23rd Annual Meeting April 16-18, 2010 Chicago, Illinois
Professor Soemmerring and His Magic Ring
David J. Apple, MD, Charles E. Letocha, MD, Dan Z. Reinstein, MD, W. Ayliffe, MD, Andreas F. Borkenstein, MD, and Brian Zaugg, BS
Professor Samuel Thomas Soemmerring (1755 – 1830) was a Professor of Anatomy who held positions at several German Universities during the late 18th/early 19th century. In ca. 1804 he described a ring-shaped pathological lesion affecting a traumatized lens that now bears his name, the Soemmerring’s Ring (SR). The SR is now understood to rank as one of the most important and clinically significant lesions affecting the lens – indeed the entire eye. We have recently learned that we must understand the nature of the SR in order to understand the pathogenesis of myriad intraocular conditions, ranging from Posterior Capsular Opacification (PCO, Secondary Cataract) to seemingly unrelated eye diseases affecting not only the lens but also other structures.
Eye pathologists typically encountered the SR while examining eyes that had had non-surgical trauma. Pathogenetically, the common denominator of this condition consisted of a rupture of the anterior lens capsule, followed by extrusion of lens substance through the break, with subsequent Elschnig Pearl formation.The residual lens assumed the familiar donut shape (resembling a weight lifter’s dumbbell when viewed in saggital sections).
During the 1980s, eye pathologists began to see more and more SRs, until they realized that it was omnipresent in almost every case of ECCE (phaco) – IOL surgery, in contrast to prior years when SR was almost exclusively associated with non-surgical ocular trauma. Therefore, this was deemed a significant lesion in terms of understanding the pathophysiology of certain post-traumatic problems with the lens, but little more.
By the mid 20th century an event occurred that transformed the SR from a sporadic occurrence to an important post-operative lesion! That event was Sir Harold Ridley’s 1949 invention of the IOL. It turns out that every patient who received an extra capsular cataract operation (ECCE or phacoemulsification) was, by definition, left with a Soemmerring’s Ring in his or her eye.
The main focus of this lecture relates to the SR cataract, but the brilliance of Professor Soemmerring’s other work is clearly reflected in several other discoveries. One means of itemizing these is to list some eponyms: Soemmerring’s bone, Soemmerring’s foramen, Soemmerring’s ganglion, Soemmerring’s ligament, Soemmerring’s muscle, Soemmerring’s nerve, Soemmerring’s ring cataract, Soemmerring’s ring cataract 2, Soemmerring’s spot. Soemmerring also researched in what we today term electronics. He preceded the other Samuel (Samuel F.B. Morse) by about 3 decades as he presented his “electrochemical telegraph” to the Munich Academy of Science in 1809.
It is not an exaggeration to state that the most common eye operation performed today is the creation of Professor Soemmerring’s Ring. It is ironic that the understanding and treatment of cataract-IOL surgery are now best be understood by looking back to events occurring over 200 years ago, 150 years prior to Ridley’s invention of this now routine surgical procedure.
The Missing Link: Paul Sullivan, MD and the History of Intraocular SF6
Christopher F. Blodi, MD
The usefulness of intraocular gas in retinal reattachment surgery was recognized for many years but the search for a gas that would last longer than air in the eye was elusive. Many ophthalmologists tried numerous gases experimentally and in the human eye. While SF6 was recognized as being a potentially useful gas by several retina specialists, it was not until EWD Norton's Jackson Lecture in 1972 that this agent was employed in human retina reattachment surgery. Dr Norton and others at the Bascom Palmer Eye Institute in Miami credited Paul Sullivan, MD, then a retina fellow, for bringing SF6 to their attention. The presentation recounts the steps that brought SF6 gas to the retinal surgeon's armamentarium and highlights the interaction between laboratory and clinical research still important today.
Bernard Becker “In His Own Words” Part II – “The Academic Years”
George M. Bohigian, MD
Bernard Becker, MD is one of the leaders in modern-day ophthalmology. His contributions to science, ophthalmology, resident training and academic medicine have been profound. His teachings have guided many in their professional and private lives. These personal reminiscences and their effect on his many friends and colleagues will be highlighted.
Part II will review his impact on the academic community as the Chairman of the Department of Ophthalmology at Washington University School of Medicine in St. Louis. His influences on ophthalmology and those who came in contact with him will be examined by using his own words and showing how they influenced others. (Part I – “The Formative Years” was presented in 2009.)
The First Western-Style Hospital in China (1835 – Present)
Chi-Chao Chan, MD
Peter Parker (1804-1888), the first American medical missionary and a Yale graduate, went to Canton (Guangzhou) China immediately after his graduation in 1834. On November 4, 1835, he opened Pu Ai Yi Yuan, the first Western-style hospital in China. Parker, who believed that eye disease was the most common ailment in China, dedicated the hospital to the treatment of eye disease. The hospital became better known as the Ophthalmic Hospital in Canton. During the first three months, he saw 1,020 eye patients and 41 other patients.
In 1855, John Glasgow Kerr (1824-1901), who graduated from Jefferson Medical College, succeeded Parker. In 1866, the hospital was relocated, had more general patients, and was renamed as Boji Hospital/Boji Medical School. In 1936, the hospital and medical school were taken over by Zhong Rongguang (1869-1942), a famous educator and the first Chinese President of Lingnan University, the formal Christian College in China that Andrew P. Happer (1818-1894) originally founded in 1888. It was then changed to Boji Hospital/ Lingnan Medical College/Lingnan University. In 1950, two Chinese ophthalmologists, Eugene Chan (1899-1986), who studied under William Holland Wilmer at the Johns Hopkins, and his wife, Winifred Mao (1910-1988), were recruited to the University, and they established the Ophthalmology Department that had only 2 inpatients and 30 outpatients per day.
