VERY common phenomenon of imperfect sight is
the one known to medical science as "muscae
volitantes" or "flying flies." These floating
specks are usually dark or black, but sometimes appear
like white bubbles, and in rare cases may assume all the
colors of the rainbow. They move somewhat rapidly,
usually in curving lines, before the eyes, and always ap-
pear to be just beyond the point of fixation. If one tries
to look at them directly, they seem to move a little far-
ther away. Hence their name of "flying flies."

The literature of the subject is full of speculations as
to the origin of these appearances. Some have at-
tributed them to the presence of floating specks — dead
cells or the debris of cells — in the vitreous humor, the
transparent substance that fills four-fifths of the eyeball
behind the crystalline lens. Similar specks on the sur-
face of the cornea have also been held responsible for
them. It has even been surmised that they might be
caused by the passage of tears over the cornea. They
are so common in myopia that they have been supposed
to be one of the symptoms of this condition, although
they occur also with other errors of refraction, as well as
in eyes otherwise normal. They have been attributed
to disturbances of the circulation, the digestion and the
kidneys, and because so many insane people have them,
have been thought to be an evidence of incipient in-
sanity. The patent-medicine business has thrived upon

236

A Pitiable Case 237

them, and it would be difficult to estimate the amount of
mental torture they have caused, as the following cases
illustrate.

A clergyman who was much annoyed by the continual
appearance of floating specks before his eyes was told by
his eye specialist that they were a symptom of kidney
disease, and that in many cases of kidney trouble dis-
ease of the retina might be an early symptom. So at
regular intervals he went to the specialist to have his
eyes examined, and when at length the latter died, he
looked around immediately for some one else to make
the periodical examination. His family physician di-
rected him to me. I was by no means so well known as
his previous ophthalmological adviser, but it happened
that I had taught the family physician how to use the
ophthalmoscope after others had failed to do so. He
thought, therefore, that I must know a lot about the use
of the instrument, and what the clergyman particularly
wanted was some one capable of making a thorough ex-
amination of the interior of his eyes and detecting at once
any signs of kidney disease that might make their ap-
pearance. So he came to me, and at least four times a
year for ten years he continued to come.

Each time I made a very careful examination of his
eyes, taking as much time over it as possible, so that he
would believe that it was careful ; and each time he went
away happy because I could find nothing wrong. Once
when I was out of town he got a cinder in his eye, and
went to another oculist to get it out. When I came back
late at night I found him sitting on my doorstep, on the
chance that I might return. His story was a pitiable one.
The strange doctor had examined his eyes with the oph-
thalmoscope, and had suggested the possibility of glau-

238 Floating Specks: Their Cause and Cure

coma, describing the disease as a very treacherous one
which might cause him to go suddenly blind and would
be agonizingly painful. He emphasized what the pa-
tient had previously been told about the danger of kidney
disease, suggested that the liver and heart might also be
involved, and advised him to have all of these organs
carefully examined. I made another examination of his
eyes in general and their tension in particular ; I had him
feel his eyeballs and compare them with my own, so
that he might see for himself that they were not becoming
hard as a stone; and finally I succeeded in reassuring
him. I have no doubt, however, that he went at once to
his family physician for an examination of his internal
organs.

A man returning from Europe was looking at some
white clouds one day when floating specks appeared be-
fore his eyes. He consulted the ship's doctor, who told
him that the symptom was very serious, and might be
the forerunner of blindness. It might also indicate in-
cipient insanity, as well as other nervous or organic dis-
eases. He advised him to consult his family physician
and an eye specialist as soon as he landed, which he did.
This was twenty-five years ago, but I shall never forget
the terrible state of nervousness and terror into which
the patient had worked himself by the time he came to
me. It was even worse than that of the clergyman, who
was always ready to admit that his fears were unreason-
able. I examined his eyes very carefully, and found them
absolutely normal. The vision was perfect both for the
near-point and the distance. The color perception, the
fields and the tension were normal; and under a strong
magnifying glass I could find no opacities in the vitreous.
In short, there were absolutely no symptoms of any

A Common Symptom 239

disease. I told the patient there was nothing wrong
with his eyes, and I also showed him an advertisement
of a quack medicine in a newspaper which gave a great
deal of space to describing the dreadful things likely to
follow the appearance of floating specks before the eyes,
unless you began betimes to take the medicine in ques-
tion at one dollar a bottle. I pointed out that the adver-
tisement, which was appearing in all the big newspapers
of the city every day, and probably in other cities, must
have cost a lot of money, and must, therefore, be bring-
ing in a lot of money. Evidently there must be a great
many people suffering from this symptom, and if it were
as serious as was generally believed, there would be a
great many more blind and insane people in the com-
munity than there were. The patient went away some-
what comforted, but at eleven o'clock — his first visit had
been at nine — he was back again. He still saw the float-
ing specks, and was still worried about them. I exam-
ined his eyes again as carefully as before, and again was
able to assure him that there was nothing wrong with
them. In the afternoon I was not in my office, but I was
told that he was there at three and at five. At seven he
came again, bringing with him his family physician, an
old friend of mine. I said to the latter:

"Please make this patient stay at home. I have to
charge him for his visits, because he is taking up so
much of my time; but it is a shame to take his money
when there is nothing wrong with him."

What my friend said to him I don't know, but he did
not come back again.

I did not know as much about muscae volitantes then
as I know now, or I might have saved both of these
patients a great deal of uneasiness. I could tell them that

240 Floating Specks: Their Cause and Cure

their eyes were normal, but I did not know how to re-
lieve them of the symptom, which is simply an illusion
resulting from mental strain. The specks are associated
to a considerable extent with markedly imperfect eye-
sight, because persons whose eyesight is imperfect al-
ways strain to see; but persons whose eyesight is ordi-
narily normal may see them at times, because no eye has
normal sight all the time. Most people can see muscae
volitantes when they look at the sun, or any uniformly
bright surface, like a sheet of white paper upon which the
sun is shining. This is because most people strain when
they look at surfaces of this kind. The specks are never
seen, in short, except when the eyes and mind are under
a strain, and they always disappear when the strain is
relieved. If one can remember a small letter on the
Snellen test card by central fixation, the specks will im-
mediately disappear, or cease to move ; but if one tries
to remember two or more letters equally well at one
time, they will reappear and move.

Usually the strain that causes muscae volitantes is
very easily relieved. A school teacher who had been
annoyed by these appearances for years came to me be-
cause the condition had grown recently much worse. I
was able in half an hour to improve her sight, which had
been slightly myopic, to normal, whereupon the specks
disappeared. Next day they came back, but another
visit to the office brought relief. After that the patient
was able to carry out the treatment at home, and had
no more trouble.

A physician who suffered constantly from headaches
and muscae volitantes was able to read only 20/70 when
he looked at the Snellen test card, while the retinoscope
showed mixed astigmatism and he saw the specks.

Cured in a Few Days 241

When he looked at a blank wall, or a blank white card,
the retinoscope still showed mixed astigmatism and he
still saw the specks. When, however, he remembered a
black spot as well as he could see it, when looking at
these surfaces, there were no specks, and the retino-
scope indicated no error of refraction. In a few days he
obtained complete relief from the astigmatism, the
muscae volitantes, and the headaches, as well as from
chronic conjunctivitis. His eyes, which had been partly-
closed, opened wide, and the sclera became white and
clear. He became able to read in moving trains with no
inconvenience, and — what impressed him more than any-
thing else — he also became able to sit up all night with
patients without having any trouble with his eyes next
day.

CHAPTER XXIV
HOME TREATMENT

IT is not always possible for patients to go to a com-
petent physician for relief. As the method of treat-
ing eye defects presented in this book is new, it may
be impossible to find a physician in the neighborhood
who understands it; and the patient may not be able to
afford the expense of a long journey, or to take the time
for treatment away from home. To such persons I wish
to say that it is possible for a large number of people to
be cured of defective eyesight without the aid, either of a
physician or of anyone else. They can cure themselves,
and for this purpose it is not necessary that they should
understand all that has been written in this book, or in
any other book. All that is necessary is to follow a few
simple directions.

Place a Snellen test card on the wall at a distance of
ten, fourteen, or twenty feet, and devote half a minute a
day, or longer, to reading the smallest letters you can
see, with each eye separately, covering the other with
the palm of the hand in such a way as to avoid touching
the eyeball. Keep a record of the progress made, with
the dates. The simplest way to do this is by the method
used by oculists, who record the vision in the form of a
fraction, with the distance at which the letter is read as
the numerator and the distance at which it ought to be
read as the denominator. The figures above, or to one
side of, the lines of letters on the test card indicate the
distance at which these letters should be read by persons
with normal eyesight. Thus a vision of 10/200 would

242

Children Quickly Cured 243

mean that the big C, which ought to be read at 200 feet,
cannot be seen at a greater distance than ten feet. A
vision of 20/10 would mean that the ten line, which the
normal eye is not ordinarily expected to read at a greater
distance than ten feet, is seen at double that distance.
This is a standard commonly attained by persons who
have practiced my methods.

Another and even better way to test the sight is to
compare the blackness of the letter at the near-point and
at the distance, in a dim light and in a good one. With
perfect sight, black is not altered by illumination or dis-
tance. It appears just as black at the distance as at the
near-point, and just as black in a dim light as in a good
one. If it does not appear equally black to you under all
these conditions, therefore, you may know that your
sight is imperfect.

Children under twelve years who have not worn
glasses are usually cured of defective eyesight by the
above method in three months, six months, or a year.
Adults who have never worn glasses are benefited in a
very short time — a week or two — and if the trouble is
not very bad, may be cured in the course of from three
to six months. Children or adults who have worn
glasses, however, are more difficult to relieve, and will
usually have to practice the method of gaining relaxa-
tion described in other chapters; they will also have to
devote considerable time to the treatment.

It is absolutely necessary that the glasses be dis-
carded. No half-way measures can be tolerated, if a cure
is desired. Do not attempt to wear weaker glasses, and
do not wear glasses for emergencies. Persons who are
unable to do without glasses for all purposes are not
likely to be able to cure themselves.

244 Home Treatment

Children and adults who have worn glasses will have
to devote an hour or longer every day to practice with
the test card and the balance of their time to practice on
other objects. It will be well for such patients to have
two test cards, one to be used at the near-point, where
it can be seen best, and the other at ten or twenty feet.
The patient will find it a great help to shift from the
near card to the distant one, as the unconscious memory
of the letters seen at the near-point helps to bring out
those seen at the distance.

If you cannot obtain a test card, you can make one for
yourself by painting black letters of appropriate size on a
white card, or on a piece of white paper. The approxi-
mate diameter of these letters, reading from the top of
the card to the bottom, is: 3% in., 1^4 in., 1% in-> 7/s in->
u/i6 in., y2 in., Ys in., % in., %6 in.

If the patient can secure the aid of some person with
normal sight, it will be a great advantage. In fact, per-
sons whose cases are obstinate will find it very difficult,
if not impossible, to cure themselves without the aid of
a teacher. The teacher, if he is to benefit the patient,
must himself be able to derive benefit from the various
methods recommended. If his vision is 10/10, he must
be able to improve it to 20/10, or more. If he can read
fine print at twelve inches, he must become able to read
it at six, or at three inches. He must also have sufficient
control over his visual memory to relieve and prevent
pain. A person who has defective sight, either for the
distance or the near-point, and who cannot remember
black well enough to relieve and prevent pain, will be
unable to be of any material assistance in obstinate cases ;
and no one will be able to be of any assistance in the
application of any method which he himself has not used
successfully.

The Duty of Parents 245

Parents who wish to preserve and improve the eye-
sight of their children should encourage them to read the
Snellen test card every day. There should, in fact, be a
Snellen test card in every family; for when properly
used it always prevents myopia and other errors of re-
fraction, always improves the vision, even when this is
already normal, and always benefits functional nervous
troubles. Parents should improve their own eyesight to
normal, so that their children may not imitate wrong
methods of using the eyes and will not be subject to the
influence of an atmosphere of strain. They should also
learn the principles of central fixation sufficiently well
to relieve and prevent pain, in order that they may teach
their children to do the same. This practice not only
makes it possible to avoid suffering, but is a great benefit
to the general health.

CHAPTER XXV
CORRESPONDENCE TREATMENT

CORRESPONDENCE treatment is usually re-
garded as quackery, and it would be manifestly
impossible to treat many diseases in this way.
Pneumonia and typhoid, for instance, could not possibly
be treated by correspondence, even if the physician had
a sure cure for these conditions and the mails were not
too slow for the purpose. In the case of most diseases,
in fact, there are serious objections to correspondence
treatment.

But myopia, hypermetropia and astigmatism are func-
tional conditions, not organic, as the text-books teach
and as I believed myself until I learned better. Their
treatment by correspondence, therefore, has not the
drawbacks that exist in the case of most physical de-
rangements. One cannot, it is true, fit glasses by cor-
respondence as well as when the patient is in the office,
but even this can be done, as the following case illus-
trates.

An old colored woman in the wilds of Honduras, far
removed from any physician or optician, was unable to
read her Bible, and her son, a waiter in New York, asked
me if I could not do something for her. The suggestion
gave me a distinct shock which I will remember as long
as I live. I had never dreamed of the possibility of pre-
scribing glasses for anyone I had not seen, and I had,
besides, some very disquieting recollections of colored
women whom I had tried to fit with glasses at my clinic.

