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Review of The Struggle by Bobby Matherne 2011

Read also review of Learn to Understand & Prevent Myopia by Bobby Matherne 2010 (external site)

Review of Tetralogia by Aune Adel, 1974

Suomen Kuvalehti magazine article 'Onko pluslaseista apua', 25th of April, 1974

Turun Sanomat article 'Jokainen tarvitsee laseja jonakin aikana elämässään' , June 13th 1973

Excerpts from correspondence with my colleague Aune Adel

After looking at my website, patient NN wrote to me (an excerpt)

 

 

THE STRUGGLE - Never To Be Forgottten A Book Review by Bobby Matherne ©2011

NOTE: SEE http://www.doyletics.com/arj/whyrvw.shtml  For FULL REVIEW

Why? What happens when people give reasons . . . and why by
Charles Tilly

Published by Princeton Univ Press/NJ in 2006
A Book Review by Bobby Matherne ©2011

Why do people give reasons? Wouldn’t you like to know? Why? Because. Okay, Because is one popular answer to the question Why? One says Because when one chooses not to answer and wants to not give a reason why. For people who actually wish to share their reasons,  Charles Tilly gives us four categories of responses to the question Why? These answers form the theme and content of this interesting and useful small book.

Why bother with this book? Well, I have four kinds of reasons to share. First, as a custom, I read books which fall in the category of the evolution of consciousness. The very title of this book tells me that the author has studied the reasons people give for things they do or things which happen to them. Because of a convention I have adopted, I had to buy this book and read it.

Second, let me tell you a story. I have just received a book written by an innovative medical doctor in Finland who had trouble with others in her profession. She writes of her difficulties with her profession in a book, entitled The Struggle: Never to be Forgotten. I helped her to get the English of her book, translated from the original Finnish by a native Finnish translator, into somewhat clearer, colloquial English. As a result of reading her book several times during this copy-editing process, I became aware of the conflicts between her and the authorities who refused to publish her various technical articles in their journals. Through the various letters in the book, I read the reasons which various journal editors gave for not publishing her work.

Third, as a free-lance writer, there are no limits placed on what I can read and review, and since it is my convention to review everything I read, this book feel under my own codes as being okay to read. Which is great since I wanted to read it.
Fourth, having a story to tell of why I wanted to read the book, having a convention of reading which it fell under, and having it qualify under my own codes as being okay to read, the only technical details I had to attend to was to order the book from Labyrinth Book Catalog and wait for it to come.
Why such a tendentious account of my buying a book and reading it? Because the four reasons I give above fall into the four categories of reasons which Tilly describes in this book that we give to the question Why? Namely, 1) Conventions, 2) Stories, 3) Codes, and 4) Technical Accounts. Obviously not every answer to the question Why? need include all four categories of reasons, but any question will evoke at least one of categories of responses. Even the terse answer Because can be seen to be a convention to the person who uses it.

Here’s how Tilly describes the four categories:

 

[page 15]
1. Conventions: conventionally accepted reasons for dereliction, deviation, distinction, or good fortune: my train was late, your turn finally came, she has breeding, he's just a lucky guy, and so on

2. Stories: explanatory narratives incorporating cause-effect accounts of unfamiliar phenomena or of exceptional events such as the 9/11 catastrophe, but also such as betrayal by a friend, winning a big prize, or meeting a high school classmate at Egypt's Pyramids twenty years after graduation

3. Codes governing actions such as legal judgments, religious penance,  or awarding of medals

4. Technical Accounts of the outcomes in the first three: how a structural engineer, a dermatologist, or an orthopedic surgeon might explain what happened to Elaine Duch on the World Trade Center's 88th floor after a hijacked aircraft struck the building on 9/11

Each of the four ways of giving reasons has distinctive properties. Each of them varies in content depending on social relations between giver and receiver. Each of them, among other consequences, exerts effects on those social relations, confirming an existing relation, repairing that relation, claiming a new relation, or denying a relational claim. But the four sorts of reason giving differ significantly in form and content. Each can be valid in a way that the others cannot.

. . .