In 1953, Lingnan University and Zhongshan University were merged and named Sun Yat-sen University; the two Ophthalmology Departments were combined and headed by Prof. Chan, who, in 1965, built the Zhongshan Ophthalmic Hospital. After the Eye Research Institute and the Office of Prevention of Blindness were added in 1982 and 1983, the Chinese government approved Profs. Chan and Mao to found the Zhongshan Ophthalmic Center, the first Eye Center in China. In 2006, the Department of Optometry and an optical shop were also included in the Ophthalmic Center. In 2007, Zhongshan Ophthalmic Center was named as the only state-level ophthalmic key laboratory in China. In 2008, the Center took care of 506,260 outpatients and performed 30,998 operations. Currently, a new hospital with 43,000 square meters is being built, and the inauguration is planned for 2011.
After 175 years, the first Western-style hospital in China, an ophthalmic hospital, is not only surviving but also thriving as the leading Eye Center in the country and one of the most prominent ophthalmic institutes in the world.
Stonewall Jackson, Uveitis and Tuberculosis
Pamela S. Chavis, MD
Tuberculosis and ocular disease may have affected Stonewall Jackson, one of the great southern generals of the Civil War, and his death deprived Robert E Lee of his balanced view and may have led to the decision to cross the Mason-Dixon line into Gettysburg, Pennsylvania.
A History of the First 50 Years of the Department of Ophthalmology at Saint Louis University, 1903-1953. (Including Selected Highlights from the Nineteenth Century)
Robert C. Drews, MD
Although ophthalmology was not a widely-recognized specialty during the 1800s, a few prominent physicians in St Louis had received training, usually in Europe, in this discipline, and some limited their practices more-or-less to eye, ear, nose and throat and finally to eye alone. These men constituted the leadership in ophthalmology in St Louis. In 1860 St. Louis was the 3rd largest city in the United States, and has remained a major eye center.
The history of ophthalmology in St Louis was largely contained in its two departments of ophthalmology. This paper reflects on the department at Saint Louis University, and the men that led it. Facilities and funds were minimal. All department members were in private practice, and their service, leadership and research were on a part-time, voluntary basis. Nonetheless, patient care, training of preceptees and (later) residents, and research productivity were laudable. This paper summarizes the work of the heads of the department, including curriculum vitae and publications, and the events that influenced the specialty of ophthalmology.
Ophthalmology and Observation: A Life “Apologia pro Vita Ophthalmologica”
Ira Eliasoph, MD
That first word “Look” has guided my life. Ophthalmology as my work was the wisest decision I ever made. We live in a visually oriented society and the basis for all Medicine is observation. To encourage others to record their own histories, I present something of my own. Observations are the key reality, not the lifeless list of a textbook. But- we must retain the wisdom of the past and the continuity of history. Virchow wrote chidingly, “Anything published more than five years ago does not exist”. We must look harder.
"A Search for the Earliest Representation(s) of Light-Rays."
Jay Enoch, PhD,DSc
One of the most charming and perhaps naïve aspects of optical history is associated with the early history of rays-of-light. The writer has described an ancient artificial eye found in Iran (circa 4800-4900 years Before the Present or BP, or circa 2800-2900 years B.C.E. = B.C.). B.C.E. stands for Before the Common Era, or about 4910 B.P. [This terminology is used in modern writings in order not to offend peoples of differing religions and cultures.] Designs were inscribed upon this artificial eye, made of a bitumen, including a geometric grid of light-rays (at 45° intervals) which were either entering into, or perhaps emanating from the eye pupil. That feature carried with it highly meaningful theoretical issues which will be discussed briefly. The presence of these "light-rays" also raised the question: What is the oldest known display of, or depiction of light-rays? The Iranian artificial eye proved to be one of the oldest known applications of rays-of-light! The oldest rays of light symbols found, to date, can be ascribed to Mesopotamian civilizations (in modern Iraq) in about 3100 B.C.E. These pictographs portrayed rays-of-light, also called "astral" symbols, represented stars (or on some occasions "the sky" [or even "God"]) in early Mesopotamian writings. A round sun with rays of light also was used in association with representations of their Sun God, Shamash.
While addressing this interesting history, the writer encountered an application of light rays in Egypt which was both remarkable and quite unique. In the "Armana Period" (circa 1350-1333 BCE/BC or 3360-3343 BP) during Dynasty XVIII of the New Kingdom of Egypt, the nation was ruled by Pharaoh Amenhotep IV, who married the beautiful Queen Nefertiti. He changed his name to Akhenaten; moved his capital to a new city, Armana; and created a new (rather short-lasting) monotheistic religion. Then, "the one God", "the Sun God Ra"; "the Aten"; or "the Aton" was the focus of religious beliefs of many individuals led by the Pharaoh. This God was symbolically represented by a round-sun-disc. For some years, associated light-rays took on special significance and unique forms! Each ray-of-light portrayed had at its termination a very small hand (!), and many of these individual delicate hands are seen bearing an ankh (a symbol of life, or of sustained life, or the giving of life), or a tool, or another symbol of religious significance. Thus, during this brief time period, rays-of-light in Egypt symbolized a means of communication, so to speak, between the Sun God and a supplicant/an individual.