246

Glasses Fitted by Mail 247

If I had so much difficulty in prescribing the proper
glasses under favorable conditions, how could I be ex-
pected to fit a patient whom I could not even see? The
waiter was deferentially persistent, however. He had
more faith in my genius than I had, and as his mother
was nearing the end of her life, he was very anxious to
gratify her last wishes. So, like the unjust judge of the
parable, I yielded at last to his importunity, and wrote
a prescription for convex 3.00 D. S. The young man
ordered the glasses and mailed them to his mother, and
by return mail came a very grateful letter stating that
they were perfectly satisfactory.

A little later the patient wrote that she couldn't see
objects at the distance that were perfectly plain to other
people, and asked if some glasses couldn't be sent that
would make her see at the distance as well as she did at
the near-point. This seemed a more difficult proposition
than the first one; but again the son was persistent, and
I myself could not get the old lady out of my mind. So
again I decided to do what I could. The waiter had told
me that his mother had read her Bible long after the age
of forty. Therefore I knew she could not have much
hypermetropia, and was probably slightly myopic. I
knew also that she could not have much astigmatism,
for in that case her sight would always have been no-
ticeably imperfect. Accordingly I told her son to ask
her to measure very accurately the distance between
her eyes and the point at which she could read her
Bible best with her glasses, and to send me the figures.
In due time I received, not figures, but a piece of string
about a quarter of an inch in diameter and exactly ten
inches long. If the patient's vision had been normal
for the distance, I knew that she would have been

248 Correspondence Treatment

able to read her Bible best with her glasses at thirteen
inches. The string showed that at ten inches she had a
refraction of four diopters. Subtracting from this the
three diopters of her reading glasses, I got one diopter
of myopia. I accordingly wrote a prescription for con-
cave 1.00 D. S., and the glasses were ordered and mailed
to Honduras. The acknowledgment was even more
grateful than in the case of the first pair. The patient
said that for the first time in her life she was able to
read signs and see other objects at a distance as well as
other people did, and that the whole world looked en-
tirely different to her.

Would anyone venture to say that it was unethical
for me to try to help this patient? Would it have been
better to leave her in her isolation without even the
consolation of Bible reading? I do not think so. What
I did for her required only an ordinary knowledge of
physiological optics, and if I had failed, I could not
have done her much harm.

In the case of the treatment of imperfect sight with-
out glasses there can be even less objection to the cor-
respondence method. It is true that in most cases prog-
ress is more rapid and the results more certain when
the patient can be seen personally; but often this is
impossible, and I see no reason why patients who can-
not have the benefit of personal treatment should be
denied such aid as can be given them by correspond-
ence. I have been treating patients in this way for
years, and often with extraordinary success.

Some years ago an English gentleman wrote to me
that his glasses were very unsatisfactory. They not only
did not give him good sight, but they increased, instead
of lessening, his discomfort. He asked if I could help

Was It Unethical? 249

him, and since relaxation always relieves discomfort and
improves the vision, I did not believe that I was doing
him an injury in telling him how to rest his eyes. He
followed my directions with such good results that in a
short time he obtained perfect sight for both the distance
and the near-point without glasses, and was completely
relieved of his pain. Five years later he wrote me that
he had qualified as a sharpshooter in the army. Did I
do wrong in treating him by correspondence? I do not
think so.

After the United States entered the European war, an
officer wrote to me from the deserts of Arizona that the
use of his eyes at the near-point caused him great dis-
comfort, which glasses did not relieve, and that the
strain had produced granulation of the lids. As it was
impossible for him to come to New York, I undertook
to treat him by correspondence. He improved very rap-
idly. The inflammation of the lids was relieved almost
immediately, and in about four months he wrote me that
he had read one of my own reprints — by no means a
short one — in a dim light, with no bad after effects;
that the glare of the Arizona sun, with the Government
thermometer registering 114, did not annoy him; and
that he could read the ten line on the test card at fifteen
feet almost perfectly, while even at twenty feet he was
able to make out most of the letters.

A third case was that of a forester in the employ of
the U. S. Government. He had myopic astigmatism,
and suffered extreme discomfort, which was not re-
lieved either by glasses or by long summers in the
mountains, where he used his eyes but little for close
work. He was unable to come to New York for treat-
ment, and although I told him that correspondence treat-

250 Correspondence Treatment

ment was somewhat uncertain, he said he was willing
to risk it. It took three days for his letters to reach me
and another three for my reply to reach him, and as
letters were not always written promptly on either side,
he often did not hear from me more than once in three
weeks. Progress under these conditions was necessarily
slow; but his discomfort was relieved very quickly, and
in about ten months his sight had improved from 20/50
to 20/20.

In almost every case the treatment of patients coming
from a distance is continued by correspondence after
they return to their homes; and although they do not
get on so well as when they are coming to the office,
they usually continue to make progress until they are
cured.

At the same time it is often very difficult to make
patients understand what they should do when one has
to communicate with them entirely by writing, and prob-
ably all would get on better if they could have some
personal treatment. At the present time the number of
doctors in different parts of the United States who un-
derstand the treatment of imperfect sight without glasses
is altogether too few, and my efforts to interest them
in the matter have not been very successful.

CHAPTER XXVI

THE PREVENTION OF MYOPIA IN SCHOOLS:
METHODS THAT FAILED

NO phase of ophthalmology, not even the problem
of accommodation, has been the subject of so
much investigation and discussion as the cause
and prevention of myopia. Since hypermetropia was
supposed to be due to a congenital deformation of the
eyeball, and astigmatism, until recently, was also sup-
posed to be congenital in most cases, these conditions
were not thought to call for any explanation, nor to
admit of any prevention; but myopia appeared to be
acquired. It therefore presented a problem of immense
practical importance to which many eminent men de-
voted years of labor.

Voluminous statistics were collected regarding its oc-
currence, and are still being collected. The subject has
produced libraries of literature. But very little light is
to be gained from the perusal of this material, and for
the most part it leaves the reader with an impression of
hopeless confusion. It is impossible even to arrive at
any conclusion as to the prevalence of the complaint;
for not only has there been no uniformity of standards
and methods, but none of the investigators has taken
into account the fact that the refraction of the eye is
not a constant condition, but one which continually
varies. There is no doubt, however, that most children,
when they begin school, are free from this defect,
and that both the number of cases and the degree of
the myopia steadily increase as the educational pro-
cess progresses. Professor Hermann Cohn, of Breslau,

251

252 Prevention of Myopia

whose report of his study of the eyes of upwards of
10,000 children first called general attention to this sub-
ject, found scarcely one per cent of myopia in the village
schools, twenty to forty per cent in the "Realschulen,"
thirty to thirty-five in the gymnasia, and fifty-three to
sixty-four in the professional schools. His investigations
were repeated in many cities of Europe and America,
and his observations, with some difference in percent-
ages, everywhere confirmed.

These conditions were unanimously attributed to the
excessive use of the eyes for near work, though, accord-
ing to the theory that the lens is the agent of accommo-
dation, it was a little difficult to see just why near work
should have this effect. On the supposition that accom-
modation was effected by an elongation of the eyeball,
it would have been easy to understand why an excessive
amount of accommodation should produce a permanent
elongation. But why should an abnormal demand on
the accommodative power of the lens produce a change,
not in the shape of that body, but in that of the eyeball?
Numerous answers to this question have been proposed,
but no one has yet succeeded in finding a satisfactory
one.1 In the case of children it has been assumed by
many authorities that, since the coats of the eye are
softer in youth than in later years, they are unable to
withstand a supposed intraocular tension produced by
near work. When other errors of refraction, such as
hypermetropia and astigmatism, believed to be congen-
ital, were present, it has been supposed that the accom-
modative struggle for distinct vision produced irritation
and strain which encouraged the production of short-

1 A satisfactory explanation of the mechanism by which near work produces
myopia has not yet been given. — Tscherning: Physiologic Optics, p. 86.

It is not yet determined how near work changes the longitudinal structure
of the eye.— Eversbusch : The Diseases of Children, vol. vi, p. 291.

Myopia and the Educational Process 253

sight. When the condition developed in adults, the ex-
planations had to be modified to fit the case, and the
fact that a considerable number of cases were observed
among peasants and others who did not use their eyes
for near work led some authorities to divide the anomaly
into two classes, one caused by near work and one un-
related to it, the latter being conveniently attributed to
hereditary tendencies.

As it was impossible to abandon the educational sys-
tem, attempts were made to minimize the supposed evil
effects of the reading, writing and other near work which
it demanded. Careful and detailed rules were laid down
by various authorities as to the sizes of type to be used
in schoolbooks, the length of the lines, their distance
apart, the distance at which the book should be held, the
amount and arrangement of the light, the construction
of the desks, the length of time the eyes might be used
without a change of focus, etc. Face-rests were even
devised to hold the eyes at the prescribed distance from
the desk and to prevent stooping, which was supposed
to cause congestion of the eyeball and thus to encourage
elongation. The Germans, with characteristic thorough-
ness, actually used these instruments of torture, Cohn
never allowing his own children to write without one,
"even when sitting at the best possible desk."1

The results of these preventive measures were disap-
pointing. Some observers reported a slight decrease in
the percentage of myopia in schools in which the pre-
scribed reforms had been made, but on the whole, as
Risley has observed in his discussion of the subject in
Norris and Oliver's "System of Diseases of the Eye,"
"the injurious results of the educational process were not
notably arrested."

1 The Hygiene of the Eye in Schools, p. 127.

254

Prevention of Myopia

"It is a significant, though discouraging, fact," he con-
tinues, "that the increase, as found by Cohn, both in the
percentage and in the degree of myopia, had taken place
in those schools where he had especially exerted himself
to secure the introduction of hygienic reforms; and the

Fig. 56. Face-Rest Designed by Kallmann, a German
Optician

Cohn never allowed his children to write without it, even when
sitting at the best possible desk.

same is true of the observations of Just, who had exam-
ined the eyes of twelve hundred and twenty-nine of the
pupils of the two high schools of Zittau, in both of which
the hygienic conditions were all that could be desired.
He found, nevertheless, that the excellent arrangements
had not in any degree lessened the percentage of increase
in myopia."1

1 School Hygiene, System of Diseases of the Eye, vol. ii, p. 361.

The Theory Breaks Down 255

Further study of the subject has only added to its dif-
ficulty, while at the same time it has tended to relieve the
schools of much of the responsibility formerly attributed
to them for the production of myopia. As the "American
Encyclopedia of Ophthalmology" points out, "the theory
that myopia is due to close work aggravated by town
life and badly lighted rooms is gradually giving ground
before statistics."1

In an investigation in London, for instance, in which
the schools were carefully selected to reveal any differ-
ences that might arise from the various influences, hy-
gienic, social and racial, to which the children were sub-
jected, the proportion of myopia in the best lighted
building of the group was actually found to be higher
than in the one where the lighting conditions were worst,
although the higher degrees of myopia were more nu-
merous in the latter than in the former. It has also been
found that there is just as much myopia in schools where
little near work is done as in those in which the demand
upon the accommodative power of the eye is greater.2
It is only a minority of children, moreover, that become
myopic ; yet all are subject to practically the same influ-
ences, and even in the same child one eye may become
myopic while the other remains normal. On the theory
that shortsight results from any external influence to
which the eye is exposed, it is impossible to account for
the fact that under the same conditions of life the eyes
of different individuals and the two eyes of the same
individual behave differently.

Owing to the difficulty of reconciling these facts on
the basis of the earlier theories, there is now a growing

1 American Encyclopedia and Dictionary of Ophthalmology, edited by
Wood, 1913-1919, vol. xi, p. 8271.
2Lawson: Brit. Med. Jour., June 18, 1898.

256 Prevention of Myopia

disposition to attribute myopia to hereditary tenden-
cies;1 but no satisfactory evidence on this point has
been brought forward, and the fact that primitive peo-
ples who have always had good eyesight become myopic
just as quickly as any others when subjected to the con-
ditions of civilized life, like the Indian pupils at Car-
lisle,2 seems to be conclusive evidence against it.

In spite of the repeated failure of preventive measures
based upon the limitation of near work and the regula-
tion of lighting, desks, types, etc., the use of the eyes at
the near-point under unfavorable conditions is still ad-
mitted by most exponents of the heredity theory as
probably, if not certainly, a secondary cause of myopia.
Sidler-Huguenin, however, whose startling conclusions
as to the hopelessness of controlling shortsight were
quoted earlier, has observed so little benefit from such
precautions that he believes a myope may become an
engineer just as well as a farmer, or a forester ; and as
a result of his experiences with anisometropes, persons
with an inequality of refraction between the two organs
of vision, he even suggests that the use of myopic eyes
may possibly be more favorable to their well-being than
their non-use. In 150 cases in which, owing to this in-
equality and other conditions, the subjects practically
used but one eye, the weaker organ, he reports, became
gradually more and more myopic, sometimes excessively
so, in open defiance of all the accepted theories relating
to the matter.

The prevalence of myopia, the unsatisfactoriness of

1 It seems to have been amply demonstrated, by the studies of Motais,
Steiger, Miss Barrington, and Karl Pearson, that errors of refraction are
inherited. And while the use of the eyes for near work is probably a sec-
ondary cause, determining largely the development of the defect, it is not
the primary cause. — Cyclopedia of Education, edited by Monroe, 1911-1913,
vol. iv, p. 361.

