‘Glasses he made sent Dr. Rakusen into court’

Charles Percival Rakusen (1894–1958) embodied the commercial networks connecting Shanghai to the UK and the US. He was born into a Russian Jewish family in 1894 in Leeds, England. At sixteen, he was working as a sales manager, residing with his parents, four younger siblings and a fifteen-year-old servant in north Hackney, London.Footnote ¹² According to his later testimonies, Rakusen apprenticed under his uncle, an optician in the UK, before joining his three uncles in America’s ‘optometry business’ in the 1910s.Footnote ¹³ While assisting with optical endeavours in the US, Rakusen also ventured into trade in Shanghai, following in the footsteps of other Jewish merchants. In 1920, Rakusen married Marie L. Crawford of San Francisco, who was also of Jewish descent. Together, they settled in Shanghai in 1922. From then until his death in 1958, Rakusen’s residence on customs records was listed as Shanghai.Footnote ¹⁴

In his early years in Shanghai, Rakusen made his mark in the newspapers – surfacing in advertisements, scandals and legal reports. By 1924, he had established himself as the proprietor of Rakusen China Co., transporting fresh eggs from the suburbs to urban Shanghai and dabbling in import, export and manufacturing.Footnote ¹⁵ Despite the apparent success of his business, his personal reputation deteriorated. Marie recalled to a newspaper in 1927 that, upon their arrival in Shanghai, Rakusen became ‘sullen, morose, and rough, both verbally and physically’, greatly humiliating her within Shanghai’s English social circles.Footnote ¹⁶ His volatile temperament extended beyond the home, resulting in frequent court appearances in Shanghai for a series of legal disputes with domestic workers, fellow merchants and policemen, both Chinese and foreign.

Rakusen’s ultimate ambition lay in the optical industry. His opportunity arose shortly before the Chinese New Year in 1923 when a group of Chinese vendors sought to sell the Empire Optical Company on Nanjing Road for cash. Through Dr Robert A. Thompson, the eye specialist responsible for the technical aspects of the company, the Chinese vendors connected with Rakusen, who they thought possessed ample capital and an interest in the optical business.Footnote ¹⁷ Taking over the shop in February 1923, Rakusen rebranded it the Oculists’ Institute Company (OIC, a pun on ‘Oh I see’). The term ‘oculist’, then synonymous with ophthalmologist, referred to the two eye physicians Rakusen hired – Dr Thompson and Dr Leo Goehring, both MD degree holders. The new name aimed to elevate the store from ‘just an optician’s place’ to ‘a professional medical institute’.Footnote ¹⁸

Yet, the following year, a legal case filed by the Chinese vendors cast a shadow of suspicion over Rakusen’s new business. It was revealed that Rakusen had never paid the agreed $2,300 for the property.Footnote ¹⁹ Describing this as a ‘deliberate swindle’, Dr Thompson, along with Dr Goehring, terminated their now acrimonious partnership with Rakusen.Footnote ²⁰ This episode left the store only staffed with ‘a number of Chinese’, ‘some girls employed in the recording’, an assistant (Rakusen’s cousin) and Rakusen himself.Footnote ²¹ Even without an oculist, Rakusen continued investing heavily in promoting his Oculists’ Institute Company (known as Ching kwong hien chin kung sze to the Chinese audience) through advertisements in both English- and Chinese-language newspapers.Footnote ²²

What eventually thrust Dr Rakusen into the limelight of Shanghai’s mass media was not his extravagant advertising, but the ‘eyesight case’. Thus named by the Shanghai newspapers, this legal dispute arose from the dizziness experienced by a customer of the OIC, Mr Chichigar, in the spring of 1926.Footnote ²³ According to Chichigar, he was on a business trip in Shanghai, when his three-year-old glasses broke.Footnote ²⁴ Guided by advertisement, he visited the OIC for a repair. Upon his entering the shop on 24 March, the assistant promptly recommended an eye examination by their esteemed specialist – ‘Doctor Rakusen’. ‘Doctor Rakusen’, after inspecting Chichigar’s old glasses, dismissed them as the work of a ‘quack’ and deemed them ‘no good’.Footnote ²⁵ Subsequently, he conducted an examination and prescribed two pairs of glasses – one for reading and another for distance vision.