Fred Loe, MD
Robert M. Feibel, MD
In the history of ophthalmology, trachoma stands as one of the most important diseases due to its wide-ranging impact on world-wide blindness. The introduction of a cure for trachoma was a milestone in ocular therapeutics.
Prior to the discovery of a cure for trachoma, no specific treatment was known and the only expedient was to destroy the involved tissue with the infectious agent to render the disease inactive. All treatments, medical, mechanical, and surgical, were unsatisfactory with cure rates of only about 20%. All these irritating and tedious medical therapies as well as both painful and disfiguring surgical maneuvers fell by the wayside when Fred Loe was one of the first to introduce sulfanilamide into the therapy of trachoma. One of the most unusual aspects of Loe’s career was that he never had any formal training in ophthalmology and was completely self-taught as an ophthalmologist.
Historical Evolution in Our Understanding of Stargardt Macular Dystrophy
Gerald A. Fishman, MD
It can, on occasion, be edifying to step back and examine the evolution in our understanding of a specific disease from its initial description to our most recent understanding of its pathogenesis and current treatment options. This evolution in our understanding often does not evolve in an unencumbered fashion but rather in a series of ebbs and tides with periods of exponential progress followed by periods of limited advancement and even the pursuit of spurious directions of investigation.
In his review, the presenter will sequentially describe some of the key contributors, and their contributions, responsible for the advancement and pursuit of information relevant to our understanding of Stargardt macular dystrophy. The journey will begin with Karl Stargardt and include a cast of participants which will include Franceschetti, François, Krill, Klien, Eagle, Fish, Delori, von Rückman, Gerber, Allikmets, Sung, Nathans, Molday, Weng, and Radu.
The progress made over the century since Stargardt disease was initially described has been impressive. Nonetheless, review of the historical evolution in our understanding of this disease exemplifies how the wheels of progress can turn slowly. But at least, by and large, they seem to turn forward.
The Vulcan Eyebrow Sign in Abraham Lincoln and His Family: A Sign of Unilateral Coronal Craniosynostosis
Ron Fishman, MD
Premature closure of one coronal skull suture produces a characteristic arching or relative elevation of the superior orbital rim on the involved side. This sign is associated with facial asymmetry, and both signs are usually the most conspicuous features in patients with mild unilateral coronal craniosynostosis.
Photographs suggest that at least 10 individuals over five generations of the Abraham Lincoln family had premature closure of one coronal suture. In 8 males there was involvement of the left side; in 2 females there was involvement of the right side.
There have been a host of newer findings about the genetic basis for synostosis, most involving fibroblast growth factor receptor mutations. It is tempting to ascribe some known mutation to this family tree, but it would be only speculation, pending analysis of Lincoln's DNA. There is already a long queue waiting for this event, should it ever occur.
Ophthalmic Abnormalities Manifested by the Gargoyles of Washington National Cathedral
Alice (“Wendy”) Gasch, MD
Of Washington National Cathedral’s (WNC) 112 gargoyles, it was possible to evaluate 108 (96%) for ocular abnormalities discernable on external exam. Human standards were used unless a gargoyle’s head closely resembled a particular animal, in which case appropriate animal standards were used. Of the gargoyles evaluated, 90 (83%) exhibited the following 17 abnormalities (frequencies are given in parenthesis): proptosis (32), peripheral corneal excavation/thinning (18), generalized corneal opacification (16), cornea plana (12), iris coloboma (11), anophthalmos (10), dermatochalasis (6), eyelid deformity (5), chemosis (4), iris disorder resembling iridodialysis (2), lacrimal system disorder (2), refractive disorder (2), microthalmos (1), ocular prosthesis (1), ptosis (1), skew deviation (1), upper eyelid retraction without proptosis (1). Thirty-two gargoyles exhibited more than one abnormality.
WHC’s gargoyles have a high prevalence of ophthalmic abnormalities. They can serve an unanticipated educational function by portraying ophthalmic pathology, thus upholding the traditional educational function of the sculpture of Gothic cathedrals, such as WNC.
The Jeffries of Boston and the First Airmail Letter
John W. Gittinger, Jr., MD
The Jeffries family of Boston was important to ophthalmology. John Jeffries, Jr., (1796-1876) founded what is now called the Massachusetts Eye and Ear Infirmary and gave a series of lectures on ophthalmology that constitute the first American textbook of ophthalmology, as has been discussed at this Society by Dr. Dan Albert. His son B. Joy Jeffries (1833-1915) also practiced ophthalmology and was the author of Color Blindness; Its Dangers and its Detection (1879), which is still in print.
The senior John Jeffries (1745-1819) was a Loyalist physician and surgeon whose accomplishments include financing and participating in the first manned balloon flight eastward across the English Channel in 1785. He delivered the first letter to be carried by air to Benjamin Franklin.
The inventor of the passenger carrying balloon, Jean-François Pilâtre de Rozier (1754-1785), was also the first person to die in an air crash. This occurred while he was trying to duplicate Jeffries’ and his companion Jean-Pierre Blanchard’s feat by crossing the English Channel from Paris to England. Fortunately for ophthalmology, John Jeffries survived his adventures and went on to father a distinguished family.
