College of Optometrists

Chemist-Opticians

A topical issue at the moment (early 2000s) is the possible granting of independent prescribing rights to optometrists. Optometrists were identified as potential candidates for the extension of this right at an early stage of the Review of Prescribing, Supply and Administration of Medicines, chaired by Dr June Crown, which reported in 1999 and led, after a consultation period to the government’s Health and Social Care Act (2001). As independent prescribers, optometrists would be able to deal immediately with minor eye problems the like of which they may encounter on a daily basis. If any pharmacist should regard this as trespassing on his own territory, the following account may act as a balance as it describes a body of twentieth century pharmacists who sought for a while to practise as sight-testing opticians as well, something which eventually became impossible. To them, pharmacy was the superior profession and ophthalmic optics (the older term for optometry) was a mere ‘sideline’.

The background to the founding of the Society of Chemist Opticians is best understood as a debate within the pharmaceutical profession as to the role of those of its members who also practised as opticians. Ophthalmic opticians had been developing as a profession in their own right since the 1860s and yet before 1895 lacked their own organisation equivalent to the Pharmaceutical Society.

The divisions within scientific disciplines had hitherto been lightly drawn. Certainly there were men of science we would now class as 'chemists' who concerned themselves with matters of optics and vision. For example John Dalton, Manchester’s favourite chemist, taught chemistry both publicly and privately and studied the weather, gases and the density of water. In 1792 at the age of 26 he discovered that the flowers of geraniums that looked pink to most people whatever the lighting conditions, to him looked blue in daylight and red at night. John Dalton saw blood as a bottle green colour. He donated his eyes to medical science so that his theory that imperfect colour vision was due to a discolouration of the vitreous humour within the human orbit could be proved and it was in fact disproved by a post-mortem. He had done enough, however, to ensure an historic immortality: Indeed ‘Daltonism’ became for a while the preferred term for colour blindness on account of the fact that he was the first to describe it, based on observations of his own visual anomaly.

Now let us jump forward a century and consider an article of July 1894 in The Optician magazine, itself a relatively new publication and more fully titled The Optician and Photographic Trades Review. The editorial, entitled the ‘Sale of Chemicals by Opticians’ is a response to the Pharmacy Act and an apparent attempt to butter up the Pharmaceutical Society for its discretion hitherto in the exercise of its statutory powers. The Society, it claimed, had exercised ‘parental care’ without becoming ‘grandmotherly’. Opticians were clearly worried that some within the pharmaceutical profession might have sought to restrict access to various poisonous substances, both those used in medicinal drugs or those for photographic processing or of use to optical and scientific instrument makers; metal workers, for instance made use of cyanide which could be purchased from chemical dealers in large quantities. The article makes clear that the public and the government, acting in the public’s name, might actually be favourably disposed to increasing the restrictions on the sale of such items whereas surely it was really the end users who should be restricted – the ‘professional anarchist’ for example, seeking to poison water supplies or manufacture high explosives.

In 1895 the British Optical Association was founded as the professional and examining body for ophthalmic opticians. Within three years the ancient livery company, the Worshipful Company of Spectacle Makers, granted its charter in 1629 and which shared premises with the Worshipful Society of Apothecaries at Apothecaries Hall, had set up a rival examining function provided on a national basis and other examining bodies soon followed. In Scotland a body to represent the jeweller-opticians, the Scottish Optical Association was founded in 1903. Closely allied to the Association of Goldsmiths in Glasgow this organisation wielded considerable political power. We can conclude from this that, given the lack of a unified professional body still less one that targeted the concerns of pharmaceutical practitioners, the Chemist-Opticians were galvanised into forming their own body.

A Society of Chemist Opticians was founded in 1905. The Society was targeted at dual practitioners, but in order to acquire adequate members it agreed very quickly that all ‘registered chemists’ could join as ‘Associates’, but not vote or hold office. Furthermore, with the BOA and the SMC leading the way for examinations the Society decided not to become an examining body as well. Rather it was established to ‘safeguard professional interests’. Nevertheless there were some similarities with the other bodies, not least in the intention to establish a library and museum. Ophthalmic opticians might well become members of the Society as well as one of the other bodies. The Society was for ‘Pharmacist-Opticians’ who were anxious to develop the education and training of entrants to the optical profession. In this we see their thinking; they would get their new members young and hopefully keep them for life. It was also established for all those who ‘deplored’ (a harsh word) the practice of a service relating to the visual welfare of the public being carried out by ‘jewellers, clock merchants and others carrying out a trade of a similar nature’.