Two days later, Chichigar received his first pair but found them ‘uncomfortable’ by that evening.Footnote ²⁶ In response, he returned to have the prescription verified. Rakusen assured Chichigar that if he continued to wear the glasses he would ‘get used to them’.Footnote ²⁷ The headaches and pain persisted, however, and eventually drove Chichigar to seek a second opinion from a competitor – Mr Reginald Victor Meyer of N. Lazarus, another Shanghai optician. On Meyer’s suggestion, Chichigar returned to the OIC for a third examination, this time with ‘a unique apparatus’.Footnote ²⁸ Still, Rakusen claimed to find no problem. Rakusen reassured Chichigar that ‘he was a man of vast experience and an oculist to Royalty’, and that the glasses ‘would be alright in time’.Footnote ²⁹ Chichigar was then provided with two new pairs of glasses, under some protest, and paid a total of $120.

The glasses did not become ‘alright’ in time. The discomfort grew so severe that Chichigar was confined to his hotel, ‘instead of going to business’.Footnote ³⁰ On 29 March, he returned to Mr Meyer asking for the name of a good oculist. He was referred to Dr Belilios, who, after an examination, prescribed new glasses which were then filled by N. Lazarus. ‘I never had any trouble after I wore the glasses prescribed by Dr. Belilios’, recalled Chichigar.Footnote ³¹ He then returned all three pairs of glasses to the OIC and requested a full refund. When Rakusen refused, Chichigar sought legal recourse. On 16 June, Chichigar, represented by his lawyer, Mr. M.B. Brown, filed a lawsuit against the OIC in the British Supreme Court.Footnote ³² They asked for not only the $120 refund but also for $380 in compensation for ‘injury, pain and discomfort and loss to business’. The major charges, as stated by Brown, pertained to the ‘negligent work’ and the ‘faulty prescription by ‘Doctor Rakusen’.Footnote ³³

The three open hearings of the ‘eyesight case’ attracted a surprisingly large audience.Footnote ³⁴ Among them were reporters representing Shanghai’s most influential English-language newspapers: the North-China Herald, the Shanghai Times and the China Press. People had gathered not only to witness legal proceedings but also to engage in a broader discussion on the definitions of professional negligence and a wrong prescription. The very validity of vision testing hung in the balance.

The judgement of an optometrist

‘Optometry is a horrible word’, remarked Judge Peter Grain in the first hearing.Footnote ³⁵ Nonetheless the discussions centred around deciphering this ‘horrible word’, for it was the word Rakusen and his lawyer used to defend his qualification in examining eyesight.

Rakusen was quite aware of the embarrassing situation of his Oculists’ Institute Co., given the absence of any eye doctors among its staff. However, he cast this not as a lack of professional competence, but rather as a highlight of his specialized commitment to refraction work. An oculist, he explained, was a medical specialist treating eye diseases, but not an expert in examining eyesight. Rakusen clarified that he never held himself to be an oculist and had never given medical advice to his customers. ‘I confined myself to optometrical and optical work.’Footnote ³⁶

So what was an optometrist? Judge Grain looked it up in an English dictionary and a medical dictionary but found no trace of this term. Witnesses from the plaintiff’s side confirmed the confusion. ‘The word is a coined American one and has no meaning’, suggested Dr Belilios, the British oculist practising in Shanghai.Footnote ³⁷ The term was not known in Germany either, according to Dr Martin Plog, another leading oculist in Shanghai. Mr Meyer, the optician at N. Lazarus, explained that the word was ‘an Americanism supposed to mean an optician’.Footnote ³⁸

Rakusen and his lawyer, Mr Newman, saw the potential of this ‘Americanism’, which in 1920s Shanghai also evoked cutting-edge science in the public imagination.Footnote ³⁹ People’s ignorance of this profession, Rakusen argued, demonstrated how specialized it was. He illustrated the rigorous training, examination and legal certification required for optometrists in the US. He emphasized that he was certified in a manner akin to a dentist or a doctor, asserting himself as a ‘doctor of optics’.Footnote ⁴⁰ Following an independent course of study, Rakusen purportedly passed the State Board Examination for Optometrists in Baltimore, Maryland in 1915, obtaining an official license. Before relocating to Shanghai, he claimed to have practised in America for six years.Footnote ⁴¹

The court controversy raised by the word ‘optometry’ reflected early attempts to validate this profession, which Rakusen witnessed both in the US and in Shanghai. As previous scholarship has noted, earlier Anglo-American efforts to establish optometry as an independent field were motivated by professional opticians seeking to distinguish themselves from merchants who sold glasses, and eye physicians who increasingly saw refractive errors as a medical issue.Footnote ⁴² The battle galvanized the establishment of the American Association of Opticians in 1898, the adoption of the term ‘optometry’ during its 1904 annual meeting, and the initiation of Columbia University’s optometric programme around 1910. The early success of these efforts led to the passage of the first Optometry Law in Minnesota in 1901, a precedent quickly followed by other states. This legislation required individuals examining eyesight and prescribing lenses to obtain certification, marking an essential step in the professionalization of optometry.Footnote ⁴³