Input of Ksawery Galezowski [1832-1907] to International Ophthalmology
A. Grzybowski, MD and M. Tomczyk
Galezowski was one of the most distinguished Polish ophthalmologists of the 19th century. He was the author of hundreds of articles and 12 books, on nearly every aspect of ophthalmology, including his major interests in ophthalmoscopy, retinal chromatoscopy, treatment of glaucoma, cataract and retinal detachment.
Despite his his many activities, a high professional position in his times and an important influence on the European ophthalmology, his private life and ophthalmic achievements have not yet been analysed in detail. French and European ophthalmologists have always considered him to be a Pole. However, in Poland Galezowski’s scientific achievements, mostly presented in the French language, are hardly known and rarely considered a part of the Polish ophthalmologic legacy.
Ksawery Galezowski was born in Lipowice, Poland in 1832. He graduated from a medical faculty in St. Petersburg and in 1858 he presented his doctoral dissertation there on ophthalmoscopy. He then left for France, where he stayed until the end of his life. From 1859-1864 Galezowski was an assistant and Chef-de-Clinique at Desmarre’s eye clinic in Paris; in 1865 he was given the title of doctor of medicine with the dissertation entitled “On Pathologic Changes of the Optic Nerve and Cerebral Diseases from which They Originate”; in 1867 he founded a private clinic, which became one of the best ophthalmic hospitals in Paris. He also worked in other Parisian hospitals, co-operating also with Charcot. Hirschberg wrote that he was assumed one of the best practitioners and surgeons in ophthalmology in those days. He was a tutor to many French ophthalmologists, as well as Polish specialists. He founded the first French monthly ophthalmic journal Journal d’ophtalmologie in 1872, which was continued from 1879 to 1907 as Recueil d’ophtalmologie. His major interests were focused in ophthalmoscopy and retinal detachment. Due to his co-operation with Jean-Martin Charcot at the Salpetriere, he gained a great deal of experience with neurological diseases and he became the pioneer of the use of ophthalmoscopy in the diagnosis of central nervous system diseases (cerebroscopy).
Galezowski did many pioneer studies in different fields of ophthalmology and certainly he was a great practitioner and tutor. His studies in ophthalmoscopy, retinal detachment and glaucoma surgery belong to the best of 19th century ophthalmology.
Marius Tscherning (1854-1939): Optical Physiologist par Excellence
David G. Harper
Marius Tscherning is best remembered as the first optical physiologist to offer a viable alternative to the Helmholtz Theory of Accommodation. He was a prodigious author, publishing approximately 100 papers and several textbooks. Even though his native language was Dutch, he translated, into French, the works of both Thomas Young and Hermann von Helmholtz, to which he appended significant introductions. This paper presents his personal observations on the controversy he stirred with his new theory of accommodation. By way of background, and with direct reference to several of his early papers in French, this paper also offers a brief survey of the rest of Tscherning’s remarkably productive academic career, starting with his study of myopia in Dutch military recruits in the early 1880s and continuing through the 1920s in both Paris and Copenhagen.
Marius Tscherning was a giant in ocular physiology who contributed much to the field, including an alternative to the Helmholtz Theory of Accommodation that created a controversy which has persisted to the present day.
Albrecht von Graefe - Unrecognized Ophthalmic Contributions
Danny H-Kauffmann Jokl, MD
Albrecht von Graefe was a prolific contributor to our modern understanding of clinical ophthalmology, description made possible in part due to his use of the Helmholtz ophthalmoscope. Closer examination of his work, particularly his seminal paper on the glaucomas reveals that his observations touched on the field of retina as well.
This paper will deal with three heretofore little, if at all heralded original retinal observations of von Graefe that have, in modern times, each been identified with prominent ophthalmologists with scant, if any, realization, due perhaps to the absence of translation from the German of the pertinent von Graefe manuscripts.
The adage to survey the German literature before assuming to have made an original observation requires, especially in the case of von Graefe, emphasis.
Congress among the Dreaming Spires
Richard Keeler, FRC Ophthal (Hon)
In July 2009, Oxford, “that sweet city with her Dreaming Spires,” hosted the Centenary of the founding of the Oxford Ophthalmological Congress. The inspiration and organisational flair for this annual meeting came from Robert Walter Doyne.
An Exhibition of archival material, antique instruments and memorabilia coincided with the Centennial Meeting. Putting on this Exhibition necessitated research, not only into the life of an extraordinary man, but also those who helped him establish this annual congress in Oxford –people such as Sir William Osler, Derrick Vail, Sydney Stephenson and Sir Anderson Critchett. A study was undertaken of the archives which included all the past programmes and of group photographs taken in the first sixty-five years. Tracking down the great grandson of the founder revealed a fortunate discovery, namely the Doyne family scrap book. This volume produced new insights into a man of many interests and talents who had become such an influence on ophthalmology in his own country and further abroad.
From the beginning, the Oxford Ophthalmological Congress attracted delegates from around the world seduced by its informal surroundings and friendly approach. The Congress has survived two world wars when membership dwindled and meetings were cancelled. It has thrived not only due to its ambience but also to the high quality and originality of many of the papers including a controversial one by Harold Ridley on his intraocular lens implant in 1951.
After the founder’s death in 1916, a Lectureship was established in his memory with many world-renowned ophthalmologists and scientists presenting this prestigious lecture including David Cogan (1963) and our own member Arthur Silverstein (1974).
This paper will highlight the life of this inspired “Oxford” man whose academic achievements were not inconsiderable having three ocular conditions associated with his name, those of the Coppock cataract, angioid streaks and honeycomb choroiditis.
