27th Annual Meeting Abstracts - 2014 - Asilomar, California

 

Ties that Bind Ophthalmic History and Classical Music

David C. Bisno, M.D.

Ties and associations between ophthalmology, fine art and the artists whom we all revere have long been generally recognized and appreciated. In particular, the Cogan Society has been the fortunate recipient of many fine presentations tying our eyes and the visual experience to the world of the artist and his canvas.

To a lesser extent have the ties and associations been recognized between ophthalmology, classical music and the composers with whom we are all familiar. With this presentation I hope to begin to illuminate this fascinating association.

We will remember and review Chevalier John Taylor (1703 - 1772), England's early oculist and most famous, if not notorious, ophthalmiater He was the eye surgeon and self promoting, legendary quack who operated on both Johann Sebastian Bach's eyes and those of Georg Friedrich Handel, both with disastrous results.

We will then turn our attention to a little known story and association - that between seeing clearly” and a composition by Ludwig van Beethoven, namely the great composer's Duet Mit Zwei Ob/igaten Augeng/asem - the Duet for Viola and Cello in E flat Major, Woo 32, ”With Two Eyeglasses Obligato” (ca. 1797). A short history of the writing of the composition - not discovered until 1940 - will be presented and then Cogan members will be treated to a rare, live performance of the humorous, 5 minute work by a professional California cellist and her husband, a retired cardio-thoracic surgeon and accomplished violist.

 

Snyder Lecture: Cogan Ophthalmic History Society

Our Ophthalmic Heritage: Superstitions, Symbols and Magic

George M. Bohigian M.D.

Science fiction writer Ray Bradbury stated that "doctors are in the business of the future."
Patients want to know what is going to happen to them, what they can do to prevent illness and if they are ill, how they can improve their health.

 Superstitions, symbols, and magic have been the armamentarium of priests, shamans and therapists since prehistoric times. In the river civilizations of Mesopotamia and Egypt primitive mystical ceremonies and incantations were the methods employed to eliminate illness caused by the “evil spirits.”  Based on the science of observation, the Hippocratic School of medicine followed diagnosis and treatment. 

 The physician became a doctor rather than a sorcerer. Today the use of the scientific method and advanced technologies has become the new standard. However much of the "art" and science still remain mysterious to the patient and the doctor. 
 
This paper explores the evolution of present day customs of Western and Eastern medicine with special attention to ophthalmology. Examples of the evolution of medical symbols, such as the Staff of Aesculapius, Caduceus, Eye of Horus, amulets, Rx, OS, OD, and OU will be reviewed. The therapeutic value of touch, the placebo effect, alternative therapies, prayers, eye contact, the wearing of a white coat will be discussed. Ophthalmic history and its use in clinical practice are still with us today

 

David Kasner, MD, and the Road to Pars Plana Vitrectomy

Chris Blodi, M.D.

Purpose: The presentation reviews the life of David Kasner, MD (1927-2001) emphasizing his role as a pioneer in early vitreous surgery.

Resources: The author completed oral and written interviews with Kasner’s family members, practice partners and professional associates.  Other sources included Kasner’s professional publications, publications by contemporary ophthalmologists and secondary historical reviews of the period.

Results: Kasner combined careful autopsy dissections with experience in teaching cataract surgery to resident physicians to introduce the new concept of complete removal of vitreous from eyes when present in the anterior chamber or incision during lens extraction procedures.  Encouraging results led Kasner to perform planned subtotal open-sky vitrectomy, first in a traumatized eye, then in two patients with amyloidosis.  The tolerance of these eyes to such extensive surgery was noted by others, especially Robert Machemer, MD, and used as a stimulus for further, even safer, vitrectomy surgery techniques through the pars plana approach.

Summary: While not the first to intentionally subtotally remove vitreous from a human eye, Kasner’s work was crucial in allowing Robert Machemer and other ophthalmologists to begin experimental and human vitrectomy surgery using a pars plana approach.

 

The Evolution of the SEE

Harry S. Brown, M.D., F.A.C.S.

Introduction: For many years countless ophthalmologists have traveled the world to treat patients with vision problems. Many have faced trying circumstances and challenges in their efforts to treat the blind. One of the major global health challenges today is the overwhelming number of cataract blind in the developing world. This is truly a humanitarian emergency of gigantic proportions. The history of the Surgical Eye Expeditions (SEE) International is presented.

Summary: The Founder's story reviews the inception and development of SEE, an international humanitarian organization of volunteer eye surgeons. The concept, organization, implementation and results are presented.

 

Charles J. Snyder (1914-1996) Ex Libris Lux

Ira Eliasoph, M.D., F.A.C.S.