2 Fox (quoted by Risley) : System of Diseases of the Eye, vol. ii, p. 357.

Preventive Measures Have Failed 257

all explanations of its origin, and the futility of all
methods of prevention, have led some writers of repute
to the conclusion that the elongated eyeball is a natural
physiological adaptation to the needs of civilization.
Against this view two unanswerable arguments can
be brought. One is that the myopic eye does not see so
well even at the near-point as the normal eye, and the
other that the defect tends to progression with very seri-
ous results, often ending in blindness. If Nature has
attempted to adapt the eye to civilized conditions by an
elongation of the globe, she has done it in a very clumsy
manner. It is true that many authorities assume the
existence of two kinds of myopia, one physiological, or
at least harmless, and the other pathological; but since
it is impossible to say with certainty whether a given
case is going to progress or not, this distinction, even
if it were correct, would be more important theoretically
than practically.

Into such a slough of despair and contradiction have
the misdirected labors of a hundred years led us ! But
in the light of truth the problem turns out to be a very
simple one. In view of the facts given in Chapters V
and IX, it is easy to understand why all previous at-
tempts to prevent myopia have failed. All these attempts
have aimed at lessening the strain of near work upon the
eye, leaving the strain to see distant objects unaffected,
and totally ignoring the mental strain which underlies
the optical one. There are many differences between
the conditions to which the children of primitive man
were subjected, and those under which the offspring of
civilized races spend their developing years, besides the
mere fact that the latter learn things out of books and
write things on paper, and the former did not. In the

258 Prevention of Myopia

process of education, civilized children are shut up for
hours every day within four walls, in the charge of
teachers who are too often nervous and irritable. They
are even compelled to remain for long periods in the
same position. The things they are required to learn
may be presented in such a way as to be excessively
uninteresting; and they are under a continual compul-
sion to think of the gaining of marks and prizes rather
than the acquisition of knowledge for its own sake. Some
children endure these unnatural conditions better than
others. Many cannot stand the strain, and thus the
schools become the hotbed, not only of myopia, but of
all other errors of refraction.

CHAPTER XXVII

THE PREVENTION AND CURE OF MYOPIA AND

OTHER ERRORS OF REFRACTION IN SCHOOLS:

A METHOD THAT SUCCEEDED

YOU cannot see anything with perfect sight unless
you have seen it before. When the eye looks at
an unfamiliar object it always strains more or less
to see that object, and an error of refraction is always
produced. When children look at unfamiliar writing or
figures on the blackboard, distant maps, diagrams, or
pictures, the retinoscope always shows that they are
myopic, though their vision may be under other circum-
stances absolutely normal. The same thing happens
when adults look at unfamiliar distant objects. When
the eye regards a familiar object, however, the effect is
quite otherwise. Not only can it be regarded without
strain, but the strain of looking later at unfamiliar ob-
jects is lessened.

This fact furnishes us with a means of overcoming the
mental strain to which children are subjected by the
modern educational system. It is impossible to see any-
thing perfectly when the mind is under a strain, and if
children become able to relax when looking at familiar
objects, they become able, sometimes in an incredibly
brief space of time, to maintain their relaxation when
looking at unfamiliar objects.

I discovered this fact while examining the eyes of
1,500 school children at Grand Forks, N. D., in 1903.1 In

1 Bates: The Prevention of Myopia in School Children, N. Y. Med. Jour..
July 29, 1911.

259

260 Prevention of Myopia

many cases, children who could not read all of the letters
on the Snellen test card at the first test read them at the
second or third test. After a class had been examined
the children who had failed would sometimes ask for a
second or third test. After a class had been examined,
read the whole card with perfect vision. So frequent
were these occurrences that there was no escaping the
conclusion that in some way the vision was improved
by reading the Snellen test card. In one class I found a
boy who at first appeared to be very myopic, but who,
after a little encouragement, read all the letters on the
test card. The teacher asked me about this boy's vision,
because she had found him to be very "nearsighted."
When I said that his vision was normal she was incred-
ulous, and suggested that he might have learned the
letters by heart, or been prompted by another pupil. He
was unable to read the writing or figures on the black-
board, she said, or to see the maps, charts and diagrams
on the walls, and did not recognize people across the
street. She asked me to test his sight again, which I did,
very carefully, under her supervision, the sources of
error which she had suggested being eliminated. Again
the boy read all the letters on the card. Then the teacher
tested his sight. She wrote some words and figures on
the blackboard, and asked him to read them. He did so
correctly. Then she wrote additional words and figures,
which he read equally well. Finally she asked him to
tell the hour by the clock, twenty-five feet distant, which
he did correctly. It was a dramatic situation, both the
teacher and the children being intensely interested.
Three other cases in the class were similar, their vision,
which had previously been very defective for distant
objects, becoming normal in the few moments devoted

No More Defective Eyesight 261

to testing their eyes. It is not surprising that after such
a demonstration the teacher asked to have a Snellen test
card placed permanently in the room. The children were
directed to read the smallest letters they could see from
their seats at least once every day, with both eyes to-
gether and with each eye separately, the other being cov-
ered with the palm of the hand in such a way as to avoid
pressure on the eyeball. Those whose vision was defec-
tive were encouraged to read it more frequently, and, in
fact, needed no encouragement to do so after they found
that the practice helped them to see the blackboard, and
stopped the headaches, or other discomfort, previously
resulting from the use of their eyes.

In another class of forty children, between six and
eight, thirty of the pupils gained normal vision while
their eyes were being tested. The remainder were cured
later under the supervision of the teacher by exercises
in distant vision with the Snellen card. This teacher had
noted every year for fifteen years that at the opening of
the school in the fall all the children could see the writing
on the blackboard from their seats, but before school
closed the following spring all of them without ex-
ception complained that they could not see it at a distance
of more than ten feet. After learning of the benefits to
be derived from the daily practice of distant vision with
familiar objects as the points of fixation, this teacher kept
a Snellen test card continually in her classroom and di-
rected the children to read it every day. The result was
that for eight years no more of the children under her
care acquired defective eyesight.

This teacher had attributed the invariable deterioration
in the eyesight of her charges during the school year to
the fact that her classroom was in the basement and the

262 Prevention of Myopia

light poor. But teachers with well-lighted classrooms
had the same experience, and after the Snellen test card
was introduced into both the well-lighted and the poorly
lighted rooms, and the children read it every day, the de-
terioration of their eyesight not only ceased, but the vi-
sion of all improved. Vision which had been below
normal improved, in most cases, to normal, while children
who already had normal sight, usually reckoned at 20/20,
became able to read 20/15, or 20/10. And not only was
myopia cured, but the vision for near objects was im-
proved.

At the request of the superintendent of the schools of
Grand Forks, Mr. J. Nelson Kelly, the system was intro-
duced into all the schools of the city and was used con-
tinuously for eight years, during which time it reduced
myopia among the children, which I found at the begin-
ning to be about six per cent, to less than one per cent.

In 1911 and 1912 the same system was introduced into
some of the schools of New York City,1 with an attend-
ance of about ten thousand children. Many of the teach-
ers neglected to use the cards, being unable to believe
that such a simple method, and one so entirely at vari-
ance with previous teaching on the subject, could ac-
complish the desired results. Others kept the cards in a
closet except when they were needed for the daily eye
drill, lest the children should memorize them. Thus they
not only put an unnecessary burden upon themselves, but
did what they could to defeat the purpose of the system,
which is to give the children daily exercise in distant vi-
sion with a familiar object as the point of fixation. A
considerable number, however, used the system intel-
ligently and persistently, and in less than a year were

1 Bates: Myopia Prevention by Teachers, N. Y. Med. Jour., Aug. 30, 1913.

Eyesight and Mentality Improved 263

able to present reports showing that of three thousand
children with imperfect sight, over one thousand had ob-
tained normal vision by its means. Some of these chil-
dren, as in the case of the children of Grand Forks, were
cured in a few minutes. Many of the teachers were also
cured, some of them very quickly. In some cases the
results of the system were so astonishing as to be scarcely
credible.

In a class of mental defectives, where the teacher had
kept records of the eyesight of the children for several
years, it had been invariably found that their vision grew
steadily worse as the term advanced. As soon as the
Snellen test card had been introduced, however, they be-
gan to improve. Then came a doctor from the Board of
Health who tested the eyes of the children and put
glasses on all of them, even those whose sight was fairly
good. The use of the card was then discontinued, as the
teacher did not consider it proper to interfere while the
children were wearing glasses prescribed by a physician.
Very soon, however, the children began to lose, break, or
discard their glasses. Some said that the spectacles gave
them headaches, or that they felt better without them.
In the course of a month or so most of the aids to vision
which the Board of Health had supplied had disappeared.
The teacher then felt herself at liberty to resume the use
of the Snellen test card. Its benefits were immediate.
The eyesight and the mentality of the children improved
simultaneously, and soon they were all drafted into the
regular classes, because it was found that they were mak-
ing the same progress in their studies as the other chil-
dren were.

Another teacher reported an equally interesting ex-
perience. She had a class of children who did not fit into

264 Prevention of Myopia

the other grades. Many of them were backward in their
studies. Some were persistent truants. All of them had
defective eyesight. A Snellen test card was hung in the
classroom where all the children could see it, and the
teacher carried out my instructions literally. At the end
of six months all but two had been cured, and these had
improved very much, while the worst incorrigible and the
worst truant had become good students. The incorrigi-
ble, who had previously refused to study, because, he
said, it gave him a headache to look at a book, or at the
blackboard, found out that the test card, in some way,
did him a lot of good ; and although the teacher had asked
him to read it but once a day, he read it whenever he felt
uncomfortable. The result was that in a few weeks his
vision had become normal and his objection to study had
disappeared. The truant had been in the habit of re-
maining away from school two or three days every week,
and neither his parents nor the truant officer had been
able to do anything about it. To the great surprise of
his teacher he never missed a day after having begun to
read the Snellen test card. When she asked for an ex-
planation, he told her that what had driven him away
from school was the pain that came in his eyes whenever
he tried to study, or to read the writing on the black-
board. After reading the Snellen test card, he said, his
eyes and head were rested and he was able to read with-
out any discomfort.

To remove any doubts that might arise as to the cause
of the improvement noted in the eyesight of the children,
comparative tests were made with and without cards. In
one case six pupils with defective sight were examined
daily for one week without the use of the test card. No
improvement took place. The card was then restored
to its place, and the group was instructed to read it every

Must Have Prevented Myopia 265

day. At the end of a week all had improved and five were
cured. In the case of another group of defectives the re-
sults were similar. During the week that the card was
not used, no improvement was noted ; but after a week of
exercises in distant vision with the card all showed
marked improvement, and at the end of a month all were
cured. In order that there might be no question as to the
reliability of the records of the teachers, some of the prin-
cipals asked the Board of Health to send an inspector to
test the vision of the pupils, and whenever this was done
the records were found to be correct.

One day I visited the city of Rochester, and while there
I called on the Superintendent of Public Schools and
told him about my method of preventing myopia. He
was very much interested and invited me to introduce
it in one of his schools. I did so, and at the end of three
months a report was sent to me showing that the vision
of all the children had improved, while quite a number
of them had obtained normal vision in both eyes.

The method has been used in a number of other cities
and always with the same result. The vision of all the
children improved, and many of them obtained normal
vision in the course of a few minutes, days, weeks, or
months.

It is difficult to prove a negative proposition, but since
this system improved the vision of all the children who
used it, it follows that none could have grown worse. It
is therefore obvious that it must have prevented myopia.
This cannot be said of any method of preventing myopia
in schools which had previously been tried. All other
methods are based on the idea that it is the excessive use
of the eyes for near work that causes myopia, and all of
them have admittedly failed.

It is also obvious that the method must have prevented

266 Prevention of Myopia

other errors of refraction, a problem which previously
had not even been seriously considered, because hyper-
metropia is supposed to be congenital, and astigmatism
was until recently supposed also to be congenital in the
great majority of cases. Anyone who knows how to use
a retinoscope may, however, demonstrate in a few min-
utes that both of these conditions are acquired; for no
matter how astigmatic or hypermetropic an eye may be,
its vision always becomes normal when it looks at a
blank surface without trying to see. It may also be dem-
onstrated that when children are learning to read, write,
draw, sew, or to do anything else that necessitates their
looking at unfamiliar objects at the near-point, hyperme-
tropia, or hypermetropic astigmatism, is always pro-
duced. The same is true of adults. These facts have not
been reported before, so far as I am aware, and they
strongly suggest that children need, first of all, eye edu-
cation. They must be able to look at strange letters or
objects at the near-point without strain before they can
make much progress in their studies, and in every case
in which the method has been tried it has been proven
that this end is attained by daily exercise in distant
vision with the Snellen test card. When their distant
vision has been improved by this means, children invari-
ably become able to use their eyes without strain at the
near-point.

