14th Annual Meeting Abstracts - 2001
The Overbrook School for the Blind
Joseph W. Sassani
The Overbrook School for the Blind is located on Malvern Avenue in West Philadelphia. Although it is a well recognized landmark for many Philadelphia commuters, few are aware of its unique features. The school was founded in 1833 by Julius Friedlander as The Pennsylvania Institution for the Instruction of the Blind. One year previously, Friedlander, who had come from Germany, began his teaching of the blind and visually handicapped by instructing two children, a brother and sister. March 17, 1999 marked the 160th anniversary of his death. Within the few years between the school’s inception and its founder’s death, the student body had increased to 59 students. The school’s name was changed to the Overbrook School for the Blind in 1946 when the school moved to its present location on Malvern Avenue. The Overbrook School can claim a number of firsts in the field of education for the blind. Its “Student Magazine” was the first monthly magazine for the blind with raised letters. Its 1833 printing of the Gospel of Mark was the first printed for the blind in North America. The Overbrook School also is unique for its architecture, which is said to be one of the exceptional examples of Spanish Renaissance architecture on the U.S. East Coast. Evidence for the uniqueness of the structure is found in the fact that the architects were invited to exhibit it at the 1900 Paris Exposition.
An English Surgeon in China: Thomas Colledge, M.D.
Popular opinion of medical missionaries has undergone wide swings over the past two centuries. Individuals who traveled far from home to spread their religious faith in conjunction with medical care have been praised effusively for their benevolent work and castigated as pompous, presumptuous, and overly pious. Today the best known missionary physician to China is the Yale-trained American Peter Parker, M.D. (1804-1888). His mentor and good friend in China was a British surgeon employed by the East India Company, Thomas Colledge, M.D. (1796-1879). These men treated thousands of Chinese, couched many cataracts, and founded the Medical Missionary Society of China.
Focal Infection and Ocular Inflammation: Evolution of a Concept
David L. Knox
Hippocrates is credited with describing that removal of badly infected teeth was followed by improvement in the arthritis of two patients. William Hunter, a British physician, in a lecture at McGill in 1910, castigated North American physicians and dentists for not removing infected teeth, or for putting caps on deeply carious molars. He believed that such practices caused arthritis and nephritis. Frank Billings of Chicago in 1915 defined “focal infection” as a local infection with streptococci or pneumococci, usually adjacent to skin or mucous membranes. He and his colleague, E.C. Rosenow, developed a concept of “Elective Localization of Streptococci” in which organisms isolated from tonsils of patients with nephritis or arthritis were organotropic respectively to kidneys or joints. Medical practitioners and ophthalmologists embraced these concepts and aggressively orchestrated removal of infected teeth, tonsils and paranasal sinuses. Unfortunately, the concept was expanded by ophthalmologists who demanded the removal of normal teeth, tonsils and paranasal mucous membranes for many disorders. Soon, a variety of voices proclaimed that the concept had gone too far. Alan C. Woods Sr., in 1942, concluded that the concept had validity but only in the case of infected tissues. World War II, antibiotics, increased living standards, and more and better physicians and dentists decreased the number of Americans with chronically infected tissues. Corticosteroids improved the care of patients with ocular inflammations. As a result, many ophthalmologists no longer search for focal infection. The concept is not now taught in American medical schools or departments of ophthalmology.
