16th Annual Meeting Abstracts - 2003
George M. Bohigian
In the everyday practice of ophthalmology we use symbols, signs and abbreviations to record our medical history, physical examination, diagnosis and prescriptions. This presentation describes the possible origins and history of some common notations such as numbers, dates, times, OD, OS, OU, RX, mathematical signs of plus, minus, equal, greater than and less than. The concept of the evolution of zero, 360 degrees, 60 minutes in an hour, 24 hours in a day and other interesting facts and figures in medicine will be discussed.
A Century of Perspective on Tscherning's Theory of Accommodation
David G. Harper
Hans Erik Marius Tscherning (1854-1939), among many other endeavors, espoused a theory of accommodation that was diametrically opposed to Helmholtz’s theory. Prof Tscherning proposed that contraction of the ciliary muscle increased zonular tension and that this resulted in flattening of the periphery of the lens while the central part of the lens bulged forward conoidally. Recently, R.A. Schachar has suggested that only the longitudinal fibers of the ciliary muscle contract during accommodation, placing more tension on the equatorial zonules while relaxing the anterior and posterior zonules. This discrete distribution of force then results in thickening of the central lens in exactly the same manner as proposed by Prof. Tscherning. Recent attempts to reverse presbyopia by increasing accommodative amplitude through surgical enlargement of the zonular ring are based directly on this theory of increased zonular tension producing a direct effect that thickens the center of the lens. That is, surgically increasing the space between lens equator and the ciliary body might allow for more tension to be exerted on the equatorial zonules during ciliary muscle contraction. Prof. Tscherning’s original contribution of the theory that underlies this modern-day experimental surgical approach has been, a century later, largely forgotten and his name is rarely mentioned.
A Dedicated Life: Mildred Weisenfeld and the Fight For Sight
Arthur M. Silverstein
In 2002, it is estimated that over US$400 million will be spent on basic ophthalmic and vision research throughout the world, the greater portion funded within the United States. But in the years immediately after World War II, the amount spent was measured only in the low thousands, and many of the world's leading causes of blindness went unchallenged. Then a young woman, herself blinded by retinitis pigmentosa, decided to do something to change this. She started an organization to raise money in support of eye research, and over the next several decades the list of those young investigators that she supported would read like a Who's Who of international ophthalmolgy and vision research of the late twentieth Century. This is her story, and the chronicle of her success.
Incidents at Shikarpur
James G. Ravin
Derrick Vail, Jr. (1898-1973) and Derrick Vail, Sr. (1864-1930) are the only father-son pair to have both been President of the American Academy of Ophthalmology and Otolaryngology. Recently, the AAO acquired an unpublished manuscript written by Derrick Vail, Jr., that describes the surgical expedition to Shikarpur, India, undertaken by these two men and their wives in 1925, shortly after he had completed his residency training at the Massachusetts Eye and Ear Infirmary. The manuscript is full of interesting anecdotes, including Derrick Vail, Jr's attempt to break the Shikarpur record for cataract extractions done in a single day by a single surgeon.
The Legacy of Derrick Vail
Denis M. O’Day (by invitation)
In 1908 Dr. Derrick Vail, Sr., as president of the American Academy of Ophthalmology and Otolaryngology, proposed a coherent plan for reforming ophthalmic education and assuring the public of competent eye care. His plan led directly to the formation of the American Board of Ophthalmology in 1915. From Dr. Vail’s proposal and the writings and actions of others most notably Edward Jackson, it is possible to discern a series of principles that undergirded this drive for reform. These principles continue to guide the Board movement in the 21st century: ethical behavior is the core value of the quality of care; the drive for reform has to come from within medicine; organized training and education are key prerequisites for quality; lay organizations are not equipped to evaluate physician competence, and an independent examining body best serves the public welfare. The historical evidence for these principles and their formation will be discussed.
The Eye Normalizer: How and Why It Worked For 30 years.