The method succeeded best when the teacher did not
wear glasses. In fact, the effect upon the children of a
teacher who wears glasses is so detrimental that no such
person should be allowed to be a teacher, and since er-
rors of refraction are curable, such a ruling would work
no hardship on anyone. Not only do children imitate the
visual habits of a teacher who wears glasses, but the

Why Should Our Children Suffer? 267

nervous strain of which the defective sight is an expres-
sion produces in them a similar condition. In classes of
the same grade, with the same lighting, the sight of
children whose teachers did not wear glasses has always
been found to be better than the sight of children whose
teachers did wear them. In one case I tested the sight of
children whose teacher wore glasses, and found it very
imperfect. The teacher went out of the room on an er-
rand, and after she had gone I tested them again. The
results were very much better. When the teacher re-
turned she asked about the sight of a particular boy, a
very nervous child, and as I was proceeding to test him
she stood before him and said, "Now, when the doctor
tells you to read the card, do it." The boy couldn't see
anything. Then she went behind him, and the effect was
the same as if she had left the room. The boy read the
whole card.

Still better results would be obtained if we could reor-
ganize the educational system on a rational basis. Then
we might expect a general return of that primitive acuity
of vision which we marvel at so greatly when we read
about it in the memoirs of travellers. But even under
existing conditions it has proven beyond the shadow
of a doubt that errors of refraction are no necessary part
of the price we must pay for education.

There are at least ten million children in the schools of
the United States who have defective sight. This condi-
tion prevents them from taking full advantage of the ed-
ucational opportunities which the State provides. It un-
dermines their health and wastes the taxpayers' money.
If allowed to continue, it will be an expense and a handi-
cap to them throughout their lives. In many cases it
will be a source of continual misery and suffering. And

268 Prevention of Myopia

yet practically all of these cases could be cured and the
development of new ones prevented by the daily read-
ing of the Snellen test card.

Why should our children be compelled to suffer and
wear glasses for want of this simple measure of relief?
It costs practically nothing. In fact, it would not be neces-
sary, in some cases, as in the schools of New York City,
even to purchase the Snellen test cards, as they are al-
ready being used to test the eyes of the children. Not
only does it place practically no additional burden upon
the teachers, but, by improving the eyesight, health, dis-
position and mentality of their pupils, it greatly lightens
their labors. No one would venture to suggest, further,
that it could possibly do any harm. Why, then, should
there be any delay about introducing it into the schools?
If there is still thought to be need for further investiga-
tion and discussion, we can investigate and discuss just
as well after the children get the cards as before, and by
adopting that course we shall not run the risk of need-
lessly condemning another generation to that curse which
heretofore has always dogged the footsteps of civiliza-
tion, namely, defective eyesight. I appeal to all who read
these lines to use whatever influence they possess toward
the attainment of this end.

DIRECTIONS

FOR USING THE SNELLEN TEST CARD FOR THE

PREVENTION AND CURE OF IMPERFECT

SIGHT IN SCHOOLS

The Snellen Test Card is placed permanently upon
the wall of the classroom, and every day the children
silently read the smallest letters they can see from their
seats with each eye separately, the other being covered

How to Use the Card 269

with the palm of the hand in such a way as to avoid
pressure on the eyeball. This takes no appreciable
amount of time and is sufficient to improve the sight
of all children in one week and to cure all errors of re-
fraction after some months, a year, or longer.

Children with markedly defective vision should be en-
couraged to read the card more frequently. Children
wearing glasses should not be interfered with, as they
are supposed to be under the care of a physician, and
the practice will do them little or no good while the
glasses are worn.

While not essential, it is a great advantage to have
records made of the vision of each pupil at the time
when the method is introduced, and thereafter at con-
venient intervals — annually or more frequently. This
may be done by the teacher.

The records should include the name and age of the
pupils, the vision of each eye tested at twenty feet, and
the date. For example:

John Smith, 10, Sept. 15, 1919

R. V. (vision of the right eye) 20/40
L. V. (vision of the left eye) 20/20

John Smith, 11, January 1, 1920
R. V. 20/30
L. V. 20/15

A certain amount of supervision is absolutely neces-
sary. At least once a year some one who understands
the method should visit each classroom for the purpose
of answering questions, encouraging the teachers to con-
tinue the use of the method, and making some kind of
a report to the proper authorities. It is not necessary
that either the supervisor, the teachers, or the children
should understand anything about the physiology of the
eye.

CHAPTER XXVIII
THE STORY OF EMILY

THE efficacy of the method of treating imperfect
sight without glasses presented in this book has
been demonstrated in thousand of cases, not
only in my own practice but in that of many persons
of whom I may not even have heard; for almost all
patients, when they are cured, proceed to cure others.
At a social gathering one evening a lady told me that
she had met a number of my patients; but when she
mentioned their names I found that I did not remember
any of them and said so.

"That is because you cured them by proxy," she said.
"You didn't directly cure Mrs. Jones or Mrs. Brown,
but you cured Mrs. Smith, and Mrs. Smith cured the
other ladies. You didn't treat Mr. and Mrs. Simpkins, or
Mr. Simpkins' mother and brother, but you may remem-
ber that you cured Mr. Simpkins' boy of a squint, and he
cured the rest of the family."

In schools where the Snellen test card was used to
prevent and cure imperfect sight, the children, after they
were cured themselves, often took to the practice of
ophthalmology with the greatest enthusiasm and success,
curing their fellow students, their parents and their
friends. They made a kind of game of the treatment, and
the progress of each school case was watched with the
most intense interest by all the children. On a bright
day, when the patients saw well, there was great re-
joicing, and on a dark day there was corresponding de-
pression. One girl cured twenty-six children in six
months; another cured twelve in three months; a third

270

Apparent Blindness Cured 271

developed quite a varied ophthalmological practice, and
did things of which older and more experienced practi-
tioners might well have been proud. Going to the school
which she attended one day, I asked this girl about her
sight, which had been very imperfect. She replied that
it was now very good and that her headaches were quite
gone. I tested her sight and found it normal. Then an-
other child whose sight had also been very poor spoke up.

"I can see all right, too," she said. "Emily" — indicat-
ing girl No. 1 — "cured me."

"Indeed P I replied. "How did she do that?"

The second girl explained that Emily had had her read
the card, which she could not see at all from the back of
the room, at a distance of a few feet. The next day she
had moved it a little farther away, and so on, until the
patient was able to read it from the back of the room,
just as the other children did. Emily now told her to
cover the right eye and read the card with her left, and
both girls were considerably upset to find that the un-
covered eye was apparently blind. The school doctor
was consulted and said that nothing could be done. The
eye had been blind from birth and no treatment would
do any good.

Nothing daunted, however, Emily undertook the treat-
ment. She told the patient to cover her good eye and go
up close to the card, and at a distance of a foot or less it
was found that she could read even the small letters.
The little practitioner then proceeded confidently as with
the other eye, and after many months of practice the
patient became the happy possessor of normal vision in
both eyes. The case had, in fact, been simply one of high
myopia, and the school doctor, not being a specialist,
had not detected the difference between this condition
and blindness.

272 The Story of Emily

In the same classroom there had been a little girl with
congenital cataract, but on the occasion of my visit the
defect had disappeared. This, too, it appeared, was
Emily's doing. The school doctor had said that there
was no help for this eye except through operation, and
as the sight of the other eye was pretty good, he for-
tunately did not think it necessary to urge such a course.
Emily accordingly took the matter in hand. She had the
patient stand close to the card, where, with the good eye
covered, she was unable to see even the big C. Emily
now held the card between the patient and the light, and
moved it back and forth. At a distance of three or four
feet this movement could be observed indistinctly by the
patient. The card was then moved farther away, until
the patient became able to see it move at ten feet and to
see some of the larger letters indistinctly at a less dis-
tance. Finally, after six months, she became able to read
the card with the bad eye as well as with the good one.
After testing her sight and finding it normal in both
eyes, I said to Emily:

"You are a splendid doctor. You beat them all. Have
you done anything else?"

The child blushed, and turning to another of her class-
mates, said :

"Mamie, come here."

Mamie stepped forward and I looked at her eyes. There
appeared to be nothing wrong with them.

"I cured her," said Emily.

"What of?" I inquired.

"Cross eyes," replied Emily.

"How?" I asked, with growing astonishment.

Emily described a procedure very similar to that
adopted in the other cases. Finding that the sight of the
crossed eye was very poor, so much so, indeed, that poor

An Astonishing Record 273

Mamie could see practically nothing with it, the obvious
course of action seemed to her to be the restoration of its
sight; and, never having read any medical literature,
she did not know that this was impossible. So she went
to it. She had Mamie cover her good eye and practice
the bad one at home and at school, until at last the sight
became normal and the eye straight. The school doctor
had wanted to have the eye operated upon, I was told,
but, fortunately, Mamie was "scared" and would not
consent. And here she was with two perfectly good,
straight eyes.

"Anything else?" I inquired, when Mamie's case had
been disposed of. Emily blushed again, and said:

"Here's Rose. Her eyes used to hurt her all the time,
and she couldn't see anything on the blackboard. Her
headaches used to be so bad that she had to stay away
from school every once in a while. The doctor gave her
glasses, but they didn't help her and she wouldn't wear
them. When you told us the card would help our eyes
I got busy with her. I had her read the card close up,
and then I moved it farther away, and now she can see
all right and her head doesn't ache any more. She comes
to school every day, and we all thank you very much."

This was a case of compound hypermetropic astig-
matism.

Such stories might be multiplied indefinitely. Emily's
astonishing record might not possibly be duplicated, but
lesser cures by cured patients have been very numerous,
and serve to show that the benefits of the method of pre-
venting and curing defects of vision in the schools which
is presented in the foregoing chapter would be far-
reaching. Not only errors of refraction would be cured,
but many more serious defects; and not only the chil-
dren would be helped, but their families and friends also.

CHAPTER XXIX
MIND AND VISION

POOR sight is admitted to be one of the most fruit-
ful causes of retardation in the schools. It is esti-
mated1 that it may reasonably be held responsible
for a quarter of the habitually "left-backs," and it is
commonly assumed that all this might be prevented by
suitable glasses.

There is much more involved in defective vision, how-
ever, than mere inability to see the blackboard or to use
the eyes without pain or discomfort. Defective vision is
the result of an abnormal condition of the mind, and
when the mind is in an abnormal condition it is obvious
that none of the processes of education can be conducted
with advantage. By putting glasses upon a child we
may, in some cases, neutralize the effect of this condi-
tion upon the eyes, and by making the patient more
comfortable may improve his mental faculties to some
extent; but we do not alter fundamentally the condition
of the mind, and by confirming it in a bad habit we may
make it worse.

It can easily be demonstrated that among the facul-
ties of the mind which are impaired when the vision is
impaired is the memory; and as a large part of the edu-
cational process consists of storing the mind with facts,
and all the other mental processes depend upon one's

1 School Health News, published by the Department of Health of New
York City, February, 1919.

274

Memory in Relation to Vision 275

knowledge of facts, it is easy to see how little is accom-
plished by merely putting glasses on a child that has
"trouble with its eyes." The extraordinary memory of
primitive people has been attributed to the fact that
owing to the absence of any convenient means of mak-
ing written records they had to depend upon their mem-
ories, which were strengthened accordingly; but in view
of the known facts about the relation of memory to eye-
sight it is more reasonable to suppose that the retentive
memory of primitive man was due to the same cause as
his keen vision, namely, a mind at rest.

The primitive memory, as well as primitive keenness
of vision, has been found among civilized people; and if
the necessary tests had been made it would doubtless
have been found that they always occur together, as they
did in a case which recently came under my observation.
The subject was a child of ten with such marvelous eye-
sight that she could see the moons of Jupiter with the
naked eye a fact which was demonstrated by her draw-
ing a diagram of these satellites which exactly corre-
sponded to the diagrams made by persons who had used
a telescope. Her memory was equally remarkable. She
could recite the whole content of a book after reading it,
as Lord Macaulay is said to have done, and she learned
more Latin in a few days without a teacher than her
sister, who had six diopters of myopia, had been able
to do in several years. She remembered five years after-
ward what she ate at a restaurant, she called the name
of the waiter, the number of the building and the street
in which it stood. She also remembered what she wore
on this occasion and what every one else in the party
wore. The same was true of every other event which
had awakened her interest in any way, and it was a

276 Mind and Vision

favorite amusement in her family to ask her what the
menu had been and what people had worn on particular
occasions.

When the sight of two persons is different it has been
found that their memories differ in exactly the same
degree. Two sisters, one of whom had only ordinary
good vision, indicated by the formula 20/20, while the
other had 20/10, found that the time it took them to learn
eight verses of a poem varied in almost exactly the same
ratio as their sight. The one whose vision was 20/10
learned eight verses of the poem in fifteen minutes, while
the one whose vision was only 20/20 required thirty-one
minutes to do the same thing. After palming, the one
with ordinary vision learned eight more verses in twenty-
one minutes, while the one with 20/10 was able to reduce
her time by only two minutes, a variation clearly within
the limits of error. In other words, the mind of the
latter being already in a normal or nearly normal condi-
tion, she could not improve it appreciably by palming,
while the former, whose mind was under a strain, was
able to gain relaxation, and hence improve her memory,
by this means.

Even when the difference in sight is between the two
eyes of the same person, it can be demonstrated, as was
pointed out in the chapter on "Memory as an Aid to
Vision," that there is a corresponding difference in the
memory, according to whether both eyes are open, or
the better eye closed.

