[...Correspondence Treatment

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 textbooks 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
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. 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. Hip 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 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 can not 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 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 lie 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 treatment 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 cases coming from a distance is
continued by correspondence after they return to their homes; and
although the patients 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. 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...]

- Dr. W. H. Bates, October 1919