The Cogan Ophthalmic History Society meeting each year includes a presentation called The Snyder Memorial Lecture. The use of his name is in remembrance of a special man, known as the Librarian of the Howe Library at the Massachusetts Eye and Ear Infirmary, and for his book, ”Our Ophthalmic Heritage”, and other writings. Charles Snyder was not a physician, but his contribution to the field of ophthalmology was immense. He was also a very interesting person with human foibles.  David Cogan was, in addition to his other attributes, a judge of people. His perception of what Charles Snyder was about, led to his appointing Charles, who had no librarian background, to a position that expanded far beyond being just a custodian of some books. When I was invited to give The Snyder Memorial Lecture in 2010, I knew little about him and immediate efforts produced nothing useful. I hope this short essay will at least partly fill that gap.

 

The Illuminometer and Light

Ira Eliasoph, M.D., F.A.C.S.

The Macbeth Illuminometer made by the Leeds and Northrup Company is a device designed to measure light levels under many different conditions and for many diverse purposes. Interest in light goes back to Prometheus and before! My own present interest goes back to my childhood. Recently one of these devices came into my possession and has been donated to the Museum of Vision of the American Academy of Ophthalmology. I feel I am in good company, since Nathaniel Bishop Harman (a noted British Oculist) designed a device he called a photometer, to measure light levels primarily for children’s classrooms. The uses of the equipment and some of the people associated with it will be mentioned. The people include Macbeth, Leeds, Northrup, and Weston. 

 

E.C. Ellett, MD - Physician, Citizen, and Soldier

Robert W. Enzenauer, M.D.

Introduction: Dr Edward Coleman Ellett, was an internationally known ophthalmologist at the turn of
the 20”‘ century, who died as he lived - en route to yet another medical meeting. A superb clinician,
noted scholar, and proud veteran, Dr Ellett is a man little known today, but well known a century ago by
most US ophthalmologists and nearly all Tennessee physicians.

Historical Approach: Review of archival medical publications and US Archives

Summary: E.C. Ellett, MD was no doubt controversial in some of his comments, both written and oral.
Dr Ellett was a major factor in the original organization of the American Board of Ophthalmology and
Otolaryngology at a meeting in Washington, D.C. on May 8, 1916. Dr Ellett was a recognized reformer
Dr Ellett’s passion for military’ medical service was well known at the time. Colonel was the
commander of Base Hospital 115, the specialty head, eye, ear, nose, and throat hospital in France during
World War l. His main interest was in graduate teaching and from the organization of the Instructional
Courses of the American Academy to his death he annually gave an hour of instruction on some subject
of clinical interest. Any intern, resident or visitor who manifested the least interest in what "The
Colonel” was doing was cordially invited to the operating room and welcomed at ward rounds. He was
the motivating influence behind annual ”Clinic Days” which for years the Memphis Society of
Ophthalmology and Otolaryngology held for the interested specialists in the mid-South area.
SUMMARY‘ Edward Coleman Ellett is a true Tennessee legacy. He published at least 449 papers,
pamphlets, case reports, editorials between 1891 and 1947 He made at least 194 presentations at
local, regional, and national meetings between 1895 and 1947 A physician, citizen, and veteran, known
to all of his Memphis colleagues as ”the Colonel.”

 

 

Herbert Herbert: His Corneal Pits and Scleral Slits

Robert M. Feibel, M.D.

Objective: To evaluate the life and professional work of the English ophthalmologist Herbert Herbert (1865-1942).

Design: Historical study

Methods: The main sources for this investigation are Herbert’s approximately 65 published papers and three monographs. Other sources are contemporary publications by other ophthalmologists and secondary historical reviews of this period. Written communications with some of Herbert’s descendants revealed previously unknown information about his life. 

Results: Herbert is now remembered for his description of the eponymously named limbal corneal pits as a sign of trachoma. This finding is essentially pathognomic of trachoma and was welcomed as a sign that could reliably diagnose trachoma from other external diseases He also described the sinuous outline of the upper lid margin, sometimes called Herbert’s sign, as a diagnostic finding of trachomatous infection. His diagnostic acumen in the field of trachoma has justly stood the test of time. However, his interest in trachoma was peripheral to his main professional work which was the study of glaucoma filtration surgery, then in its early development from 1900 to 1920. He was one of the major pioneers in the development of original techniques for this surgery. He emphasized the use of small incision sclerotomy to produce an even and diffuse filtration bleb, rather than the large incision sclerectomy proposed by other surgeons which he felt produced too large and thin a filtering bleb subject to complications. This point has also stood the test of time. However, he erred in developing and championing the use of deliberate iris inclusion into the filtering sclerotomy (iridencleisis) to prevent closure of the sclerotomy, a technique which was questioned at that time and eventually discredited. The iris free procedure of trephining developed by his contemporary Robert H. Elliot became the preferred glaucoma filtering procedure until the introduction of peripheral iridectomy with scleral cautery (thermal sclerostomy) in the 1950s and then trabeculectomy in the 1970s.