Under the present educational system there is a con-
stant effort to compel the children to remember. These
efforts always fail. They spoil both the memory and
the sight. The memory cannot be forced any more than
the vision can be forced. We remember without effort,

Interest Necessary to Good Vision 277

just as we see without effort, and the harder we try to
remember or see the less we are able to do so.

The sort of things we remember are the things that
interest us, and the reason children have difficulty in
learning their lessons is because they are bored by them.
For the same reason, among others, their eyesight be-
comes impaired, boredom being a condition of mental
strain in which it is impossible for the eye to function
normally.

Some of the various kinds of compulsion now em-
ployed in the educational process may have the effect of
awakening interest. Betty Smith's interest in winning a
prize, for instance, or in merely getting ahead of Johnny
Jones, may have the effect of rousing her interest in
lessons that have hitherto bored her, and this interest
may develop into a genuine interest in the acquisition
of knowledge ; but this cannot be said of the various fear
incentives still so largely employed by teachers. These,
on the contrary, have the effect, usually, of completely
paralyzing minds already benumbed by lack of interest,
and the effect upon the vision is equally disastrous.

The fundamental reason, both for poor memory and
poor eyesight in school children, in short, is our irra-
tional and unnatural educational system. Montessori has
taught us that it is only when children are interested
that they can learn. It is equally true that it is only
when they are interested that they can see. This fact
was strikingly illustrated in the case of one of the two
pairs of sisters mentioned above. Phebe, of the keen
eyes, who could recite whole books if she happened to
be interested in them, disliked mathematics and anatomy
extremely, and not only could not learn them but became
myopic when they were presented to her mind. She

278 Mind and Vision

could read letters a quarter of an inch high at twenty
feet in a poor light, but when asked to read figures one
to two inches high in a good light at ten feet she mis-
called half of them. When asked to tell how much 2 and
3 made she said "4," before finally deciding on "5;"
and all the time she was occupied with this disagreeable
subject the retinoscope showed that she was myopic.
When I asked her to look into my eye with the ophthal-
moscope, she could see nothing, although a much lower
degree of visual acuity is required to note the details of
the interior of the eye than to see the moons of Jupiter.
Shortsighted Isabel, on the contrary, had a passion for
mathematics and anatomy and excelled in those sub-
jects. She learned to use the ophthalmoscope as easily
as Phebe had learned Latin. Almost immediately she
saw the optic nerve, and noted that the center was whiter
than the periphery. She saw the light-colored lines, the
arteries; and the darker ones, the veins; and she saw
the light streaks on the blood-vessels. Some specialists
never become able to do this, and no one could do it
without normal vision. Isabel's vision, therefore, must
have been temporarily normal when she did it. Her
vision for figures, although not normal, was better than
for letters.

In both these cases the ability to learn and the ability
to see went hand in hand with interest. Phebe could
read a photographic reduction of the Bible and recite
what she had read verbatum, she could see the moons of
Jupiter and draw a diagram of them afterwards, because
she was interested in these things ; but she could not see
the interior of the eye, nor see figures even half as well
as she saw letters, because these things bored her. When,
however, it was suggested to her that it would be a good

Central Fixation of the Mind 279

joke to surprise her teachers, who were always reproach-
ing her for her backwardness in mathematics, by taking
a high mark in a coming examination, her interest in the
subject awakened and she contrived to learn enough to
get seventy-eight per cent. In Isabel's case letters were
antagonistic. She was not interested in most of the sub-
jects with which they dealt, and therefore she was back-
ward in those subjects and had become habitually my-
opic. But when asked to look at objects which aroused
an intense interest her vision became normal.

When one is not interested, in short, one's mind is not
under control, and without mental control one can neither
learn nor see. Not only the memory but all other men-
tal faculties are improved when the eyesight becomes
normal. It is a common experience with patients cured
of defective sight to find that their ability to do their
work has improved.

The teacher whose letter is quoted in a later chapter
testified that after gaining perfect eyesight she "knew
better how to get at the minds of the pupils," was "more
direct, more definite, less diffused, less vague," possessed,
in fact, "central fixation of the mind." In another letter
she said: "The better my eyesight becomes, the greater
is my ambition. On the days when my sight is best I
have the greatest anxiety to do things."

Another teacher reported that one of her pupils used
to sit doing nothing all day long and apparently was not
interested in anything. After the test card was intro-
duced into the classroom and his sight improved, he be-
came anxious to learn, and speedily developed into
one of the best students in the class. In other words, his
eyes and his mind became normal together.

A bookkeeper nearly seventy years of age who had

280 Mind and Vision

worn glasses for forty years found after he had gained
perfect sight without glasses that he could work more
rapidly and accurately and with less fatigue than ever
in his life before. During busy seasons, or when short
of help, he has worked for some weeks at a time from
7 a. m. until 11 p. m., and he insisted that he felt less
tired at night after he was through than he did in the
morning when he started. Previously, although he had
done more work than any other man in the office, it
always tired him very much. He also noticed an im-
provement in his temper. Having been so long in the
office, and knowing so much more about the business
than his fellow employees, he was frequently appealed
to for advice. These interruptions, before his sight be-
came normal, were very annoying to him and often
caused him to lose his temper. Afterward, however, they
caused him no irritation whatever.

In another case, symptoms of insanity were relieved
when the vision became normal. The patient was a
physician who had been seen by many nerve and eye
specialists before he came to me, and who consulted me
at last, not because he had any faith in my methods, but
because nothing else seemed to be left for him to do.
He brought with him quite a collection of glasses pre-
scribed by different men, no two of them being alike.
He had worn glasses, he told me, for many months at a
time without benefit, and then he had left them off and
had been apparently no worse. Outdoor life had also
failed to help him. On the advice of some prominent
neurologists he had even given up his practice for a
couple of years to spend the time upon a ranch, but the
vacation had done him no good.

I examined his eyes and found no organic defects and

Under Terrific Strain 281

no error of refraction. Yet his vision with each eye was
only three-fourths of the normal and he suffered from
double vision and all sorts of unpleasant symptoms. He
used to see people standing on their heads and little
devils dancing on the tops of the high buildings. He also
had other illusions too numerous to be mentioned here.
At night his sight was so bad that he had difficulty in
finding his way about, and when walking along a country
road he believed that he saw better when he turned his
eyes far to one side and viewed the road with the side
of the retina instead of with the center. At variable in-
tervals, without warning and without loss of conscious-
ness, he had attacks of blindness. These caused him
great uneasiness, for he was a surgeon with a large and
lucrative practice and he feared that he might have an
attack while operating.

His memory was very poor. He could not remember
the color of the eyes of any member of his family, al-
though he had seen them all daily for years. Neither
could he recall the color of his house, the number of
rooms on the different floors or other details. The faces
and names of patients and friends he recalled with diffi-
culty or not at all.

His treatment proved to be very difficult, chiefly be-
cause he had an infinite number of erroneous ideas about
physiological optics in general and his own case in par-
ticular, and insisted that all these should be discussed;
while these discussions were going on he received no
benefit. Every day for hours at a time over a long period
he talked and argued. His logic was wonderful, appa-
rently unanswerable, and yet utterly wrong.

His eccentric fixation was of such high degree that
when he looked at a point forty-five degrees to one side

282 Mind and Vision

of the big C on the Snellen test card he saw the letter
just as black as when he looked directly at it. The strain
to do this was terifnc and produced much astigmatism;
but the patient was unconscious of it and could not be
convinced that there was anything abnormal in the
symptom. If he saw the letter at all, he argued, he must
see it as black at it really was, because he was not color-
blind. Finally he became able to look away from one
of the smaller letters on the card and see it worse than
when he looked directly at it. It took eight or nine
months to accomplish this, but when it had been done
the patient said that it seemed as if a great burden had
been lifted from his mind. He experienced a wonderful
feeling of rest and relaxation throughout his whole body.

When asked to remember black with his eyes closed
and covered he said he could not do so, and he saw every
color but the black which one ought normally to see when
the optic nerve is not subject to the stimulus of light.
He had, however, been an enthusiastic football player
at college, and he found at last that he could remember
a black football. I asked him to imagine that this foot-
ball had been thrown into the sea and that it was being
carried outward by the tide, becoming constantly smaller
but no less black. This he was able to do, and the strain
floated with the football, until, by the time the latter had
been reduced to the size of a period in a newspaper, it
was entirely gone. The relief continued as long as he
remembered the black spot, but as he could not remem-
ber it all the time, I suggested another method of gaining
permanent relief. This was to make his sight volun-
tarily worse, a plan against which he protested with
considerable emphasis.

"Good heavens!" he said. "Isn't my sight bad enough
without making it worse?"

A Problem Not To Be Solved By Glasses 283

After a week of argument, however, he consented to
try the method and the result was extremely satisfac-
tory. After he had learned to see two or more lights
where there was only one, by straining to see a point
above the light while still trying to see the light as well
as when looking directly at it, he became able to avoid
the unconscious strain that had produced his double and
multiple vision and was not troubled by these super-
fluous images any more. In a similar manner other
illusions were prevented.

One of the last illusions to disappear was his belief
that an effort was required to remember black. His logic
on this point was overwhelming, but after many demon-
strations he was convinced that no effort was required
to let go, and when he realized this, both his vision and
his mental condition immediately improved.

He finally became able to read 20/10 or more, and
although more than fifty-five years of age, he also read
diamond type at from six to twenty-four inches. His
night blindness was relieved, his attacks of day blind-
ness ceased, and he told me the color of the eyes of his
wife and children. One day he said to me :

"Doctor, I thank you for what you have done for my
sight, but no words can express the gratiude I feel for
what you have done for my mind."

Some years later he called with his heart full of grati-
tude, because there had been no relapse.

From all these facts it will be seen that the problems
of vision are far more intimately associated with the
problems of education than we had supposed, and that
they can by no means be solved by putting concave, or
convex, or astigmatic lenses before the eyes of the
children.

CHAPTER XXX

NORMAL SIGHT AND THE RELIEF OF PAIN FOR
SOLDIERS AND SAILORS

THE Great War is over and among the millions
of brave men who laid down their lives in the
cruel conflict there were some who thought that
they were doing so that wars might be no more. But
the earth is still filled with wars and rumors of war, and
in the countries of the victorious Allies the spirit of mili-
tarism is rampant. In the United States we are being
urged to increase naval and military expenditure, and
there is a strong demand for universal military training.
Whether it is necessary for us to join in the competition
of armaments which resulted in the terrific convulsion
through which we have just passed is a question which
need not be entered into here ; but if we are going to do
so, we may as well have soldiers and sailors with normal
sight; and if we attain this end we shall not have borne
the burdens of militarism and navalism altogether in
vain.

After the United States entered the recent war I had
the privilege of making it possible for many young men
who had been unable to meet the visual requirements
for admission to the army and navy, or to favorite
branches of these services, to gain normal vision; and
seeing no reason why such benefits should be confined
to the few, I supplied the Surgeon General of the Army
with a plan whereby, with far less trouble and expense
than was involved by the optical service upon which

284

A Leading Cause of Rejection 28,5

we were then depending to make the worst of the en-
listed eye-defectives available for service at the front,
normal vision without glasses might have been insured
to all soldiers and sailors. This plan was not acted upon,
and I now present it, with some modifications, to the
public, in the hope that enough people will see its mili-
tary value to secure its adoption.

If we are to have universal military training, we shall
find, as the nations of Europe have found, that it will be
necessary to take measures to provide suitable material
for such training. In Europe this necessity has resulted
in extensive systems of child care, but in this book we
are concerned only with the question of eyesight. In the
first draft for the recent war, defective eyesight was the
greatest single cause for rejection, while in later drafts
it became one of three leading causes only because of an
enormous lowering of an already low standard. Yet
there is no impediment to the raising of an army which
might be more easily removed. If we want our children
to grow big enough to be soldiers, without losing most
of their teeth and developing flat feet and crooked spines
before they reach the military age, we shall have to make
some arrangements, as every one of the advanced coun-
tries of Europe has done, for providing material as well
as intellectual food in the schools. We shall have to
employ school physicians on full time, and pay them
enough to compensate men of eminence for the loss of
private practice. We shall also have to see that the
children are not sacrificed to the ignorance or poverty
of their parents before they reach school age. But to
preserve their eyesight it is only necessary to place
Snellen test cards in every school classroom and see that
the children read them every day. With this simple

286 Normal Sight for Soldiers and Sailors

system of eye education beginning in the kindergarten
and extending through the whole educational process up
to the university and the professional school, it would
soon be found that the young men of the country, on
arrival at the military age, were practically free from
eye defects.

But some years must elapse before this happy result
can be achieved; and all eyes, moreover, no matter how
good their vision, are benefited by the daily practice of
the art of seeing, while by such practice those visual
lapses to which every eye is subject, and which are par-
ticularly dangerous in military and naval operations, are
either prevented or minimized. Therefore a system of
eye education for training camps and the front should
also be provided. For this purpose the method used in
the schools could be modified.

Under conditions of actual warfare, or on the parade
grounds of training camps, a Snellen test card might be
impracticable, but there are other letters, or small ob-
jects, on the uniforms, on the guns, on the wagons, or
elsewhere, which would serve the purpose equally well.