Walter H. “Terry” Marshall
The Eye Normalizer, a 20th century quack device, is but one of the many mechanical nostrums promoted over the last 150 years to render spectacles useless. The device will be examined, as well as the successful marketing techniques used by the Barrett family to promote the Eye Normalizer. Additional comments will address the broader subject of medical quackery, concentrating on why medical quackery continues to thrive, unabated.
Jules Cloquet, French Anatomist and Surgeon, 1790-1883
Ophthalmologists are clearly familiar with Cloquet’s Canal. The Frenchman who described it, Jules Germain Cloquet, began his career as an apprentice in the workshop of his father who was a draftsman. Soon, however, he began modeling anatomic figures. By 1817 Cloquet had become a Doctor of Medicine practicing surgery and teaching anatomy. He is best known in surgical circles for his description of the femoral canal, and especially Cloquet’s node in the inquinal area. Cloquet was a man of many interests which included acupuncture. He liked to travel and became close friends with the much younger Gustave Flaubert, who authored Madame Bovary and other novels. Flaubert was a womanizer, whose dalliances were quietly tolerated by Cloquet.
The Genius of Edmond Halley and the Transit of Venus
David Bisno (by invitation)
Venus crosses the sun rarely. Edmond Halley taught us in 1714 that on those few occasions when we, the 2nd inner planet, and the source of all our energy line up, the human eye has an extraordinary opportunity to view an event which, properly considered, will allow us to determine the distance from the earth to the sun. We will consider what the man whose name rides on a comet told the Royal Society, the history of that quest including Captain James Cook and the opportunity we will all have for 20 minutes on June 8, 2004 to prove, or disprove, the 18th Century Astronomer Royal.
Benjamin Franklin and the Treatment of Stroke
Stanley Finger (by invitation)
Although considered one of the founding fathers of the United States and a man of letters, throughout his life Franklin had a serious interest in health and medicine. He was a champion of smallpox inoculations, introduced the flexible urinary catheter to America, evaluated Mesmerism, invented bifocals, and wrote on colds, skin disorders, gout, and stones, all of which he suffered. Perhaps most interesting is his application of electricity to the palsies and other nervous disorders, including seizures and deafness. This paper looks at what Franklin did in his clinical trials and what he concluded in this long overlooked facet of his scientific-medical life.
Fish Stories and Clinical Trials
William C. Frayer and William J. Frayer (by invitation)
The magazine Science has had a long and highly respected history. It was no surprise, therefore, that when an article appeared in the September, 1952 issue touting the value of fish lens protein injections for the prevention and treatment of cataracts, the story stimulated extensive coverage in the lay press. An unknown number of patients received a series of injections of the secret vaccine. In fact, the theory described in the article was based on a false premise. It was alleged that fish lens protein is species specific and will not produce antibodies to human lens protein. The article itself was unsubstantiated, either by literary reference or by the qualifications of its authors. A poorly designed clinical trial was included , but the results were far from conclusive. The senior author, Ralph Shropshire, had succeeded in having two, also unsupported, preliminary papers published in the Archives of Ophthalmology in 1937. When ophthalmologists began to see severe complications of this treatment, in the form of lens induced uveitis following cataract extraction, they raised the alarm. The American Academy of Ophthalmology and Otolaryngology requested an investigation by the National Research Council. A very distinguished committee performed an extensive review of the entire matter, and concluded that the practice was not only worthless but dangerous. Shropshire was found to have no qualifications, and was, in fact, in prison by this time on drug and other charges. A number of editorial decisions and ethical concerns had an obvious impact on this story. These factors will be compared to contemporary practices.