Roughly speaking, then, reasons why distribute this way:

	Popular	Specialized
Formulas	Conventions	Codes
Cause-Effect Accounts	Stories	Technical Accounts

With this diagram one can see conventions are popular everyday formulas followed by the average person, whereas codes are specialized formulas for which special training and reference books may be required. Stories are popular cause-effect accounts and move to Technical Accounts when given by specialists in some field.

Reason giving methods are dependent on the social relationship between those involved.

[page 24, 25] Reason giving resembles what happens when people deal with unequal social relations in general Participants in unequal social relations may detect, confirm, reinforce, or challenge them, but as they do so they deploy modes of communication that signal which of these things they are doing. In fact, the ability to give reasons without challenge usually accompanies a position of power. In extreme cases such as high public offices and organized professions, authoritative reason giving comes with the territory. Whatever else happens in the giving of reasons, givers and receivers are negotiating definitions of their equality or inequality.

In her book, The Struggle: Never to Be Forgotten, Dr. Kaisu Viikari ,M.D. Ph. D. in Ophthalmology, writes of her experience trying to get a synopsis of her lecture to the Finnish Ophthalmological Society  accepted in its Journal. Her innovative work, described in stories and detailed technical accounts, was rejected for this reason: “It differed from prevailing ideas.” Here was the editor of the scientific journal falling back on conventions and codes instead of simply allowing Viikari’s cause-effect relationships laid out in her stories and technical accounts to simply speak for themselves. In other words, through my reading of this book, I came to see how the forces of opposition took sides: each side used two of the four categories of reasons laid out by Charles Tilly in this book.
In addition there was a negotiating of relationships between the two parties in exactly the manner Tilly describes in this next passage.

[page 16] In each case, acceptability of the reasons given depends on their match with the social relations that prevail between giver and receiver. Just as people involved in unequal relations regularly negotiate acceptable signals of deference or distinction, participants in reason giving maneuver in both directions: generally giving reasons that match the presumed relationship, but also signaling proposed definitions of the relationship by means of reasons given.

[NOTE: MIDDLE EIGHT PAGES OF REVIEW OMITTED,
SEE http://www.doyletics.com/arj/whyrvw.shtml  For FULL REVIEW]

RECONCILING REASONS
The sixth and last chapter is Tilly’s summary of how we use the various categories of reason. The entire book is a short and valuable read for any serious thinker, scientist, or innovator. It explains in detail how any innovative work will likely deviate from the norm of codes and conventions in a specialty, and will put a speaker or writer at risk of being minimized or even ignored by her intended audience. Tilly gives a robust solution to this conundrum in his suggestion of superior stories. Tilly teaches undergraduates about social processes. Most of his Columbia graduates likely “will become doctors, lawyers, engineers, entrepreneurs, business executives, or public officials”.
[page 173] Relationships between my students and me add up to only one small case of a very large phenomenon: the giving and receiving of reasons. But those relationships illustrate this book's two basic arguments. First, appropriate reason giving varies with the relation between giver and receiver; the point holds just as strongly for technical accounts and stories as for conventions and codes. Second, the giving of reasons creates, confirms, negotiates, or repairs relations between the parties. Aristotle's analysis of rhetoric, after all, prepared us for just such an observation. Conventions do much of everyday relational work. We should be glad they do, since constant deployment of codes, technical accounts, and stories would complicate life enormously without improving it. Yet stories are a great human invention, since they provide a medium of explanation that is widely accessible, flexible, and persuasive. When life does get complicated, stories take over the bulk of relational work.

In the case of technical accounts, how can these ever get assimilated by those outside of the field of a specialty who have no access to the arcane terms and jargon which fills the accounts of someone’s innovative work? Tilly offers us the example of professional historians, and then points out that one way reaching those new to a field is through the writing of textbooks by various experts.