Lacrimal Parasympathetic Innervation: A Model for Going Astray
Steven A. Newman
In medicine, as in many areas, there is a tendency to accept published data as fact. This is especially true in anatomy, where anatomic tracings, once described, are often re-quoted without ever questioning the primary source. Jendrassik in 1893 and Goldieher in 1894 correctly recognized that sectioning the facial nerve produced loss of parasympathetic innervation to the lacrimal gland. Working without the tracers available today, they further delineated the anatomic connections between the geniculate and spheno-palatine ganglion in the pterygo-maxillary area via the greater superficial petrosal and vidian nerves. Having correctly identified this basic branch of the autonomic nervous system, they then proposed post-ganglionic innervation to the lacrimal gland via connections through the zygomatic temporal nerve. This presumption of anatomic connection persists in atlases of anatomy published today. It wasn’t, however, until 1965, when GL Ruskell began to study rabbits and later monkeys, that direct connection to the inferior orbital fissure by the lacrimal nerve was demonstrated. In 1971, he demonstrated that damage to the spheno-palatine ganglion resulted in degeneration of parallel, unmyelinated fibers reaching the lacrimal gland. In spite of this work, anatomy books published today continue to demonstrate the zygomatico-temporal connection of the parasympathetic fibers. Ideas once implanted are extraordinarily difficult to uproot.
The Publications of the American Academy of Ophthalmology
Stanley M. Truhlsen
For 105 years, the AAO has published the Transactions, later titled Ophthalmology, to record for the membership the papers presented at the annual meeting. As the Academy initiated new educational programs, it became necessary to expand the scope of its primary publications Transactions/Ophthalmology, alter its format and content, accept free papers for publication and develop new publications. In 1932, a new publication, The Bulletin, appeared, the first of the news magazines, followed by other efforts to provide information and educational aids to the members. Through the years, new programs required new publications. Manuals, monographs, basic and clinical science courses, self assessment materials, etc facilitated continuing medical education. The list of Academy publications has grown through the years and are wide ranging, including the new eAcademy, as aids to the membership as well as to other fields of medicine and the public.
The Historical Saint Lucy
St. Lucy, venerated as the patron saint of vision, was martyred in 304 A.D. Pagan roots of myths associated with St. Lucy date back to the time of the Etruscans. Historical facts dispute the commonly accepted legend that the saint’s eyes were removed around the time of her death. Analysis of the art of the Middle Ages and Renaissance reveals the origin of the common myth associated with St. Lucy.
The Bower Manuscript on Ayurveda
The proof of the antiquity of Indo Aryan medicine (Ayurveda) can be found in the antiquity of their civilization. The oldest surviving manuscript on Ayurveda, the Bower Manuscript, is housed in the Bodleian Library at Oxford University. Glimpses of the Bower Manuscript will be presented.
The Foundations of Oculomotor Physiology
Robert S. Jampel
There is, as yet, no universal understanding of the normal function of the oculomotor system or an accepted theory of the pathophysiology of strabismus. I will trace the early views of oculomotor function from Thomas Willis to Hermann von Helmholtz and compare them with recent ideas. In 1664, Thomas Willis (1621-1675), the father of neurology, published his seminal book “Cerebre Anatome, cui accessit Nervorum descriptio et usus” (Anatomy of the brain, with a Description of the Nerves and their Function), which was the first basic text on neuroanatomy. His description of the function of the eye muscles was based on his belief that emotions played a causative role in neurological disease. He explained the action of the six ocular muscles (four straight and two obliques) and the sympathy that existed between them that avoided “squinting”. The muscles were named upward as holy and devout in prayer; downward as in the humble and pious; outward as in indignation or aversion; obliquely, amatory, because lovers beheld one another obliquely or sideways. Inward movement of one eye was like the squinting drunkard.
John Hunter (1728-1793), “The Founder of Scientific Surgery”, described the oblique extraocular muscles and from their anatomical configuration predicted their function. To him is attributed the concept of ocular counter-rolling.
Cornelius Donders (1818-1891) was the first, circa 1846, to provide a general theory of oculomotor function that bears his name. He is credited with formulating the first basic law of oculomotor physiology.
Hermann von Helmholtz (1821-1894) was among the first to attempt a quantification of oculomotor function.
Decorative Spectacle Cases
J. William Rosenthal
From the time that spectacles were invented, circa 1287, it was evident that a protective case would be needed to house these fragile optical instruments. Early cases were carved of wood, with recesses for the spectacles and carving on the lids. By the 1750’s, steel cases were devised. As spectacles became lighter in weight due to frame metals, and lens size was reduced, it was possible to place spectacles in very attractive cases, especially for ladies, and light but sturdy ones for men. These days, a spectacle case is a statement of the user’s attitude and some may be wild!!
