24th Annual Meeting Abstracts - 2011
Arlt Orders His Ophthalmoscope: A Study in Provenance
Christopher F. Blodi, MD
Purpose: To review the 150-plus year journey of a letter originally sent by a prominent eye surgeon to a famous inventor as an example of the study of provenance.
Resources: Primary historical documents, oral and written communications with secondary sources, review of literature.
Body of paper: In 1851 the already-famous eye surgeon Ferdinand Arlt wrote Herman Helmholtz a letter requesting that the inventor build and send Arlt one of the very first ophthalmoscopes. Reviewing the provenance of the letter provides an opportunity to describe the lives of its owners: from writer and recipient to a famous industrialist to renowned figures in German ophthalmic history.
Summary: The value of a historical document often lies not only in the entity itself, but in the knowledge of its ownership through time.
Traditional cosmetic & medicinal use of Kohl & Henna: their efficacy v. side effects
Pamela S. Chavis, MD
Introduction or purpose: To review Kohl & Henna in the context of their composition, use and side effects
Historical approach or resources: literature review
Body of paper: Kohl (surma) and henna are used in Arabic countries, Africa, Pakistan and India . Studies suggest they can contain high concentrations of lead as well as other elements; however, the antiseptic qualities of these preparations may be linked to the PH & the amount of lead. It is common practice to use them cosmetically; kohl is used for eyebrows and eyeliner in children and adults. Kohl is also used medicinally for skin problems to aid healing both in children (after circumcision, etc). and in adults. Kohl can be found in conjunctiva and lacrimal sac of patients using it as eyeliner; children in these countries can have high lead levels which relates to many factors including its use on the umbilicus and for cosmesis. Henna contains lead and mercury and the amount relates to the color of henna.
Summary or conclusions: Traditional medications can have general medical implications.
The St. Louis Society for the Blind and Visually Impaired: 100 Years of Help
Robert C. Drews, MD
Introduction or purpose: To summarize the formation and activities of the Society on its hundredth anniversary.
Historical approach or resources: Society files, Missouri Historical Society archives, Becker Library, web sites, oral history.
Body of paper: Purpose, accomplishments, historical figures, anecdotes.
Summary or conclusions: The hundredth anniversary is an occasion for recalling a proud history.
Charles H. Beard, his encyclopedic surgical text and Chicago Life and Ophthalmology
Ira Eliasoph, M.D., FACS
Body of Paper: Chicago was a city of great contrasts. There were great accomplishments and some rascals. The Columbian Exposition brought Chicago to new prominence in the United States and the World. Doctor Charles Heady Beard (born January 27, 1855 and died January 3, 1916) among other accomplishments wrote an encyclopedic text called “Ophthalmic Surgery; A Treatise on surgical Operations Pertaining to the Eye and its Appendages: With Chapters on Para-Operative Technic and Management of Instruments”. His great grandson is a practicing physician. The original text is hard to find, but the book has been reprinted as a valued classic. Doctor Beard was an important figure in the growth of Ophthalmology in Chicago
"Testifying Before the U.S. Congress in Behalf of the National Eye Institute, N.I.H., during the Early Years of Its Existence."
Jay M. Enoch, Ph.D., Dr(s). Sci.(h.c.)
Body of Paper: In the early days of the National Eye Institute (NEI), N.I.H., testifying before the U.S. Congress was a bit of an adventure for those of us called upon to participate in these activities. Then, the development of testimony was managed through the good offices of Research to Prevent Blindness. This activity was supervised by Mr. David Weeks, who also served at that time as Mayor of Ho-Ho-Kus, New Jersey . Speakers were often lodged in Washington at the venerable Hay-Adams Hotel, across the street from the White House. There, we practiced and refined our testimony with Mr. Weeks. Here, the speaker describes his first opportunity to present testimony before the House of Representatives in 1969 or 1970. Clearly, the late Dr. David Shoch of Northwestern and the speaker were a bit naive, but apparently we did our job satisfactorily. We also appeared before the Senate. JME had a number of opportunities to fill this role on later occasions in behalf of RPB and the NEI.