The introduction of American optometry to China was predominantly a commercial concern. By the seventeenth century, practices of lens making and dispensing had become well established in the domain of local craftsmen, particularly in the commercialized lower Yangzi region.Footnote ⁴⁴ Prior to the advent of professional vision testing, local optical stores served merely as retail establishments, a fact noted by Otto Durham Rasmussen (b. 1888), an Australian optometrist briefly employed by Rakusen in the 1920s. At a traditional optical store, Rasmussen recorded, customers tried on various ready-made spectacles by themselves to find the most comfortable fit, sometimes ‘to the accompaniment of encouraging, if vague remarks from the optician and quite often from the entire shop staff – bookkeepers, manager, clerks and workmen – who all gathered around to lend their expert minds to the task’.Footnote ⁴⁵ Without any refracting instruments or professional examiners, he wrote, costumers relied only on a dozen testing lenses set in a wooden board, and the shop signs up and down the street, for a very rough self-test.Footnote ⁴⁶ The testing lenses, unfortunately, had a very crude gradation of foci and varied across the country. Asked by Rasmussen about the lack of standardized templates, one local staff said that they were unnecessary – ‘what’s the use of them? It is easy for a man to select his own lenses simply by looking through them!’Footnote ⁴⁷

It was against this self-service model that optometry was introduced to Shanghai through the American-trained ‘modern spectacle school’ at the turn of the century. One pioneer was John Goddard of Ohio, under whom Rasmussen acquired his first training in optometry. The new business model revolved around two distinct services: refracting, wherein customers underwent examinations by trained staff to determine their refractive errors, and customized manufacturing, which involved crafting lenses tailored to individual prescriptions. This pioneering approach quickly achieved commercial success among foreign and Chinese entrepreneurs, and gave rise to a new profession, the optometrist. Located several blocks away from the OIC on the bustling Nanjing Road, for example, was the most influential native brand, the Chinese Optical Company (Jingyi Yanjing Gongsi). Chang Sze-tek, its founder, rose from a petty clerkship in an exchange shop in Shanghai, to technician in Dr Goddard’s workshop, and finally to Shanghai tycoon.Footnote ⁴⁸ As the company expanded to more than a dozen major cities in China between 1912 and 1922, each new store was staffed by an experienced refracting specialist (yanguang zhuren) to provide complimentary vision testing.Footnote ⁴⁹

The commercial success and the social reputation of the ‘modern optical school’ hinged on its knowledge and expertise in scientific refracting (kexue yanguang). An optometrist was portrayed in advertisements as a craftsman scholar, a professional who mastered the secret of light and possessed acute judgement of how ‘deep’ eyesight was.Footnote ⁵⁰ This scientific persona distanced the new professional from the shop clerks in the ‘ancient optical school’, who came to represent backwardness. While the refracting specialists in Shanghai lacked formal education, professional organizations or legal regulation, they managed to bring the latest American advancements to Shanghai through short-term programmes, conferences, association memberships, journal subscriptions and imports.Footnote ⁵¹ Within its national network, the Chinese Optical Company established professional qualifications for their staff, for example through training in uniform testing procedures.Footnote ⁵² In other words, a new standard of testing was formalized by optometry-minded entrepreneurs seeking to bolster their authority and business with American science.

Amidst this growing enthusiasm, Rakusen defended his professional credentials in court.Footnote ⁵³ He highlighted his qualifications by American standards, noting that he had passed the state examination and held a ‘doctor of optics’ degree. Rakusen also provided a detailed account of the standard procedures he had followed: first, he measured Chichigar’s old glasses using ‘the only lensometer available in Shanghai’; next, he examined Chichigar’s eyeballs and eyelids to rule out the need for a medical referral; finally, he employed a retinoscope to assess refractive error, an ophthalmometer to measure astigmatism and a subjective test to ‘verify the accuracy of the instruments used’.Footnote ⁵⁴

Taken together, these procedures, Rakusen argued, demonstrated his adherence to professional standards in conducting the test. And this defence worked: despite the controversy surrounding Rakusen’s titles, the absence of documented proof and the British judge’s remark that optometry ‘is a horrible word all the same’, Rakusen was found to have shown ‘no negligence of work’.Footnote ⁵⁵ Judge Grain explained that when Chichigar was advised to undergo an eye examination after requesting his glasses be mended, his eyesight was ‘tested by various opticians’ instruments’, which demonstrated a level of care and skill ‘within the limits of the optometrist’s ability’.Footnote ⁵⁶ In other words, there was no evidence that the diagnosis was not made with the ‘reasonable and proper care, skill, and judgment of the average optician’.Footnote ⁵⁷

The judgement of the machines

Even the most qualified and careful practitioner was not immune to error. While Rakusen might dismiss controversy over his professionalism, it was far harder to prove that his diagnosis for Chichigar was flawless. This uncertainty was especially acute in cases of refractive error, where the line between diagnosis (the understanding of the problem) and prescription (the proposed solution) blurred in problematic ways. Confronted by a patient’s first-hand evaluation of a prescription’s effects, how could a practitioner convincingly defend the original diagnosis?