Not that the Society of Chemist Opticians was entirely opposed to the idea of opticians being traders. As retail chemists they could hardly have adopted such a position. In 1907 a lecture was organised in which Mr F.W. Mackinney spoke on ‘Some suggestions for successful trading’. In any case they were campaigning against an entrenched position; the bulk of the British spectacle-making industry remained centred upon the Hatton Garden district of London (the centre of the jewellery trade) and would remain so until the 1950s. What in fact was happening was that a separate profession of dispensing optician was forming, and to a lesser extent a role of manufacturing optician. Many opticians both tested sight and dispensed (and a few made their own frames, perhaps from real tortoiseshell) but it was possible to perform only the one function, particularly if you worked for one of the new optical chains such as J. Lizars of Glasgow, or Dollond & Co (which became Dollond & Aitchison in 1927). In such practices both the main opticians’ functions were performed under one roof but not necessarily by the same person. This reduced the number of individuals who might want to join a professional body for ophthalmic opticians, particularly one that offered no qualifications, certificates or affix.

Thus in 1922 (and perhaps also due to lessons learned in the Great War) the Society became an Institute and began examining. Passing the exam and paying the annual subscription, which was £1 and 5 shillings in 1931, entitled the member to use the affix MICO, standing for Member of the Institute of Chemist Opticians. The examinations were only open to candidates who were already qualified pharmacists. It was possible to be a Chemist-Optician, but never the other way round.

We return to the aforementioned optical journal, by now called The Optician and Scientific Instrument Maker, which in May 1922 carried an article that had also appeared in the Pharmaceutical Journal on ‘The Chemist as Optician. Notes on Opening an Optical Department by a member of the Pharmaceutical Society’. It is a lengthy and revealing article and begins by describing sight-testing optics as a ‘sideline’ that had been a profitable and interesting ‘adjunct’ to many a pharmacist’s business for the last twenty-five years. More condescendingly still the author implies that a pharmacist is peculiarly fitted to undertake such work having been scientifically trained, being able to master the underlying principles and, importantly, already possessing the confidence of the public. Then however, the writer changes tack. He refers to an optician of such experience and skill that even ‘medical men’ of the district (note the distinction) send patients to him and, moreover, visit him themselves. He explicitly recommends the pharmacist thinking of moving into optics to take the exam of the BOA or the SMC. (This is rather ironic since the SMC actually required the holders of its diplomas to sign a form agreeing not to use drugs in their work! This stance was not abandoned until 1938). Within months he would probably have recommended the exams of the new Institute of Chemist Opticians instead. He offers advice on the layout of the practice. The optical department should be on the same level as the pharmacy in case elderly patients cannot mount stairs or require to be wheeled in whilst seated in their bath chairs. Nevertheless the room need only be small, possibly as small as 10ft long and a converted corridor will do. To this author a minimum of equipment is required, a good trial case being sufficient in most cases. He goes so far as to suggest that ‘many opticians keep a good show of instruments for “swank” and with the idea of impressing their clients’. Notably he cautions against maintaining a large stock, (indeed any stock) of frames and lenses, advising instead that pharmacist opticians order frames on a per client basis, even thought this means increased postage costs, and he states that lens grinding is not a practical proposition for the pharmacist optician and such work should be contracted out to prescription houses. He advises instead that the pharmacist optician make up for this extra cost and inconvenience by becoming a specialist, for instance in frame fitting. He should also exploit his position as a pharmacist to attract the clients in the first place:

The Pharmacist enjoys unique opportunities for pushing optics, opportunities unknown to those who rely upon their optical qualifications alone. Every day customers enter the pharmacy who can be looked upon as potential optical clients. A lady mentions the fact that she suffers with headaches. A tactful conversation leads to a visit to the sight testing room and the discovery that she is suffering from a slight error of refraction.