James Graham – An Oculist in America
Charles Letocha, MD
James Graham, famous (or infamous) for his sex therapies, Temple of Health and the Celestial Bed during his career in London, was educated in Edinburgh and spent about 4 years (1769-1774) in the American colonies as an oculist/aurist. Examining his methods gives us insight into the treatment of eye diseases at that time period and also an introduction to the types of practitioners who treated the eyes in 18th century America.
Athanasius Kircher and his Ars Magna Book
Harry Mark, MD
Kircher was a Jesuit polymath born 1601in Fulda central Germany and died 1680 in Rome, one of the last scholars aspiring to know everything. His fascinating book, translated as Important Knowledge about Light and Shadow, is regarded as his most important encyclopedic work. It is today often appreciated mainly for its beautiful copper plated illustrations. Concerning the eye and vision he discussed its structure and function, including the inverted retinal image, visual-field, and fantasies. Of interest is also the camera obscura and probably the first design for a slide projector. Although not primarily an inventor, the popularity his works helped disseminate scientific and useful knowledge, and provided him with some income.
Color Blindness and Art
Michael F. Marmor, MD
Literature on color problems in artists is limited — by knowledge in ancient times, and reluctance to advertise in modern times. Comments in old compendia of renaissance artists such as Vasari have been reviewed, as well as data on more modern artists whose color vision has been measured. The effects of red-green color deficiency will be simulated through computer processing.
The implications of color blindness will be discussed with respect to artists suspected of deficiency, known to be deficient, and erroneously thought to be affected. These include renaissance artists, giants like Constable, the Irish painter Paul Henry, etchers Meryon and Milton, and others. Arguments will be supported by historical documentation and some new computer demonstrations of color-blind perceptions.
One cannot diagnose color-blindness from an artist’s work, but when present there are often some characteristic features to the art.
The Case History of an Eighteenth Century Case History
J. Fraser Muirhead, MD
A number of years ago I came across an English translation of an interesting article in the 1834 edition of James Wardrup’s, “The Morbid Anatomy of the Human Eye.” It was an abridged translation of a German language article published 1798 by D. Manniske (the “D” is an abbreviation for doctor). In the English translation, Manniske describes using a “microscope” during the removal of a migratory, rather large, buried corneal foreign body. With the microscope he inspected his initial incision to clarify the nature of the foreign body before enlarging the incision to remove it. To use a microscope at this early date was very interesting. After this citation his report remained unnoticed in the literature as far as I could determine.
Manniske’s identity remained unknown to me until I found on the Internet the German family Manniske and a German hospital of that name. The later source led me to very helpful contacts through which I learned much of his personal history, which I describe; his full name, where he was born, was raised, and practiced general medicine, where he received his medical education, and something of his personality and personal achievement. I visited his home town, the modern Manniske Hospital there, and saw his home and office, and the building housing the hospital he founded in 1799; which I illustrate. To determine the type of microscope he used was less successful. I make some conjectures illustrated with photographs of contemporary instruments.
Although Manniske’s late 18th century case report had no influence on the development of ophthalmic microsurgery, I suggest that he be credited for recognizing the need for better visualization in eye surgery and for using the then available technology to help him perform a simple eye surgical procedure.
Wheatstone, Brewster, Oatman
Steven A. Newman, MD and H, Stanley Thompson, MD
The concept of perspective was introduced in the early Renaissance adding “depth” to artists’ illustrations. Although the definition of the horopter and the perception of near and distance targets were introduced by Aguinlonius in 1637, it was not until the early part of the 19th century that two British scientists, Charles Wheatstone and David Brewster, made presentation of three dimensional images possible by the invention of the stereoscope. Although most of our experience with stereoscopy is the result of its immediate combination with an invention at almost the same time (photography), some of the earliest works of three-dimensional viewing were painstaking drawings. In 1913, in the year following his death, Edward L. Oatman, a surgeon at Manhattan Eye, Ear, and Throat Hospital, published 234 illustrations depicting disease of the fundus. Although preceded by external photographs for teaching in ophthalmology, this was the first use of stereoscopy to illustrate retinal pathology almost 20 years before the first stereoscopic fundus photos were demonstrated. As each of the drawings had to be done by hand and from a different prospective, this was a formidable undertaking by an ophthalmologist otherwise in private practice.
This paper will review Oatman’s 1913 Diagnostics of the Fundus Oculi set in the context of the introduction of stereoscopic viewing by Wheatstone and Brewster in the early 19th century. Stereoscopy has transformed not only our vision of pictures but our picture vision. As a mode of communication and education, stereoscopy has, is, and will continue to play an important role in our perception of the visual system.
Susruta of Ancient India
VK Raju, MD, FRCS, FACS
The golden age of surgery in ancient India rests largely on the accomplishments of Susruta, who lived sometime between 800 and 600 BC. Susruta practiced and taught the art of surgery at the University of Benares in the ancient city of the same name, located on the banks of the river Ganges. His monumental treatise on surgery, Susruta Samhita, established him as the father of Indian Surgery. He was the first surgeon to systematise surgery by dividing it into separate fields. He is known as the originator of plastic surgery, cataract operation, laparotomy, and vesical lithotomy.
Due to a language barrier Susruta’s work did not reach the western world until recently. A brief account of missing links between Ayurveda and Modern Medicine will be presented.