Conclusion: Herbert should be remembered as an acute and original observer, and as an innovative surgeon who developed some of the pioneering techniques in glaucoma filtering surgery.  

Published as:  Feibel R.M.  Herbert Herbert:  His Corneal Pits and Scleral Slits.  Ophthalmology 2014; 121:1142-8; PMID 24424250      

 

 

 

 

Evolutionary Medicine

Ron Fishman, M.D.

Abstract: This will be an exercise in “deep history”. Evolutionary Medicine attempts to use modern evolutionary theory to give a different perspective to medical problems. Our usual clinical approach is to reduce pathology to the abnormal function of organs, tissues, cells, and, if we are lucky, to individual molecules. This may then identify the most immediate or proximate cause of the abnormality. Evolutionary approaches can complement this by asking different questions. For instance:

Why do certain trade-offs occur, such as in sickle-cell anemia.?

Why do biological pathogens such as bacteria, develop resistance to antibiotics, and cancer cells to chemotherapeutic agents?

How did some inefficient features of human anatomy (such as the need to close the airway during swallowing) come about?

 

Abraham Nemeth: Facilitator of Math and Science Careers for the Blind

Alice (“Wendy”) Gasch, M.S., M.D.

Introduction or Purpose: …to provide an overview of Abraham Nemeth, MS, PhD (1918-2013), a blind mathematician whose work, including the development of the widely-used Nemeth Braille Code for Mathematics and Science Notation, made math-related careers viable options for the blind.

Historical approach, methods or resources: literature review

Results or summary of paper: The field of mathematics often has been considered beyond the capacity of the blind to master. However, Abraham Nemeth, MS, PhD, (1918-2013), congenitally blind, proved that conception wrong through his successful career as a blind, tenured professor of mathematics and computer science. Moreover, he provided mechanisms and inspiration for blind individuals to pursue careers that involve mathematics. The primary means that Nemeth provided is the Nemeth Braille Code for Mathematics and Science Notation. The Code streamlined learning of math and science for the blind, and it quickly became the national standard for teaching math to blind students in the United States, Canada, New Zealand, and elsewhere. Nemeth also helped devise Braille versions of the slide rule and other computational and scientific instruments, as well as a calculator that provides spoken results. In addition, he was the primary developer of MathSpeak, a popular system for communicating math orally. 

Summary or conclusions: Abraham Nemeth, blind since birth, played a major role in enabling the blind to pursue math-related careers. 

 

 

Arthur Gloor – A half century of ophthalmology in daily practice and in a city hospital in the first half of the last century (1899 – 1954)

Balder P. Gloor, M.D.

Introduction : The complete patient records from Arthur Gloor’s daily practice in ophthalmology from 1899-1954 are archived in the State Library of Solothurn, Switzerland. The records illustrated by innumerable small drawings in the text together with larger drawings of an extraordinary quality deliver an outstanding picture of ophthalmology of the first half of the last century. The purpose of this paper is, after a brief overview on the material and of the CV of A.Gloor, to focus on a few selected cases that may show some major differences between ophthalmology of the first half of the last century and of our times. 

Resources are the 67 books - “Diaria” - containing on around 32 000 pages the illustrated records of the 45 319 patients seen and other personal documents of A. Gloor archived at the “Zentralbibliothek” of the State of Solothurn, A. Gloor’s Autobiography, the ophthalmology books he used daily and personal remembrances of his grandson B.G..

Material and Methods: The material mentioned under Resources was worked up thoroughly. Selected parts of it are presented.

Summary: Dr. Arthur Gloor (1869-1954) got his MD 1892, was trained in Surgery, Internal Medicine and under Carl Mellinger (1858-1917)  in Ophthalmology 1892-1899 in Basel. From 1899-1954 he practiced ophthalmology in his own practice and as head of a small department in a state hospital in Solothurn, capital of the state of Solothurn in the Swiss confederation. He was, together with Jules Gonin, one of the founding members of the Swiss Ophthalmological Society in 1908.  

The examples of diseases and treatments that differ most of our times and their impact on the patients are shown. These were cataract-surgery, treatment of injuries,  membraneous conjunctivitis (croupous conjunctivitis), phlyctenular keratoconjunctivitis and tuberculosis, ulcers of the cornea, retinal detachment and retinitis albuminurica. Insufficient drugs, many of them derivatives of mercury, no antibiotics, no steroids, no drugs against hypertonia, needles and suture material not fine enough to close corneal perforations and the wounds after cataract extractions, and long lay days after surgery with severe consequences characterize those days. 

The histories of the patients contain comments reaching far over ophthalmology. They reflect not only the character of daily practice of ophthalmology during the first half of the last century, but become also a source of social history of the city and state of Solothurn and the personal life-story of the ophthalmologist.

 

Allvar Gullstrand and Intracapsular Accommodation: His Nobel Prize Lecture, December 11, 1911.