This predatory attitude to the public does not sound attractive nor does it tally with the high ideals of the Society of Chemist Opticians when it had been founded in Edwardian times. In 1924, various letters to the Chemist and Druggist journal reveal that the nature of the renamed Institute of Chemist Opticians, now over a year old, was baffling some pharmacists. For instance J Harcombe Cuff wrote in with a spirited defence of the old Society’s policy – that it was to protect the rights of all Chemists who were opticians, whether qualified or not; that as a small society that, uniquely, offered no salary to its officials it was never likely to appoint examiners of the quality of say the BOA and so it was its policy to recommend its members to take the exams of those bodies. The editor helpfully told readers that the Society had been founded in 1904 (incorrect) and that a list of members was published annually in the Optical Almanac. A second letter, from J.J. Laws, one of the original founders, defends the new Institute, pointing out that the qualifying examination of the Pharmaceutical Society already contained the elementary teaching of optics and it was logical to seek to build upon that. This time the editor had to report that the ‘Institute’ was ‘apparently of recent growth. There is no mention of it in any optical reference book nor in the Educational Number of the Chemist and Druggist which for many years has dealt with optical qualifications’.

Notably the first of these letter writers, Mr Harcombe Cuff, had claimed that ‘Chemists by their scientific training generally make the best opticians from the point of view of sight-testing, and if they will throw their support on the side of unity and the recognised examining bodies they can greatly help the movement for a still higher standard of optical education’. Leaving aside the biased opening statement we can discern in this a recognition of what would be the over-riding theme of the next thirty years – a push for unity which alone would persuade the government to legislate for the compulsory registration of opticians.

How likely was unity in the period before the NHS? Not very likely it would appear. F.G.Howell, who had passed the examinations of both the BOA and the SMC (which was a common combination) wrote an article in October 1945 on the age-old theme of whether ophthalmic opticians should have window displays. Fulminating against them he asks the rhetorical question: ‘Do we….elect to choose pharmacy as our ideal of professionalism?’ The implication is plain. Opticians are not salesmen, pharmacists are. Opticians are proper professionals, like solicitors, accountants and architects or even (to include a medical example) dentists, none of whom would ever dream of advertising and whose clients come to them by reputation alone. Pharmacists are shopkeepers who might be subject to inducements to push certain manufacturer’s products.

Set against this negative view is the account of the Institute’s annual dinner in 1947 at which the Secretary of the BOA proposed the toast, the President of the Institute (a surgeon) spoke warmly of a ‘triangle of forces’ - medicine, pharmacy and ophthalmics - and Mr G.A Mallinson qualified under both the Pharmaceutical Society and the Spectacle Makers Company as well as being secretary of the National Pharmacists Union supposedly spoke for all when he said that unity and co-operation would grow and strengthen the value of both optics and pharmacy to the general public. He ended ‘We have far too many separate bodies’ and he wished that ‘there were only one – so long as the other is the Institute of Chemist Opticians.

No matter how well they could socialise together the various bodies were nevertheless in competition with each other for members’ subscription and examination fees. The advent of the National Health Service changed matters again.

From henceforth the Institute accepted non- pharmacists and its name was changed yet again to the Institute for Optical Science (IOSc).

The loss of the name ‘chemist’ from its title was significant as in time it would become just another opticians’ association and not one of the stronger ones. At the time of its foundation however in 1948, the Institute of Optical Science was determined to maintain the dual profession identity. Its motto was ‘Utrumque ad paratus’, basically to be prepared on both sides, and its emblem was a pestle and mortar alongside an opticians’ trial frame.

Some new members from exclusively the optical side were still unsure that the Institute treated both sides equally. The Committee minutes record the receipt of a letter in 1953 from F.R. Hinton asking if the IOSc had in fact narrowed its field of interest to representing pharmacists alone. He received a reply to the effect that it had always been the Institute’s policy (i.e. since 1948) to ‘especially put forward’ the Pharmacist Optician point of view… and that is what the Joint Examining Committee (on which the IOSc was represented along with the BOA, SMC, NAO, and SAO) was looking for.