Humans made mistakes, but machines, Rakusen insisted, did not. He argued that the scientific instruments he used guaranteed the accuracy of his examinations – a claim that aligned neatly with his marketing strategy. Promoted as the ‘most modern and best equipped in the orient’, his practice embodied the optical industry’s enthusiasm for newly imported technologies in Shanghai.Footnote ⁵⁸ In accounts of the ‘modern optical school’, instruments such as the retinoscope, ophthalmometer and ophthalmoscope were said to deliver tests ‘without the slightest error’.Footnote ⁵⁹ Central to Rakusen’s defense was his reliance on the retinoscope.

With a handle, a light source and a mirror, a retinoscope was an instrument designed specifically to measure refractive error. During the examination, conducted in a dark room, the examiner directed a beam of light into the patient’s eye. While switching the trial lenses placed before the eye, the examiner observed through the retinoscope the movement of light reflected from the retina. When the appropriate lens was reached, the reflected light ceased to move, indicating that the incoming light had been brought into proper focus on the retina (see Figure 1).Footnote ⁶⁰ Originally developed by ophthalmologists, the retinoscope drew on two major late nineteenth-century ophthalmological innovations. The first was the ophthalmoscope invented by Hermann von Helmholtz (1821–94), which made the inside of the eye visible to the medical gaze for the first time. The second was the reconceptualization of refractive error – from a subjective visual complaint to a mechanically defined and optically measurable condition – by Franciscus Donders (1818–89).Footnote ⁶¹ Building on these foundations, Edward Jackson (1856–1942), a leading figure in American ophthalmology, promoted retinoscopy through his publications, lectures and clinical teachings, helping to establish it as a standard tool in routine eye care.

Figure 1.

‘An illustration of the objective refracting examination’, from Jingyi yanjing gongsi shizhou jinian ce (The Tenth Anniversary of the Chinese Optical Company), Shanghai, 1921. Courtesy of the Shanghai Library.

Figure 1 Long description

Two men are seated in a room equipped with optical instruments. One man is positioned on the left, facing the other, who is seated on the right. Between them is a table with optical equipment, including a retinoscope. An eye chart is visible on the wall behind the man on the right. The floor has a patterned design. Chinese text is present at the bottom of the image, providing additional information or context related to the scene.

What made this invention revolutionary, according to Jackson, was its capacity to assess eyesight without relying on the patient’s cooperation.Footnote ⁶² Before this instrument, lens selection depended entirely on patients’ subjective impressions and how they communicated these to the optician – a process that, as Rasmussen observed, resembled trying on shoes in a store. But even with scientifically designed eye charts, patient judgement remained frustratingly important. ‘The moment the psychology of visual judgement enters as a positive element into the determination of the lens to be prescribed, just that instant the ophthalmologist fails’, complained John Newcomb, a US military ophthalmologist in the Attending Surgeon’s Office in 1919:

With the retinoscope, ophthalmologists hoped to eliminate the randomness in patient input. A simple glance at the movement of the shadow on the retina was now enough for examiners to tell the exact refractive error, marking the advent of the so-called objective vision test. Thus the retinoscope promised to circumvent the poor judgement of those without ‘intelligence’ such as ‘small children’ and ‘the mentally defective’. It also bypassed the false judgement of those with perceived ‘perversity’ or ‘self-interest’, such as ‘malingerers’, ‘conscripts’ or ‘applicants for pensions, insurance or society benefits’.Footnote ⁶⁴ It could even overcome language barriers that had previously frustrated ophthalmologists working with immigrants.

