31st Annual Meeting
March 23-25, 2018
Snyder Lecture: Robert M. Feibel
Cuban Epidemic Optic Neuropathy (1991-1993) and José Saramago’s novel Blindness (1995)
Abstract: José Saramago’s novel Blindness (1995) describes a city in which all residents but one suddenly become blind. In this contagious epidemic, all victims complain that their vision is milky-white, not black, as blindness is typically portrayed. The overwhelmed authoritarian government quarantines the blind in an abandoned mental hospital, where the total breakdown in society among the inmates contributes to the novel’s allegorical discussion of how human beings conduct themselves individually and how they organize themselves politically in this dystopian and violent community. The only sighted character is the ophthalmologist’s wife, who becomes the moral center and heroine of the story. She states one of the themes of the novel: “By organizing itself, to organize oneself is, in a way, to begin to have eyes.”
While the novel’s allegory employs ideas of eyes, vision, seeing, blindness, and ophthalmology, I call attention to an actual epidemic of blindness in Cuba in 1991-93, the same years that Saramago was presumably composing his novel. Cuban Epidemic Optic Neuropathy caused significant visual loss, peripheral neuropathy, and other neurological symptoms in 50,000 persons, an incidence of almost 0.5% of the entire population of almost 11 million. Initially the Cuban government proposed a viral cause, and denied that the actual cause was vitamin deficiency due to famine and malnutrition, exacerbated in many patients by smoking and alcohol consumption. Eventually, the Cuban government reacted in a humane and effective manner with widespread distribution of multivitamins to both affected patients and then the entire population, which quickly ended the epidemic.
Saramago was a life-long member of the Communist party, and a friend and admirer of Fidel Castro and his government. Although I have no proof that Saramago was influenced by the actual Cuban epidemic, I think it plausible. This presentation describes the history of the actual epidemic, and relates it to some of the medical and literary questions raised by the fictional epidemic.
Special Achievement Award Lecture: Ronald S. Fishman
Evolution of Contralaterality in the Vertebrate Brain, or Why do We Have an Optic Chiasm?
Abstract: Contralateral representations of vision and other senses as well as motor control of voluntary movements appear generally in the vertebrate brain. They result from a crossing-over or decussation, of axons at the midline, and have been widely studied in delineating the molecular mechanisms of axonal growth and guidance in the CNS, a topic of great research interest. But why evolution crafted such decussations in the first place is rarely if ever discussed, even by those with special interest in the evolution of brain structure, who do not even seem to recognize that decussation is a design element deserving of explanation. No general consensus exists to explain the evolution of decussation, but three hypotheses will be presented:
1. the argument from vision, stemming from the production of an inverted and reversed retinal image by the camera eye of vertebrates;
2. the argument from inversion of the invertebrate body plan to the vertebrate one;
3. the argument from topology.
President’s Lecture: Art Silverstein
Virulent Smallpox: When Did It Start?
Abstract: Smallpox—Variola major—has been one of the great killers among epidemic infectious diseases. While the disease has often involved every ocular structure, I will not present this as an ophthalmic story. Rather, I shall offer it as an epidemiologico-historical tale, with interesting genetic and evolutionary implications. Moreover, receipt of the story by ‘smallpox experts’ has led me to the awareness of a problem in the sociology of science; how much should the historian believe of what the experts say?
Many believe that virulent smallpox (V. major) has existed throughout the ages, apparently joined in recent centuries by its more benign offshoot (V. minor), until both were eradicated by the joint efforts of the WHO and CDC. We will first define the origin and clinico-pathological differences between Variola major and V. minor. Early pandemics will be assessed, then the comments of medieval physicians, and then longtime British and continental records of causes of death. All this has led us to suggest that virulent smallpox did not appear until nearly 1600 C.E. But if this were so, how then explain the decimation of the Amerindian populations of Central and South America in the early 1500s? A genetic basis for this will be offered.
Any productive person, scientist or otherwise, will understandably take pride in and be protective of his accomplishments, but commitment to one's concepts or to the reigning paradigm may lead to the rejection of any challenges. This may have been the case with the present thesis. I will discuss several other substantive instances along the same lines, which may serve as a cautionary note to the serious historian of science.
