CORRESPONDENCE treatment is usually regarded 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 functional 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 derangements. One cannot, it is true, fit glasses by correspondence as well as when the patient is in the office, but even this can be done, as the following case illustrates.
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 w 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 prescribing 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.
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If I had so much difficulty in prescribing the proper glasses under favorable conditions, how could I be expected 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. 1 knew also that she could not have much astigmatism, for in that case her sight would always have been noticeably 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
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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 concave 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 entirely 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 without glasses there can be even less objection to the correspondence method. It is true that in most cases progress 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 cannot have the benefit of personal treatment should be denied such aid as can be given them by correspondence. 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
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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 discomfort, 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 rapidly. 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 relieved 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 treatment, and although I told him that correspondence treat
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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 till 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 probably 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 understand 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.[NOTE: Interesting enough, this the final sentence of this paragraph appears in one of the 1920 editions, but not in another!:] I would consider it a privilege to treat medical men without a fee, and when cured they will be able to assist me in the treatment of patients in their various localities.