David G. Harper M.D.

Introduction: Allvar Gullstrand, working independently at the turn of the 20th century, expanded on the prior research efforts of Helmholtz and others to develop a theory of "intracapsular accommodation" that would explain the total observed increase in focusing power that occurs during accommodation.

Resources: Gullstrand's Nobel Prize acceptance speech and his contributions to the 3rd edition of Helmholtz's Treatise on  Physiologic Optics, among other 19th- and 20th-century ophthalmic literature.

Summary of paper: Allvar Gullstrand M.D. of Uppsala, Sweden, a founding member of the Swedish Ophthalmologic Society in 1908, was awarded the Nobel Prize in Medicine in 1911, the only ophthalmologist to date to gain this honor. In his Nobel acceptance speech, delivered at the end of that same year, he recapped the research efforts that led him to a better understanding of  the phenomenon of intracapsular accommodation. Helmholtz, working six decades earlier, had been one of the earlier investigators to recognize that in order to produce a lens of the same dimensions as the crystalline lens and with the same focal length, it would have to comprise a material with a greater index of refraction than that of the core of the lens. In other words, the whole of the human lens has a greater index of refraction than any one of its parts. In attempting to account for this phenomenon, Helmholtz divided the lens into a core, which he described as "an almost spherical double convex lens of positive focal length", and the separate layers that surround it. Building on these observations, Dr. Gullstrand would study the alterations that occurred in the interior of the lens during accommodation and that increased the focusing power beyond what would be expected from the changes in the overall form of the lens. His studies delineated a significant increase in accommodative power of the "core lens", or nucleus, an increase that was greater than what occurred in the lens external to the nucleus. Having published his research in a series of appendixes to the 3rd. edition of Helmholtz's Treatise on Physiologic Optics, Gullstrand would use the title of his Nobel speech, "How I Found the Mechanism of  Intracapsular Accommodation", to lay claim publicly to his discoveries. A better understanding of this complex refractive issue would have to await the application of Scheimpflug photography to the eye later in the 20th century, which made it possible for the first time to obtain an accurate picture of the central geometry of the lens with accommodation.

Conclusion: Though he is known today primarily for having developed the slit lamp, Allvar Gullstrand's investigations into the  intralenticular changes that occur during accommodation were also significant. By identifying the nucleus as the primary seat of such changes, he left the door open to further research into what we now know is a significant factor not only in accommodation but also in its decline.

 

Enough Sight To Fight? – The History of Military Visual System Requirements

Richard W. Hertle, M.D.

Purpose: This paper focuses on the realization by soldiers, since antiquity, of the importance of the visual system in battle, how this was measured, and how modern military visual requirements evolved to their current state. 

Historical Approach: Medical military libraries, Internet, British and Civil War Museums Historical record’s and numerous military manuals served as source materials.

Summary: Medicine has a five-fold role to play in war (1) Selection of suitable military personnel by excluding from the armed services the physically and mentally unfit. (2) To protect against disease thus maintaining healthy personnel. (3) To give medical attention and treatment to those who are injured. (4) To assist in the rehabilitation of the disabled. (5) Research to improve methods of treatment and discover the etiology of disease with a view to its prevention, control, or eradication. The description of the Roman Soldier in “De Re Military,” written in the 5th century by Vegetius states; "Let, therefore, the youth who is to be chosen for martial tasks have observant eyes, hold his head up, have a broad chest, muscular shoulders, strong arms, long fingers, not too extended a wait measure, lean hams, and calves and feet not distended with superfluous flesh but hard and knotted with muscles…….." If you had lived in the time of the early Romans and could see Alcor, you would have been eligible to be an archer in the Roman army. Snellen is no doubt the inventor of part of the evolution of the modern system of testing visual acuity, although either Viennese ophthalmologist Eduard Jaeger or Giraud-Teulon, could each have claimed priority. It was not until the 20thsystem of acuity, binocular and color vision testing were added to military requirements for service. 

Conclusions: Necessity and natural selection were the driving forces for recruitment and assignment in ancient and medieval armies, i.e., talented archers, horsemen and swordsmen. There was a passing interest in “testing” of any special sensory system. Since the advent of mechanized warfare more soldiers can perform more tasks, more uniformly, radically changing the way soldiers are selected. Modern military duty eligibility requirements and assignments are now the result of tests and documentation procedures resulting from a mixture of medical knowledge, science and potential legal consequences. Nowhere is this more evident than in the evolution of stringent visual system requirements for military service.

 

Dr. Jokichi Takamine - Inventor of Adrenaline

Danny H.-Kauffmann Jokl, M.D.

Introduction or Purpose: The Meiji era in Japan and the Reconstruction Period in the United States coincided not only chronologically, but in the intellectual ferment created by the advent of the Industrial Age. No person exemplifies this better than Dr. Jokichi Takamine. He  born to a Samurai physician family in the last years of the Edo Period and was quick to realize the advantages afforded him by the entrepreneurial spirt of America, his adopted land.