[page 178] In fact, almost every group of specialists faces its own version of the same problem: how to offer credible, comprehensible reports of findings, recommendations, and explanations it has arrived at by means of specialized codes and technical accounts. For their own work, for example, professional historians depend heavily on esoteric codes: proper use of archives, correct excavation and interpretation of archaeological material, appropriate analysis of art works, and so on (Gaddis 2002, Van de Mieroop 1999). They also construct technical accounts strongly embedded in recognized historical sources, previous research, and knowledge of the settings in which the events they are analyzing occurred. Yet when they turn to writing textbooks or publications for general readers, they have no choice but to suppress or simplify much of their professional expertise. Superior stories serve them well.

What about those other specialties? What are their choices outside of writing textbooks?

[page 178, 179] The same goes for philosophers, theologians, cosmologists, biologists, physicians, lawyers, and generals. They must mix and match among four main alternatives:

1. speak only to fellow specialists
2. educate (some members of) their audiences in their specialized codes and technical accounts
3. recast their reason giving in the form of superior stories
4. count on translators and interpreters who already speak the language to do the recasting

Speaking only to your fellow specialists is the easiest. But it runs the risk that other people will misunderstand, misrepresent, or simply ignore whatever you are doing. Educating audiences in your specialty is a wonderful enterprise if you have the power and skill to do so. Depending on translators and interpreters — science writers, popularizers, and knowledgeable amateurs — saves plenty of grief when the translators and interpreters know their stuff. But for a wide range of specialists, writing your own superior stories has the virtue of making you think about the relevance of your daily work to humanity at large, or at least the humanity with which you make contact outside of your study, laboratory, or conference hall.

In my writing career, I have worked with three innovators, Joseph W. Newman, Doyle P. Henderson, and Kaisu Viikari, M. D. Ph. D. I have acted as an advisor, a translator, an interpreter, a science writer, and as a knowledgeable amateur at various times with each of these specialists in their fields. Each one offers to the world a panacea, a universal cure for some problem. Newman’s contribution is a way of converting atoms of copper directly into energy promising unlimited energy. Henderson’s cosmological discovery offers us a world free of fear, anger, anxiety, and all the various bodily states which infuse humans before the onset of full cognitive memory at age 5 . Dr. Viikari’s  lifetime of ophthalmological research and ministering to her suffering patients offers us freedom from eye-glass-induced myopia and a spate of other diseases from the resulting pressure by the muscles of the eye, such as macular degeneration, retinal detachment, cataracts, and migraines.

In the case of each of these remarkable innovators, the enforcers of conventions and codes have blocked their progress. Newman’s patent for his amazing machine was declined, even in the face of overwhelming support by all experts who examined it and excellent technical accounts describing the cause-effects of its operation. Henderson opened a clinic in Los Angeles next to a drug rehabilitation clinic. His clinic took the rejects from the Rehab Clinic and cured them. His process turned alcoholics into social drinkers and lesbians into bi-sexuals. This raised an uproar from those who deemed this to be  a violation of conventions and codes, so they threatened prosecution of Henderson for dispensing medicine without a license and shut his clinic down. Alcoholics were free thenceforth to remain alcoholic. Dr. Viikari’s innovative approach to prescribing plus lenses for incipient myopia prevented the vicious cycle of stronger and stronger minus lenses which creates the syndrome of pseudo-myopia. She was shouted down in a lecture to her peers for simply using the phrase pseudo-myopia, which was outside of the codes of the optical profession, perhaps even now. In the cases of each of these innovators, in diverse fields, the conventions and codes which their work seemed to violate, caused their work to be suppressed, exactly the way the work of Dr. Ignaz Semmelweis’s innovative work in antisepsis was condemned by the director of his hospital in Vienna who subsequently had Semmelweis committed to an insane hospital . All the while  women died by the thousands in childbirth as doctors continued, for a time, to go from demonstrating deliveries in cadavers to delivering babies inside of live women, without washing their hands as Semmelweis had already proven effective in saving lives! Semmelweis is known as the Father of Antisepsis today, but the seamy underbelly of the medical profession is rarely mentioned in connection with Semmelweis today. Barbara McClintock, in contrast with Semmelweis, had her innovations recognized and her life’s work vindicated within her lifetime. The jury is still out for Newman, Henderson, and Viikari, but when one is confronting entrenched paradigms in any field, one must always think in the long term. Gregor Mendel’s ground-breaking work with smooth and wrinkled peas was forgotten about for over thirty years, until William Bateson recognized its value and gave the field its name, genetics.