Lucien Howe, Hereditary Blindness, and the Eugenics Movement
James G. Ravin, MD and Alexandra M. Stern, PhD
Lucien Howe MD (1848-1928) was a leader of American ophthalmology during the late 19th and early 20th centuries. Howe’s influence has been felt for more than a century. Many of Howe’s articles may be found readily online in publications such as the Transactions of the American Ophthalmological Society and JAMA. Howe published a book on the ocular muscles which is considered one of the 100 most important 20th century ophthalmic books. What is little known is his leadership role in the eugenics movement.
During his presidency of the American Ophthalmological Society, the organization established the Howe Medal which is one of the highest awards in the specialty. Toward the end of his life Howe founded a research laboratory at the Massachusetts Eye and Ear Infirmary of Harvard Medical School. After more than 50 years of practice in Buffalo, NY, Howe moved to Cambridge, MA, to become the first director of the laboratory. Both the laboratory and the library now bear his name. He held high office in the Medical Society of the State of New York and was chair of the Section of Ophthalmology of the American Medical Association.
Howe also became president of the Eugenics Research Association. As a leader he advocated social reform, often through legislative action. This paper explores Howe’s influence on the American eugenics movement and his support of policies for eugenic sterilization and marriage restriction of individuals diagnosed with hereditary blindness. Howe’s correspondence with Charles Davenport, PhD, the key person in American eugenics, and Davenport’s deputy, Harry Laughlin, ScD, which is now held by the American Philosophical Society in Philadelphia, shed remarkable light on Howe’s thinking.
Howe was a pioneer in ophthalmology who advanced the field in both clinical care and research. Significantly, he paved the way for important research on the hereditary components of eye diseases and raised awareness of the role of inheritance in certain ophthalmological conditions. In retrospect, however, Howe’s perspicacious intellect also drew him into eugenic concepts that were cutting edge of thought at the time. Today we would consider them as faulty science and biased against the disabled, immigrants and ethnic minorities.
Howard Leslie Lieberman, MD (1922 – 2006)
David M. Reifler, MD
The techniques and results of cataract surgery changed dramatically over the last three decades of the 20th century. Formerly popular methods of intracapsular cataract extraction gave way to extracapsular techniques with smaller incisions and the routine use of phacoemulsification. Chicago ophthalmologist Howard L. Lieberman MD was an early adopter of phacoemulsification and intraocular lens implantation. Although he never took the lead authorship on any of his (27 peer-reviewed) publications, Dr. Howard Lieberman was deeply involved in this transformation as an early adopter of newer techniques, as a collaborator and co-author on clinical studies, and as a teacher of a new generation of cataract surgeons.
A chance meeting between the author and Natalie Lieberman in October 2009 led naturally to a discussion of her deceased husband, Dr. Howard Lieberman, who practiced ophthalmology for many years in Chicago. From Natalie’s perspective, Howard’s life was important to the history of cataract surgery through his early adoption of phacoemulsification and his introduction of several instruments that bear his name. His talents ranged from masterful surgical skills to designing surgical instruments to playing piano and accordion. He was a warm family man, a generous teacher and clinical collaborator. Further research confirmed that during his career, Dr. Lieberman participated in a great paradigm shift in the techniques of cataract surgery.
Gordon Lynn Walls (1905-1962). A Tribute and Personal Memoir
Melvin L. Rubin, MD
A personal history with Professor Walls and our interactions over 15 years, including a summary of his scientific career and academic contributions.
The Evolution of Retinal Nutrition
Ivan R. Schwab,M.D, FACS
Retinal nutrition has evolved to address the continued complexity in retinal anatomy as vertebrates have become more derived. The phylogeny of retinal nutrition is difficult to document because of inadequate fossilization, but we may surmise the progression by examining the retinal vascular system of extant animals. Lampreys, the oldest known living vertebrate, have choroidal sinuses which probably evolved into the more sophisticated embedded choroidal gland in extinct placoderms and many bony fish. The choroidal gland was supplanted by the falciform fold in some fish but this still represents choroidal (mesodermal) tissue. In more derived fish and as the retina becomes more complex, the membrana vasculosa retinae appears, as the first sign of the hyaloidal system.
Extant amphibians, show a hyaloidal system, but the more derived terrestrial vertebrates such as reptiles show the first signs of a central retinal artery in the form of the conus. As reptiles evolve to birds, the conus becomes more complex and organized as the pecten. Snakes, with their fossorial detour, lost the conus and re-established a mesodermal system resembling the membrana vasculosa retinae. The other arm of the reptilian evolution, the synapsids, which includes the line that led to mammals, reveal choroidal thickening followed by a central retinal artery although there are several variations, and some unique exceptions.
Some of the marsupials do have direct vascularization of the retina with the central retinal artery in a much more intimate manner than the conus or pecten, but in a different distribution than placental mammals. Within the placental mammals, there are several variations eventually leading to primates as the most derived. Mammalian vascular systems have evolved from an anangiotic retina, through a paurangiotic, and merangiotic pattern, to a more complex holangiotic distribution. These patterns suggest that as vertebrates diverged and matured the retina became thicker and the nutritional requirements more demanding. The vascular system responded with increased vascular penetration into the retina with more sophisticated and intimate development.
Ophthalmology at Valparaiso
Pamela C. Sieving, MA, MS
Valparaiso University today is a thriving small university in northwest Indiana; its only current medical offering is an undergraduate nursing degree. At the beginning of the 20th century, however, it offered both medical and dental degrees, advertising itself as “A School in the Interest of Progressive Medicine,” and attracted students from across the United States and internationally.