Historical Approach, methods or resources: From original source material, autobiography and biography will be described his inventive skills as he adapted fermentation techniques practiced in Japan, at first to alcohol distillation in the United States and finally to the use of enzymes as medical therapies, 
His ultimate achievement was the crystallization and purification for medical use of "adrenaline"and its application to "bloodless surgery". This is akin today of the use of Avastin, not to speak of its lifesaving cardio-vascular benefit. 

Summary: Ever cognizant of the need for international cooperation he strove to expose his adopted land to the culture and traditions of his birthplace and to foster Japanese-merican ties.

 

Arthur MacCallan: Trachoma Pioneer in Egypt

Richard Keeler

Introduction: For centuries trachoma was endemic in Egypt. At the turn of the 20th. century a large fund was made available to try and alleviate this scourge. This paper will give an account of the work of one man, Arthur MacCallan, an obscure ophthalmologist, who over a period of 20 years, transformed the life of thousands of the people of Egypt through establishment of traveling and permanent ophthalmic hospitals throughout the country. 

Historical resources: This account is only possible as a result of the author being made aware of Arthur MacCallan's large personal archive now in the possession of his grandson, Michael. The author digitally scanned the thousands of photographs and documents in this archive, many of which were then used in Michael MacCallan's recent private publication Light out of Deep Darkness. His book forms the basis of this paper. 

Summary: For the first time a detailed account can be given to the mountain Arthur MacCallan had to climb in his drive to establish both traveling and permanent ophthalmic hospitals in every province in Egypt to combat trachoma and other eye diseases. By his own admission this was initially a mere pinprick in solving the problem, but his pioneering work became the foundation of success 100 years later. 

Conclusion: This paper will highlight how one man, through dedication, perseverance planning and brilliant administration changed the lives of many people with eye diseases most especially trachoma.

 

Edmund Spaeth, from Wartime to Wills

Teri Kleinberg, M.D. 

Purpose: To provide a brief history of Edmund Spaeth, MD, the father of modern oculoplastic surgery and on the founding board of the American Board of Plastic Surgery.

Methods: Interview with his son, George Spaeth, MD, literature search, review of his 1939 book Principles and Practice of Ophthalmic Surgery.

Results: Edmund Spaeth (1890-1976) was born in Webster, New York, the son of a Lutheran minister. Rather than follow in his father's footsteps, he chose to embark on a journey that would take him from paying room and board to live in his own home to medical school, then on to serve in the Army Medical Corps during World War I. Having honed his trauma surgery skills on the ‘field, he traveled to Vienna, Austria, to train in ophthalmology. In 1929, he then proceeded to write the first book in English devoted to oculoplastic surgery. This was the beginning of a remarkable career of education and patient care.

Conclusion: Edmund Spaeth was a prominent oculoplastic surgeon well-respected by his patients and his peers. He played a fundamental role in the development of oculoplastic surgery as a sub-specialty of ophthalmology.

 

Datura: Dilation into Darkness

Linda Lawrence, M.D.

Introduction: Plants from the Datura genus have long been used for medicinal purposes and in rituals by witches and shamans of indigenous populations worldwide. The plants contain tropane alkaloids, atropine, hyoscyamine and scopolamine. Despite its toxicity and potential for abuse, the datura species is commonly grown in many gardens and is indigenous to many area worldwide, including California. 

The use of "asthma cigarettes" with datura stramonium was a common treatment for asthma until recent times. Other medicinal uses will be described.

Datura and its ritualistic uses are recorded from the time of Aristotle. But they may be best known to many of us through Carlos Castaneda's "The Teachings of Don Juan, A Yaqui Way of Knowledge". In his research, Castaneda was taught the secrets of the plant, which allowed him to "fly like a bird".

The indigenous practices with datura are ancient, with documented use from the Aztec and Inca civilizations in Central and South America. It was also widely used in China and Europe through the Middle Ages. Even today, datura is being used in many present-day ritualistic practices around the world.

Many deaths have been attributed to this highly toxic plant, both from an overdose by seemingly "recreational" users or accidental ingestion.

The application to ophthalmology comes from accidental exposure to the datura plants causing unilateral mydriasis that is well documented in the literature, but not common knowledge. 

 

John Thomas Woolhouse (1666-1734), bold ophthalmic innovator and teacher

Christopher T. Leffler, M.D., MPH.

Co-authors: Stephen G. Schwartz, M.D., MBA.

Introduction: John Thomas Woolhouse (1666-1734) was an English oculist who practiced in Paris. Some historians have derided him as a “charlatan” and have criticized him for adhering to the old notion that a cataract was a membrane anterior to the lens.

Methods: We reviewed texts and journal articles of Woolhouse, the handwritten notes of his 1721 lecture series at the Royal Society of Medicine, and contemporary newspaper accounts.