[page 180] We can also read this book's teachings in the opposite direction. The reasons people give you reflect their approaches to relations with you. Most of the time, conventions and stories confirm relations that you already knew existed: you instantly recognize the "wrong" convention or story, which claims a relationship you prefer not to acknowledge. When someone offers you codes or technical accounts in unfamiliar idioms, you rapidly choose between two interpretations: either this person has misunderstood the relationship between you, or she is claiming superiority and demanding deference by virtue of esoteric knowledge. If, of course, you have asked for a summary of the relevant codes and technical knowledge, you have already established the inequality of your relationship, at least for the purposes of this conversation. A clever, sympathetic interlocutor can shift the relational balance by pushing the account you have asked for toward conventions and stories. Giving reasons does a wide range of social work. That work always includes shaping the relationship between giver and receiver of reasons.
            That is why, in fact, I have written this book as a superior story. Since you, I, and every other active human will continue giving and receiving reasons every day of our lives, we might as well understand how reasons work.

The enterprise before us is exploration into life. Where are you bound? What codes and conventions bind you without your being aware of them? Are you like the fish that the frog told, “You are always immersed in water.” The fish objected strenuously saying, “What water? If I were in water, I would know it.” That describes the situation of civilized humanity with its codes and conventions. We live in them constantly and mostly ignore their existence. When someone dares to suggest a condition outside of a code, we look upon them incredulously, we exorcize them from our presence, we try our best to ignore them, and we make them go away. We may even laugh at them, we may ridicule their work, and we give as reasons for doing so the codes and conventions we judge them violating. But innovation has always proved stronger than conventions and codes, and in the long term, innovations will overcome the doubters, protestors, and detractors to establish a new regime in which people will forget that they enjoy the very benefits they once considered impossible.

 

Read also review of Learn to Understand & Prevent Myopia by Bobby Matherne http://www.doyletics.com/arj/nomyopia.htm

 

Review of Tetralogia by Ophthalmologist Aune Adel:

Translated from Suomen Lääkärilehti (Finn Med J)6/74, Tetralogia -nakemys oftalmologiasta - Lataa suomenkielinen pdf

 

Tetralogy -A view on ophthalmology

This book is intended to ophthalmologists, the author herself being an ophthalmologist. It should, however, interest specialists in other fields since an enterily new approach to ophthalmolgy is
presented. This study breaks the traditional narrow boundaries of ophthalmolgy penetrating into the most central fields of medicine as a whole.

This book is not a doctrinal! work based on theoretical speculation nor is it a product of an unusual imaginative power. On the contrary, it is the anatomy of the work at a private practice during a period of years. The results of this work, however, did not fully satisfy the practitioner. Instead they seemed continuously to leave the door open to criticism leading to the search for new ways and methods. The ideas of the book, it seems to me, started with an intense questioning. Why does this particular patient show this kind of a refrative error, an anisometropia, a heterophoria, an increased intraocular tension etc. When the answer finally emerged the symptomatic treatment was resolutely given up. Thus "the exact correction" of a refractive error, the operative measure, the hastily written prescription for lowering the tension were abandoned. With the etiological factor found, the recognized academic measures no longer proved rational. Logical thinking combined with longterm clinical observation led to new methods and to therapy in conditions which, until now, have been considered beyond treatment.