Jennifer Arch: Eyesight, Vision, Love, and War in Three Medieval and Early Modern Literary Works
Abstract: Three of the greatest poets in the Western tradition—Boccaccio, Chaucer, and Shakespeare—told the story of Troilus and Cressida, set during the Trojan War and very loosely connected to the Iliad. Famously, Troilus, a true lover, is betrayed by Cressida, a false woman, when the exigencies of war force them apart. Boccaccio (Il Filostrato, 1330s), Chaucer (Troilus and Criseyde, 1381-85), and Shakespeare (Troilus and Cressida, ca. 1601) used the Troilus story to explore concerns specific to their own times and cultures. All three use the image the eye to explore how people fall in love, and what happens when they do. “Streams” from the eye are presented in Chaucer, for example, as physical; his Troilus doesn’t want to fall in love, but is hit by the streams from Criseyde’s eyes. Understanding love as something tangible that arises from a physical meeting of the eyes raises key questions about love, morality, and free will. If love is something that one is struck by physically, does that mean that lovers are excused from the irrational, extreme, unconventional, and sometimes immoral behaviors in which they engage? Is love chosen, or is it more like a disease contracted against the sufferer’s will? And why does it matter that these connections between love, eyes, vision, and disease are explored in texts set in times of war? My presentation will explain these issues briefly, using modern English translations, for those interested in how eyesight has been used imaginatively in Western literature.
Christopher Blodi: "Power to the Blind": The Kenneth Jernigan Story
Abstract: Purpose: To review the pivotal role of Kenneth Jernigan in advancing the blind civil rights movement. Methods: Review of primary and secondary literature, interviews with participants. Results: Kenneth Jernigan (1926-1998) was born blind. After graduating from college he worked with the early blind activist, Jacobus TenBroek, a law professor at the University of California. The two men realized that enfranchising the blind to control their education and public lives was of utmost importance and could be furthered by having the blind take control from the sighted governmental agencies tasked with helping the visually disabled. At age 32 Jernigan was appointed head of the Iowa Commission for the Blind, an almost-moribund state agency. There he put into place a new and revolutionary training system focused on better integrating the blind into the community. With his driving personality, Jernigan remade the agency into a world-wide model and delved into political activities at the state level. By 1978 Jernigan realized that he could better serve the blind by becoming director of the National Foundation for the Blind, leading the organization until his death. Through his activities at a state and national level Jernigan became a revered figure for the blind and spearheaded a trend for society to accept the visually disabled as capable of being productive citizens able to make their own life decisions. Conclusion: Kenneth Jernigan played a seminal role in the blind civil rights movement, an important historical transformation poorly understood and rarely studied by eye care providers.
George Bohigian: The Eye in Motion Pictures - An Illustrated History
Abstract: The history of early filmmaking and how the physiology of the eye and brain make the pictures "move" will be discussed. Additionally, this presentation highlights the author’s favorite motion picture scenes in which the eye becomes the artistic focal point. One of the most deconstructed and analyzed scenes in film history will be explored in Hitchcock’s Psycho, from Norman Bates’ peeking through the motel walls at Janet Leigh’s character to the final close-up cut of her pupil and the drain. Other films where the use of the eye are explored include 2001: A Space Odyssey, Un Chien Andalou (An Andalusian Dog) by Salvador Dali, A Clockwork Orange, Dracula, Diabolique, The Shining, The Good, The Bad and The Ugly, The Godfather, The Terminator, and The Lord of the Rings.