Results: Woolhouse taught students from across Europe. We have identified six generations of oculists in his family. He was the first to attach the name glaucoma to the palpably hard eye in 1707. He may also have been the first to teach that a soft eye was unlikely to recover vision. Credit for these teachings has traditionally gone to one of his students, Johannes Zacharias Platner, in 1745. Woolhouse’s recommendation of paracentesis to relieve ocular tension from hydrophthalmia was adopted by his students. Some historians have stated that he proposed iridotomy as a theoretical procedure, which was later carried out by Cheselden. In fact, Woolhouse described techniques he had performed which today would be called pupilloplasty, synechiolysis, or pupillary membrane lysis. He was also a pioneer in dacryocystectomy for chronic dacryocystitis, and in congenital cataract surgery. His writings from 1714 onward repeatedly stress that the vast majority of patients with visual disorders required depression of the crystalline humor (for what he called glaucoma), as opposed to removal of an anterior membrane (which he called cataract).

Conclusions: Woolhouse was a bold ophthalmic innovator and teacher who made major contributions which have lasted to this day. Although he may not have wanted to admit it, he ultimately adopted much of the evolving understanding of the nature of lens opacities. However, his stubborn refusal to adopt the newer semantics has detracted from a full appreciation of his contributions.

 

The History of the Intraocular Lens by way of Hollywood (Mrs. Miniver and The Battle of Britain) and Keynote.

Donelson R. Manley, M.D.

Purpose: The development of the intraocular lens resulted because of eye injuries sustained during the Battle of Britain during World War II. Using today's technology of audio-visual techniques this time in world history will be presented in a meaningful and interesting manner.

Historical Approach, Methods, Resources: David Apple, M.D. was the official biographer of Harold Ridley and wrote his authoritative book about Ridley and the development of the intraocular lens. I had a discussion with David Apple prior to his untimely death about this subject. He knew of my interest in using the modern methods of making learning interesting and fun. He suggested that I develop a talk on the subject. I used his book freely and watched a number of movies that dealt with this time. Two movies stood out. Mrs. Miniver and The Battle of Britain. Using clips from these movies and photos from Apple's book the story evolved.

Summary: Using modern audio visual methods the story of the development of the intraocular lens will be presented in a manner that allows an understanding of the time during which it took place. In addition, a 1951 cataract operation lasting less than two minutes showing Harold Ridley implanting his lens will be shown.

 

Anecdotal Anesthesia: A Brief History of Pivotal Moments in Ophthalmic Anesthesia

Mark J. Mannis, M.D., F.ACS

Purpose: To review, in broad outline, the development and use of anesthesia in ophthalmic surgery and the pivotal moments in its evolution.

Historical Approach, Methods, Resources: Review of texts in anesthesia and anecdotal reports in the ophthalmic literature.

Summary: Prior to the discovery of inhalation anesthesia and topical cocaine, ophthalmic surgery was performed relying on soporific agents as well as patient fortitude. Each new type of anesthesia presented distinct challenges and alterations in technique for the ophthalmic surgeon. The current array of anesthetic options provide contemporary surgeons with a variety of safe anesthetic approaches that have had a colorful and interesting historical development.

 

DIET PILLS AND THE CATARACT OUTBREAK OF 1935. REFLECTIONS ON THE EVOLUTION OF CONSUMER PROTECTION LEGISLATION

 

Curtis E. Margo, M.D.   Co-author: Lynn E. Harman, M.D.

Introduction or purpose: To examine whether the cataract outbreak of 1935 due to diet pills containing dinitrophenol (DNP) had any effect on the passage of the Food, Drug and Cosmetic Act of 1938. 
Historical approach, methods or resources:  Review relevant historical documents including online archives of the Food and Drug Administration. 

Results or Summary of paper:  An outbreak of cataracts in 1935 caused by DNP, the active ingredient of popular diet pills at the time, highlighted the inability of the Food and Drug Administration (FDA) to prevent harmful drugs from entering the marketplace.  Just two years earlier, the FDA used horrific images of ocular surface injury caused by cosmetics at the World’s Fair in Chicago to garner public support for legislative reform. The FDA had to walk a fine line between a public awareness campaign and lobbying Congress while lawmakers debated the need for consumer protection. The cataract outbreak of 1935 was conspicuous in the medical literature during the height of New Deal legislation, but questions persist as to how much it affected passage of the proposed Food, Drug, and Cosmetic Act (of 1938). 

Conclusions: David and Frances Cogan played prominent roles in initially reporting these toxic cataracts and then raising awareness of the epidemic during its height. Congressional legislation designed to strengthen the regulatory authority of the FDA languished in committee for years. The cataract outbreak probably had little impact on the eventual legislative outcome, but medical opinion concerning the safety of DNP may have contributed to the voluntary withdrawal of the diet drug from the market.    