In 1949 the Institute for Optical Science had 1636 members. Whilst these need not necessarily be pharmacists they did have to be ‘engaged in a profession acceptable to the Council’. In reality this opened the way for membership of a number of medical practitioners, ophthalmologists (including the distinguished Dr Margaret Dobson) and physicists. A future secretary of the Institute, Reginald Goode, would nonetheless describe the membership as a ‘creative minority’. A school was opened at Wilton Crescent offering evening classes in premises rented from Obrig Laboratories, an important company in the contact lens field. The Institute offered a Diploma in Ophthalmics for which Part 1 could be obtained by various routes including Part 1 of the Chemist and Druggist examination of the Pharmaceutical Society or an equivalent- two subjects of which must be chemistry and physics. Part 2 however was entirely ophthalmic or medical in its nature and content. To obtain the fellowship entailed sitting for six topics including ocular pharmacology and bacteriology. At this time the Institute was the only examining body to include ophthalmic surgeons on its Council and on examining panels. This was very much the hobby-horse of the Censor of exams, Professor H. Hartridge, but the Joint Examining Committee (JEC) strongly disapproved.

Members of the Institute (especially if they were qualified pharmacists) were allowed to use cycloplegics and mydriatics, but were advised to consult the patient’s medical practitioner before doing so. Cycloplegics fix the dilation of the pupil. Atropine or a similar antimuscarinic drug induces paralysis in the ciliary muscles of the eye, which can be useful when the iris or ciliary body is inflamed. Mydriatics widen the pupil, mimicking the effect of dim light. Some sympathomimatic drugs bring about mydriasis but not cycloplegia by stimulating the ciliary muscles. Such drugs included cocaine and ephedrine. Similarly if Members of the Institute were fitting contact lenses with the use of drugs, an ophthalmologist was to be consulted first. Fluorescein was useful in this respect. This is a water-soluble orange dye that can be applied by strips and which glows a brilliant green when blue or ultraviolet light is shone upon it. It can also be used in a dilute solution to detect defects on the surface of the cornea and can be injected into a vein for use in retinal angiography – the results being captures with a retinal camera. The Institute set up research groups on the effects of anti-histamines on vision and the effects of sex hormones on vision. Reflecting the spirit of the age as well as its long held hatred of jewellers the Institute was also opposed to the idea of any of its members being engaged in ‘occupations not associated with the NHS’.

It began to encourage all its members to join the Association of Optical Practitioners (AOP) in effect the trade union for the profession, which shared its premises and most of its staff with the British Optical Association in 65 Brook Street. It was felt that the AOP offered the best means of acquiring the unity required to establish a strong protective body along the lines of the BMA or the National Pharmaceutical Union.

In May 1950 the Insurance and Companies Department of the Board of Trade questioned the right of the IOSc to represent all optical science…it suggested a change of name before it would offer registration as a company. This was fought off, though not without difficulty since the NHS Act of 1946 had been strict and rather simplistic in its definition of opticians (those who tested sight were OOs and those who supplied optical appliances were DOs) and the IOSc was claiming something much more - that it represented ‘the ophthalmic and allied optical services’, the latter group of which included medical practitioners who were supposedly the preserve of the General Medical Council.

The difficulties continued. It became apparent that the Institute was losing its student members – some to other examining bodies and others because they had decided not to pursue an optical career. The Institute’s journal was delayed and cut down, local branches were no longer financed and the corporate diary was cancelled.

In 1950 a lecture programme was run. Gilbert Harding of radio’s The Brains Trust spoke on ‘How to enjoy the Arts –without knowing too much about any of them’ and there were also lectures on astronomy, personalities and Professor Pear on ‘Mental differences between the sexes’. As the lectures were open to a general public the word ‘scientific’ was deliberately dropped from the title of the programme, but it is not difficult to see why some must have felt the series was scarcely relevant to the Institute’s true purpose and the cost was prohibitive after 1951.

That year there was a rumour that George Giles, Secretary of the BOA had persuaded the other examining bodies not to employ anyone associated with the IOSc. Giles had supposedly hinted to a staff member of the Northampton Polytechnic (now City University) that if he resigned from the teaching college of the IOSc he would try and get him a job at the London Refraction Hospital (now the Institute of Optometry on Newington Causeway). I have been unable to trace the end of this story.

In March 1951 the Inter-Departmental Committee on the Statutory Registration of Opticians chaired by Lord Crook, summoned the IOSc seeking to know why they felt a need for their own body and to what trades they felt objection. The Institute gave an illustration of an optical department at one Co-op branch which was part of a section selling boots and shoes. The Scottish Association of Opticians had criticised it (implying that perhaps it was missing out on members north of the border to the IOSc). The SMC had criticised it, but the Institute countered that its exams were harder and therefore more worthy. In November a member, Mr A.C. Finlay appealed in desperation to the Council because his local Labour Exchange would not recognise his qualification. It turned out they still had not heard of the name change. In January 1952 an approach was made to the National Association of Opticians with a view to amalgamation. The NAO turned them down saying the time was ‘not propitious’.