An Ophthalmologist Afield: Vincent (Censu) Tabone, A President of Malta P*
Robert M. Feibel, MD
Purpose: This paper documents the life and work of Vincent (Censu) Tabone who had a dual career both as an innovative and successful ophthalmologist and as a politician and statesman in his native Republic of Malta , his career culminating as the President of Malta. Resources: Most of the published and available sources on Tabone concentrate on his service in politics and government. I have concentrated on his work in ophthalmology and have obtained unpublished material from his family about his career in ophthalmology.
Body of paper: Born in 1913, Tabone obtained his medical degree from the University of Malta . After serving in World War II, he obtained three graduate degrees in ophthalmology in the United Kingdom . He then returned to Malta where he began his private practice. Entrusted with the supervision of a campaign to eradicate trachoma in the island of Gozo (part of Malta ), his efforts virtually eliminated this disease. Based on this success, in 1952 he was the first ophthalmologist engaged by the World Health Organization to run similar programs around the world. He traveled to many countries in the mid and far East to initiate and supervise trachoma eradication programs and was in demand as an expert in this field. His greatest challenge and success was in Taiwan . Although he continued in his ophthalmologic practice, he became interested in Maltese politics, serving as a Member of Parliament for 23 years, as Minister of Labor and Social Welfare and then as Minister of Foreign Affairs. He was elected the President of the Republic from 1989 to 1994 and had a historic and successful term. Summary: Tabone had a unique and remarkable life: a dedicated ophthalmologist for 40 years and a politician for 30 years. Both were satisfying to him, but he felt his proudest achievements were in ophthalmology.
Depictions of Ophthalmologists on Postage Stamps
Andrew P. Ferry, M.D.
Body of paper: I am aware of some 20 ophthalmologists who have had their images depicted on postage stamps of various nations in honor of their professional accomplishments. [The USA has never done so.] Some of these men are household names in the world of ophthalmology. Others are less well known to current ophthalmologists and to their colleagues in related professional fields. I will present brief sketches of these ophthalmologists in chronological order and, in each case, I’ll show the stamp/stamps on which he was depicted.
Jakob Henle and the Germ Theory of Disease
Ronald S. Fishman, MD
Body of Paper: Friedrich Gustav Jakob Henle (1809-1885) was a German anatomist, physiologist and pathologist whose name is attached to over a dozen structures, including Henle's layers of the retina, choroid, and iris, as well as Henle's loop of the kidney. He is less well recognized as an early exponent of the Germ Theory of Disease, well before Pasteur. In his book On Miasmata and Contagia (1840), Henle set forth the principles which guided his pupil Robert Koch and should properly be known as the Henle- Koch postulates.
Sources: Included are the only biography of Henle in English (1921), Henle's Anatomy of the Human Body (1841), On Mismata and Contagia (1840), and excerpts from Henle's major work, the 3-volume Handbook of Systematic Human Anatomy (1855-1873).
William Moon and his Tactile Reading System
Alice (“Wendy”) Gasch, MD
Introduction or purpose: …to provide an overview of William Moon, a 19th-century, blind Englishman who devoted his life to improving the welfare of the blind, and the tactile reading system – an alternative to Braille – that he created.
Historical approach or resources: Sources of information about William Moon and his reading system are scarce. I used web sites of various British organizations. Some have the text of material published decades ago about Moon and his reading system. E-mails to the organizations were fruitless for obtaining additional information. A PubMed search yielded two articles: an 1850 letter by Moon to the editor of Lancet (that I haven’t been able to obtain) and a 1998 article on Hauy, Barbier, Braille, and Moon in J Med Biogr (that was requested in mid-December, but that I haven’t yet received). I accessed the Report of the Pennsylvania Home Teaching Society and Free Circulating Library as a Google book.
Body of paper: William Moon, FRGS, FRSA, LLD (1818-1894) was a British evangelist, teacher of the blind, inventor, and publisher. After becoming totally blind at 21 years old, he devoted his life to improving the welfare of the blind. Being a staunch evangelist, Dr. Moon wanted the blind to be able to read, not just to further their general education, but, more specifically, to enable them to read the Bible. Thus, in 1843, he developed “Moon,” a simple, tactile reading system that was easier to learn than those available. The characters of Moon have bold, simple outlines, making them easy to discern by touch. Furthermore, most characters are unaltered or slightly altered Roman letters, and the system incorporates few contractures.