 

Mikhail Lomonosov on Light and Colors

Harry H. Mark, M.D.

Purpose: To describe Lomonosov's contribution to optics

Method: Primary and secondary sources

Summary: Light was viewed by Mikhail Lomonosov as undulations in a material ether composed of three sorts of connected serrated particles, eliciting in a diminishing order of their size the primary colors  red, yellow and blue. The color of objects depended on their affinity of their particular substances to these ether particles. This analogy of colors to substances and qualities can be traced back to antiquity. On the other hand, the material ether also appeared in the modern electromagnetic theory of light, though no evidence exists that Lomonosov's speculations were in any way incorporated into the generally available body of knowledge.

 

Blindness and Deafness in Artists and Composers

Michael F. Marmor, M. D. Stanford University

Purpose:  To consider the impact of vision and hearing loss upon great painters and musical composers.  Why did blindness alter the work of Degas and Monet, while Beethoven and Smetana wrote some of their best works while deaf?   And is vision loss ever a problem for composers?

Historical Approach:  Historical reading and discussion with musicians has been used to gain insight into the effects of sensory loss on composers, along with my prior work on visual loss in artists.  Historical data on these painters and composers has been reviewed in light of their sensory deficits, work habits and productivity. Examples from artists such as Cassatt, O’Keeffe, Degas and Monet will be presented, and composers including Beethoven, Smetana and Fauré (deaf), Stanley and Rodrigo (blind near birth), Handel and Delius (blind late in life).   

Results:  There are two major distinctions between the role of vision and hearing for these arts.  First, there is a written surrogate for music, the musical score, which allows composers to “hear” what is on the page, and to write and edit music while totally deaf.  However, it is difficult to compose when there interference from internal noise (tinnitus).  There is no surrogate for vision to allow a painter to work when the subject is a blur, or the colors on the canvas cannot be distinguished.  Second, while the appreciation of art is visual, and that of music is auditory, the transcription of both art and musical composition is visual.  Thus, visual loss does pose a problem for composers who are accustomed to writing down their own music and reading scores, as it disrupts their habitual modes of composing and editing. 

Conclusions:  Vision loss prevents a painter from seeing the world clearly and from seeing works as they appear to others.  But hearing loss does not stop a composer from “hearing” music from the written score. The greatest problem with deafness for a composer is not the lack of sound but extraneous sound (tinnitus). Visual loss is has been disabling for some older composers who transcribed and edited their music visually—but this may change in future years with the availability of computer programs (MIDI) that read and transcribe music. 

 

Ophthalmic injuries at Hiroshima and Nagasaki - David Cogan and the Atomic Bomb Casualty Commission

Steven A. Newman, M.D.

Introduction:  Predicated on the understanding of electromagnetic radiation, it is not surprising that potential damaging effects of electromagnetic radiation were recognized by ophthalmologists early on.  The glass blowers cataracts were known by the end of the 19th century.  Keratoconjunctivitis from ultraviolet radiation at high altitudes could affect climbers.  In 1900, 1905, and 1913 epidemics of damage to the macula from viewing eclipses and unprotected visible light damage to the outer segments of the retina.  With the 1893 recognition of expedient energy by Becquerel, and subsequent use of cathode ray tubes to produce x-rays, the potential for both therapeutic and traumatic injuries related to radiation were born.  It was rapidly recognized that these forms of radiation could be both beneficial, but also cause damage to the eye.  Some of the pathologic results were studied by Freddy Verhoeff who was to be Cogan’s mentor.  By the late 1940s, workers exposed to cyclotrons were noted to have developed cataracts.  Subsequent to Becquerel’s 1896 discovery, Schmidt and Madame Currie recognized that additional sources of natural radiation occurred from thorium, polonium, actinium, and radium.  Further work was provided by Rutherford, Crookes, Ramsey, Soddy, and Huggins.

Methods and Purpose:  Early studies interested in the systemic effects of radiation poisoning and epidemiologists were dispatched by the Atomic Energy Commission.  In 1950, because of his experience with cyclotron workers, David Cogan was asked to go to Japan, set up an eye clinic, and study the effects of the radiation on the visual system.

Results:  David Cogan actually expected not to find any cataracts because the dosage was expected to be two or three times the lethal dosage of whole body radiation.  He erroneously assumed that any who had received enough radiation to cause cataracts would not have survived.  Subsequently, when he was to discover cataract formation, he realized that he had failed to consider the possibility of body shielding.  This was brought home by one of the kitchen maids working for the Atomic Bomb Commission who had developed loss of head hair, but no loss of body hair due to shielding at the time of the explosion.  Four years after the bomb exposure, she developed progressive visual loss, and was found to have cataract formation.  After examining over a thousand patients, cataracts were present in ten percent of the survivors who had been within one kilometer of the hypocenter.  Although the latent period for development of cataracts was shorter than previous cataracts seen in cyclotron and x-ray workers, it still averaged three to four years.