Details of medical education in ophthalmology at Valparaiso in the early decades of the 20th century provide insight into preparation for this early surgical specialty and relationships among institutions providing medical education and training in the Chicago area.
Ophthalmic Treasures from the Galter Health Sciences Library Special Collections at Northwestern University, Chicago, Illinois
Ron Sims, MA
This brief presentation will serve as an introduction for the archival exhibit that will immediately follow.
The Optic Nerve is Still Hollow?
David Taylor, MD
The hollow optic nerve as an anatomical and physiological concept was maintained in Western medicine from about 300 BCE to the 19th century.
As part of a wider study of the history of the optic nerve and vision, I visited the libraries of the Topkapi and Sulimaniye in Istanbul to view the original manuscripts of the early Arabian ophthalmic writers and from this I have studied the Humoral physicians and their view of how sight was generated.
1. The early period- Greece
2. The Arabian era
3. William of Conches 1090-1154
4. Georg Bartisch’s Ophthalmodouleia
5. The Renaissance
6. Gemma, Descartes, Briggs and van Leeuwenhoek
7. The last doubters
8. Harvey Cushing
In terms of deeply embedded traditions in many cultures of the world, the optic nerve is still hollow!
The Adventures of Dr. Otis Lee
H. Stanley Thompson, MD and John C. Lee, MD
This is a brief biosketch about how a bright young man in China, through a very unusual set of circumstances, managed to get an ophthalmology residency at Iowa with C.S.O’Brien. This is a story about how a high-quality ophthalmologist can sometimes drop out of the sky.
Classics of Ophthalmology and Optics in Two Famous Rare Book Collections
Lilla Vekerdy, MA, MLS
This presentation highlights several outstanding classics of the history of ophthalmology and optics from the fifteenth to the eighteenth centuries held in two world-renowned rare book libraries: The Bernard Becker Collection and the Dibner Library in the Smithsonian Institution. These resources became milestones in the development of ophthalmology and optics from the Middle Ages to the Modern Era. The books articulate not only the authors’ scientific thoughts but also exemplify cultural and artistic objects.
Through the perusal of the books selected from the above two libraries, it is possible to vividly re-draw the development of these two scientific fields as they manifested in their own eras as well as contributed to contemporary science. The presentation will also emphasize how book collectors added to a cultural lore that helps us detect and understand the roots and advancement of many fields, in this case the science of ophthalmology and optics.
Christoph Scheiner – Jesuit Priest and Natural Philosopher
Wolfgang H Vogel, PhD
Christoph Scheiner was born in Germany in 1573/75 and died in 1650. He became a Jesuit priest and lived and worked in various cities in Germany, Austria and Italy where he either taught as professor of mathematics or served the Church in other capacities. He is a little known but brilliant mathematician, physicist and astronomer (he was among the first to use the telescope and to confirm the existence of the sunspots discovered by Galileo) but was also keenly interested in and performed many experiments in optics and physiology of the eyes. He published widely and his major works “Oculus” or “Eye” and “Rosa Ursina Sive Sol” or “The Ursine Rose or Sun” were published in 1619 and 1626-1630.
His interest in the eye was inspired by the works of the German Astronomer and royal mathematician Johannes Kepler. Scheiner described in the above mentioned books not only the current ocular knowledge but also his own studies on ocular optics and anatomy. He corrected the existing knowledge about the optic nerve which was thought to leave the eye opposite the pupil in that he dissected animal eyes and observed its nasal exit. He determined the curvature of the cornea by looking at the images of a window on the eye and on glass balls of different curvatures and then extrapolated the known curvature of the glass ball to the eye when both images were equal. By removing the posterior part of an animal eye he looked at a candle and saw the candle side reversed and up side down verifying experimentally Kepler’s theory that light rays crossed within the eye. He determined that the pupil constricts when an object was brought slowly closer to the eye as well as that the pupil would also constrict if a bright light is directed towards it (he also mentioned that this reaction occurs only in the live but not enucleated animal eye). He looked through two pin holes in a cardboard at a needle held perpendicular to it and when focusing on the needle he saw one but when focusing on far or near objects he saw two needles; he concluded that the lens must have changed its curvature during accommodation contradicting Kepler’s theory that the lens moves forth and back during accommodation. He also observed that an healthy eye would see through the two pin holes only one distant tower while an ametrope eye would see the tower double (known as Scheiner’s test and the basis for the later developed Shack-Hartmann wave front analyzer). He also mentioned the stenopeic effect in that a pinhole allows only a very narrow beam of light to enter the eye at a right angle which causes sharper vision and a clearer image of seen objects.
Casey Wood – Ophthalmological and Ornithological Polymath
David L. Williams, MA, VetMB, PhD, CertVOphthal, FRCVS
Casey Wood was born in Wellington, Ontario, Nov. 21, 1856. His father was a well-known physician, a native of the State of New York, and could trace his ancestry back to immigrants from Berkshire, England who settled in New York in 1717. He studied medicine at Bishop’s College, Montreal which soon became McGill University with further studies at Berlin, Vienna, Paris and London where he worked at Moorfields. He studied in Montreal under William (later Sir William) Osler and it was at this early stage that his passion for ophthalmology began. Before then however, even from childhood, his second passion, for nature study and particularly ornithology, took root. Together ophthalmology and ornithology would guide Wood through his life. Having no children, he, his wife Emma and their pet parrot John Paul toured the globe, collecting material for his magnum opus The Fundus Oculi of Birds, Especially as Viewed by the Ophthalmoscope (1917). This was not just a work arising from a general interest in birds. Wood considered that the superior optics and visual capability of many birds when compared with the human eye may well lead to discoveries which would improve human vision.
