Retrospective diagnosis, or a patient history?

It is a truth universally acknowledged that a library in possession of historic spectacles must be in want of an optometrist to interpret them.

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Author: Daniel Hardiman-McCartney MCOptom, Clinical Adviser and Neil Handley, Museum Curator
Date: 7 April 2017

Recently, the BBC covered a story about Jane Austen, the early nineteenth century novelist. Following simple tests on three surviving pairs of her spectacles, carried out with a portable focimeter, the British Library speculated that arsenic (a common ingredient used in medicines at the time) may have contributed to her death. The basis of the claim seemed to rest on the progressive increase in her lens prescription, potentially attributable to a build-up of poisoning in the body. What caught our eye, however, was the Library's explicitly expressed hope that optometrists could advise them as to the likelihood of this being the case.

The College is indeed a repository of knowledge and expertise on all matters relating to human vision. Furthermore, as custodian of the world’s oldest optical museum we take an interest in the lived experience of people with visual impairment from past ages. Historians have studied the eyesight of other famous figures such as Sir Joshua Reynolds, now believed from his journal description to have experienced a detached retina. We were therefore pleased to learn of the British Library’s interest.

Hitherto the main connection of Jane Austen with the world of optics is the appealing fact that the ABDO College at Godmersham Park is supposedly the model after which she based the fictional Mansfield Park (1814). Now the profession has been challenged to provide what amounts to a retrospective diagnosis of a long deceased patient. Almost needless to say, there are potential difficulties in doing so, which were acknowledged in our initial response on our consumer-facing website, Look After Your Eyes.

Based on the information reported in the press, we were able to give an opinion, heavily qualified with a statement concerning what else we would wish to learn: 'We now know that Austen’s spectacle strength increased from +1.75 to +4.75 and +5.0 in each eye, a significant increase in her prescription. In order to consider other options, it would be very helpful to know what age she was when she wore each pair'.

Thus far that information has not been forthcoming, and it is not even certain that she necessarily would have worn them at different dates. In the novel Emma (1815) the character Jane Fairfax is quoted by Miss Bates as having said that 'everybody ought to have two pairs of spectacles'. This was in case one might break, but rather than buy two identical pairs at the same time it was common to keep an older pair, or to wear a pair inherited from a relative. A beautiful pair of spectacles in the College museum, probably dating from Jane Austen's time, are known to have been listed in a will and passed down between generations.

To this we might add that we do not know how many pairs were supplied to Austen during her lifetime, whether these three pairs found in her writing desk were the only ones or if there were others that have not survived. Indeed, despite their survival, we are unable to quiz the patient as to whether she found them useful and actually wore any particular one of these pairs much, if at all. Furthermore we should recall that Austen died in 1817, well before any form of scientific sight testing existed and there were no standard test targets for her to use. It is highly unlikely that these lens powers were selected for her with any input from a qualified person. They were most likely chosen by the author herself on a trial-and-error basis and many factors, including the lighting conditions that applied at the time she was making her selection, or the object on which she was attempting to focus, could have caused her to overcorrect. In 1824 the optician Dr William Kitchiner, author of Economy of the Eyes, wrote about the use of such 'mighty Magnifiers', referring specifically to a pair his grandmother kept in a writing desk and suggesting that there was a particular 'delight' to be had from using them, not necessarily to see things in proper proportion.

We now know that Austen’s spectacle strength increased from +1.75 to +4.75 and +5.0 in each eye, a significant increase in her prescription.

The fact that the British Library's spectacles were found in Jane Austen's writing desk seems, on first consideration, to be a fairly reliable provenance, however the possibility that the contents of the desk have been tampered with at any point since her death has to be taken into account. This is particularly so because, unfortunately, we think there are at least some grounds for doubting that all three pairs belonged to her. The glasses are all oval-rimmed which was a new style that was only really coming into fashion after 1800, but in an era when any notion of fashion eyewear would not really have been understood, the new style was slow to gain ground and most spectacles before the time of Waterloo would have remained resolutely round-rimmed. One pair, in a tortoiseshell frame with tapering sides, is of a type generally assigned by spectacle historians to the 1820s or later. Another is of thin wire, which is of a design more usually encountered in the mid-19th century. One of the consequences of our increased knowledge about the history of spectacles is that, sadly, there have been many instances of famous people's glasses having to be discounted. The two most famous examples are the pairs which for many years were claimed to have belonged to Oliver Cromwell (died 1658) and King James II (died in exile 1701). Neither one turned out to be any earlier than the mid-18th century. In a similar literary context, in our museum we have what purport to be the spectacles of Dr Johnson (died 1784), but we ourselves have suggested that these probably post-date 1790.