The central theme of "Tetralogy" is the refraction of the eye, its determination, variations and its effect on the organism as a whole. Contrary to the textbooks, which divide refractive errors into three groups, the author believes that there is only one refractive error, hyperopia, together with its various grades. Thus myopia and astigmatism are distortions, artefacts, due to the corrective mechanisms of the eye, the accommodation performed by the ciliary muscle with its autonomous innervation. Under continuous strain and a presumable overexitability the result may end not only in pseudo-myopia and pseudo-astigmatism but at same time in overactivation, a possible sensitization of the entire autonomous nervous system. This is manifested in clinical symptoms as headaches, migraine, epilepic attacks, attacks of pseudo-angina pectoris, intestinal spasms, to mention only a few. Ocular symptoms include accommodative spasm, often combined with pseudo-myopia and pseudo-astigmatism, anisometropia, nystagmus, conjunctival irritations, photophobia, even detachments and degenerative conditions of the retina. Treatment is always solved once the etiology is found. Thus refractive error should not necessarily be corrected by prescribing lenses giving the best visual acuity at distance but by correcting the latent hyperopia as thoroughly as possible. Seemingly paradoxically, plus lenses are prescribed for pseudo-myopia the idea being, of course, relaxation of the accommodative spasm. The hazards of minus lenses are clearly brought out in the clinical material of the book.

Further the book shows clearly that applying optics as such into a living organism, the eye, may have a clearly damaging effect. of the refractive error at the moment of an examination is a relatively simple procedure by present methods. Thus correction of a refractive error according to the retinoscopy or refractometer findings and prescription of lenses giving the best visual aquity at five to six meters is easily performed. In practice this has led to certain schematism and nonchalans. Prescrpition of lenses come easily (touring ophthalmolgists prescriptions by opticians). On the other hand, a procedure that consists in a nearly mechanical mesuring, may easily become tedious. Many ophthalmologists therefore consider refraction the least interesting part of their field. It has even become a negation, it may be omitted entirely or left in the hands of the least experinced practitioner or of an optician. The results may be disastrous.

Adoption of the ideas ov Tetrlogy may not come easily. For an ophthalmologist it means a change of attituide and abandoning hypothesis already crystallized to axioms. But once adopted they offer the possibility of really helping the patient. They not only give significans to determination of refraction so often considered trivial but at the same time open up new dimensions invisible to both the retinoscope and the ophthalmoscope -a fact for which an ophtalmologist cannot be but grateful. The author has not by customary scientific methods attempted to prove her achievements. Every practising ophthalmologist, however, will be able to find the observations true provided he has the desire to "see wood for trees". Tetralogy, in my opinion, is more than a more scientific work. It breaths the joy of a basic perception having its full applicability in practice. This joy the author wants to share with her colleagues. What importance Tetralogy will have on medicine as a whole can so far only be envisaged.

Aune Adel Ophthalmologist

 

Articles:

 

Suomen Kuvalehti 25th of April, 1974

(download pdf 2.3 MB 8 pages)

 

 

Turun Sanomat June 13th 1973

(download pdf 2.9 MB 1 page)

When journalist Vieno Räty from Turun Sanomat interviewed me in May 1973 about Tetralogia, she said that reading the book all the time had made her think about Jonathan Livingston Seagull. I immediately got hold of this book, and I have collected here a number of thoughts that describe the struggle needed for my thoughts to break through, too.

Most gulls don't bother to learn more than the simplest facts of flight.

I don't mind being bone and feathers, Mum. … I just want to know.

Of course, it is impossible to love hatred and meanness.

You just have to go on looking for yourself.

I want to share with others what I have found out myself.

When they hear about it, Jonathan thought, my revolutionary achievement, they will be wild with joy. How much more there now is to living … there's reason to live.

Excerpts from correspondence with my colleague Aune Adel:

Helsinki, 26 November 1973

Dear Kaisu,
I have given a lot of thought to your book, and been amazed over how well your insights hit the mark. Finally I feel that my own jigsaw pieces of ophthalmologic problems are starting to fall into place. I just returned from Meltola (a sanatorium that she visited for consultations) feeling great, as I really felt that refraction had given me results that were satisfying, at least to myself. I was genuinely surprised to see that the pressures of a glaucoma congestivum subject had gone down by around ten mmHg after I had added the missing +1.50 to both lenses, at the same time ending up with two equal ones. You may guess that I will now address other glaucomas under pilocarpin treatment. It is indeed remarkable that no one has discovered the disadvantages of pilocarpin before… I am curious to find out what I can achieve with a couple of troublesome pairs of eyes…

But I am disgusted to see that our colleagues are so unwilling to give up their deep-rooted beliefs. I must admit that I have myself had my doubts and been happy with retinoscopy, although I have often seen that in another year, the cylinder can be quite the opposite, or gone altogether. Happy, however, is the wrong word. On the contrary, just as you said, I was not happy with the results, even if I did feel that the refractions were more or less correct, as I still believed in my retinoscopy. As you well know, your book has caused great irritation in many of our self-assured colleagues. They know that they are right. Time will tell that Kaisu beat us all to it by miles.