But while The Fundus Oculi of Birds is the book for which Wood is remembered today, he was a key general ophthalmologist in North America at the end of the 19th century. His 1896 publication implicating methyl alcohol in the etiology of toxic amblyopia was considered a classic work. Wood was editor at various times of the Ophthalmic Record, the Annals of Ophthalmology, and the American Journal of Ophthalmology (of which he was a founder in 1884). He wrote of “A System of Ophthalmic Therapeutics” (1909), “A System of Ophthalmic Operations” (1911), and edited the eighteen-volume American Encyclopedia of Ophthalmology(1914- 1920).
But more than that, Wood was fascinated by the history of ophthalmology and, of course, by comparative ophthalmology. In these ways he can readily be considered the Duke Elder of the late 19th century. While Duke Elder produced his System of Ophthalmology, Wood has his massive multivolume dictionary. While Duke Elder’s first volume was entitled The Eye in Evolution, Wood had his avian ophthalmic interests. While Duke Elder started each section of The System with a biographical piece, Wood translated numerous historical ophthalmic texts from all over the world into English. A masterpiece is his translation of the earliest printed book on ophthalmology, De oculis eorumque egritudinibus et curis, written by the 12th-century physician, Benvenuto Grassi, and first published in Ferrara in 1474.
For most of his working life Casey Wood was an ophthalmologist in Chicago, either at Northwestern University or the University of Illinois, joining the faculty in 1899 and becoming Head of Ophthalmology in 1913, when the College of Physicians and Surgeons of Chicago became the University of Illinois College of Medicine. However, it was Wood's pursuits outside of clinical ophthalmology that earned him the description as "one of the most colorful and outstanding figures in ophthalmology at the turn of the century, not only in Chicago but nationally and internationally as well." Wood retired in 1920 and thenceforth traveled widely in pursuit of ornithology and ophthalmology, collecting specimens in British Guiana, the Caribbean, the South Pacific, India, Ceylon, Australia, and New Zealand. In 1929 he organized the ornithological titles at the British Museum and prepared its first catalogue describing that collection. Wood spent much of his last decade at the Vatican Library in the translation of medieval European and Arabic ophthalmic manuscripts showing what a diverse range of interests filled his time.
It has to be said that from a political perspective Wood held some views with which we might not agree – he was an ardent fascist, supporting Mussolini in the 1930s while he worked in Europe towards the end of his life, but had progressive views on the importance of animal experimentation held in balance with animal welfare. These opinions stem from his interest both in human medicine and also in environmental conservation, developed in his early childhood in the fields around his home in Ontario.
A Brief History of Comparative Ophthalmology
David Williams, MA, VetMB, PhD, CertVOphthal, FRCVS
For the past century and more there have been ophthalmologists and visual scientists captivated by the variation of the eye across species.
Casey Albert Wood was not alone in his passion for comparative ophthalmology. Gordon Lindsay-Johnson (1853-1943), was almost exactly Wood’s contemporary. Johnson’s ophthalmic career began as a registrar at the Royal Westminster Hospital in London followed by a period at the Royal Eye Hospital there. During this period, he spent much of his spare time at the Zoological Society of London performing ophthalmic observations on a wide variety of species, this resulting in papers first on the mammalian eye and secondly on the eyes of reptiles and amphibians. In this he was ably assisted by Arthur Head, ophthalmic artist of no mean distinction, as may be observed looking at his illustrations of the fundus of species from tigers to rattlesnakes. Head was also responsible for the illustrations in Wood’s The Fundus Oculi of Birds, most of which were also undertaken in painstaking hours in the Zoological Collection at Regent’s Park.
Standing between Wood and Johnson and ourselves are the French ophthalmologist Andre Jean Francois Rochon Duvigneaud and the American Gordon Walls. Rochon Duvigneaud will be remembered for his comment that a raptor was ‘a wing guided by an eye’ but had considerably wider comparative interests, documented in his book Les Yeux et la Vision des Vertebres of 1943. Born in 1863 he studied medicine in the Faculte de Bordeaux and later in Paris writing a seminal doctoral thesis on the anatomy of the human iridocorneal angle. His studies took him from the human eye to a more comparative approach and in 1926, rather in the same way Wood had done years earlier, he retired from clinical practice to devote his time to comparative ophthalmology. He was the first to recognize recessively inherited glaucoma with buphthalmos in the New Zealand White rabbit although in human ophthalmology he is more commonly associated with the syndrome resulting from traumatic collapse of the superior orbital fissure which bears his name.
Gordon Walls was the only one of our comparative ophthalmic investigators who was not first a human ophthalmologist. He published a number of papers and monographs in comparative ophthalmology but is primarily remembered for his masterpiece ‘The Vertebrate Eye and its Adaptive Radiation’, published a year earlier than Rochon-Duvigneaud’s text. Walls was originally an engineer, moving into zoology in Harvard where he undertook work on the ultrastructure of the retina across the vertebrates. Study of the reptile eye in particular allowed him to formulate many of his ideas on the evolution of the vertebrate photoreceptor but his interest in development of the eye through evolution ranged across its whole anatomy and physiology, his life’s work finishing with study of the intricacies of comparative color vision on the one hand and of the evolution of ocular movement and extraocular muscle action on the other.