Was there any good news for the Institute? Standards were acknowledged to have remained high. One candidate who had already passed the NAO diploma with flying colours but was also sitting the Institute’s diploma came out of the room and told the examinations inspector that the Diploma in Optics was surely the ‘coming ‘ examination. The inspector’s report noted in wry fashion that ‘I am sure he will be confirmed in that opinion when he learns that you have referred him in one subject’. Then the Crook Report was issued and the Institute was jubilant because the report had come out firmly in favour of the use of surgeons as examiners.

In the early to mid fifties amalgamations were temporarily off the agenda when it became apparent that fewer examining bodies would lead to a reduced number of ophthalmic optician representatives on the envisaged General Optical Council. Pharmacy seemed to have little place in the forthcoming new order. In October 1954 the BOA dropped the study of chemistry, maths and physics from its first year exam syllabus preferring in future to stipulate these subjects only as a pre-professional requirement. In September 1955 the IOSc cancelled its proposed course in Ocular Pharmacology after only five enquiries had been received and two sets of fees paid.

In the run-up to the passing of the Opticians Act (1958) and the final establishment of the General Optical Council (1960) it became clear once more that there were too many competing bodies. In 1956 the NAO was finally subsumed into the BOA. In July 1957 Mr R.A. Baxter a council member of the IOSc who had also been elected Vice-President of the BOA found the pressure of serving two bodies too great. Significantly it was the IOSc from which he chose to resign. The writing was on the wall. In September 1957 the Examiners Report noted that a majority of candidates had already passed the exams of other bodies. That year a joint committee of ophthalmic opticians was established. Whereas the BOA and the SMC had three seats each, the IOSc and the Scottish Association were given only two. This lack of parity was a source of grievance but in part reflected the Institute’s own habit of seeing itself as both in optics and yet apart from it. An internal report comparing ophthalmic optics with pharmacy had drawn the following conclusions:

• That to practise as a Pharmacist required membership of a professional body including the payment of a retention fee and adherence to a code of ethics, but this was not the case in optics.
• That, unlike optics, pharmacy was not a profession that initiated a health service. (21st century pharmacists might well not accept this assessment).
• That although pharmacy was still attracting rising numbers of university graduates, it offered lower rewards as a profession than optics. It was perhaps more lucrative to specialise in optics alone.

In May 1958 the IOSc agreed to sponsor an Association of Optical Practitioners’ lecture by Cecil Flick but made a very revealing comment in the process, saying that as an ‘educational body’ it would really have preferred a lecture by an ophthalmic surgeon. This concerning one of the foremost figures in ophthalmic optics of the day, a prolific and distinguished author, lecturer and course organiser!

The proactive, voluntary secretariat was somewhat aged by now, for instance at the Harrogate Congress in 1957 the President declared 'I especially enjoyed the lecture on Streak Retinoscopy by Mr. Cockerham. Had I been 30 years younger I would have liked very much to put many of his suggestions into practice'. So, in 1962, the inevitable happened, although quite suddenly in the event, negotiations having begun in April and the outcome being reported by the Summer. Officially the Institute was amalgamated with BOA. It had already been sharing premises since its base at the College of Preceptors had been threatened with demolition. In practice it was entirely swallowed up and no trace remained except that for the first seven to ten years the BOA Council was to include three pharmaceutical representatives. Furthermore a Pharmaceutical Optics Committee was established which broadened the activity of the BOA and did much work on the optical side effects of drugs.

The day of the Chemist Optician was over, though of course some individuals continued to practise in both fields. Indeed the ex Institute men argued that there was no need for their organisation since it had already achieved its primary aim ten years earlier when the Crook Report had recommended that:

1) There shall be no objection to registered ophthalmic opticians practising pharmacy and that 2) the pharmacist optician would be allowed to practise his two chosen professions. The Optician journal continued to carry articles on the use of drugs in ophthalmics and to report regularly on issues in the Pharmaceutical press. Take this report from December 1961:

Instead of the more usual type of lecture on drugs, Mr Meakin gave a lecture which he admitted should have been given to pharmacists, but as many points were so important, he felt it was essential that opticians should have some knowledge of them.