In a deep irony, the retinoscope promised an accurate capture of the patient’s visual experience precisely by excluding their lived testimony. It was designed, in other words, to reduce the eyes to ‘optical devices’ to be examined.Footnote ⁶⁵ Patients simply had their eyes fixed and their mouth shut as they waited for the penetrating medical gaze. To further eliminate patient interference, some ophthalmologists recommended using drugs like atropine to paralyse the ciliary muscle, completely silencing the eye’s active accommodation. This practice was enthusiastically embraced by Chinese physicians and researchers from the Department of Ophthalmology at the American-funded Peking Union Medical College (PUMC) in 1921.Footnote ⁶⁶ Dr Hua Te Pi, then a clinical assistant who later founded the Chinese Journal of Ophthalmology, argued that to ensure accurate and objective refraction, the eye should be rendered a ‘dead object’, like a camera, deprived of its ‘automatic contrivance’.Footnote ⁶⁷ Thus, in PUMC’s eye clinic, the usage of atropine was not limited to children whose ocular accommodation was generally most active and disturbing. Anyone under the age of forty (and sometimes even the elderly) would have their eyes ‘put at rest’ before a retinoscopy was applied. Dr Pi and his colleagues believed that the retinoscope, with the assistance of the paralysis of the ciliary muscle, was the ‘most reliable apparatus’ in screening China’s large myopic population, most of whom were illiterate.Footnote ⁶⁸ Resonating with Dr Pi, Rakusen suggested that retinoscopes had a particular value in China, as so many clients either were illiterate or spoke languages he did not understand. Using a retinoscope, Rakusen testified, he could examine the eye ‘almost without asking any questions’ but could still ‘arrive at proper prescription’.Footnote ⁶⁹

The retinoscope not only eliminated the patient as an unreliable knowledge maker in the diagnostic process, but also diminished their authority as a knower in evaluating the prescription. According to the ‘modern optical school’, refractive errors were not something that a patient could perceive through their embodied experience, like the clarity or blur they felt when trying on lenses. The real defect was usually hidden and could be discovered only by the objective judgement of instruments.Footnote ⁷⁰ In other words, the machine knew the body better than the patient. This belief in the machine was confirmed in clinical cases recorded by William K.H. Yen, a famous refracting specialist working for the Chinese Optical Co. In his practice, Yen prescribed lenses strictly based on retinoscopic results. When twenty-two-year-old student Li Shao Kan reported that his distant vision felt ‘a little blurred’ after trying on newly prescribed glasses, for example, Yen showed no concern over the test results and insisted that Li ‘[wear] them constantly’. Yen’s confidence in the retinoscope paid off, as Li not only regained normal eyesight but also found relief from the eye fatigue he had experienced from reading.Footnote ⁷¹

The epistemic authority of the retinoscope enabled examiners to assert control and pre-empt potential challenges posed by patients’ own judgements.Footnote ⁷² Despite warnings from Dr Jackson and Dr Pi that its use should be restricted to ‘worthy members of the medical profession’, practitioners like Rakusen soon incorporated the retinoscope into their work. With this tool, Rakusen was no longer just a salesman helping customers choose the best fit. He now claimed to know exactly what was best for them. The machine gave him the confidence to assure Chichigar that nothing was wrong with the prescription – the dizziness, uneasiness and blurriness were merely temporary, and the glasses ‘would be alright in time’.

The five prescriptions for Miss Mary Palma

If the retinoscope and other instruments ensured a valid vision test, then why was Rakusen sued for his ‘wrong prescription’?

Rakusen’s prescription was ‘absolutely and definitely’ wrong, Chichigar’s lawyer argued. This was proved by a number of ‘eminent specialists’ – two ‘leading oculists’ and one ‘experienced optician’ in Shanghai.Footnote ⁷³ First came witness Dr Belilios, who introduced himself as ‘a holder of three Edinburgh University degrees, M.B. Ch.B., M.D., and F.R.C.S.’, ‘a professor of Ophthalmology at St. John’s university’ and an ‘ophthalmic surgeon to St. Luke’s hospital with over 20 years’ experience in the profession’.Footnote ⁷⁴ Dr Belilios testified that Chichigar was not more than moderately short-sighted. After checking the OIC prescription, he concluded that both lenses were ‘too strong’ and ‘would never become suitable for [the] plaintiff’s eyes’.Footnote ⁷⁵ This judgement was later confirmed by Dr Martin Plog and Mr Meyer.Footnote ⁷⁶