Homage to Dr. Albert von Pflugk, Ophthalmologist, Historian, Collector, and Patron of the Zeiss Museum: With attention to his Pioneering Work on Spectacle Coins and Metals. Part I
Jay M. Galst
A biography of Dr. von Pflugk will describe his pioneering work in 1921 on the depiction of spectacles on coins and medals. Part I will include coins and medals depicting spectacles as an optical instrument. Part II at a future meeting will include coins and medals depicting spectacles as a symbol.
Visual Acuity Measurement in A Historical Perspective
Modern visual acuity measurement starts with Snellen’s letter chart (1862). This paper traces earlier attempts and later modifications that were initially rejected because the time was not ripe, but later became part of today’s standards.
It draws attention to the role of Donders, Snellen’s mentor, who instigated the work in the context of his epoch-making work on Accommodation and Refraction (1864). Donders was a conceptual genius, who with von Graefe, Bowman and von Helmholtz formed the foursome that pushed the field (1850-1875). The next century saw many proposals, but few substantive advances until the last half of the 20th century. At that time, the need for more accurate measurement for vision rehabilitation and for collaborative clinical studies led to the adoption of new standards.
Ancient Lenses and Visual Illusion Measured at the Louvre, Paris I: An Initial Analysis of a Unique Reserve Eye #3009, Egyptian Old Kingdom, Artifact Found at Saqqara
Jay M. Enoch, et al. (Paper discussed by Robert Heitz}
The first known lenses had origin during the 4th and 5th Dynasties of the Egyptian Old Kingdom, ca. 2600-2400 BC or 4600 -4400 years ago (BP). They appeared briefly again about 1700 BC, then disappeared. All known examples of these lenses are found at Le Louvre, Paris, and The Egyptian Museum, Cairo. With the kind cooperation of Le Louvre, their reserve eyes and the statue “Le Scribe Accroupi” were examined optically in November 1999. These outstanding lenses are complex, made of fine quality rock crystal (either crystalline quartz or fused quartz, described today respectively as alpha-silica and fused silica). Because of their complexity, application, and quality, it is doubtful these were the “first” lenses. This is a first effort to characterize better these lenses optically, in order to define (as best possible) their properties and optics, to measure the “eye-following illusion” built into the design, and to consider their relationship to the associated eye-like structure, really a form of schematic eye. Examination of the unique reserve eye, Le Louvre #3009, was facilitated by the fact that it was open at the top and no resin blocked the in situ view of the lens.
The Earliest Fundus Visualization of Living Eyes
Robert F. Heitz
On November 12, 1704, the medical doctor Jean Méry presented to the French Royal Academy of Sciences, Paris, his observation that if a cat is immersed in water its retinal vessels became visible. On March 20, 1709, Philippe de La Hire pointed out that this was due to the abolition of the corneal refraction. Méry’s experiment of eye immersion for fundus visualization was repeated and supplemented later in humans: in 1845 by Adolf Kussmaul, in 1851 by Johann Nepomuk Czermak for the construction of the orthoscope, and in 1891 by Oswald Gerloff, for the earliest successful fundus photography.
The Snyder Lecture
A Passion for Books: William Osler, Casey Wood and McGill University
Two of McGill University’s most distinguished physicians were passionate book collectors on a major scale. A general discussion on forming a book collection will consider the qualities necessary, motivation, ways of going about it and disposal of collections. This will be followed by brief biographies of Osler and Wood, with specific attention to how they both approached book collecting and why they decided to donate their libraries to McGill University.
Examples from each of their collections will be presented.
Koch's Postulate and Hansen's Dilemma
Michael F. Marmor, M.D.