This lecture concerned the need for sterility in ophthalmic solutions and likewise during the application of fluorescein and during contact tonometry (in which the internal pressure of the eye is measured, one of the principal tests for glaucoma). Mr Meakin also discussed germicides, the storing of drugs and coloured label codes.

A year later Mr W.J. Porter was able to argue that ‘opticians are better trained than many medical men who are not compelled to take examinations in drugs’. If you think this sounds like an ex Chemist-Optician talking you would be right, but he is now advocating the cause of all opticians. His lecture concerned the use of drugs in refraction where one of the main difficulties was maintaining the sterility of eye drops for any length of time – the modern solution he recommended was the ‘Minim’ single dose disposable container marketed by Smith & Nephew Pharmaceuticals Ltd. He then spoke about local anaesthesia, contact lens wetting solutions, emergency saline and the healing effects of cod liver oil

In 1972 Kenneth Harwood, a distinguished BOA councillor from a respected optical dynasty co-authored a careers guide for young people called ‘Field Of Vision’ in which he explained the life of an ophthalmic optician as well as his own somewhat untypical experiences doing such work on Ascension island and St Helena. In it he points out that the first register of the General Optical Council (Published 1959) had contained 7000 names but that ‘quite a number of these’ were also pharmacists who divided their time between pharmacy and ophthalmic optics. Harwood comments that this was a useful combination for the service of patients in the average small town between the wars. I think we can draw from this the implication that it was no longer considered (at least from the optical side) as an appropriate combination for the career entrant. Dispensing optics was perhaps a different matter: In 1977 BBC School Television transmitted a programme entitled ‘A Job Worth Doing? Dispensing’, which looked at the work of young people in two jobs under the umbrella title of dispensing – one a dispensing optician, the other a pharmacy technician. In fact, apart from the title, there was little to connect the two roles.

Pupils who watched that programme will be in their mid forties at least by now. Much has happened since.

In 1985 advertising restrictions on optometrists were relaxed and shop window displays became commonplace. Henceforth their practices became much more like retail businesses. The big four chains developed – Dollond & Aitchison (the only well-established firm), Boots Opticians, (founded 1987), Vision Express (an offshoot of the French parent company GrandVison) and Specsavers – the lattermost really being a series of franchises, founded on Guernsey in 1984 but which has expanded dramatically in the last three years and is now a ‘superbrand’ according to national economic monitoring bodies. All four giants bought up many of the established optical names: Clement Clarke, Lancaster & Thorpe, C.W. Dixey, Theodore Hamblin etc. Recently some new names have come on the scene attempting to offer a pan-healthcare service, optometry, other eye services such as laser surgery and therapies from chiropody and dentistry through to reflexology and aromatherapy – the Health Clinic has been one of the fastest growing and fastest to fall.

The Pharmaceutical Society had become the Royal Pharmaceutical Society. The British Optical Association amalgamated with the Scottish Association of Opticians and the examining faculty of the Worshipful Company of Spectacle Makers in 1980 to form what was called the British College for Ophthalmic Opticians (Optometrists) – surely the worst title for a receptionist to read out on the telephone (and they had to…in full!). Several founding fellows were also fellows of the Pharmaceutical Society. The BOA Museum recently accepted some equipment from one such dual fellow – Mr Henry Percival Southcott, not just his trial case but also his pill making machine and roller.

A short while later the Worshipful Company began offering optical technician courses. The British College received a royal charter and became simply The College of Optometrists, shortly to adopt the royal prefix. In 1986 a separate Association of British Dispensing Opticians (ABDO) was formed when its two predecessors, The Association of Dispensing Opticians and the Faculty of Dispensing Opticians, were merged following the Health and Social Security Act of 1984. Since 1999 ABDO has operated its own Training College at Godmersham mansion near Ashford.

In the 1970s and 1980s it was wondered if a common educational faculty between what are now the two Colleges would result. To combine the two distinct branches of optics would be major exercise in itself. The thought men once had of combining that work with Pharmacy as well is now confined to history.

This article is an edited version of a lecture given by the BOA Museum Curator to the British Society for the History of Pharmacy on 7 May 2003. Reproduced with permission of the BSHP.