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This month we take a look at a colourful sign with nice old style lettering, but the divisive arguments that lay behind the production of signs like this were anything but cosy.
At the top you'll notice the letters N.O.T.B. These stood originally for the National Ophthalmic Treatment Board. For all the official-sounding nature of the title this was in fact a private company founded by the British Medical Association in partnership with the Guild of Dispensing Opticians in an ultimately failed attempt to convince the 1927 Ministry of Health Committee of Enquiry into matters relevant to the registration of opticians, that medical men could (and in their opinion should) do the job of examining eyes and testing sight instead of ophthalmic opticians. It was set up in direct competition to the Joint Council of Qualified Opticians which had contracts to provide eye services for policy holders of many of the nation's medical insurance companies. To be fair there was an aim to relieve the burden on hospitals although the following entry in the British Medical Journal (February 1930) indicates a certain underlying prejudice:
Doctors engaged in general practice are frequently consulted by patients ...who are unable to pay an ophthalmic surgeon's fee. A general practitioner often sends the patient to a hospital, knowing that if he does not do so the patient will either "put off the evil day" or go to a sight-testing optician.
The NOTB's initial membership comprised some 350 consultants and 500 general medical practitioners with some ophthalmic experience but not necessarily any special training in optics, plus about 300 dispensing opticians. It was hardly a partnership of equals since the medical men claimed the status of a profession whereas 'dispensing optician' was not, at the time, a protected term. The minimum fee was 15 shillings of which the ophthalmic surgeon took a guinea and the dispensing optician received just 4s.6d which had to include the cost of utility nickel-rimmed spectacles if issued. Mr N. Bishop Harman, the otherwise distinguished ophthalmologist, was a primary agitator against the optical profession. He told the BMA Council that the scheme would be judged a success because 'it had staked out the claim of the (medical) profession to do work of this nature. If it had not been for this scheme the sight-testing optician would almost certainly have captured the position'.
This was fighting talk but fighting of another sort would alter the battleground completely within twenty years. The territorialist position was to be outdated by the social changes following the Second World War following which the NOTB was dealt a killer blow by the introduction of the National Health Service. The free NHS eye examination meant that there was an unprecedented growth in demand for sight-testing services. None of the previously existing scheme providers could hope to meet this demand on its own.
A successor company, the NOTB Association, was formed in July 1955 and it is this association that produced the plaque we see here to denote its network of Medical Eye Centres. In the run up to the Opticians Act of 1958, NOTBA campaigned hard to protect this network by seeking to define the role of the ophthalmic optician and securing the provision that any form of treatment must involve a referral to a medical practitioner.
Thereafter the animosity between the eye professions faded and, from the patient point of view, there was perhaps a welcome degree of choice of service provision. Renamed the Medical Eye Centre Association (MECA), the company was supported by organisations from within the professions of both dispensing optics and optometry. Its principal sponsors were the Association of Dispensing Opticians (later ABDO) and FODO the Federation of Ophthalmic and Dispensing Opticians. It collapsed, however, following the introduction of NHS sight-testing fees in 1989. As a consequence the number of Ophthalmic Medical Practitioners in membership of the scheme fell to just 440. MECA filed for insolvency and was eventually wound up in May 1990. Its records from 1930-1990 may be consulted in the Wellcome Library and form an interesting case study of optical politics in the middle two quarters of the twentieth century.