Despite adhering to standard procedures and utilizing the retinoscope, Rakusen failed to provide the prescription deemed proper by the ‘eminent specialists’. The divergence in the examiners’ judgements did more than call Rakusen’s competence into question – it placed the validity of the testing method itself in jeopardy. The involvement of human examiners, this suggested, undermined the very reliability that the machine was meant to ensure. ‘There were things to be done with [the] apparatus which were very easy to explain but very hard to do’, Dr Martin Plog disclosed at the court.Footnote ⁷⁷ While retinoscopy was touted as simple to understand, easy to learn and accurate, Edward Jackson, the prominent American ophthalmologist, conceded in his textbook that it was a technique difficult to completely master, especially in cases that remained ‘difficult and puzzling’.Footnote ⁷⁸ Jackson claimed a margin of error of only an eighth to a quarter diopter in objective tests, a seemingly small range. However, Dr C.A. Clapp, an ophthalmologist practising in Baltimore, challenged this assertion in 1924 by analysing clinical data from over fifteen thousand eyes. He found that only 35.92 per cent of cases fell within the limits of accuracy claimed by Jackson. Clapp demonstrated that the disparity in diagnoses between the two physicians was much larger than was commonly believed. The issue was exacerbated by the apparent objectivity of the retinoscopy, which often led examiners to be overly confident in its results and forgo a second check. Once a result was obtained through retinoscopy, examiners discouraged further refinement.Footnote ⁷⁹

This uncomfortable reality was good news for Rakusen. Given the frequent and often unavoidable divergence in prescriptions, it was challenging to define what a ‘wrong prescription’ was. To underscore this point, Rakusen and his lawyer called Miss Mary Palma to the witness box, opening the second hearing on the morning of 16 June 1926.Footnote ⁸⁰

Miss Palma’s presence was unexpected. She wasn’t an eye specialist, or an optical expert, and had not directly witnessed the dispute between Chichigar and Rakusen. Moreover, as a woman, she stood out in a courtroom dominated by men. Yet she embodied something equally important: the lived experience of a patient.

Palma’s testimony was a revelation. A woman of poor eyesight, she was once sent by Rakusen to five leading eye specialists in Shanghai: Dr de Megio, Dr Belilios, Dr Opp, Dr Plog and Dr Burton. To the astonishment of the courtroom, each doctor had provided her with a different prescription.

Her story struck a chord with the audience. Which diagnosis, if any, was to be trusted?

What if no two prescriptions were ever identical? Rakusen prompted the audience to think critically. Among the five prescriptions received by Miss Palma, Rakusen argued, all but two were very different. He emphasized the significant divergence in the prescription provided by Dr Belilios, noting the glaring omission of a cylinder. ‘That was an obvious mistake and one that should not have been made.’ In comparison, he contended that his prescription for Chichigar was fair, with no significant deviation from others, and was accurately crafted at the time of examination.Footnote ⁸¹

The truth, Rakusen and his lawyer, Newman, suggested, lay within a range and changed over time. The difference between his prescription and the ones by Dr Belilios, Dr Plog and Mr Meyer, he argued, had been exaggerated. Sometimes an eye was over-corrected and other times under-corrected. But this difference did not suggest ‘a wrong prescription’. They could be as correct as each other, Rakusen suggested. If any of the oculists or opticians made a second examination, they ‘might have modified their opinion’. ‘Any honest oculist or optician would admit that a certain percentage of his patients came back with complaints, and it was just the same with dentists and medical men’, he revealed.Footnote ⁸²

Dr Belilios, Dr Plog, and Mr Meyer needed to fight back, not only for Chichigar, but also for the credibility of their profession. A community of experienced experts was immediately formed to regulate the false judgement of a single outlier. In these highly technical cases, Chichigar’s lawyer, Mr Brown, proposed, the shared opinion of experts must be prioritized.Footnote ⁸³ Dr Martin Plog then testified that prescriptions for short-sightedness often varied depending on the judgement of the doctor, which came from ‘training and experience’. But the judgement ‘should not vary very much’. ‘One could not expect oculists always to agree, but there were differences which were legitimate and others which were not’, added Dr Belilios.Footnote ⁸⁴ It was because of the overall consistency in prescriptions within a ‘reasonable difference’ that a second examination was usually not needed for examiners with experience, skill and good training.

Regarding Palma’s case, Dr Belilios remarked, ‘the patient was a very difficult one’.Footnote ⁸⁵ The experts emphasized that it was her condition, rather than their methods, that led to the significant disparities in their assessments. When Miss Palma sought assistance from Mr Meyer at N. Lazarus, she was redirected to Dr Belilios. Citing her ‘dull mind’, Dr Belilios suggested that Palma had difficulty providing correct answers to questions ‘necessary to a perfect examination’.Footnote ⁸⁶ Palma’s insistence that she had given ‘proper answers’ fell on deaf ears at the court. Assessed by a community of seasoned experts, she was ultimately deemed ‘a most unsuitable patient’ for an accurate prescription.Footnote ⁸⁷

Patient experience, through a new lens

Miss Palma might have been brushed aside as a dubious witness – a female patient described as having a ‘dumb mind’. Yet the fact of her five conflicting prescriptions remained, exposing the limits of so-called objective testing. The very figure meant to be rendered passive before the instrument – the patient – turned out to be capable of completely disrupting the test. For all the promises of objective machines, subjective patient experience continued to shape and complicate the production of medical evidence.