The History of Toxoplasmosis: The Early Discoveries
G. Richard O'Connor (by invitation)
Things are not always what they seem to be. Although Nicolle and Manceaux are generally credited with the discovery of Toxoplasma gondii in 1908, other authors had undoubtedly seen the same parasite at about the same time or even earlier. Leveran, for example, is alleged to have seen Toxoplasma in the nucleated red blood cells of the paddy bird Padda oryzivore in 1900. Darling had seen Toxoplasma in a muscle biopsy in 1908, but thought that it was Sarcosporidia. Splendore in 1908 thought that Toxoplasma was a parasite only of the rabbit, failing to realize that the organism was widespread in the animal kingdom
Ocular toxoplasmosis was first described by the Czechoslovakian ophthalmologist Josef Janku in 1923. His subject, an infant suffering from fatal neonatal toxoplasmosis, had been observed to have a "coloboma" of the macula. Sections of this eye showed organisms identical to those described by Nicolle and Manceaux, but confirmation of the infection in neonates awaited the transmission of Toxoplasma from necropsied ocular and cerebral tissues to experimental animals. This was done by Wolf, Cowen, and Paige in 1939. For many years all ocular toxoplasmosis was thought to be congenital in origin.
Acute adult toxoplasmosis with lymphadenopathy and chorioretinitis was described in a seldom-recognized paper by Wising in 1952, and in the same year Wilder published her famous paper on the histological finding of Toxoplasma parasites in the retinas of 41 adults, suggesting that toxoplasmosis may have been acquired in adult life. She gave credit for the idea of adult acquisition of the disease to Rieger (1951) who has seldom been recognized for his work on toxoplasmosis.
The nearly simultaneous publications of Hutchison in Scotland and Frenkel in Kansas City (1970) showed that the cat was the definitive host of Toxoplasma. This provided an essential link in the heretofore unknown life-cycle of Toxoplasma, confirmed it as a coccidian parasite, and provided the first recommendations as to prevention of the disease.
The First Pathologist to Devote a Full-time Career to Ophthalmic Pathology
Gordon K. Klintworth
A major milestone in the history of ophthalmic pathology came to an end in January 2000 with the death of Norman Ashton. Until this superb scientist and scholar accepted the invitation of Sir Stewart Duke-Elder in 1948 to become the pathologist at the newly founded Institute of Ophthalmology in London, no professional pathologist in the world had chosen a full-time career in ophthalmic pathology. Sir Stewart picked a remarkable 35-year-old man for the job. Ashton provided a clinical service to Moorfields Eye Hospital and established an internationally renowned Department of Ophthalmic Pathology where he trained a generation of ophthalmic pathologists and facilitated the careers of many outstanding ophthalmologists by providing them with a fundamental background in research and clinically relevant pathology. Ashton set extremely high scientific standards and his elegant writings reflected a masterly command of the English language.
This super star made numerous important scientific contributions during his long career, sometimes in collaboration with colleagues, and it is through his writings that he will be forever remembered and judged by future generations. Ashton's research focused primarily on the vasculature of the eye in health and disease, but he also made contributions on corneal disease, ocular infections, ocular cancer, inborn errors of metabolism and ocular disease in animals. Aside for his scientific contributions, Ashton was a gifted man with many talents. Ashton’s sense of humor and competence as a humorist made him a popular after dinner speaker. Ashton's aptitude as an artist was also recognized by his peers and he designed the Badge of the President of the Association of Clinical Pathologists. Impressed by the success of the American Ophthalmic Pathology Club (now called Verhoeff-Zimmerman Society), Ashton founded the European Ophthalmic Pathology Society with Willem Manschot and Ry Andersen and was made life president of that organization.
While acknowledging the important contributions of practicing clinical ophthalmologists to the knowledge base in ophthalmic pathology, Ashton became convinced many years ago that future progress in ophthalmic pathology would come not come from ophthalmologists who undertook the discipline as a part-time pursuit. The reason for this conclusion is simple, as Ashton stated "perhaps it would be as reasonable to expect them to have had the time to become conversant with the many developments in pathology as it would be to expect a general pathologist to be skilled, for instance, in the latest methods of cataract extraction or the management of glaucoma".