After Dr. Moon devised an efficient means of printing material in Moon, The British and Foreign Bible Society wanted to distribute passages of Scripture in Moon abroad, which provided a major impetus to adapt Moon to foreign languages. Eventually, Moon was adapted to 419 foreign languages and dialects.
Other endeavors that Dr. Moon undertook for the blind included the founding of Home Teaching Societies to educate blind children and the establishment of free lending libraries of Moon books to supply the Societies. These Societies and their associated libraries were founded throughout Britain and in Sweden , Canada , the United States , and Australia. After Dr. Moon’s death, his daughter, with support from his son, an ophthalmologist who immigrated to Philadelphia , continued to print and distribute books in Moon until 1914, when both she and her brother died. Then the “Moon [Printing] Works” became a branch of Britain ’s National Institute for the Blind (now the Royal National Institute for the Blind) that currently makes available literature in Moon and a Moon teaching curriculum. Today, of the many tactile reading systems invented, only those based on Moon and Braille are used significantly, and the latter certainly predominate. Braille eclipsed Moon for logistical and political reasons. Moon is slower to read, bulkier, and more difficult to print than Braille. Moreover, Moon faced a major impediment when a world congress that met in Paris in 1878 selected Braille and the most appropriate reading and writing system for the blind. Nevertheless, Braille has not totally replaced Moon, and today several hundred individuals in Great Britain use Moon.
Summary or conclusions: William Moon’s desire to improve the welfare of the blind led to multiple endeavors. Perhaps the most ingenious one was creation of “Moon,” a tactile reading system that became the first widely-used means of reading for the blind. Today, more than 150 years after its creation, due to its boldness and simplicity, Moon still proves helpful, particularly among blind, learning-disabled children and adults, and among print-readers who have lost their vision late in life.
The Focal Infection Theory and its Consequences
John W. Gittinger, Jr., MD
Introduction or purpose: To recount the sometimes disastrous effects of an unproven medical theory
Historical approach or resources: The bacteriological advances of the early 20th century provided the theoretical basis for a surgical bacteriology that was unscientific and dangerous.
Body of paper: The doctrine of focal infection or autointoxication postulated that bacterial infections in various organs, especially the teeth and intestines, caused both physical and psychiatric disease and that removal of these diseased organs could cure these disorders. Dr. John Kellogg, medical director of the enormously popular and influential Battle Creek Sanitarium, argued that changes in bowel flora could improve vision. The distinguished ophthalmologist Dr. Hunter Holmes McGuire, a president of the American Ophthalmological Society, reported curing uveitis by appendectomy. In psychiatry, ethical boundaries were crossed when inmates of the New Jersey State Hospital at Trenton were subjected to serial surgeries by its director Dr. Henry Cotton, which were continued despite evidence that these were both ineffective and dangerous. Dr. Bayard Holmes in Chicago was so convinced that his son’s schizophrenia had a bacterial basis in his appendix that he operated on him, resulting in his death.
Summary or conclusions: Sir Stewart Duke-Elder’s System of Ophthalmology devotes ten pages to a discussion of the focal infection theory in uveitis and concludes that the evidence supporting this theory is inadequate and that “patient treatment—sometimes violently and mutilatingly radical—is pursued with all the arrogance of faith and none of the modesty of knowledge.”
S Duke-Elder, ES Perkins, System of Ophthalmology Vol. IX Diseases of the Uveal Tract. St. Louis : The C.V. Mosby Company, 1966.
JH Kellogg, Autointoxication or intestinal toxemia. Battle Creek , Michigan : The Modern Medicine Publishing Co., 1919.
HH McGuire, Uveitis dependent upon focal infection in the appendix. Trans Am Ophthalmol Soc 1920; 18:186-193.
R Noll, Infectious insanities, surgical solutions: Bayard Taylor Holmes, dementia praecox and laboratory science in early 20th-century America . Part 2. History of Psychiatry 2006:17:299-311.
A Skull, Madhouse; A tragic tale of megalomania and modern medicine. New Haven : Yale University Press, 2005.
Retina and macula have their own history – from Felix Platter (1583) to OCT
Balder P. Gloor, MD (invited)
Introduction or purpose: The history of elucidation of the function and structure of the Retina and Macula has a long way full of controversies. The lecture focuses on some landmarks, on its main players and their stories.
