Thus “a patient 25 years old had no error of refraction when he looked at a blank wall without trying to see (i.e., under complete relaxation and total absence of strain); but if he said he was 26, or someone else said he was 26, he became myopic (as shown by Bates’ rapid retinoscopy). The same thing happened when he said or tried to imagine that he was 24. 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.” There is also the case of the little girl who told a lie. The retinoscope revealed a change towards myopia the moment she replied “No” to the question, “Did you have an ice-cream?”; while she was giving truthful answers “the retinoscope indicated no error of refraction.” This appears to be, so to say, a physical expression of the inward eye of the conscience.
A queer assortment of evidence is brought forward to prove that the refractive changes in the eye are produced by the extra-ocular muscles. There is, for example, the “proof” that aphakic patients are able to read small type with distance glasses. That the daily experience of ophthalmologists is to the contrary is perhaps of some significance, though obviously not as significant as the few instances Bates records, for which, incidentally, perfectly good explanations are available, as anyone acquainted with the literature knows.[1] There is, indeed, an extensive and controversial literature on the actual mechanism whereby the contour of the lens changes during accommodation; the facts themselves are not disputed—except by Bates, who produces experimental evidence that in the fish removal of the lens does not interfere with accommodation.
The fish experiment is amply illustrated by photographs, but there is no reference to the fact that accommodation in the fish is different physiologically and anatomically from that of the mammal. Mammalian experiments, mainly on the rabbit and cat, are recorded, and here the rather startling point emerges that a nerve or muscle cut across and tied up again will carry an impulse on being tied, though physiologists would not expect any such result before days or weeks had elapsed. Mammalian anatomy is also illuminated in these experiments. Apparently the standard teaching that the cat is endowed with a superior oblique muscle is not correct. It should be added that this is only an incidental observation; but that pharmacologists err in believing that atropine acts only on unstriped muscle is part of the general argument, for Bates found that this drug will paralyze the extrinsic muscles which produce accommodation. One experiment, illustrated in fig. 23, appears to show that the dead fish still has a living mind; its brain is pithed to induce relaxation.
The treatment based on these revolutionary observations aims at mental relaxation, and the pithed fish appears to be its prototype. The Bates system of treatment seems to have many devotees, and one incident may be worth noting. In 1931 the Republican Ministry of Public Health of Prussia warned against this method as a form of quackery,[2] but in Hitlerite Germany a voluminous literature on the subject has spread the cult and there is apparently no lack of practitioners and patients.
It will be noticed that this article contains two main lines of argument.
First: Bates’ method of visual education cannot be sound, because it is used by Germans.
Second: Bates’ method of visual education cannot be sound, because certain experiments devised to confirm the hypothesis, by which Bates sought to explain the success of his method, were not conducted properly.
The first argument is exactly like that which was used, more than a century ago, to discredit the stethoscope. Readers of John Elliotson’s papers will recall his account of this ludicrous episode in the history of English medicine. Owing to anti-French prejudice, it was twenty years or more before Laennec’s invention came into general use among English physicians.
In precisely the same way, owing to prejudice against magnetizers and mesmerists, hypnotism was under the ban of official British medicine for an even longer period. For half a century after Braid had formulated his classical hypothesis and Esdaile had performed scores of major operations under hypnotic anaesthesia, the British Medical Association officially held that there was nothing in hypnotism but fraud and quackery.
Medical history has a dismal way of repeating itself in these matters, and it looks as though visual education were to suffer the same fate as hypnotism and the stethoscope.
I may add that the argument from nationalism hardly seems justified in the present instance. The art of seeing was worked out by an American physician and is extensively taught at the present time in the United States and England. “Seeing-schools” have also existed for many years in Germany. Some of these schools were doubtless bad and deserved the censure of the Republican Health Ministry; but others, as it would appear from an article contributed in 1934 by an army surgeon to the Deutsche Medizinische Wochenschrift, must have been excellent.
In this article, Dr. Drenkhahn records that, in many cases of refractive error among army recruits, he found that marksmanship was better when the men wore no corrective glasses, but underwent a course of visual training at a seeing-school. To those who notice any falling off of vision, Dr. Drenkhahn gives the following advice: not to go immediately to an eye specialist, who will generally prescribe glasses, but to consult the family physician and, when he has taken steps to correct the general physical and psychological condition, to go to a seeing-school and learn the proper way to use the eyes and mind.
So much for the first line of argument. The second is equally irrelevant, being based, not on prejudice this time, but on mental confusion and bad logic. For, incredible as it may seem, Mr. Sorsby entirely fails to distinguish between two totally different things: the primary evidence confirming the existence of certain phenomena, and the secondary evidence adduced to substantiate the hypothesis, in terms of which those phenomena are explained. The phenomena, which Bates sought to explain in terms of his unorthodox theory of accommodation, were those marked improvements in vision, which regularly followed the practice of certain educational techniques.
The evidence for the occurrence of such phenomena can be supplied by the thousands of persons who, like myself, have derived benefit from following the procedures in question, and by the scores of conscientious and experienced instructors who teach the method. If Mr. Sorsby really wanted to know about this evidence, he would get in touch with a few reliable teachers, ask permission to watch them at work and, if his own vision is defective, take a course of visual re-education. Instead of that, he seeks to discredit the whole idea of visual re-education by denying the validity of the experiments used by Bates to support his explanatory hypothesis.
Needless to say, the idea of visual education emerges unscathed from this hopelessly misdirected attack. For it is obvious that, even if this secondary evidence were untrustworthy, even if the hypothesis supported by that evidence could be proved to be incorrect, this would make absolutely no difference to the facts which that hypothesis was originally intended to explain. In the history of human effort, effective arts have always preceded correct explanatory hypotheses. Thus, an art of metallurgy existed for several thousands of years before the formulation, in the present century, of satisfactory hypotheses to account for the phenomena of tempering and alloying.
According to Mr. Sorsby’s view, the incorrectness of their hypotheses should have made it impossible for the old smiths and founders to possess an art of metal working. Again, if Mr. Sorsby’s argument made sense, there could be no such thing as modern medicine. Our knowledge of the human mind-body is limited and patchy, and our theories about it are admittedly inadequate. Nevertheless, an effective art of medicine exists, in spite of the fact that many medical hypotheses will, in the future, certainly be proved false, while new hypotheses will be formulated, of which contemporary physicians cannot even dream. Bates’ theory of accommodation may be as incorrect as were the eighteenth- and nineteenth-century explanations of the efficacy of lime-juice in cases of scurvy. Nevertheless scurvy was cured by lime-juice, and Bates’ method of visual education actually works.
[1]
Amer. J. Ophthal., 1921, 4, 296.
[2]
Klin. Mbl. Augenheilk., 1931, 87, 514.
APPENDIX II
In myopes especially, posture tends to be extremely bad. This may be directly due in some cases to the short sight, which encourages stooping and a hanging of the head. Conversely, the myopia may be due in part at least to the bad posture. F. M. Alexander records cases in which myopic children regained normal vision after being taught the proper way of carrying the head and neck in relation to the trunk.
In adults, the correction of improper posture does not seem to be sufficient of itself to restore normal vision. Improvement in vision will be accelerated by those who learn to correct faulty habits