John D. Bullock: Sir William Osler – A Wannabe Ophthalmologist
Abstract: William (after William of Orange) Osler was born 07/12/1849 in, what is now, Ontario, Canada. His father, Featherstone Osler, was (like Cogan’s Episcopalian father) a minister of the Church of England, the first occupation contemplated by William in 1867, when he matriculated at Trinity College, Toronto. However, Osler became increasingly interested in medical sciences and was admitted to the Toronto School of Medicine, later transferring to McGill. He was influenced by R. Palmer Howard, Professor of Medicine, who wanted Osler to become part of McGill’s teaching staff. After William received his medical degree in 1872, his father and brothers agreed to subsidize a two-year study abroad. Osler was interested in ophthalmology and Howard encouraged him to visit Moorfields Eye Hospital in London. Osler meet with William Bowman who did not offer him a position, advising that microscopic research and histological techniques would help him in his later pursuits. Accordingly, Bowman urged him to study with the physiologist John Burdon Sanderson at University College, London (and later, Regius Professor of Medicine at Oxford). Osler’s first research project was an animal model of anterior chamber inflammation in frogs. Soon thereafter, however, Osler received word from Howard that three individuals were planning to set up ophthalmological practices in Montreal. Osler later wrote: “As you may imagine I was not a little disappointed at the blighting of my prospects as an ophthalmic surgeon, but I accept the inevitable with a good grace.” Instead of pursuing a career in ophthalmology, Osler became a world famous medical writer, historian, lecturer, and teacher, one of the four founding professors of the Johns Hopkins Hospital, Regius Professor of Medicine at Oxford, and the most renowned physician of his time. We can only wonder what would have happened if Osler had devoted his genius, drive, and talents to ophthalmology.
Gerhard Cibis: Heinrich Harms 1908-2003
Abstract :Through the tutelage of Cogan Society member Stanley Thompson I spent the six research months of my Iowa Opthalmology Residency in Tübingen Germany working on pupil perimetry with Dr. Elfriede Aulhorn. Taking full advantage of department lectures, rounds and patient presentations I also had the privilege of assisting the department chairman Prof. Heinrich Harms (1908-2003) in surgery on his private patients. I thus gained insight into the history and background of Dr. Harms’ achievements in Opthalmology many still relevant and current in Ophthalmic practice.
Harms and Aulhorn pioneered Static perimetry which is the principle of all current automated perimiters. He invented ten o nylon suture. How he came to this will be described. He participated in evolution of the Operating microscope working with Hans Littmann of the nearby Carl Zeiss company. Benefiting from the operating microscope and fine nylon suture he developed trabeculotomy probes to perform what is known as trabeculotomy ab externo. While his hopes that that proceedure would be beneficial in primary open angle glaucoma failed, it prooved to be very effective for congenital glaucoma. Description of the proceedure as learned from Prof. Harms and used throughout my career in Pediatrtic Ophthalmology will be presented.
Ira Eliasoph: Vision Doctors' Vision (An Illustrated Narrative or Graphic Tale)
Abstract: My chief said, when I was a resident, "Remember We Are Vision Doctors". And so we are, but how about our Vision. we have spent years and decades helping patients. Think please of "Vision Doctors' Vision". The ancients had concerns about eye diseases and painted on rocks and in caves and tested Vision by looking at the stars. Helmholtz gave us the Ophthalmoscope (Augenspiegel) and gave birth to modern scientific ophthalmology. Fridenberg (1903) wrote of his vision of the future doing graded keratotomies to correct refractive errors. We are viewers of art for enjoyment and education. We are Artists for pleasure and for teaching. We seek to understand and extend what we know and see. We benefit from the research of Torsten Weisel and ultrasound, MRI's, CAT scans, OCT and the confocal microscope. We will soon have cars that see for us. We are Visionaries - Lux et Veritas will yield a new harvest.
Wendy Gasch: The Eponyms of the Human Eyelid Glands
Abstract: Purpose: to provide insight into the eponyms of the human eyelid glands. Methods: review of material on the internet and in print. Results: The human eyelid glands were named for the individuals who discovered them: Johann Heinrich Meibom (1638-1700), German physician and scholar; Eduard Zeis (1807-68), German general surgeon with interests in ophthalmology and pediatrics– and a special interest in plastic surgery; Karl Friedrich Theodor Krause (1797-1868), German physician, anatomist, and health official; Emilj Franzevic von Wolfring (1832-1906), Polish ophthalmologist; Giuseppe Vincenzo Ciaccio (1824-1901), Italian physician, anatomist, and histologist; Jacob Anton Moll (1832-1914), Dutch anatomist and possibly oculist. Conclusion: During the 18th and 19th centuries, all eyelid glands were discovered by the individuals for whom they were named. These individuals were all Europeans, primarily Germans, and nearly all, if not all, physicians with a tangential interest in anatomy. Significant improvements in the microscope by Anton van Leeuwenhoek in 1674 and subsequently by Ernst Abbe in the 1860’s may have prompted and certainly facilitated the anatomical work of these scientists.