Dr. Shigeto, a radiologist and chief administrator of a hospital in Hiroshima rapidly recognized the true source of the explosion that destroyed the city when he found that all of his films had been exposed, except for those that were in a basement and shielded.  He knew that the film had been exposed to radiation, even prior to the announcement of the atomic bombing.  Following their work in Japan, the Atomic Bomb Commission was tasked with setting up a general eye service at Los Alamos Hospital, a research program at the laboratories.  Subsequent experimental work would further define the ocular effects of radiation.

Conclusions:  The end of World War II brought a new recognition of the potential medical effects of atomic weapons.  These could produce not just acute traumatic effects, but also the potential for visual system involvement, as well as multiple systemic pathologies seen in patients suffering long standing results from radiation damage.  

 

Sigmund Freud meets Herman Knapp

James G. Ravin, M.D.

Introduction/Purpose:  To describe the meeting of two extremely important individuals in the history of medicine.

Historical approach, methods, resources:  Evaluation using primary resources (Freud’s private letters and publications, Knapp’s publications) and secondary resources (extensive literature on both individuals).

Results/Summary:  In 1886, 29-year-old Sigmund Freud was in Paris doing a fellowship in Charcot’s neurological clinic at the Salpetrière Hospital.  He had just missed making the discovery that topical cocaine anesthetizes the ocular surface.  Two years earlier his friend Carl Koller made that discovery.   At the time he travelled to France, Freud’s research interests were brain anatomy and special histological stains, not yet psychoanalysis.   Herman Knapp, then 53, the foremost ophthalmologist in the US, happened to make a visit to the Salpetrière and overheard Freud and a Viennese colleague speaking German.  Knapp introduced himself and immediately recognized Freud’s name from his treatise on cocaine.  When the colleague said he was astonished to learn Freud had done this work with a drug that was little known earlier, Knapp replied he was the one who started it all.  Knapp’s extensive research on cocaine followed Freud’s work.       

Knapp and Freud also attended weekly ophthalmological rounds with Parinaud, who is famous for two syndromes.

Conclusion:  Freud and Knapp met at an important point in the history of medicine.  Their interests coincided with cocaine and aspects of clinical medicine.  

 

Scriptural Optics

Ivan R. Schwab M.D. F.A.C.S.

Introduction or purpose: To examine the references to atmospheric optics in the Bible and other religious literature

Historical approach or resources: Photography, search engines, the Bible, Talmud, and Qu’ran

Body of paper: Biblical references to physical atmospheric phenomena illustrate that early peoples witnessed these events but could not explain nor understand them. Some of these events would have been so uncommon and extraordinary as to occur only once, if at all, during a lifetime. Hence, these spectacular and rare events were attributed to supernatural forces, and described by the best writers of the time with the only explanation they could conjure. Such events are now explained by optics. For example, when a rainbow was observed, it was described in the Bible as a supernatural event. The story of the burning bush may well have been a solar parhelion. Ezekiel’s wheel (a celestial wheel within a wheel) could well have been an ice crystal display. The account in Revelations of the opening of the sixth seal (when the sun turns to ashcloth and the moon turns blood…) probably represents a solar eclipse and lunar eclipse respectively. These two events usually occur together in the same geographic region in close temporal proximity because of celestial mechanics. Understanding of such atmospheric events usually came gradually as the necessary tools were developed.

Summary or conclusions: The understanding of optical phenomena requires knowledge of the laws of physics. Those who wrote the religious texts including the Bible, the Talmud and the Qu’ran had little knowledge and no understanding of physics, but were good observers. The observations of unusual phenomena in our atmosphere would have required explanation at the time. The writers relied on supernatural and superstitious explanations which is why myths arose surrounding such phenomena.

 

Cover Story: The Evolution of Covers of the Journal Formerly Known as "The Archives."

Pamela C. Sieving, MA, MS, AHIP

Co-author: Daniel M. Albert, MD, MS

Introduction: Between 1869 and 2014, the journal founded by Herman(n)  Knapp, and now owned by the American Medical Association, underwent more cover design changes than title changes. This paper looks at the choices made by Knapp and his successors, reflecting both their circumstances and the state of ophthalmology during their tenures. 

Historical Approach/Methods/Resources: Original source material: covers and content of the journal, supplemented by editorial commentary and studies by Fishbein, Snyder and Ravin on the history of the journal.

Summary/Conclusion: Cover information ranges from bare minimum listing of editor, editorial board and publisher, to enticements for the reader into the journal via extensive listings of authors and titles, to those highlighting major content, sometimes with high-quality photographs. The editorial boards are sometimes featured, providing intriguing glimpses into the international leadership of the profession of ophthalmology over nearly 150 years.

 

Page last updated June 12, 2017