The Snyder Lecture:
The Origin and Development of San Francisco Academic Ophthalmology
William H. Spencer
Formal medical education in San Francisco began in 1859 when Dr. Elias Samuel Cooper, an ambitious and colorful eye, ear and general surgeon, inaugurated the first medical school in the Far West, the “Medical Department of the University of the Pacific”. This presentation will briefly chronicle the chaotic, unregulated and isolated medical environment that then existed in provincial California. The scope of the subsequent discussion will be restricted to the evolution of the precursor organizations of the San Francisco Bay Area’s modern medical schools, the establishment of current eye training programs and the seminal educational contributions of pioneering ophthalmologists.
Unheralded and Prophetic Percy Fridenberg
Percy Fridenberg drew excellent architectural sketches, wrote the Columbia College Song in 1886 (still happily rendered), was very involved with the Mount Sinai Hospital in New York, and was important to the American Academy of Ophthalmology. He was brother-in-law to Emil Gruening and had two ophthalmologist brothers. He published a little known but prophetic and visionary case report 100 years ago. He was one of “the number who lived faithfully a hidden life, and rest in unvisited tombs.”
Silas Weir Mitchell, M.D. (1829-1914):
Neuroophthalmology and The American Civil War
Richard W. Hertle
In addition to the life of Silas Weir Mitchell, this paper will discuss contributions to ophthalmology resulting from his experiences during the American Civil War. He enrolled at the Jefferson Medical College in 1848, graduated M.D. in 1851, and immediately left for Europe on a clipper ship, with his sister, Elizabeth. Mitchell settled in Paris to study medicine. There he was most influenced by Claude Bernard. He returned to Philadelphia, where he joined his father’s medical practice until his death in 1914.
With the outbreak of the American Civil War, Hammond placed him in charge of Turner’s Lane Hospital in Philadelphia, a 400-bed army hospital for nervous diseases. This was an ideal location for Mitchell to pursue his interest in nerve diseases and wounds of the nerves. He conducted extensive neurological research at the hospital. He went to Gettysburg and brought back carloads of wounded and took careful notes, wrote detailed case studies, and published the findings in numerous articles and books, including Reflex Paralysis (1864). The most important work to result from studies of these soldiers, however, was Gunshot Wounds and Other Injuries of Nerves, which was published in 1864 and in which the first reference is made to “ causalgia.”
Later in life, Mitchell devoted his attention to writing novels and poetry. Two of his novels achieved great popular success at the time - Hugh Wynne in 1897 and The Adventures of Francois in 1898. Eponyms credited to Mitchell include; Barraquer-Simons syndrome (a rare childhood disease characterized by loss of subcutaneous fat from the face and trunk), Bernard-Horner syndrome, “Mitchell's rest cure” (treatment for victims of nervous disorders, chiefly hysteria and neurasthenia) and Mitchell's syndrome I (idiopathic paroxysmal vasodilation of peripheral vasculature marked by sudden onset of burning pain in the hands and feet, diminution of temperature sense, and occasional glossalgia and feeding difficulty).
The Artistry of Annette Smith Burgess, Max Brodel’s Student and William Holland Wilmer’s Illustrator:
An Ophthalmological Gem
Robert B. Welch
When the Wilmer Institute opened in 1925, Dr. Wilmer soon envisioned an atlas of various diseases of the ocular fundus. To accomplish this he hired Annette Smith Burgess, a student of the famous Max Brodel who was the Director of the Department of Art as Applied to Medicine at Hopkins. Mrs. Burgess would go on to become one of America’s greatest ophthalmic illustrators whose contributions included not only her beautiful works of art but her expertise as a gifted teacher throughout her career. During her 35 year career at Wilmer, Mrs. Burgess not only illustrated Dr. Wilmer’s Atlas and Dr. Woods’ books on uveitis but almost every article coming out of the Wilmer Institute. She will always be remembered as an integral part of the history of the Wilmer Institute.
