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The Economics of Glasses
AMERICAN JOURNAL OF OPHTHALMOLOGY P U B L I S H E D MONTHLY BY T H E O P H T H A L M I C P U B L I S H I N G COMPANY
EDITORIAL STAFF LAWRENCE T. POST, editor 524 Metropolitan building, Saint Louis W I L L I A M H. CRISP, consulting editor 530 Metropolitan building, Denver EDWARD JACKSON, consulting editor 217 Imperial building, Denver CLARENCE LOEB, associate editor 1054 Tower Road, Hubbard Woods, Illinois
HANS BARKAN 490 Post street, San Francisco EDWARD C. E L L E T T Exchange building, Memphis, Tennessee HARRY S. CRADLE 58 East Washington street, Chicago M. URIBE TRONCOSO 350 West 85th street, New York
J O H N M. W H E E L E R 30 West Fifty-ninth street, New York Address original papers, other scientific communications including correspondence, also books for review and reports of society proceedings to Dr. Lawrence T. Post, 524 Metro politan building, Saint Louis. Exchange copies of medical journals should be sent to Dr. William H. Crisp, 530 Metropolitan building, Denver. Subscriptions, applications for single copies, notices of change of address, and commu nications with reference to advertising should be addressed to the manager of subscrip tions and advertising, 508 Metropolitan building, Saint Louis. Copy of advertisements must be sent to the manager by the fifteenth of the month preceding its appearance. Authors' proofs should be corrected and returned within forty-eight hours to the editor. Twenty-five reprints of each article will be supplied to the author without charge. Addi tional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted.
T H E ECONOMICS OF GLASSES T h e economics of glasses m a y b e seen from t h r e e p o i n t s of v i e w : 1, T h a t of t h e p a t i e n t , w h o seeks relief from dis ability, or discomfort, t o g a i n a n d pre serve h e a l t h ; 2, T h a t of t h e physician w h o seeks t h e c a u s e s of t h e s y m p t o m s , a n d d e t e r m i n e s t h e m e a n s for t h e i r r e moval, or p r e v e n t i o n ; 3, T h a t of t h e m a n u f a c t u r e r a n d seller of glasses, w h o seeks t o e n l a r g e his b u s i n e s s a n d m a k e it m o r e profitable. T h e first concern of t h e p h y s i c i a n is to r e n d e r t h e b e s t service to his pa tient. A profession exists to r e n d e r serv ice to t h e c o m m u n i t y . P o o r medical ad vice is t h e m o s t e x p e n s i v e t h i n g in t h e h i g h cost of health. T h e medical ad vice t h a t is given free in t h e a d v e r t i s e m e n t s , in t h e daily p a p e r s , or s t u c k u n der t h e front door, costs t h e public m o r e t h a n t h e advice t h e y p a y for, a n d this is t r u e of t h e advice t h e y g e t a b o u t glasses. T h e good of t h e w e a r e r is t h e reason for w e a r i n g glasses, a n d m u s t d o m i n a t e t h e c h o o s i n g a n d fitting of t h e m .
P a t i e n t s w h o come w i t h e r r o r s of re fraction often k n o w , from experience, t h e h i g h cost of p o o r advice. T h e o p t o m e t r i s t , w h o is m o s t a n x i o u s t o sell h i g h priced lenses a n d t h e latest in frames, can h a r d l y be expected to a t t a c h g r e a t i m p o r t a n c e t o t h e a c c u r a c y of a scientific m e a s u r e m e n t . T o o often t h e M.D., w h o h a s chosen " O p h t h a l m i c sur g e r y " for his specialty, t h i n k s too little of t h e i m p o r t a n c e of a m e t r o p i a , t o give t h e t i m e n e c e s s a r y for r e p e a t e d t e s t s of t h e refraction, even to s e c u r e t h e best r e s u l t s of his c a t a r a c t o p e r a t i o n s . B u t w h e n an a c c u r a t e correction h a s been prescribed, t h e i n t e r e s t of t h e p a t i e n t still r e q u i r e s t h o u g h t . P o o r service as to frames m a y be given b y t h e optician, w h o seeks his 100 p e r c e n t profit, b y a d vising t h e l a t e s t style of frames or ma t e r i a l ; a n d if t h e p a t i e n t seeks for the cheapest glasses t h a t will m e e t the pre scription, t h e m o n e y he m a y save will really be no saving. T o m e e t fully t h e obligation to g u a r d his p a t i e n t ' s interest, t h e d o c t o r w h o 246
EDITORIALS
prescribes lenses must first find what is the best correction and judge if it is likely to give relief, supplement his pre scription with instructions as to the careful use of his eyes, and then see that the prescription is taken to a reliable op tician who skilfully fits the frames. In the present state of the optical business there are many selling glasses who have little understanding of the fitting of frames, or of its importance. It is there fore necessary for the prescriber to judge of the accuracy of the finished glasses and their mountings; to follow up the wearing of the glasses, and to explain the difficulties that arise from their use. This is the kind of service for which the competent and conscientious ophthalmologist is to be compensated. As adequate compensation is asked and given, good services will be appreciated and expected; and the community will be benefited. Two dangerous illusions, that the young doctor has to get rid of are, that big fees go with a large operative prac tice, and that both are desirable. A sur geon who attained high rank in ab dominal surgery, went over his books after twenty years of such work, and found that his abdominal sections had brought him an average of ten dollars each. An ophthalmic