By the way, as far as my own '"myopea" is concerned, I used to think that with my visus of one, I was a regular myope. Only in the last few years (at the age of 50-53) have I noticed my eyes stringing in the evenings, and I have not been able to read. I get tired and have to put the book away before I've even started. Yesterday, Sunday, I wore +2 glasses around the house all day (even though I had go give up playing music, as I could not see the fingering numbers). In any case, today I have been quite energetic, although in the past, every time I left Meltola my eyes were closing half way home and I was nearly falling asleep; even now, in the evening, I am quite bright, and my usual tiredness that has afflicted me all my life (and which I have consequently thought pathological) is gone. If only I did not have to wear the minus glasses at work I would be feeling better still. I have not yet received my Executives.

By the way, I have recently not increased the minuses in the glasses of a single patient. By applying a few drops of Cyclogyl to finish with I have been able to demonstrate that the old glasses will give them at least as good a visus as those slightly stronger ones that they thought they needed. To my surprise, after "Cycloplegia" I have observed with all those I have examined so far that after a full dose of drops, they have no trouble reading text with their own glasses from a distance of 30-40 cm, corresponding to a visus of one. In other words, they all suffer from an accommodation spasm which only relaxes enough to give them the same distance visus with their own glasses as they would have with a slightly stronger pair. In my opinion, this is proof of pseudomyopia. But how can I explain to the patients that they should not wear minus glasses at all.

........

2 December
Yesterday at the company's Christmas party I got talking to a surgeon and happened to mention the ideas of Tetralogia. He had already heard about your book and wished to read it. … He showed more understanding than many of our ophthalmologist colleagues (and told me he had heard from a physiatrist how the wearers of minus glasses kept coming for headache treatments after getting stronger prescriptions). I, too, have always been irritated by myopes who complain about headaches. They should, logically speaking, be free of headaches, and hence the false conclusion: the eyes cannot be the cause of your headaches.)

Yes, Kaisu, we have a lot to thank you for. You have indeed achieved more than our whole science of ophthalmology all put together so far. From here, it will be good to carry on.

I would love to come and let you examine me some time. I would not like to take a lot of your time, but I believe a basic examination would be a good idea (with one eye, I can see "soot particles", so I started suspecting vitreous ablation – that could indeed be possible).
With love,
Aune

 

***

 

Christmas 1973

Dear Kaisu,
thank you for taking the time to write despite your pneumonia. I ran into Heta at Stockmann's last Saturday, and she was really surprised that you were able to come and spend that long evening with us. I am just as convinced as you are that you put your health at risk by writing Tetralogia and looking after your patients. I admire and marvel at your work, which has untold significance, not only to us ophthalmologists – I hardly dare honour myself with the title, as I have caused so much harm by my ignorance – but more than anything to the suffering mankind (this without any attempt at sounding pathetic).

After finally understanding the idea I have seen that all my patients really are variations of the same theme. It is heart-rendering to see in my chair a girl aged 15 or 16 who has worn minus ad 5.50 glasses since she was 9 and who already has irrevocable, irregularly shaped atrophic white areas in the eye fundus. And what is worse, she is so fixated to her glasses that she will not give them up, not even while she is waiting for cycloplegia. I only wish from the bottom of my heart that I can keep her until my other colleagues see the truth. I so enjoy my work when I know what I am doing, can get results and be certain about them. You were of course right in assuming that it was high time for Maadi (her daughter) to wear plus glasses (at 10 years of age). One of her eyes had already tightened to +0.5, the other remained at +1.50. I examined at the same time a couple of other girls in her class, and they all now wear +1.50 glasses to start with. Both had often complained of headaches. I should have picked up on it ages ago. In a manner of speaking, they read twice as much as the others, all subjects both in French and Finnish, write a lot and spend a lot of time on their homework. Maadi loves school and for her own pleasure does maths exercises far exceeding what her teacher asks her to do.