The Impact of Failing Vision on the Late Works of Degas
Michael F. Marmor
The French Impressionist Edgar Degas had a maculopathy of unknown type, and slowly failing vision over the last decades of his life. Rather accurate estimates of his acuity can be obtained from comments in correspondence, changes in his handwriting, and changes in the fineness of shading lines in his work. Since his subjects (dancers and nudes) were large, his visual loss did not prevent him from drawing the different postures that intrigued him over many years. But as his acuity fell to 20/200 levels or worse after 1900, he could no longer make precise outlines and shading lines as he used to do. His works began to appear coarse or even crude—and one might question why the meticulous painter would tolerate this degradation of images. The answer may lie in the fact that he could not see them as we do, and his blurred vision smoothed over many of the problems.
A Talk on the Wilde Side: Sir William Wilde
John W. Gittinger, Jr.
William Robert Wilde (1815-1876)—although eclipsed by the fame of his controversial and creative son, Oscar—was a remarkable man. His two volume Narrative of a Mediterranean trip, published when he was only 25, and his descriptions of Irish superstitions established him as a literary figure. He was knighted for his work on the Irish census. As a surgeon he founded an eye and ear hospital and, in 1862, published An essay upon the malformations and congenital diseases of the organs of sight. This work provides insights into the state of ophthalmic knowledge just at the time that introduction of the ophthalmoscope was about to revolutionize the field. (Sir William’s illegitimate son Dr. Henry Wilson joined his father’s practice and is credited with bringing this instrument to Ireland.)
Professor Hermann Cohn (1838-1906)
Danny H.-Kauffmann Jokl
Cohn was a pupil of Kirchhoff, Bunsen, and Helmholtz. His work in school-age populations in Breslau, Germany (Silesia) documented the presence of eye problems that had previously been unrecognized. This led ultimately to the employment of physicians in schools, together with the special education of teachers in the recognition of potential eye diseases.
David Peter Choyce: Sir Harold Ridley’s Almost-Forgotten Protégée
David J Apple
The story of Sir Harold Ridley’s invention and first implantation of the intraocular lens at Saint Thomas’s Hospital in London on 29 November, 1949 is well-known. Conversely, several achievements of a protégée of Sir Harold’s, Mr. David Peter Choyce, are mostly forgotten. Choyce’s first contact with Ridley was in 1950 at Moorfield’s Eye hospital, where, as a young ophthalmologist-in-training, he had the good fortune to witness Ridley’s second implant. A review of Choyce’s record confirms a significant number of original innovations in the field of anterior segment surgery—including many procedures taken for granted today, but not properly associated with his name. These include early work on both kerato- and intraocular lens refractive procedures, keratoprostheses, pioneering pediatric implant procedures and others. Proof of this is made evident in a 1957 thesis he wrote, a compilation of his clinical research efforts, consisting of a summation of several reports that had mostly been rejected for publication. In addition he was a vocal advocate of Ridley’s implants, especially at a time in their evolution when they were not well accepted by many authorities. Unfortunately his tenacious adherence to anterior chamber lens technology, while in general clinically sound, caused many to question his influence and hence he remained poorly understood, even until after his death in 200l. In my opinion, a study of the evidence proving his accomplishments places him as one of the most innovative ophthalmologists in his surgical field in the 20th century.
Robert Louis Stevenson: Optical Engineer
Robert Louis Stevenson, the famous author of Treasure Island and Dr. Jekyll and Mr. Hyde, was born into a family of lighthouse engineers. He was home-schooled and then entered Edinburgh University to study engineering, to his father's great pleasure. Robert presented a paper, On a New Form of Intermittent Light for Lighthouses, to the Royal Scottish Society of Arts on March 27, 1871. The paper won the Society's Silver Medal. Lighthouses needed to be identifiable at nighttime to aid the ships passing by. To do this a system of distinctive on and off illumination was used and this information about each lighthouse's illumination code was issued in booklets for sailors. Fresnel lenses could rotate around a fixed light, a light could rotate within a fixed lens apparatus, or shades could intermittently occlude the light. Stevenson's contribution was to devise a series of sectors of hemispheric mirrors that rotated around the light but within the dioptric lens system. As these mirrors rotated they would block the light for varying times as the back of the mirror faced the sea and when the concave mirror surface faced the sea the light was exposed and actually was accentuated by reflection. His father added his own modification to the system in Robert's speech. After winning the prize and proving he was capable of doing well as an engineer, Robert informed his father that he was dropping out of the engineering program. They compromised with Robert enrolling in law school.