Resources: Library of the Institute of History of Medicine, University of Zurich , Prints from 16th to 20ieth century
Summary: Modern age of ophthalmology begins with Felix Platters Anatomy. He localized light sensitivity in the retina instead in the lens in 1583. Kepler, 21 years later, secured the key position of the retina in the process of vision by his work on dioptrics of the eye. He discussed the reversed image on the retina at length. It took ophthalmologists almost 200 more years to realize, that vision was possible without the lens. Physicists, astronomers assumed a special structure with high resolution in the center of the eye long before the anatomists Buzzi (1782) and Soemmerring (1804) detected the yellow spot. Soemmerring was convinced that there was a hole in the middle of the macula and that this, not the optic disc, would explain Marriott’s blind spot. The life of Christian Koeck, Soemmerrings artist, adherent to the French revolution, is a special story. The battle on the macular hole impended progress until the middle of the 19th century. – In the meantime progress came from physics and physiology. Newtons discovery that white light was composed of different colours (1704) became the base of the theories of colour vision by Young and Purkinje 120 years later. The Purkinje shift and the trichromatic theory of Young foresaw the two different sensory elements in the retina, one for vision in the dark, the other for vision in daylight and there three elements for colour vision. Young already estimated 60 millions of sensitive points to reach a resolution of one minute of arc in a 140° field, not too far from Krause 1876 and Osterberg 1934. Purkinje had visualized the retina and the macula entoptically 1819 long before ophthalmoscopy and before the anatomists (Treviranus 1834/35 (rods and cones!) Michaelis 1838, Bowman 1847, Kölliker 1854, Müller 1857, Schultze 1871) had established the histology of the retina and Macula. The Purkinje figure of the retinal vessels allowed Müller to localize the light receptors below the vessels in the layer of the rods in 1851. In the same year Helmholtz’s ophthalmoscope started the revolution in clinical ophthalmology. Coccius described the wall and foveolar reflex of the Macula in 1853, but there was no yellow in the Macula - until Vogt used red free light (1913), but Gullstrand contradicted loudly. Next steps in clinical ophthalmology were slitlamp biomicroscopy by Koeppe (1920) and Goldmann (1938), after world war II fluorescein-angiography and in our times the OCT. Goll detected the visual purple and its bleaching by light 1876! 55 years later Wald got the Nobel prize for the elucidation of the visual process. Further progress in structure and function of the retina brought the work of Ramon Cajal, Poliak, Dowling and Boycott, Young and Bok. Finally genetics showed that almost any structure and cell of the retina may develop its own hereditary disease.
Retinal surgery at the time Gonin was swimming against the mainstream
Balder P. Gloor, MD (invited)
Introduction: This paper focuses more on ideas, missed findings, correct and wrong assumptions of Jules Gonins forefathers and of his contemporaries and how they were led to more or less unsuccessful, sometimes horrifying surgical methods to treat retinal detachments than on Gonins work itself, well known indeed. This allows to demonstrate how straight forward Gonins approach to cure retinal detachment really was. Furthermore some claims of Gonins colleague Vogt regarding priority have to be cleared.
Resources: Original literature in the library of the School of Medicine of 19th to 20ieth century.
Body of paper: Lecture
Summary: Tears in the Retina were observed by Coccius 1853, short after the invention of the ophthalmoscope. De Wecker (1875, 1879) and Leber (1882) were the first to declare these tears as the cause of retinal detachment, this in disagreement to all other prominent figures in ophthalmology of that time, who took the tears as a secondary event. Astonishingly enough Leber revoked his thesis in 1908. Exudation from the choroid, pressure from behind and similar theories encouraged adventurous types of surgery. V.Graefe, the overlord, followed by Bowman, suggested to cut the retina to drain the fluid from subretinal space into the vitreous (1863). Deutschmann added injections of rabbit vitreous 1895. Schoeler injected a solution of iodine in the subretinal space (1894). Galezowski tried to reattach the retina by sutures, later by drainage and by closing a supposed tear in the zonule (1902,1903), strictly denying retinal tears as the cause of the detachment. Nevertheless Vogt used Galezowskis publications, falsifying Galezowskis statements, to deny in publications and in a report to the Nobel prize awarding committee Gonins priority regarding closure of the tear. Therapeutic nihilism prevailed when Dufour and Gonin became - against their expectations! - by meticulous pathological and clinical studies convinced, that the retinal tear is the origin of the detachment (1904 and 1906). During the next ten years Gonin developed the hypothesis, that the detachment may be healed by closing the tears by exactly placed heat coagulation. From 1913 to 1920 he tested the hypothesis. From 1916 on he did surgery on an increasing number of cases, proved his thesis and started to report successes and failures at meetings. When he presented his findings at the meeting of the French Society in 1920, colleagues, especially Sourdille, jeered at him. The turning point came much later at the International Congresses 1928 in Amsterdam and 1933 in Madrid. But Sourdille defended his approach until his son convinced him to switch 1935. Deutschmann stuck to his horror procedure until his death. - Astonishing are two things: 1. how long insufficient observation of what comes first and what follows, what is cause and what is effect, misconceptions and prejudices could impede a logical procedure. 2. that among the hundreds of learned ophthalmologists only one pursued the idea that closure of the tear could be the solution until he could prove it, this 45 years after de Weckers had declared the tear as cause of the detachment.