Letters or objects which require a vision of 20/20
should be selected by some one who has been taught what
20/20 means, and the men should be required to regard
these letters or objects twice a day. After reading the
letters they should be directed to cover their closed eyes
with the palms of their hands to shut out all the light,
and remember some color, preferably black, as well as
they are able to see it, for half a minute. Then they
should read the letters again and note any improvement
in vision. The whole procedure would not take more
than a minute. It should be made part of the regular
drill, night and morning, and men with imperfect sight

No Soldier Should Wear Glasses 287

should be encouraged to repeat it as many times a day
as convenient. They will need no urging: for imperfect
vision is a bar to advancement and excludes from the
favorite branch of the service, namely, aviation.

In each regiment every ten men should be under the
supervision of one man who understands the method,
and who must possess normal vision without glasses.
He should carry a pocket test card, consisting of a few
of the smaller letters, and should test the vision of the
men at the beginning of the training, and thereafter at
intervals of three months, reporting the results to the
medical officer in charge.

Since errors of refraction are curable, no soldier should
be allowed to wear glasses; but if the use of these aids
to vision is permitted, the men wearing them should not
be required to take part in the eye drills, as the method
will do them no good under these conditions. When they
see the benefits of eye education, however, they may wish
to share them and will, no doubt, be willing to submit
to the inconvenience resulting, temporarily, from going
without their glasses.

In military colleges the same method could be used as
in the schools; but a daily eye drill should also form
part of the maneuvers on the parade ground, so that the
students may be prepared to use it later in training
camps or at the front.

To aviators, whether engaged in military or civilian
operations, or whether they are flying merely for pleas-
ure, eye education is of particular importance. Accidents
to aviators, otherwise unaccountable, are easily explained
when one understands how dependent the aviator is upon
his eyesight, and how easily perfect vision may be lost
amid the unaccustomed surroundings, the dangers and

288 Normal Sight for Soldiers and Sailors

hardships of the upper air. It was formerly supposed
that aviators maintained their equilibrium in the air by
the aid of the internal ear; but it is now becoming evi-
dent from the testimony of aviators who have found
themselves emerging from a cloud with one wing down,
or even with their machines turned completely upside
down, that equilibrium is maintained almost entirely, if
not altogether, by the sense of sight.1 If the aviator loses
his sight, therefore, he is lost, and we have one of those
"unaccountable" accidents which, during the war, were
so unhappily common in the air service. All aviators,
therefore, should make a daily practice of reading small,
familiar letters, or observing other small, familiar ob-
jects, at a distance of ten feet or more. In addition, they
should have a few small letters, or a single letter, on
their machines, at a distance of five, ten, or more feet
from their eyes, arrangements being made to illuminate
them for night flying and fogs, and should read them
frequently while in the air. This would greatly lessen
the danger of visual lapses with their accompanying loss
of equilibrium and judgment.

As has already been pointed out, eye education not
only improves the sight, but affords a means by which
pain, fatigue, the symptoms of disease and other discom-
forts can be relieved. For this latter purpose it is of the
greatest value to soldiers and sailors; and if, during the
recent war, they had only understood the simple and al-
ways available method of relieving pain by the aid of the
memory, not only much suffering, but many deaths from
the destructive effects of pain upon the body might have
been prevented. A soldier in a flooded trench, if he can
remember black perfectly, will know the temperature of

6> 1918' P' 398; Hucks: Scientific American,

Palming Instead of Morphine 289

the water, but will not suffer from cold. Under the same
conditions he may succumb from weakness on the march,
but will not feel fatigue. He may die of hemorrhage,
but he will die painlessly. It will not be necessary to
give him morphine to relieve his pain; and thus to the
dangers of the battlefields will not be added the danger
of returning to civil life under the handicap of a lifelong
morphine habit.

This danger, there is reason to believe, assumed enor-
mous proportions during the war. The Germans used a
bullet which broke when it struck the bone and caused
intense pain. The men often died of this pain before help
arrived. Whey they were rescued the surgeons at once
gave them morphine. A few hours later the injection
was probably repeated. Then the drug was given less
frequently, but in many cases it was not discontinued
entirely while the man was in the hospital. A Red Cross
surgeon at a meeting of the New York County Medical
Society stated that he had been responsible for pro-
ducing the morphine habit in thousands of soldiers, and
that every physician at the front had done the same. By
such a simple method as palming all this might have
been prevented.

If we are going to have universal military and naval
training, an essential part of that training should be the
instruction of the prospective soldiers and sailors in the
art of relieving their own pain; and in the event of war
every one who goes to the front, in whatever capacity,
from the generals and admirals down to the ambulance
drivers, should understand palming. Everyone in the
war zone, no matter how far behind the lines, may need
this knowledge to relieve his own pain, and everyone
may need it to relieve the pain of others.

CHAPTER XXXI
LETTERS FROM PATIENTS

The following letters have been selected almost at random
from the author's mail-bag, and are only specimens of many
more that are equally interesting. They are published because
it was felt that the personal stories of patients, told in their own
language, might be more interesting and helpful to many readers
than the more formal presentation of the facts in the preceding
chapters.

ARMY OFFICER CURES HIMSELF

Ai noted in the chapter on ''What Glasses Do to
Us," the sight always improves when glasses are
discarded, though this improvement may be so
slight as not to be noticed. In a few unusual cases, the
patients when freed from the handicap of a condition
which compels them to keep their eyes continually un-
der a strain, find out, in some way, how to avoid strain,
and thus regain a greater or less degree of their normal
visual power. The writer of the following letter was
able, without any help from anyone, to discover and put
into practice the main principles presented in this book,
and thus became able to read without his glasses. He is
an engineer, and at the time the letter was written was
fifty-one years of age. He had worn glasses since 1896,
first for astigmatism, getting stronger ones every couple
of years, and then for astigmatism and presbyopia. At
one time he asked his oculist and several opticians if
the eyes could not be strengthened by exercises, so as to

290

Glasses at the Front 291

make glasses unnecessary, but they said: "No. Once
started on glasses you must keep to them." When the
war broke out he was very nearly disqualified for ser-
vice in the Expeditionary Forces by his eyes, but man-
aged to pass the required tests, after which he was or-
dered abroad as an officer in the Gas Service. While
there he saw in the "Literary Digest" of May 2, 1918, a
reference to my method of curing defective eyesight
without glasses, and on May 11 he wrote to me in part
as follows:

"At the front I found glasses a horrible nuisance, and
they could not be worn with gas masks. After I had
been about six months abroad I asked an officer of the
Medical Corps about going without glasses. He said I
was right in my ideas and told me to try it. The first
week was awful, but I persisted and only wore glasses
for reading and writing. I stopped smoking at the same
time to make it easier on my nerves.

"I brought to France two pairs of bow spectacles and
two extra lenses for repairs. I have just removed the
extra piece for near vision from these extra lenses and
had them mounted as pince-nez, with shur-on mounts,
to use for reading and writing, so that the only glasses
I now use are for astigmatism, the age lens being off.
Three months ago I could not read ordinary head-line
type in newspapers without glasses. To-day, with a
good light, I can read ordinary book type, held at a
distance of eighteen inches from my eyes. Since the
first week in February, when I discarded my glasses, I
have had no headaches, stomach trouble, or dizziness,
and am in good health generally. My eyes are coming
back, and I believe it is due to sticking it out. I ride
considerably in automobiles and trams, and somehow

292 Letters From Patients

the idea has crept into my mind that after every trip
my eyes are stronger. This, I think, is due to the rapid
changing of focus in viewing scenery going by so fast.
Other men have tried this plan on my advice, but gave
it up after two or three days. Yet, from what they say,
I believe they were not so uncomfortable as I was for a
week or ten days. I believe most people wear glasses
because they 'coddle* their eyes."

The patient was right in thinking that the motor and
tram rides improved his sight. The rapid motion com-
pelled rapid shifting.

A TEACHER'S EXPERIENCES

It has frequently been pointed out in this book that
imperfect vision is always associated with an abnormal
state of the mind, and that when the vision improves
the mental faculties improve also, to a greater or lesser
degree. The following letter is a striking illustration of
this fact. The writer, a teacher forty years of age, was
first treated on March 28, 1919. She was wearing the
following glasses: right eye, convex 0.75D.S. with con-
vex 4.00D.C., 105 deg.; left eye, convex 0.75D.S. with
convex 3.50D.C., 105 deg. On June 9, 1919, she wrote:

"I will tell you about my eyes, but first let me tell you
other things. You were the first to unfold your theories
to me, and I found them good immediately — that is, I
was favorably impressed from the start. I did not take
up the cure because other people recommended it, but
because I was convinced : first, that you believed in your
discovery yourself ; second, that your theory of the cause
of eye trouble was true. I don't know how I knew these
two things, but I did. After a little conversation with
you, you and your discovery both seemed to me to bear

Enjoys Her Sight 293

the ear-marks of the genuine article. As to the success
of the method with myself I had a little doubt. You
might cure others, but you might not be able to cure me.
However, I took the plunge, and it has made a great
change in me and my life.

"To begin with, I enjoy my sight. I love to look at
things, to examine them in a leisurely, thorough way,
much as a child examines things. I never realized it at
the time, but it was irksome for me to look at things
when I was wearing glasses, and I did as little of it as
possible. The other day, going down on the Sandy Hook
boat, I enjoyed a most wonderful sky without that hate-
ful barrier of misted glasses, and I am positive I distin-
guished delicate shades of color that I never would have
been able to see, even with clear glasses. Things seem
to me now to have more form, more reality, than when
I wore glasses. Looking into the mirror you see a solid
representation on a flat surface, and the flat glass can't
show you anything really solid. My eyeglasses, of
course, never gave me this impression, but one curiously
like it. I can see so clearly without them that it is like
looking around corners without changing the position.
I feel that I can almost do it.

"I very seldom have occasion to palm. Once in a great
while I feel the necessity of it. The same with remem-
bering a period. Nothing else is ever necessary. I sel-
dom think of my eyes, but at times it is borne in upon
me how much I do use and enjoy using them.

"My nerves are much better. I am more equable, have
more poise, I am less shy. I never used to show that I
was shy, or lacked confidence. I used to go ahead and
do what was required, if not without hesitation; but it
was hard. Now I find it easy. Glasses, or poor sight

294 Letters From Patients

rather, made me self-conscious. It certainly is a great
defect, and one people are sensitive to without realizing
it. I mean the poor sight and the necessity for wearing
glasses. I put on a pair of glasses the other day just for
an experiment, and I found that they magnified things.
My skin looked as if under a magnifying glass. Things
seemed too near. The articles on my chiffonier looked
so close I felt like pushing them away from me. The
glasses I especially wanted to push away. They brought
irritation at once. I took them off and felt peaceful.
Things looked normal.

"From the beginning of the treatment I could use my
eyes pretty well, but they used to tire. I remember mak-
ing a large Liberty Loan poster two weeks after I took
off my glasses, and I was amazed to find I could make
the whole layout almost perfectly without a ruler, just
as well as with my glasses. When I came to true it up
with the ruler I found only the last row of letters a bit
out of line at the very end. I couldn't have done better
with glasses. However, this wasn't fine work. About
the same time I sewed a hem at night in a black dress,
using a fine needle. I suffered a little for this, but not
much. I used to practice my exercises at that time, and
palm faithfully. Now I don't have to practice, or palm;
I feel no discomfort, and I am absolutely unsparing in
my use of my eyes. I do everything I want to with them.
I shirk nothing, pass up no opportunity of using them.
From the first I did all my school work, read every
notice, wrote all that was necessary, neglected nothing.

"Now to sum up the school end of it: I used to get
headaches at the end of the month from adding columns
of figures necessary to reports, etc. Now I do not get
them. I used to get flustered when people came into

Central Fixation of the Mind 295

my room. Now I do not ; I welcome them. It is a pleas-
ant change to feel this way. And — I suppose this is
most important really, though I think of it last — I teach
better. I know how to get at the mind and how to make
the children see things in perspective. I gave a lesson
on the horizontal cylinder recently, which, you know,
is not a thrillingly interesting subject, and it was a re-
markable lesson in its results and in the grip it got on
every girl in the room, stupid or bright. What you have
taught me makes me use the memory and imagination
more, especially the latter, in teaching.

"To sum up the effect of being cured upon my own
mind : I am more direct, more definite, less diffused, less
vague. In short, I am conscious of being better centered.
It is central fixation of the mind. I saw this in your
latest paper, but I realized it long ago and knew what
to call it."

A MENTAL TRANSITION

A man of forty-four who had worn glasses since the
age of twenty was first seen on October 8, 1917, when he
was suffering, not only from very imperfect sight, but
from headache and discomfort. He was wearing for the
right eye concave 5.00D.S. with concave 0.50D.C., 180
degrees, and for the left concave 2.50D.S. with concave
1.50D.C., 180 degrees. As his visits were not very fre-
quent and he often went back to his glasses, his progress
was slow. But his pain and discomfort were relieved
very quickly, and almost from the beginning he had
flashes of greatly improved and even of normal vision.
This encouraged him to continue, and his progress,
though slow, was steady. He has now gone without his
glasses entirely for some months, and his nervous con-

296 Letters From Patients

dition has improved as much as his sight. His wife was
particularly impressed with the latter effect, and in De-
cember, 1919, she wrote:

"I have become very much interested in the thought
of renewing my youth by becoming like a little child.
The idea of the mental transition is not unfamiliar, but
that this mental, or I should say spiritual, transition
should produce a physical effect, which would lead to
seeing clearly, is a sort of miracle very possible indeed,
I should suppose, to those who have faith.