Interestingly, the debate over Chichigar’s prescription shifted away from testing procedures and toward his own experience. At a key moment during the court proceedings, medical experts began to address what Chichigar had actually felt. When pressed to explain ‘exactly what was wrong with the O.I.C. prescription’, Dr Belilios avoided technical arguments and instead adopted Chichigar’s perspective.Footnote ⁸⁸ He responded that if he shared Chichigar’s vision defect and had worn the glasses prescribed by Rakusen, he would ‘have gone crazy’.Footnote ⁸⁹ In support of this view, Dr Martin Plog and Mr Meyer argued that because the lenses were overly strong, they were sufficient to ‘make the wearer feel giddy’ and ‘induce a feeling of seasickness’.Footnote ⁹⁰

Rakusen, too, felt compelled to address Chichigar’s sentiments. He insisted that Chichigar had expressed himself as ‘very highly pleased’ with the glasses.Footnote ⁹¹ ‘He tried them on, looked across the street, and admired himself in the glass’, Rakusen asserted, without any ‘complaint of headache or pain’.Footnote ⁹² When questioned about Chichigar’s subsequent consultations with other specialists, Rakusen suggested that Chichigar was ‘a very nervous man’ and ‘very changeable’.Footnote ⁹³ He also dismissed Dr Belilios’s testimony, arguing that Belilios could not genuinely know what Chichigar felt.

But Chichigar did have a say about his own experience. Together with his lawyer, he shared his experience as a carefully crafted narrative. They argued that the glasses prescribed by Rakusen had led to debilitating symptoms, including ‘dizziness’, ‘bad headaches’ and ‘eyestrain’, disrupting Chichigar’s daily life and crippling his ability to work. The term ‘eyestrain’ held particular significance in their argument. This concept, then taking hold in the ocular profession and in American popular culture, underscored the importance of properly fitted glasses. While it may have seemed to be a minor complaint, eyestrain was framed by American medical professionals as indicative of uncorrected refractive errors that could have serious consequences for overall health and workplace performance.Footnote ⁹⁴ By adopting this novel scientific vocabulary, Chichigar not only legitimized his suffering, but also asserted his right to be heard in a landscape dominated by expert opinions.

And Chichigar was heard by the judge. ‘It is obvious that the defendant (Rakusen) made a serious mistake and caused the plaintiff some considerable pain and suffering’, Judge Grain concluded in his final ruling.Footnote ⁹⁵ A simple comparison, Grain suggested, proved the ‘somewhat grave mistake’ made by Rakusen: his glasses produced headaches and dizziness in Chichigar, who was later suited ‘satisfactorily ever since’ by glasses prescribed by Dr Belilios. Although Rakusen was not found legally liable for his practice, the verdict stopped short of a complete victory for him. Invoking both the ‘serious mistake’ and Rakusen’s ‘misleading advertisements’, the judge exercised his discretion to ‘make no order as to costs’, meaning that Chichigar was not required to pay Rakusen’s legal expenses, as losing parties ordinarily would.Footnote ⁹⁶

The case of Chichigar foregrounds the tension between mechanical diagnosis and prescriptions that acted on living bodies. Instruments like the retinoscope allowed examiners to conduct more objective tests for refractive error, but they did not always lead to glasses that aligned with the patient’s embodied experience. A gap often remained between what the retinoscopy uncovered about the eye’s inner structures and what the patient felt, as William Sharp, an ophthalmologist in Indianapolis, noted in 1920. Sharp admitted that while the retinoscope, combined with cycloplegic drugs, could reduce the eye to a ‘dead object’ and yield precise measurements, those measurements often failed to provide lenses that felt ‘comfortable’ and ‘acceptable’ to the patient. No matter how meticulous the retinoscopic examination, patients ‘will not always accept the exact deductions or additions’, and ‘modifications are often required’.Footnote ⁹⁷

The final judgement on Rakusen’s ‘wrong prescription’ underscored the unexpected power patients wielded in scrutinizing and regulating diagnostic tests, even as machines and medical professionals gained growing dominance in the field. Chichigar’s protest would have been difficult to sustain in earlier times, when lens selection was left largely to the discretion of the customers themselves. As Rasmussen observed, in traditional optical shops, ‘When a customer desired to change an unsuitable pair of spectacles, the request was almost invariably met with a flat refusal, based on the argument that the purchaser made his own choice and was responsible for his miscalculations.’Footnote ⁹⁸ The rising authority of ‘scientific testing’, ironically, created a new space for patients to exercise power, but in a different way. They gained a voice to identify discrepancies between their embodied experience and the machines’ supreme insights.