Use of Concave Mirrors as Visual Corrections
And Magnifying Devices Preceded Spectacle Corrections
Jay .M. Enoch
The Renaissance Society of America invited me to examine use of mirrors for magnifiers and refractive corrections prior to spectacle development. With help from Vincent Ilardi, U Mass, a fragmentary, but convincing argument based on available literature was presented in Florence, Italy.1 Evidence suggested that two concave mirrors (or one concave and one flat mirror) were used for this purpose. The second mirror provided left/right image reversal (and in appropriate instances, added magnification). A description of broad refractive mirror use in Rome was provided by Seneca (4 BC – about 65 AD).1, 2 Later descriptions were provided by Della Porta, and Albertotti.See 1 Mark Smith, U Missouri, suggested the same visual results were achievable by employing the polished concave bowl of a “spoon”. This application utilized a different optical technique from reported designs.1 Recently, Ilardi called my attention to a book by Nicholas de Cusa (ca 1464). Contrary to the expectation that spoon mirrors might be made of polished metal, de Cusa3 mirrors were made from fine grained, highly polished wood. From one spoon, he created four different mirrors. Concave and convex mirrors were fabricated from the front and back of the spoon bowl. A convex (or concave?) cylindrical mirror was made from one side of the handle, and a flat mirror was produced on the reverse side. The word “cylinder” was employed, but de Cusa didn’t discuss use of spoon mirrors as a reading aid. This largely unknown and unusual history of refractive corrections will be reviewed.
Stanley M. Truhlsen
The Knapp family is unique in the annals of American ophthalmology in that members of three generations achieved national and international recognition and prominence for their contributions to our specialty. Herman J. Knapp migrated to the United States from Germany in the mid-19th century and established himself as one of the leading ophthalmologists in America. He started the Archives of Ophthalmology, founded an eye and ear hospital, was instrumental in the establishment of the Section on Ophthalmology in the AMA and was its first Chairman. He published many papers and presented many papers before many ophthalmology societies and taught many who became leaders in American ophthalmology. Arnold Knapp followed his father as Editor of the Archives of Ophthalmology, Professor of Ophthalmology at Columbia University's College of Physicians and Surgeons, was involved in and held office in many eye societies, had a large bibliography and was recognized as one of foremost American ophthalmologists in the first half of the 20th century. Philip Knapp, the third generation and American trained member of Knapp family, like his illustrious forebears, became a Clinical Professor at the College of Physicians and Surgeons and lectured widely, particularly on the subject of ocular motility. He enjoyed a national and international reputation, taught many students and fellows and was a raconteur of the first order. Truly a remarkable family.
Strabismologists I Have Known and How They Influenced Me
I am going to discuss with you a group of strabismologists that it was my good fortune to have known. These individuals were giants of their time. I will present personal reminiscences rather than evaluations of their professional contributions, which can be found elsewhere. I will discuss Francis Heed Adler, Rudolph Aebli, Harold Whaley Brown, Hermann Martin Burian, David Cogan, Edmund Cooper, Frank Duncan Costenbader, Hiram Hardesty, John Hermann, and Philip Knapp.
Doing History: The Cogan Society after 15 Years.
Ronald S. Fishman
At the end of this 16th annual meeting, some 113 speakers will have presented some 421 papers on various historical aspects of ophthalmology and visual science. Although there was often overlap, almost all of these papers can be placed in two general categories depending on the main focus of the paper: A. Biographic treatments of doctors, scientists or famous patients Historical treatments of institutions, professional organizations or geographically defined professional groups (247 or 58%). B. Developments in basic and clinical science, where the emphasis was on evolving concepts of normal function and disease, or diagnostic and therapeutic techniques and instrumentation (156 or 37%). This leads to diverse thoughts on history in general and, in particular, the writing of the history of medicine and science by non-professional historians.