John Gittinger: That the Blind May Write; William Hickling Prescott and the Noctograph
Abstract: "Not blindness but the inability to endure blindness is a source of misery." --John Milton William Hickling Prescott (1796-1859) joined a distinguished group of authors whose major works were composed while blind. Milton, for example, was blind when he wrote both Paradise Lost and Paradise Regained. Prescott was struck in the eye by a piece of hard bread during a food fight while an undergraduate at Harvard and eventually lost vision in both eyes, possibly from sympathetic ophthalmia. Despite this handicap he went on to become the preeminent American historian of the Spanish conquest. He learned Spanish and had his sources in that language read to him—usually by individuals who did not actually speak the language. His major works: The History of the Reign of Ferdinand and Isabella the Catholic (1837), History of the Conquest of Mexico (in three volumes, 1843), and The History of the Conquest of Peru (1847), and History of the Reign of Philip II (volumes I and II, 1855, volume III, 1858), however, were written on a device called a noctograph. In the era before the invention of pens that did not require frequent re-inking or of the typewriter, it was difficult for a blind person working alone to be sure that what he was writing down was actually transcribed. The noctograph, a type of ruled slate, allowed Prescott to complete hundreds of pages without the necessity of employing a stenographer.
Erich Horn: Financing the Cure: Historical trends in the Cost of an American Medical Education
Abstract: To become duly licensed to practice medicine independently in the United States, physicians are required to graduate from an accredited medical school and then finish post-graduate residency education. Unlike in some countries, the cost of this training is generally borne by the physician-in-training. 2017 figures supplied by the Association of American Medical Colleges suggest the median cost of a 4 year medical school is $207,866 for a public education and $278,455 at a private medical school. Tuition and school fees alone at Johns Hopkins Medical School were $57,230, which excludes the considerable costs of housing, food and transportation. Examining how these medical school costs have changed in the past century is the focus of this research. The economic and social context of these educational costs will be considered as well. Currently, the median household income is $59,039 (an all-time high, adjusted for inflation, according to the US Census Bureau), which provides a useful comparision. I hypothesize that the costs of medical education have outpaced general inflation and that ophthalmologists have better return on investment from training costs than some other medical specialities because of higher income potential following the completion of their education.
Christopher Leffler, Stephen G. Schwartz, and John Q. Le: American Insight Into Strabismus Surgery Before 1838
Abstract: English surgeon John Taylor attempted to perform strabismus surgery in the 18th century. The field languished until, in Germany, treatment of strabismus by cutting an extraocular muscle was proposed by Louis Stromeyer in 1838 and performed by Johann Friedrich Dieffenbach in 1839. According to traditional teaching, there has never been any proof that anyone in the United States thought of the idea of strabismus surgery before Stromeyer’s report. In 1841, American surgeon William Gibson wrote that he had cut extraocular muscles to treat strabismus several times beginning in 1818 but never published his cases. Gibson’s former trainee Alexander E Hosack of New York confirmed Gibson’s memory. Interestingly, Hosack’s family had a connection with the family of New York oculist John Scudder Jr (1807-1843), whose reported cure of strabismus by cutting some of the fibers of an extraocular muscle was described in newspapers throughout the United States in 1837. Thus, Scudder’s report preceded that of Stromeyer. Scudder’s claim cannot be verified, but his description could have influenced Stromeyer, and demonstrates that the idea of strabismus surgery did exist in America before 1838.