surgeon who had done two hundred cataract extractions found, that for the operations and post operative attendance, he received on the average about fifteen dollars apiece. If he operated a second time on the same case he received a smaller fee. The same attention, time and effort, spent on a refraction case would have given him as large a fee, and generally secured a patient who would return to him, every three or five years, for a similar service. Such patient would ac tually have been put to less expense, than if he had gone to a dealer who ex pected to supplement his first sale of glasses by having his customer come back after a few weeks, or months, to have his glasses checked up to see if they could be improved, or, who might be induced by a good salesman, to change his frames every time the manu facturers found it profitable to put a
247
new style on the market. There is a good economic foundation for the eye physician to serve the community, by conscientious measurement of errors of refraction. Edward Jackson. PERFECT SIGHT W I T H O U T GLASSES Because, many years ago, Apostles were sent forth to carry a message throughout the world, and because a modern American faddist flooded Ger many and other countries with his faithful disciples, the latter have no hesitation in comparing the late Wil liam H. Bates with the sender of those Apostles. The Prussian Minister of Public Wel fare has issued an official document stigmatizing the Bates "schools" as practicing quackery. The patients of this pretender are chiefly to be classed, according to Jaensch (Klinische Monatsblatter fur Augenheilkunde, 1931, volume 87, page 514) as hysterical and neurotic subjects of the type so easily in fluenced by another American healer of world fame. Bates himself claimed to cure glaucoma, myopia, hyperopia, astigmatism, presbyopia, cough, hay fever, rheumatism, trigeminal neural gia, incipient cataract, syphilitic iritis, retinitis, and keratitis, and to relieve the toxic effects of typhoid, influenza, and gonorrhea. It is rather usual for ethical physi cians to treat quacks and quackery as beneath their notice, and to avoid study and discussion of claims and methods regarded as fraudulent or misleading. But mere statements by Prussian Min isters of Public Welfare or by medical organizations that any so-called school of healing practices quackery do not sat isfy the general public, and there is grave question whether to ignore com pletely these false claims is not to fail in our educational duty to the community. To the scientific ophthalmologist the arguments of Bates and his followers are transparently and ridiculously mis leading. To the layman, however, they may sometimes sound plausible. Most of us know little about the "sight schools" ("perfect vision without
EDITORIAL STAFF LAWRENCE T. POST, editor 524 Metropolitan building, Saint Louis W I L L I A M H. CRISP, consulting editor 530 Metropolitan building, Denver EDWARD JACKSON, consulting editor 217 Imperial building, Denver CLARENCE LOEB, associate editor 1054 Tower Road, Hubbard Woods, Illinois
HANS BARKAN 490 Post street, San Francisco EDWARD C. E L L E T T Exchange building, Memphis, Tennessee HARRY S. CRADLE 58 East Washington street, Chicago M. URIBE TRONCOSO 350 West 85th street, New York
J O H N M. W H E E L E R 30 West Fifty-ninth street, New York Address original papers, other scientific communications including correspondence, also books for review and reports of society proceedings to Dr. Lawrence T. Post, 524 Metro politan building, Saint Louis. Exchange copies of medical journals should be sent to Dr. William H. Crisp, 530 Metropolitan building, Denver. Subscriptions, applications for single copies, notices of change of address, and commu nications with reference to advertising should be addressed to the manager of subscrip tions and advertising, 508 Metropolitan building, Saint Louis. Copy of advertisements must be sent to the manager by the fifteenth of the month preceding its appearance. Authors' proofs should be corrected and returned within forty-eight hours to the editor. Twenty-five reprints of each article will be supplied to the author without charge. Addi tional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted.
T H E ECONOMICS OF GLASSES T h e economics of glasses m a y b e seen from t h r e e p o i n t s of v i e w : 1, T h a t of t h e p a t i e n t , w h o seeks relief from dis ability, or discomfort, t o g a i n a n d pre serve h e a l t h ; 2, T h a t of t h e physician w h o seeks t h e c a u s e s of t h e s y m p t o m s , a n d d e t e r m i n e s t h e m e a n s for t h e i r r e moval, or p r e v e n t i o n ; 3, T h a t of t h e m a n u f a c t u r e r a n d seller of glasses, w h o seeks t o e n l a r g e his b u s i n e s s a n d m a k e it m o r e profitable. T h e first concern of t h e p h y s i c i a n is to r e n d e r t h e b e s t service to his pa tient. A profession exists to r e n d e r serv ice to t h e c o m m u n i t y . P o o r medical ad vice is t h e m o s t e x p e n s i v e t h i n g in t h e h i g h cost of health. T h e medical ad vice t h a t is given free in t h e a d v e r t i s e m e n t s , in t h e daily p a p e r s , or s t u c k u n der t h e front door, costs t h e public m o r e t h a n t h e advice t h e y p a y for, a n d this is t r u e of t h e advice t h e y g e t a b o u t glasses. T h e good of t h e w e a r e r is t h e reason for w e a r i n g glasses, a n d m u s t d o m i n a t e t h e c h o o s i n g a n d fitting of t h e m .