"In my husband's case, certainly some such miracle
was wrought; for not only was he able to lay aside his
spectacles after many years' constant use, and to see to
read in almost any light, but I particularly noticed his
serenity of mind after treatments. In this serenity he
seemed able to do a great deal of work efficiently, and
not under the high nervous pressure whose after-effect
is the devastating scattering of forces.

"It did not occur to me for a long time that perhaps
your treatment was quieting his nerves. But I think
now that the quiet periods of relaxation, two or three
times a day, during which he practiced with the letter
card, must have had a very beneficial effect. He is so
enthusiastic by nature, and his nerves are so easily stim-
ulated, that for years he used to overdo periodically.
Of course, his greatly improved eyesight and the relief
from the former strain must have been a large factor in
this improvement. But I am inclined to think that the
intervals of quiet and peace were wonderfully beneficial,
and why shouldn't they be? We are living on stimulants,
physical stimulants, mental stimulants of all kinds. The
minute these stop we feel we are merely existing, and
yet, if we retain any of the normality of our youth, do you

Relaxation Versus Glasses 297

not think that we respond very happily to natural simple
things?"

RELIEF AFTER TWENTY-FIVE YEARS

While many persons are benefited by the accepted
methods of treating defects of vision, there is a minority
of cases, known to every eye specialist, which gets little
or no help from them. These patients sometimes give up
the search for relief in despair, and sometimes continue
it with surprising pertinacity, never being able to aban-
don the belief, in spite of the testimony of experience,
that somewhere in the world there must be some one
with sufficient skill to fit them with the right glasses.
The rapidity with which these patients respond to treat-
ment by relaxation is often very dramatic, and affords a
startling illustration of the superiority of this method
to treatment by glasses and muscle-cutting. In the fol-
lowing case relaxation did in twenty-four hours what
the old methods, as practiced by a succession of eminent
specialists, could not do in twenty-five years.

The patient was a man of forty-nine, and his imperfect
sight was accompanied by continual pain and misery, cul-
minating twenty years before I saw him, in a complete
nervous breakdown. As he was a writer, dependent upon
his pen for a living, his condition was a serious economic
handicap, and he consulted many specialists in the vain
hope of obtaining relief. Glasses did little either to im-
prove his sight, or to relieve his discomfort, and the eye
specialists talked vaguely about disease of the optic nerve
and brain as a possible cause of his troubles. The nerve
specialists, however, were unable to do anything to re-
lieve him. One specialist diagnosed his case as muscu-
lar, and gave him prisms, which helped him a little.

298 Letters From Patients

Later, the same specialist, finding that all of the apparent
muscular trouble was not corrected by glasses, cut the
external muscles of both eyes. This also brought some
relief, but not much. At the age of twenty-nine the pa-
tient suffered the nervous breakdown already mentioned.
For this he was treated unsuccessfully by various spe-
cialists, and for nine years he was compelled to live out
of doors. This life, although it benefited him, failed to
restore his health, and when he came to me on September
13, 1919, he was still suffering from neurasthenia. His
distant vision was less than 20/40, and could not be im-
proved by glasses. He was able to read with glasses, but
could not do so without discomfort. I could find no symp-
tom of disease of the brain or of the interior of the eye.
When he tried to palm he saw grey and yellow instead of
black ; but he was able to rest his eyes simply by closing
them, and by this means alone he became able, in twenty-
four hours, to read diamond type and to make out most
of the letters on the twenty line of the test card at twenty
feet. At the same time his discomfort was materially re-
lieved. He was under treatment for about six weeks, and
on October 25 he wrote as follows :

"I saw you last on October 6, and at the end of the
week, the llth, I started off on a ten-day motor trip as
one of the officials of the Cavalry Endurance Test for
horses. The last touch of eyestrain which affected me
nervously at all I experienced on the 8th and 9th. On
the trip, though I averaged but five hours' sleep, rode
all day in an open motor without goggles and wrote re-
ports at night by bad lights, I had no trouble. After the
third day the universal slow swing seemed to establish
itself, and I have never had a moment's discomfort since.
I stood fatigue and excitement better than I have ever

Out of the Woods 299

done, and went with less sleep. My practicing on the
trip was necessarily somewhat curtailed, yet there was
noticeable improvement in my vision. Since returning I
have spent a couple of hours a day in practice, and have
at the same time done a lot of writing.

"Yesterday, the 24th, I made a test with diamond type,
and found that after twenty minutes' practice I could get
the lines distinct, and make out the capital letters and
bits of the text at a scant three inches. At seven I could
read it readily, though I could not see it perfectly. This
was by an average daylight — no sun. In a good daylight
I can read the newspaper almost perfectly at a normal
reading distance, say fifteen inches.

"I feel now that I am really out of the woods. I have
done night work without suffering for it, a thing I have
not done in twenty-five years, and I have worked steadily
for more hours than I have been able to work at a time
since my breakdown in 1899, all without sense of strain or
nervous fatigue. You can imagine my gratitude to you.
Not only for my own sake, but for yours, I shall leave no
stone unturned to make the cure complete and get back
the child eyes which seem perfectly possible in the light
of the progress I have made in eight weeks."

SEEKING A MYOPIA CURE

In spite of the emphasis with which the medical pro-
fession denies the possibility of curing errors of refrac-
tion, there are many lay persons who refuse to believe
that they are incurable. The author of the following
statement represents a considerable class, and was re-
markable only in the persistency with which he searched
for relief. He was first seen on June 27, 1919, at which
time he was thirty-two years of age. He was wearing

300 Letters From Patients

concave 2.50D.S. for each eye, and his vision in each eye
was 20/100 — . After he had obtained almost normal
vision he wrote the following account of his experiences
for "Better Eyesight" :

"When the 'Lusitania' was sunk I knew that the
United States was going to get into trouble, and I wanted
to be in a position to join the Army. But I was suffer-
ing from a high degree of myopia, and I knew they
wouldn't take me with glasses. Later on they took al-
most anyone who wasn't blind, but at that time I couldn't
possibly have measured up to the standard. So I began
to look about for a cure. I tried osteopathy, but didn't
go very far with it. I asked the optician who had been
fitting me with glasses for advice, but he said that myopia
was incurable. I dismissed the matter for a time, but I
didn't stop thinking about it. I am a farmer, and I knew
from the experience of outdoor life that health is the
normal condition of living beings. I knew that when
health is lost it can often be regained. I knew that when
I first tried to lift a barrel of apples onto a wagon I could
not do so, but that after a little practice I became able to
do it easily, and I did not see why, if one part of the body
could be strengthened by exercise, others could not be
strengthened also. I could remember a time when I was
not myopic, and it seemed to me that if a normal eye
could become myopic, it ought to be possible for a myopic
eye to regain normality. After a while I went back to
the optician and told him that I was convinced that there
must be some cure for my condition. He replied that
this was quite impossible, as everyone knew that myopia
was incurable. The assurance with which he made this
statement had an effect upon me quite the opposite of
what he intended, for when he said that the cure of

It Ought To Be Possible 301

myopia was impossible I knew that it was not, and I re-
solved never to give up the search for a cure until I found
it. Shortly after I had the good fortune to hear of Dr.
Bates, and lost no time in going to see him. At the first
visit I was able, just by closing and resting my eyes, to
improve my sight considerably for the Snellen test card,
and after a few months of intermittent treatment I be-
came able to read 20/10 — in flashes. I am still improv-
ing, and when I can see a little better I mean to go back
to that optician and tell him what I think of his ophthal-
mological learning."

FACTS VERSUS THEORIES

Reading fine print is commonly supposed to be an ex-
tremely dangerous practice, and reading print of any kind
upon a moving vehicle is thought to be even worse.
Looking away to the distance, however, and not seeing
anything in particular is believed to be very beneficial to
the eyes. In the light of these superstitions, the facts
contained in the following letter are particularly inter-
esting :

"On reaching home Monday morning I was surprised
and pleased at the comments of my family regarding the
appearance of my eyes. They all thought they looked
so much brighter and rested, and that after two days of
railroading. I didn't spare my eyes in the least on the
way home. I read magazines and newspapers, looked at
the scenery; in fact, used my eyes all the time. My
sight for the near-point is splendid. Can read for hours
without tiring my eyes. ... I went downtown to-
day and my eyes were very tired when I got home. The
fine print on the card [diamond type] helps me so.. . .
I would like to have your little Bible [a photographic re-

302 Letters From Patients

duction of the Bible with type much smaller than dia-
mond]. I'm sure the very fine print has a soothing effect
on one's eyes, regardless of what my previous ideas on
the subject were."

It will be observed that the eyes of this patient were
not tired by her two days' railroad journey, during which
she read constantly; they were not tired by hours of
reading after her return ; they were rested by reading ex-
tremely fine print; but they were very much tired by a
trip downtown during which they were not called upon
to focus upon small objects. Later a leaf from the Bible
was sent to her, and she wrote:

"The effect even of the first effort to read it was won-
derful. If you will believe it, I haven't been troubled
having my eyes feel 'crossed' since, and while my actual
vision does not seem to be any better, my eyes feel a
great deal better."

CURED WITHOUT PERSONAL ASSISTANCE

I am constantly hearing of patients who have been able
to improve their sight by the aid of information con-
tained in my publications, without personal assistance.
The writer of the following letter, a physician, is a re-
markable example of these cases, as he was able not only
to cure himself, but to relieve some very serious cases of
defective vision among his patients.

"I first tried central fixation on myself and had mar-
velous results. I threw away my glasses and can now
see better than I have ever done. I read very fine type
(smaller than newspaper type) at a distance of six inches
from the eyes, and can run it out at full arm's length and
still read it without blurring the type.

"I have instructed some of my patients in you?

Cataract Relieved 303

methods, and all are getting results. One case who has
a partial cataract of the left eye could not see anything
on the Snellen test card at twenty feet, and could see the
letters only faintly at ten feet. Now she can read 20/10
with both eyes together, and also with each eye sepa-
rately; but the left eye seems, as she says, to be looking
through a little fog. I could cite many other cases that
have been benefited by central fixation, but this one is
the most interesting to me."

CHAPTER XXXII
REASON AND AUTHORITY

SOME one — perhaps it was Bacon — has said:
"You cannot by reasoning correct a man of ill
opinion which by reasoning he never acquired."
He might have gone a step further and stated that neither
by reasoning, nor by actual demonstration of the facts,
can you convince some people that an opinion which they
have accepted on authority is wrong.

A man whose name I do not care to mention, a pro-
fessor of ophthalmology, and a writer of books well
known in this country and in Europe, saw me perform
the experiment illustrated on Page 40, an experiment
which, according to others who witnessed it, demon-
strates beyond any possibility of error that the lens is
not a factor in accommodation. At each step of the op-
eration he testified to the facts; yet at the conclusion he
preferred to discredit the evidence of his senses rather
than accept the only conclusion that these facts admitted.
First he examined the eye of the animal to be experi-
mented upon, with the retinoscope, and found it normal,
and the fact was written down. Then the eye was stimu-
lated with electricity, and he testified that it accommo-
dated. This was also written down. I now divided the
superior oblique muscle, and the eye was again stimulated
with electricity. The doctor observed the eye with the
retinoscope when this was being done and said: "You
failed to produce accommodation." This fact, too, was
written down. The doctor now used the electrode him-
self, but again failed to observe accommodation, and

304

Discredited His Own Observations 305

these facts were written down. I now sewed the cut ends
of the muscle together, and once more stimulated the
eye with electricity. The doctor said, "Now you have
succeeded in producing accommodation," and this was
written down. I now asked:

"Do you think that superior oblique had anything to do
with producing accommodation?"

"Certainly not," he replied.

"Why?" I asked.

"Well," he said, "I have only the testimony of the
retinoscope; I am getting on in years, and I don't feel
that confidence in my ability to use the retinoscope that
I once had. I would rather you wouldn't quote me on
this."

While the operation was in progress, however, he gave
no indication whatever of doubting his ability to use the
retinoscope. He was very positive, in fact, that I had
failed to produce accommodation after the cutting of the
oblique muscle, and his tone suggested that he considered
the failure ignominious. It was only after he found him-
self in a logical trap, with no way out except by discredit-
ing his own observations, that he appeared to have any
doubts as to their value.

Patients whom I have cured of various errors of refrac-
tion have frequently returned to specialists who had pre-
scribed glasses for them, and, by reading fine print and
the Snellen test card with normal vision, have demon-
strated the fact that they were cured, without in any way
shaking the faith of these practitioners in the doctrine
that such cures are impossible.

The patient with progressive myopia whose case was
mentioned in Chapter XV returned after her cure to the
specialist who had prescribed her glasses, and who had
said not only that there was no hope of improvement, but

306 Reason and Authority

that the condition would probably progress until it ended
in blindness, to tell him the good news which, as an old
friend of her family, she felt he had a right to hear. But
while he was unable to deny that her vision was, in fact,
normal without glasses, he said it was impossible that
she should have been cured of myopia, because myopia
was incurable. How he reconciled this statement with
his former patient's condition he was unable to make
clear to her.