In 1879, Armauer Hansen, the most eminent physician in Norway, was struggling to prove the last of Koch's postulates for leprosy, namely that the bacillus could be transferred to animals or humans to cause disease. As part of these studies, he inoculated the conjunctiva of a young woman who had anesthetic leprosy with material from a leprous nodule in another patient. No nodule developed, but what did develop was a lawsuit. The woman claimed pain and distress, and that she never gave consent. Hansen was brought to trial, and many prominent colleagues stepped forward to defend the famous researcher. However, Hansen did not argue the point, and in fact, acknowledged that he did not ask consent for fear that she would say No! But he felt justified because he believed there would be no permanent harm, and the knowledge to be gained was important. The legal case was open and shut, and Hansen was convicted, but in a Solomonic decision the Judge stripped Hansen of his position as Resident Physician in the Bergen Leper Hospital while allowing him to remain Medical Officer of Health for Leprosy in Norway. The bureaucracy associated with human experimentation may be modern, but the principle that no bodily harm be inflicted without consent is of long-standing in Western morals and law.
1800 Years of Making Use of Pupillary Mobility as an Indicator of Visual Potential
H. Stanley Thompson
A chronological review of comments touching on this topic, starting with Galen and continuing through the history of Western Medicine.
Julius Hirschberg’s Last American Journey- Insights and Anecdotes
Danny H.Kauffmann- Jokl
Julius Hirschberg (1843-1925) was arguably the greatest chronicler of ophthalmic history. He made three trips to the United States in 1877, 1892, and 1905, the last as an invited guest of the newly established Ophthalmology Section of the AMA at its 56th meeting in Portland, Oregon. He chronicled his transatlantic steamer and consequent transcontinental train journey with precise, often humorous, insightful observations of the newly expanding America and its people, much as if he were presenting an interesting clinical case. As the feted German Professor, editor of a prominent international ophthalmic journal and an authority on the magnetic removal of intraocular foreign bodies, he met and described American ophthalmology leaders ñ Weeks, Knapp, deSchweinitz and Pischel, to name a few. He describes them honestly both as a teacher proud of the success of his former students and as the ever-strict German Professor-mentor who does not hesitate to criticize gently his former charges when necessary.
Irving H. Leopold (1915-1993)
Irving Leopold was born in Philadelphia and spent most of his life there. He received his medical degree from the University of Pennsylvania in 1938 and then studied with the great Francis P. Adler. He did research in chemical warfare and during these years published 19 papers on ocular pharmacology. For some years he was Director of Research at the Wills Eye Hospital. He moved to New York City in 1965 to become Chief of the Ophthalmology Service at the Mount Sinai Hospital, as well as Professor and Chair of Ophthalmology at the new medical school there. He expanded the residency program, wrote extensively, and spoke brilliantly at meetings.
How George Washington’s Spectacles Saved the Republic
Ronald S. Fishman
In March 1783, with the last peace negotiations all but final, an incident occurred which might have defeated the American Revolution at the last minute. The officer corps of the Continental Army had not been paid for almost five years. To obtain the benefits they had been promised by the Continental Congress, a conspiracy of officers arose with the intention of doing this while they were still armed. George Washington recognized that if the Army could succeed in bullying Congress, the precedent would be fatal for the prospects of the new republic. He met with the agitated, hostile officers in a crowded church hall in Newburgh, New York. He tried to reason with them without success. Then, in a piece of high political theater involving his spectacles, he broke up the conspiracy within a few minutes.
Masolino da Panicale: A Neglected Innovator of Renaissance Perspective
Christopher W. Tyler
The first accurate use of perspective is generally attributed to Filippo Brunelleschi in two lost panels at some unknown date in the early 1400s. However, we may ask what are the first surviving paintings using accurate perspective? Despite the claims in most histories of perspective, the earliest attributable perspectives were painted by Masolino da Panicale in 1423-5, well before the contributions of Masaccio, Donatello, Uccello, Montegna, Leonardo or Durer. I will review the evidence of his pervasive role in disseminating perspective ideas at the beginning of the Renaissance and attempt to restore him some of the credit which has been withheld from his achievements, largely because he emphasized perspective to the detriment of other compositional elements.
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