So we would be guarded in making any automatic assumption that these were indeed the spectacles of the patient. Nevertheless, speculating about spectacles is an interesting intellectual pursuit and looking to reports on her writing we can glean some further information. There were reports of recurring conjunctivitis in her early twenties that could be linked to her health problems and possible cataracts, partially with a condition such as Addison’s disease; also considered an explanation for her illness. Arsenic is an interesting explanation, but there are other more commonly occurring conditions that could possibly account for changing spectacle strength.

Retrospective diagnoses are speculative and should always be open to debate. That is why in our response to the British Library's challenge, and the BBC's reporting of it, we have listed a range of possible eye sight problems that Austen may have had, from the simple possibility of latent hypermetropia to the least common, but nevertheless possible cause, that she had early onset of fast-growing cataracts caused by Arsenic treatment.

As Austen herself wrote in Persuasion (her posthumously published novel of 1818) “Time will explain”....or maybe it won't, since historians know that there are some mysteries that might never be adequately explained.


Daniel Hardiman-McCartney FCOptom
Clinical Adviser, The College of Optometrists

Daniel graduated from Anglia Ruskin University, where he won the Haag Strait prize for best dissertation. Before joining the College, he was Managing Director of an independent practice in Cambridge and a visiting clinician at Anglia Ruskin University. He has also worked as a senior glaucoma optometrist with Addenbrooke’s Hospital in Cambridge, with Newmedica across East Anglia and as a diabetic retinopathy screening optometrist. Daniel was a member of Cambridgeshire LOC from 2007 to 2015 and a member of the College of Optometrists’ Council from 2009 to 2014, representing its Eastern region.  

He is Clinical Adviser to the College of Optometrists for four days each week, dividing the remainder of his time between primary care practice and glaucoma community clinics. Daniel is a passionate advocate of the profession of optometry, committed to supporting all members of the profession and ensuring patient care is always at the heart of optometry. He was awarded Fellowship by Portfolio in December 2018.

Neil Handley MA AMA FRSA
Museum Curator, The College of Optometrists

Neil Handley is recognised as one the UK’s principal historians of spectacles, vision aids and opticians. He has been curator of the British Optical Association Museum at The College of Optometrists in London since 1998 and is a Liveryman of the Worshipful Company of Spectacle Makers.

The Curator is available for lectures and informal talks off-site as well as guided tours of the museum gallery and College Meeting Rooms. Considered to be an authority on ophthalmic history he can also advise on items on optical and optometric heritage including their identification and dating. He has been awarded the medal of the Ocular Heritage Society of America on several occasions.

Neil was awarded the Associateship of the Museums Association in 2002 and was one of the first 17 museum professionals in the country to gain the AMA+ qualification in May 2007. He now serves as a Museums Association Mentor for younger curators.

Neil was elected Chairman of the prestigious London Museums of Health and Medicine (2011-14), widely considered within the profession to be one of the most dynamic and go-ahead museum specialist networks. During this time he oversaw that organisation's first strategic review for fifteen years. He is also a past Vice Chairman of the Scientific Instrument Society and became a Fellow of the Royal Society for the Encouragement of Arts, Manufactures and Commerce (FRSA) in 2012.

Front cover of the book Cult Eyewear 2011

Neil  has published articles on spectacle frame design, the history of opticians, artificial eyes and facial prosthetics. He has contributed to a number of books on the history of the subject, including a chapter on artificial eyes for the book Devices and Designs (2006) and the major German publication Treasury of Optics (2012). He spent much of 2009 and 2010 writing a book on Cult Eyewear, the first serious analytical study of the historical development of branded fashion spectacle frames, published by Merrell on 27 September 2011. He also co-authored, with David Cartwright, the second volume of the College History, The College of Optometrists: A History 1998-2015, published in October 2015. He has also written articles for journals as diverse as Optometry in Practice, Contact Lens and Anterior Eye, Ophthalmic and Physiological Optics, From the Master and Wardens (newsletter of the Worshipful Company of Spectacle Makers), Ophthalmic Antiques, Gewina (Dutch Journal for the History of Science), Antiquarian Horology and Pharmaceutical Historian.

Contact the Curator by email

Or follow him on Twitter @neilhandleyuk


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