A lady with compound myopic astigmatism suffered
from almost constant headaches which were very much
worse when she took her glasses off. The theatre and
the movies caused her so much discomfort that she feared
to indulge in these recreations. She was told to take off
her glasses and advised, among other things, to go to
the movies ; to look first at the corner of the screen, then
off to the dark, then back to the screen a little nearer to
the center, and so forth. She did so, and soon became
able to look directly at the pictures without discomfort.
After that nothing troubled her. One day she called on
her former ophthalmological adviser, in the company of
a friend who wanted to have her glasses changed, and
told him of her cure. The facts seemed to make no im-
pression on him whatever. He only laughed and said, "I
guess Dr. Bates is more popular with you than I am."

Sometimes patients themselves, after they are cured,
allow themselves to be convinced that it was impossible
that such a thing could have happened, and go back to
their glasses. This happened in the case of a patient al-
ready mentioned in the chapter on "Presbyopia," who
was cured in fifteen minutes by the aid of his imagina-
tion. He was very grateful for a time, and then he began
to talk to eye specialists whom he knew and straightway
grew skeptical as to the value of what I had done for him.

Discredited His Own Experience 307

One day I met him at the home of a mutual friend, and
in the presence of a number of other people he accused
me of having hypnotized him, adding that to hypnotize
a patient without his knowledge or consent was to do
him a grievous wrong. Some of the listeners protested
that whether I had hypnotized him or not, I had not only
done him no harm but had greatly benefited him, and he
ought to forgive me. He was unable, however, to take
this view of the matter. Later he called on a prominent
eye specialist who told him that the presbyopia and astig-
matism from which he had suffered were incurable, and
that if he persisted in going without his glasses he might
do himself great harm. The fact that his sight was per-
fect for the distance and the near-point without glasses
had no effect upon the specialist, and the patient allowed
himself to be frightened into disregarding it also. He
went back to his glasses, and so far as I know has been
wearing them ever since. The story obtained wide pub-
licity, for the man had a large circle of friends and ac-
quaintances; and if I had destroyed his sight I could
scarcely have suffered more than I did for curing him.

Fifteen or twenty years ago the specialist mentioned in
the foregoing story read a paper on cataract at a meeting
of the ophthalmological section of the American Medical
Association in Atlantic City, and asserted that anyone
who said that cataract could be cured without the knife
was a quack. At that time I was assistant surgeon at the
New York Eye and Ear Infirmary, and it happened that I
had been collecting statistics of the spontaneous cure of
cataract at the request of the executive surgeon of this
institution, Dr. Henry G. Noyes, Professor of Ophthal-
mology at the Bellevue Hospital Medical School. As a
result of my inquiry, I had secured records of a large num-

308 Reason and Authority

her of cases which had recovered, not only without the
knife, but without any treatment at all. I also had rec-
ords of cases which I had sent to Dr. James E. Kelly of
New York and which he had cured, largely by hygienic
methods. Dr. Kelly is not a quack, and at that time was
Professor of Anatomy in the New York Post Graduate
Medical School and Hospital and attending surgeon to a
large city hospital. In the five minutes allotted to those
who wished to discuss the paper, I was able to tell the
audience enough about these cases to make them want
to hear more. My time was, therefore, extended, first to
half an hour and then to an hour. Later both Dr. Kelly
and myself received many letters from men in different
parts of the country who had tried his treatment with
success. The man who wrote the paper had blundered,
but he did not lose any prestige because of my attack,
with facts upon his theories. He is still a prominent and
honored ophthalmologist, and in his latest book he gives
no hint of having ever heard of any successful method of
treating cataract other than by operation. He was not
convinced by my record of spontaneous cures, nor by Dr.
Kelly's record of cures by treatment; and while a few
men were sufficiently impressed to try the treatment
recommended, and while they obtained satisfactory re-
sults, the facts made no impression upon the profession
as a whole, and did not modify the teaching of the
schools. That spontaneous cures of cataract do some-
times occur cannot be denied; but they are supposed to
be very rare, and any one who suggests that the condi-
tion can be cured by treatment still exposes himself to
the suspicion of being a quack.

Between 1886 and 1891 I was a lecturer at the Post-
Graduate Hospital and Medical School. The head of the
institution was Dr. D. B. St. John Roosa. He was the

Man Not a Reasoning Being 309

author of many books, and was honored and respected
by the whole medical profession. At the school they had
got the habit of putting glasses on the nearsighted doc-
tors, and I had got the habit of curing them without
glasses. It was naturally annoying to a man who had
put glasses on a student to have him appear at a lecture
without them and say that Dr. Bates had cured him.
Dr. Roosa found it particularly annoying, and the trouble
reached a climax one evening at the annual banquet of
the faculty when, in the presence of one hundred and fifty
doctors, he suddenly poured out the vials of his wrath
upon my head. He said that I was injuring the reputa-
tion of the Post Graduate by claiming to cure myopia.
Every one knew that Donders said it was incurable, and
I had no right to claim that I knew more than Donders.
I reminded him that some of the men I had cured had
been fitted with glasses by himself. He replied that if he
had said they had myopia he had made a mistake. I sug-
gested further investigation. "Fit some more doctors
with glasses for myopia," I said, "and I will cure them.
It is easy for you to examine them afterwards and see if
the cure is genuine." This method did not appeal to him,
however. He repeated that it was impossible to cure
myopia, and to prove that it was impossible he expelled
me from the Post Graduate, even the privilege of resigna-
tion being denied to me.

The fact is that, except in rare cases, man is not a rea-
soning being. He is dominated by authority, and when
the facts are not in accord with the view imposed by au-
thority, so much the worse for the facts. They may, and
indeed must, win in the long run; but in the meantime
the world gropes needlessly in darkness and endures
much suffering that might have been avoided.

INDEX

Accommodation, 10, 26 (see
also "Aphakia," "My-
opia," "Presbyopia")

Arlt on, 29

Author on, 38, 54, 69

Briicke on, 29

Cohn on, 29

Cramer on, 25

Davis on, 33

Descartes on, 24

Donders on, 24, 29, 32, 38,
210, 211

Duane on, 211

Forster on, 32

Fuchs on, 211

von Graefe on, 32

Helmholtz on, 24, 26, 32

Hensen on, 29

Holmes on, 212

Huxley on, 29

Jackson on, 211

Kepler on, 23

Landolt on, 26

Langenbeck on, 24

Loring on, 33

Roosa on, 210

Sanson on, 29

Scheiner on, 24

Tscherning on, 27

de Schweinitz on, 36, 211

Volckers on, 29

Young on, 24, 30
Ainus, 16
Amblyopia, 111, 113 (see also

"Squint")

Anisometropes, 256
Aphakia, 32, 47, 95, 96
Arlt, 29

portrait, frontispiece

Armati, v, 81

Astigmatism, 12, 70, 149, 251
prevention, 251, 265
production, 12, 36, 39, 42,

43, 45, 89, 266, 282
treatment, 229, 234, 273,
306 (see also "Refrac-
tion, errors of, treat-
ment")
Atropine, 43, 48, 50, 69, 228,

234
Aviators, 287

Barrington, 256
Bell, 184
Briicke, 29

Camera, 13, 114, 149
Cataract, 89, 111, 214, 220

treatment, 121, 134, 158,

272, 307

Central fixation, 114, 281
Christian Scientists, 209
Cohn, 29, 78, 251, 252, 253, 254
Colds, 208

Conjunctiva, 111, 118, 122
Cornea, 12, 36, 122 (see also

"Images, on cornea")
Correspondence treatment, 246
Coughs, 208
Cramer, 25

Darkness, 189

Davis, 33

Descartes, 24

Donders, 23, 24, 25, 29, 32, 38,

210, 211, 222, 223
Dresslar, 190
Duane, 211, 225

311

312

Index

Eccentric fixation (see "Cen-
tral fixation")
Emmetropia, 11, 93
Eversbusch, 222, 252
Eye, 11, 13

evolution of, 1

muscles of, 38, 44

retina of, 114

unable to fix a point, 159

Fabre, 102

Face-rests, 253, 254

Faith Curists, 209

Forster, 32

Fovea, 114

Fox, 256

Fuchs, 211, 222, 225

Images, 24, 54

on cornea, 24, 54, 59, 60, 64,
66, 68

on iris, 59, 63, 65

on lens (back of), 24, 54,
62, 67

on lens (front of), 24, 54

on sclera, 59, 62, 63, 64
Imagination, 148, 165, 217
Indians, 2, 15, 256
Insanity, 280
Iritis, 121, 122

[ackson, 211

[ohnson, 37

[upiter, moons of, 103, 121, 275

fust, 254

Gislason, 227

Glasses, v, 8, 81, 181, 219

Glaucoma, 111, 220

treatment, 121, 133, 208
Gould, 4
von Graefe, 32

Hansen-Grut, 222

Hay fever, 208

Helmholtz, 24, 26, 32, 36, 38

portrait, 31
Hensen, 29
Holmes, 212
Home treatment, 242
Huxley, 29
Hypermetropia, 10, 222, 251,

266

prevention, 251, 266
production, 14, 39, 42, 53,

63, 65, 66, 75, 89, 266
treatment, 229, 234, 273
(see also "Refraction,
errors of, treatment")

Illusions,

of imperfect sight, 148,

172, 219, 280, 282
of normal sight, 138, 172,

180

Kelly, 308
Kepler, 23

Lancaster, 83

Landolt, 23, 26, 86

Langenbeck, 24

Lawson, 255

Lens (see "Accommodation "

'[Cataract," "Images,"

"Presbyopia")

Light, 78, 123, 183, 253, 261
Lonng, 33

Macaulay, 275

Macula, 114

Memory, 126, 136, 151, 202, 274

Military training, 284

Mind, 89, 106, 115, 148, 196, 274

295 (see also "Memory")
Montessori, 106
Moros, 6
Morphine, 289
Motais, 256

Moving pictures, 108, 161, 192
Muscae vplitantes, 176, 236
Muscle, ciliary, 11, 29, 75 85

211, 215 (see also "Atro-

pine")
Muscles, external, 32, 37, 38, 89

Index

313

Myopia, 8, 10, 222 (see also
"Accommodation")

Barrington on, 256

Cohn on, 251, 252, 253, 254

Bonders on, 309

Eversbusch on, 252

Fox on, 256

Just on, 254

Lawson on, 255

Motais on, 256

Pearson on, 256

prevention, 8, 39, 251, 259

production, 2, 11, 14, 63,
65, 75, 89, 109, 257

Risley on, 253

Roosa on, 308

Sidler-Huguenin on, 8, 82,
256

Steiger on, 256

treatment, 8, 82, 120, 141,
157, 158, 170, 251, 259,
271, 299 (see also "Re-
fraction, errors of, treat-
ment")

Tscherning on, 252

Neuralgia, 207

Night blindness, 281, 283

Nystagmus, 117

Ophthalmology, 1, 214
Ophthalmometer, 34, 60, 66
Ophthalmoscope, 23, 117, 160
Optic nerve, 89, 108, 111, 112,

122, 127, 157
Optimums, 198

Pain, 133, 155, 202, 288

Palming, 123 (see also "Mem-
ory")

Paralysis, 131

Parsons, 184

Patagonians, 2

Pearson, 256

Pessimums, 198

Pigmies, 3

Polyopia, 112, 149, 174, 178, 179,
283

Presbyopia, 210

Pupil 190, 214
Purkmje, 24, 25

Ray, 37
Reading, 192

Refraction, errors of (see also
"Astigmatism," "Hyper-
metropia," "Myopia")
cause, 1, 14, 89, 106 (see

also "production")
occurrence, 5, 75, 98, 251,

267, 285

prevention, 1, 245, 285, 288
production, 14, 38, 62, 75,

89, 106, 114

treatment, 1, 101, 112, 118,

123, 136, 148, 159, 183,

242, 246, 259, 270, 274

Refraction, variability of, 10,

75, 85, 213, 215, 286, 287

Relaxation (see "Refraction,

errors of, treatment")
Retina, 89, 109, 111, 114, 220
Retinoscope, 17, 110, 137
Rheumatism, 208
Risley, 253
Roosa, 210, 308
Rosenau, 4

Sanson, 29

Saturn, rings of, 121

Scheiner, 24

School-books, 192, 253

de Schweinitz, 36, 211

Sclera (see "Images, on scle-

ra")

Scotomata, 177, 185, 186
Scott, 4

Sense, nerves of, 108
Shifting, 159

Sidler-Huguenin, 8, 82, 256
Snellen, 19
Snellen, jr., 69
Snellen test card, 19, 200, 242,

244, 268, 287

Soldiers and sailors, 5, 284
Squint, 112, 117, 118, 221, 227,

272

Steiger, 256
Stevens, 222

314

Index

Strain, 89, 106, 115, 172, 178,

192, 257
Swinging, 159

Truth, 74
Tscherning, 27, 30, 252

Verhoeff, 184

Vision, defects of, 4, 264 (see
also "Refraction, errors
of, occurrence;" "Refrac-
tion, variability of")
limits of, 104, 121
military standards of, 5

Vision, primitive, 1, 2, 3, 6, 15,

16, 121, 267, 275
standard of normal, 19, 123
Visual centers, 108, 123
Volkers, 29

Webster, 35
Whooping cough, 208
Woinow, 33
Worth, 222, 223, 225

Young, Dr. A. G., 193
Young, Dr. Thomas, 24, 30
portrait, 28

01608003G

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