P a t i e n t s w h o come w i t h e r r o r s of re fraction often k n o w , from experience, t h e h i g h cost of p o o r advice. T h e o p t o m e t r i s t , w h o is m o s t a n x i o u s t o sell h i g h priced lenses a n d t h e latest in frames, can h a r d l y be expected to a t t a c h g r e a t i m p o r t a n c e t o t h e a c c u r a c y of a scientific m e a s u r e m e n t . T o o often t h e M.D., w h o h a s chosen " O p h t h a l m i c sur g e r y " for his specialty, t h i n k s too little of t h e i m p o r t a n c e of a m e t r o p i a , t o give t h e t i m e n e c e s s a r y for r e p e a t e d t e s t s of t h e refraction, even to s e c u r e t h e best r e s u l t s of his c a t a r a c t o p e r a t i o n s . B u t w h e n an a c c u r a t e correction h a s been prescribed, t h e i n t e r e s t of t h e p a t i e n t still r e q u i r e s t h o u g h t . P o o r service as to frames m a y be given b y t h e optician, w h o seeks his 100 p e r c e n t profit, b y a d vising t h e l a t e s t style of frames or ma t e r i a l ; a n d if t h e p a t i e n t seeks for the cheapest glasses t h a t will m e e t the pre scription, t h e m o n e y he m a y save will really be no saving. T o m e e t fully t h e obligation to g u a r d his p a t i e n t ' s interest, t h e d o c t o r w h o 246
EDITORIALS
prescribes lenses must first find what is the best correction and judge if it is likely to give relief, supplement his pre scription with instructions as to the careful use of his eyes, and then see that the prescription is taken to a reliable op tician who skilfully fits the frames. In the present state of the optical business there are many selling glasses who have little understanding of the fitting of frames, or of its importance. It is there fore necessary for the prescriber to judge of the accuracy of the finished glasses and their mountings; to follow up the wearing of the glasses, and to explain the difficulties that arise from their use. This is the kind of service for which the competent and conscientious ophthalmologist is to be compensated. As adequate compensation is asked and given, good services will be appreciated and expected; and the community will be benefited. Two dangerous illusions, that the young doctor has to get rid of are, that big fees go with a large operative prac tice, and that both are desirable. A sur geon who attained high rank in ab dominal surgery, went over his books after twenty years of such work, and found that his abdominal sections had brought him an average of ten dollars each. An ophthalmic surgeon who had done two hundred cataract extractions found, that for the operations and post operative attendance, he received on the average about fifteen dollars apiece. If he operated a second time on the same case he received a smaller fee. The same attention, time and effort, spent on a refraction case would have given him as large a fee, and generally secured a patient who would return to him, every three or five years, for a similar service. Such patient would ac tually have been put to less expense, than if he had gone to a dealer who ex pected to supplement his first sale of glasses by having his customer come back after a few weeks, or months, to have his glasses checked up to see if they could be improved, or, who might be induced by a good salesman, to change his frames every time the manu facturers found it profitable to put a
247
new style on the market. There is a good economic foundation for the eye physician to serve the community, by conscientious measurement of errors of refraction. Edward Jackson. PERFECT SIGHT W I T H O U T GLASSES Because, many years ago, Apostles were sent forth to carry a message throughout the world, and because a modern American faddist flooded Ger many and other countries with his faithful disciples, the latter have no hesitation in comparing the late Wil liam H. Bates with the sender of those Apostles. The Prussian Minister of Public Wel fare has issued an official document stigmatizing the Bates "schools" as practicing quackery. The patients of this pretender are chiefly to be classed, according to Jaensch (Klinische Monatsblatter fur Augenheilkunde, 1931, volume 87, page 514) as hysterical and neurotic subjects of the type so easily in fluenced by another American healer of world fame. Bates himself claimed to cure glaucoma, myopia, hyperopia, astigmatism, presbyopia, cough, hay fever, rheumatism, trigeminal neural gia, incipient cataract, syphilitic iritis, retinitis, and keratitis, and to relieve the toxic effects of typhoid, influenza, and gonorrhea. It is rather usual for ethical physi cians to treat quacks and quackery as beneath their notice, and to avoid study and discussion of claims and methods regarded as fraudulent or misleading. But mere statements by Prussian Min isters of Public Welfare or by medical organizations that any so-called school of healing practices quackery do not sat isfy the general public, and there is grave question whether to ignore com pletely these false claims is not to fail in our educational duty to the community. To the scientific ophthalmologist the arguments of Bates and his followers are transparently and ridiculously mis leading. To the layman, however, they may sometimes sound plausible. Most of us know little about the "sight schools" ("perfect vision without