Vincenz Fukala (1847-1911) - versatile surgeon and original historian of ophthalmology
Andrezej Grzybowski, MD
Introduction or purpose: The name of Fukala is well-known in ophthalmology, mainly due to his works in refractive surgery, however not much is known about his private life and other achievements. The aim of this study was to shed more light on his life and less known clinical and scientific interests.
Historical approach or resources: Search in city and university archives in Cracow, Vienna, Karlove Vary and Pilsen as well as literature search and analysis.
Body of paper: Vincenz (Wincenty) Fukala was born into a Polish family in Zólkiew (at present Ukraine) in Polish Galicia on January 22nd, 1847. He studied medicine and specialized in ophthalmology in Vienna. Fukala demonstrated the benefit of clear-lens removal in young, high-degree myopia. Although, several surgeons had risked surgery in high-degree myopia in former decades, most were afraid of complications at that time; and surgical treatment failed to become established. Thanks to his determination, Fukala convinced his skeptical colleagues of the efficacy of his surgical method of lens discission. He performed the first lens discission on April 3rd, 1887  and in 1889 was the first to lecture on the surgical treatment of high degree myopia. However, the procedure was abandoned because of the inacceptable rate of retinal detachment, which was incurable at that time. He also operated cataracts, glaucoma, developed surgical methods for treating ectropium in chronic blepharitis, and performed orbital surgery to fix ocular prostheses. His original historical concepts and publications concerning ancient and Arabian ophthalmology are of great interest.
Summary or conclusions: Wincenty Fukala was an important 19th century ophthalmologist, mainly known because of his works on refractive lens surgery. Fukala´s clear-lens operation in young individuals was successful in thousands of highly myopic patients at the turn of the last century. Fukala, what is much less-known, dealt also with other subjects, developing several surgical methods to treat defective lid positions in chronic inflammatory diseases, and carried out orbital operations to fix ocular prostheses. He studied many historical achievements in vision and ophthalmology. His thorough historical analysis and original conclusions have been used in the 20th century works on the origins of neuroscience and history of vision.
Accommodation in the 18th Century: The Bakerian and Croonian Lectures
David G. Harper, MD
Introduction: This presentation outlines 18th-century attempts to understand ocular accommodation, as reviewed by Dr. Thomas Young in his Bakerian Lecture of 1800.
Resources: The Bakerian and Croonian Lecture Series
Body of paper: This presentation describes research struggles with accommodation over the course of the 18th century. The story begins in 1719 with Dr. Henry W. Pemberton’s inquiry into the muscularity of the lens, followed by similar inquiries, some of which would suggest an analogy of the lens to the muscular parts of pellucid animals. Emphasis is on Dr. Thomas Young’s research during the 1790s on accommodation, the results of which were presented by him in his Bakerian Lecture read on November 27, 1800. Featured are his references to the work of other 18th-century scholars, some of whom, like Young, presented their findings in Bakerian or Croonian Lectures. Included also is a brief review of the origin of these lectures. The presentation highlights how Young incorporated the ideas of others while keeping an open mind to any and all possibilities relating to accommodative mechanisms during what would ultimately prove a futile search for an accommodative mechanism related to changes in corneal curvature or possible elongation of the globe from extraocular muscle contraction. Finally, we will see how Young arrived at his ultimate belief—while denying the existence of muscle in the ciliary body—that the lens itself is a muscle, in spite of the fact that he was unable to identify any nerve supply to the lens, on the one hand, or to produce any change in its curvature through electrical stimulation, on the other.