Curtis Margo and Lynn E. Harman: Charles Dickens, Trachoma, and Pre-Victorian England
Abstract: In the early 1820s a Yorkshire boarding school was devastated by an outbreak of blinding ophthalmia. The cause of the epidemic was – in all likelihood – trachoma, then known as Egyptian ophthalmia. The headmaster of the Yorkshire school, William Shaw, was sued for gross negligence by two families whose sons went blind during the outbreak. The epidemic and trial would play an indirect role in creating one of literatures most notorious fictional characters. Roughly 18 years after the trial Charles Dickens modeled the vile schoolmaster Wackford Squeers in Nicholas Nickleby after Shaw, whose reputation and career would later be ruined by his thinly disguised portrayal in the novel. The original boarding school epidemic took place at the same time that the first eye hospital in London was moving to Lower Moorfields, an institution that 17 years earlier was established primarily to cope with Egyptian ophthalmia. This presentation explores trachoma’s wide-ranging impact on pre-Victorian England, from inspiring an enduring literary villain to the creation of a renowned eye hospital.
Harry Mark: Measuring the Eye, a History
Abstract: Measurements of Nature and the human body began around the 15th century. Thomas Young in 1804 probably did the first measurement of an eye - his own's axial length. His method improved later by sonometry and x-rays. Cocaine facilitated diagnostic methods such as tonometry and tonography, while screens aided examination of ocular motility, visual acuity and visual fields. The ophthalmoscope led to measurement of the retina, and the retinoscope refractive errors. Keratometry measured corneal curvature and its refractive power and the slit lamp permitted counts of corneal endothelial cells and measurements of the lens. Exophthalmos and pupil's size may be measured by a ruler, though specific tools were invented for this purpose.
Michael Marmor: A Truly Dominant Disease
Abstract: Long before Mendel disseminated his ideas in the late 1800s a French butcher named Jean Nougaret (born 1617), who was unable to see at night, spread his affliction among descendants up to the present day. The family was studied in 1838 by an eminent Belgian ophthalmologist Florent Cunier when a descendant sought exemption from the French army—and was denied for 7 years until the genealogy was recognized. The great chronicler of hereditary eye disease, Edward Nettleship, viewed the family as confirmation of Mendelian dominant inheritance. The eminent Jules Francois discovered a family branch after a night-blind individual had a traffic accident. This pedigree would be remarkable enough, but also in the 17th century a Danish farmer Niels Sorensen, according to family tradition, suffered so much in the war against Sweden that he became night-blind for life…and passed on the trait. In 1909 a Danish ophthalmologist Sigurd Rambusch documented the genealogy, which still continues. This rare disease, dominant congenital stationary night blindness, is now understood to derive from mutations in rod transduction genes. It remains a challenge to ophthalmologists because there is no loss of acuity or fundus abnormality—and like Nougaret’s descendent in the French army, recognition requires an acceptance of symptoms…and recognition of genealogy (along with an electroretinogram and genetic analysis). Royal diseases such as porphyria can be traced back further, but the Nougaret and Rambusch pedigrees are surely among the longest in ophthalmology.
Steven Newman: Ernest Maddox and Heterophoria
Abstract: Introduction: The second half of the 19th Century saw the introduction of science into ophthalmology. Helmholtz invented the ophthalmoscope, Donders put refraction on a scientific basis, Snellen quantitated macular function, and Aubert and Forester, plus von Graefe quantitated peripheral visual fields. The second half of the 19th Century also saw an increasing interest in ocular motility; in particular, how the eyes moved together and whether there was a tendency (phoria) to drift or fixed malalignment (tropia). Materials & Methods: Primary and secondary sources were used to paint a picture of Ernest Maddox, his life and contributions to ophthalmology. Information was also gathered on those that preceded and other investigators who further modified his devises. Results: Maddox’s study and interest in heterophoria led to the invention of the several extraordinarily useful instruments, many of which are still in use (or should be in use) today. Probably the most useful, the Maddox rod, permits extraordinarily rapid assessment of phoria in all nine cardinal positions. He recognized the ability of a cylinder to change the pattern of a fixation light and thus permit dissociation. Conclusions: The Maddox rod is an effective means of dissociating fusion to measure heterophoria in nine cardinal positions. It is portable and simple to use. It is very reproducible, particularly at distance, although a more quantitative assessment (Hess screen) can be useful in some cases. The Maddox rod can be applied to essentially all patients, looking for subtle abnormalities in motility.