The advent of ‘scientific testing’ not only bolstered profits within the optical industries but also brought new challenges in mediating between machines and customers. On the one hand, the push for objective accuracy required improvements in both instruments and examiner training. On the other, examiners had to strike a delicate balance between the pursuit of precision and the experiential knowledge of their patients. The ideal of testing vision without any input from the patient, as envisioned by Jackson and others, remained a distant goal. As vision testing became more common, failing to find this balance could result in dissatisfied customers, loss of income, and even legal consequences.

It was against this tension that a new ritual of diagnostic testing emerged in Shanghai’s optical industry. As Rasmussen noted, modern optical shops were outfitted with instruments like retinoscopes, which often served as ‘silent testimony’. Their bulky, mysterious forms, draped in black cloth, stood as ‘an impressive last line of defense against difficult customers’. They were, in Rasmussen’s words, ‘a solemn reminder of what they could do if they ever got going’.Footnote ⁹⁹ Yet despite the presence of these advanced instruments, Rasmussen found that most refraction practices relied heavily on patients’ evaluations. Opticians would often walk alongside the patients, quietly confirming that the selected lenses were ‘just the sort of thing the patient really should wear’.Footnote ¹⁰⁰ In many cases, the optician would conduct the tests on behalf of the customer, to save time and effort. The ‘polite fiction’ that the optician was exercising his own professional discretion was maintained with due dignity, preserving the illusion of expertise while allowing customers to make their own choices.

Even the fluctuations in patient judgement held significant meaning in the new ritual. What had improved greatly in the modernist shops, Rasmussen found, was their after-sale services. If, after a few days’ trial, a patient discovered his choice to be ‘too strong’ or otherwise ‘incorrect’, the modernist vendors would ‘obligingly alter it once’, and ‘frequently more often, without further charge’.Footnote ¹⁰¹ This was proved by the wide use of guarantee coupons, which usually promised several free changes whenever ‘the degree of the lens is found to be undesirable’.Footnote ¹⁰² Similar guarantees were also ‘prominently displayed’ in the shop of the OIC.Footnote ¹⁰³ ‘The very reason of the guarantee made by the O.I.C.’, Rakusen and his lawyer explained, ‘was that patients should return, time and time again, in order that they would be completely satisfied’.Footnote ¹⁰⁴ This back-and-forth was essential, they insisted, since a proper eye exam could never be finished in ‘only one sitting’.Footnote ¹⁰⁵

This common practice revealed that the unsuitability of lenses wasn’t seen just as an embarrassment for examiners or as evidence of incompetence. Rather, it was part of their communication with patient experience. During cross-examination, both Dr Belilios and Dr Plog acknowledged that even medical practitioners like themselves were not immune from mistakes. Mr Meyer, furthermore, highlighted that those ‘bad patients’ often came back for a second examination.Footnote ¹⁰⁶ But it was ‘quite easy’ to detect whether there was a mistake and to ‘put matters right’ if a patient came back and described his symptom’, the doctors explained.Footnote ¹⁰⁷ The pursuit of validity, this demonstrated, was achieved through continuous commitment to customers’ satisfaction.

‘If a patient returned and told me such a story as that of Mr. Chichigar’, Mr Meyer testified, ‘I would know there was something wrong’.Footnote ¹⁰⁸ Chichigar wouldn’t have taken the matter to court if Rakusen had upheld his promise. Rakusen’s mistake didn’t lie in providing an inaccurate prescription. The prescription, as he claimed, could have been ‘fair at the time of the examination’. However, since he didn’t conduct a follow-up examination, Rakusen later (somewhat compromisingly) admitted, he wasn’t certain whether Chichigar would now find wearing the glasses uncomfortable.Footnote ¹⁰⁹

While his guarantee invited customers to return for modifications, Rakusen merely advised Chichigar to ‘get used to them’ during the subsequent three interactions. He might have been too confident in the machine, or simply dismissive of Chichigar, an Indian man whom he described as ‘very nervous’ and ‘changeable’. Rakusen’s lawyer made things worse by downplaying Chichigar’s complaints: ‘I do not see why a headache should interfere with business … I have had to work many a time with a splitting headache.’Footnote ¹¹⁰ The giddiness, eyestrain, headaches and pain that they dismissed, however, had grown too substantial and legitimate in 1920s Shanghai. The true point of contention, it seems, lay in Rakusen’s refusal to keep helping his client.