 

You may guess I have had many chats with my colleagues, but I cannot say I've made much progress. It appears very difficult for them to see the forest for the trees. By the way, I was going to mention that when I was teaching the last group of students, I managed to interest some of them. One of the students started carefully asking how you should go about prescribing those cylinders. I said you might as well forget everything about the cylinders, and told them why. I should also say that this started an exceptionally lively discussion, and they asked if I was now teaching them some completely new doctrine. I said, of course, that this idea has already been published, and I would like to think they went to the library to read Tetralogia. Sometimes I wonder about this carefully planned teaching of ours: fragmented details with no content or guidelines. They respectfully listen to the clear-cut and erudite lectures of such as Ahti (Professor Tarkkanen), and I am sure they are convinced that ophthalmology must be something extremely advanced and difficult to understand. I am only so disgusted to witness all the evil that senseless prescriptions have caused. In the US, optometrists – you know, that lower cast – tend to say that the greatest cause for sore eyes and headaches is the ophthalmologist. I only think about the mass examinations of schoolchildren – distance visus, retinoscopy under cycloplegia and a prescription for glasses, all on a single breath. Yesterday I saw a young man studying for the entrance exams of a techincal college who came to Helsinki to get reading glasses. At Lehtinen's he had got weak minus glasses with a prism, the next colleague said that he needed no glasses (by the way, that was K....o, so not even he has picked up on the basics yet!) and finally, he got plus glasses from me. However, he had already spent hundreds of Finnmarks. I can only say that the patients have more sense than highly educated doctors.

I myself now have my Executives: the top part is -1.75 and the line of the bottom part +1, so high up that when I am looking straight ahead I can immediately go back to the plus side in case I have been obliged to look through the minus section. To my own surprise, I really have in this short time gone down by almost one dioptre. In other words, I wear the plus glasses for using the microscope and ophthalmoscope, which has made the work immensely easier. But as you said, I was rapidly heading down the road of suffering. Unexplained heart cramps, peculiar periodic intestinal cramps (which even led into that gallstone operation) and now, this autumn, insomnia and feelings of anxiety and tiredness that were always with me. The only thing that kept me from relying on psychopharmacological medications was my fear of drugs only releaving symptoms.

It may be too early to say that I am now well, if a follow-up period is required, but in my own mind I am convinced that I have recovered completely, and what a relief it was to know the cause to my symptoms. You are certainly right in that refraction could solve many psychiatric and other inexplicable cases. I am so grateful for my own recovery that I can never find words to describe it. Oh yes, and migraines; I spotted another new medication(?)in Duodecim, with which they claimed they had achieved some kind of results. I myself only a couple of years ago suffered a typical severe attack after going to see a performance of Carmen at the ice hockey stadium. I felt slightly nauseous coming home, but early in the morning I woke up with a dreadful headache and started vomiting. I should have seen that it was caused by the oculovagal reflex, which may have been further provoked by the fact that I was sitting high up near the ceiling and had to strain to see anything on a stage that seemed unnaturally small over too long a distance.

I would suggest that you should write about these reflectory symptoms. It could help untold numbers of patients and doctors. A few days ago in the coffee room a young, athletic otologist colleague of mine mentioned something about having had a severe attack resembling a pyloric spasm and seemed to be very much puzzled by the fact that it had hit him like a bolt from the blue. I asked him straight away it he wore minus glasses. Yes, he did. I said this could even be the reason. He was clearly interested, but wondered when I urged him to do away with his glasses at least when they are not absolutely necessary. But the glasses feel so good, he replied. Well, that's the whole point. We unhappy pseudos don't even realize how we tightened ourselves and our autonomic nervous system to the limit. Every word in Tetralogia is so apt that now that I am really reading it I cannot but wonder. What clarity and accuracy of observations, what correct conclusions, and finally a therapy that we knew nothing about, only getting it right sometimes by accident. This is how it feels. Indeed, the share of clear diseases is insignificant both in our field but also in that of internal medicine. But we are content to treat our idiopathic ablations and high blood pressure once the harm has already been done and publish our completely useless scientific studies without even realizing that in actual fact, we have achieved very little. Round and round it goes, and we go along with it.