James Ravin: Burning the Eyes with Lime as a Form of Justice in Late 18th Century China
Abstract: The Punishments of China, a book by George Mason published in 1801, is a classic work that describes aspects of the Chinese code of penal laws during the Qing Dynasty. One of the topics described and illustrated is blinding with lime, but is not as severe as another, beheading. Westerners were fascinated by Mason's description of Chinese methods of interrogation and rendering justice. European interest in Chinese justice culminated in 1904, when photographs of a man being flailed alive made their way out of China. The rationale for Qing laws evolved with a logic that was quite different from what evolved in England and was later adopted in the US.
Richard Schroeder and Robert Feibel: Quicklime as an Ocular Chemical Weapon: Examples in Ancient and Medieval Warfare
Abstract: Chemical warfare is one category of weapons of mass destruction, along with biologic, radiologic, and nuclear warfare. The use of chemicals to attack the eye is commonly thought to have begun with the introduction of poisonous gases during World War I (1914-1918). Despite the severe ocular damage from such chemicals, especially mustard gas, they produced no decisive effects during that war, nor more recently when used in the Iran-Iraq War (1980-1988). Despite these recent examples, chemical weapons are anything but modern in usage and have important precursors in history. This paper describes several occasions in ancient and medieval history of the use of pulverized quicklime as a weapon to damage the eye. Quicklime (calcium oxide) is a caustic alkaline compound which is obtained by heating calcium carbonate (from limestone or material such as seashells) in a kiln. The first example comes from Roman history during the first century BCE. A second example in China was documented in 178 CE. In his book on military and naval tactics, the Byzantine Emperor Leo VI (ruled 886-912) suggested the use of lime powder as a weapon in naval battles. The best documented and most decisive example occurred in 1217 between the English and French fleets sailing in the English Channel during the Battle of Sandwich. The English, inferior in ships and soldiers, used hand-held slingshots and arrows to throw powdered lime into the eyes of the French soldiers and sailors. Quicklime had been used in the defense of fortified sites on land previously, but this event marked an early usage of quicklime as a naval weapon that proved of decisive importance for a key battle in the history of England and Europe.
Stephen Schwartz, Christopher Leffler and Pamela Chavis: The Monocular Duke of Urbino
Abstract: Federico da Montefeltro (1422–1482), the Duke of Urbino, was an important figure in the history of the Italian Renaissance. He was a very successful military commander (condottieri), political leader, and benefactor of the arts. He is perhaps best known as the subject of a famous painting by Piero della Francesca (1416–1492), which displays the Duke in left profile and highlights his oddly shaped nose. The Duke is known to have lost his right eye due to an injury sustained while jousting, which is why the painting portrays him from the left. Many prominent historians, both medical and non-medical, have taught that the Duke subsequently underwent nasal surgery to remove tissue from the bridge of his nose in order to expand his visual field in an attempt to compensate for the lost eye. There is general agreement that such a surgery would have been possible in 15th-century Italy. In theory, removal of a piece of the nose may have expanded the nasal visual field, especially the “eye motion visual field” that includes eye movements. In addition, removing part of the nose may have reduced some of the effects of ocular parallax, specifically the rhino-optical phenomenon. Finally, shifting of the visual egocenter may have occurred, although this seems likely unrelated to the proposed nasal surgery. Whether or not the Duke actually underwent the surgery cannot be proven, but it seems unlikely that this would have substantially improved his visual function. Of the many other famous historical monocular military leaders – including Philip of Macedon, Hannibal Barca, Date Masamune, and (possibly) Horatio Nelson – none were reported to have undergone compensatory nasal surgery.
C.P. Wilkinson: Was Hypophysectomy a Useful Therapy for Advanced Diabetic Retinopathy?
Abstract: Contemporary non-ophthalmic medical texts regarding diabetes imply that hypophysectomy was of no value in the treatment of advanced diabetic retinopathy. However, a thorough analysis of surgical data demonstrates that the procedure had a favorable effect upon cases with selected stages of the disorder. This presentation will review the rationale for this surgery and the surgical results that followed, stressing that in spite of some favorable outcomes, the results of photocoagulation therapy and the complications of hypophysectomy dictated the demise of the latter operation.
Page last updated February 14, 2018