I am sure I'm exhausting you, but what is in my heart is in my mouth, and it's great to unburden myself when so far, I cannot get any response here. You may be sure that I will do everything in my power for this cause. It is a great joy and honour to me, with no intention of going all solemn on you.

Now you have to get yourself better, and if I could, I would order you to take a year off, and if I were able to, I would gladly take care of your patients in the meantime.

...Merry Christmas! Thank you for your promise to examine me, as I would be very interested in observing your system on the spot. If you have recovered, I will come to Turku for a study visit some time early next year. Now that I am fairly clear about the general principles, I don't think that learning would be wasted on me.
So long, Aune

 

***

 

On 20 January 1974, Aune ia. writes:

…and as I have said, I find Tetralogia the most valuable ophthalmologic work I ever read!

(By the way; this "overly smart" colleague of mine told me in some connection that they say in England Duke-Elder knows nothing about refraction!)

I also met (the above-mentioned surgeon) – recently (he had already referred another headache patient to me in the meantime) and said that he now fully understands the state of terrible parasympathetic irritation that asp (accommodation spasm) patients live in.

Only ophthalmologists refuse to understand.

Many thanks for your instructions and unbeatable comment "the cloudier your vision, the sooner you will be better". I could not put it better myself.

 

***

On 12 April 1974, Aune writes: :

I just took a glance at the textbook "Ophthalmology, Principles and Concepts" written by Newell that is very popular at the clinic. I was astounded to see that there wasn't so much as a chapter dedicated to refraction. Only the examination of visus was described shortly. Ophthalmologists don't realize they have turned their backs on the most essential thing!
I rechecked it: at the end of the thick book I found a small "chapter" that was not titled refraction but "Optical Defects of the Eye" – in other words, precisely what us ophthalmologist want to see in refraction – and again no clinical symptoms and nothing about the role of accommodation.

Further, on 21 April 1976

...what an experience the day before yesterday as I was watching a ballet performance filmed at the Bolshoi Theatre on TV : I tried my small opera glasses for a few seconds. While I could see the smallest details, I felt such a cramp in my chest that I told Norman about it straight away. He told me at once to put on my glasses, which where right there by my side.

 

After looking at my website, patient NN wrote to me (an excerpt):

I'm sure I wouldn't be sitting here writing at all without you. I will never forget the 20-kilometre bus journey home from your surgery.
I came to your office with glasses that were -2 Sf, -3 Cyl, and I thought I couldn't even read number plates, as I had such a bad case of astigmatism. Indeed, I could not see the whole plate to begin with. After rather a lot of itching, the persistent cramp relaxed, and to my surprise I was able to read the numbers. The doctor was not perfectly happy with me, as I mixed up the numbers 3 and 8. Apparently I was an interesting and open-minded patient, as I was made sit on the chair for two and a half hours.
My front was soaking wet from the water running down from my eyes. The doctor asked me to look at the glasses on my nose that had given me the visus of 1. They had +2 lenses.

On the way home I did not put the old glasses on my nose, as I understood my problem.
To my surprise, I could read the newspaper of the person sitting in front of me – without glasses. For a few days I felt wonderfully relaxed and happy. But the spasm gradually deteriorated. I found the new glasses satisfactory, however. Acquaintances travelling on the same bus said I looked more relaxed and no longer so tense.

This took place some 28 years ago, but these events were etched on my memory forever. I am now 72 and feel healthy and active. I still have small scars on my forehead as a souvenir of three careers.
But what indeed is the value of my real hyperopia?

She relates further:
My own optician – when I said that these glasses make my back sore - just laughed at the idea of the glasses affecting my back.
He did not get it.