Summary: Early efforts to understand accommodation, while touching on some of the actual mechanisms behind the process, would continue to confound researchers at least until the discovery of the ciliary muscle more than two decades after Young’s lecture.
William Thomson, MD (1833-1907); Civil War Surgeon and The Evolution of Ophthalmology
Richard W. Hertle, MD
Introduction or purpose: To relate how the life of a civil war surgeon and ophthalmologist, represents the 19th century ophthalmic transition from European based training.
Historical approach or resources: Library, Internet, historical records and personal letters used in combination as source materials.
Body of paper: William Thomson, born in Chambersburg, Pa., January 28, 1833, the son of Alexander Thomson, Judge of the Sixteenth Judicial District of the State, and Jane Graham. At eight years old he suffered an ulcerated cornea and was kept confined to a darkened room for nearly two years. Although his eyesight was impaired, he finished his schooling and received his medical degree from Jefferson Medical College. Ten years after his graduation when the civil war broke out he abandoned practice for the insecure future of army life. In the summer of 1861, as assistant surgeon, as lieutenant, he entered the regular service before the disaster of Bull Run. He served in the Army of the Potomac and in Washington and Alexandria until, in 1862; he joined General McClellan's headquarters as chief of staff to the medical director, Jonathan Letterman.
After the gallant fight at South Mountain, he was left in superior charge of a field where lay, dead or wounded, two thousand Union men and Confederates. In the light of this experience he proposed two reforms, which were adopted throughout the war. Thomson received a commendation from President Lincoln for this leadership. In Washington, at the Army Medical Museum, he collaborated with Dr William Fisher Norris in a seminal project in photomicrograph and also created the Medical Illustration Service of the Armed Forces Institute of Pathology.
After his military service and, a short period of general practice, according to Silas Weir Mitchell, “with his enterprising hopefulness and extraordinary command of resources, he turned whither his tastes led, and told me, to my surprise, that he intended to practice only ophthalmic medicine.” At that time this required courage, and, as some believed, training in Europe, in general, and Germany specifically. Dr. Thomson accomplished this through his knowledge of optics, focused application of surgical principles and simple practice. Dr Mitchell also writes, "No one more than Dr. Thomson recognized the necessity of accurately and fully correcting the errors of refraction …. always with the aid of full mydriasis.”
He rapidly prospered as one of the first ophthalmology specialists in that city and was on the Wills Eye Hospital Staff and the faculty of Jefferson Medical College, where he was the first professor of ophthalmology.
Summary or conclusions: Dr. Thomson’s path in medicine shows a peculiar “American” theme in ophthalmic training during development of the great American eye hospitals in the second half of the 19th century. He played a key role in convincing physicians and medical students of the value of the ophthalmoscope. Dr. Thomson's lasting contributions to ophthalmology were concerned with the influence, detection, and correction of the anomalies of the refraction of the eye and with the investigation of color blindness.
Congress among the Dreaming Spires
Introduction or Purpose: 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.
The paper will explore his career and the unique heritage he left behind.
Historical approach or resources: 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, Emeritus Professor of Medicine at the University, 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.
Body of paper: 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 intra ocular 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)
The 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.
Summary or conclusions: The establishment and success of the Oxford Ophthalmological congress over 100 years will be reviewed with special focus given to its founder, Robert W Doyne.
The Invention of Bifocals
Charles E. Letocha, MD
Introduction or purpose: Since the meeting is in Philadelphia, I chose a theme related to that city. Historical approach or resources: examination of contemporary documents regarding bifocals.
Body of paper: the evidence for Franklin being the inventor of bifocals and the evidence against that conclusion will be examined.
Summary or conclusions: I believe that the evidence supports Franklin as the inventor
The History of the Three Step Test for Isolated Cyclovertical Muscle Palsy
Donelson R. Manley, M.D.
Introduction or Purpose: Of the twelve cyclovertical muscles, eight have vertical and torsional actions. These are the inferior and superior oblique and inferior and superior rectus muscles. Any one or more of these may become paretic as a result of a disease process resulting in a hyper and/or cyclodeviation.
Historical approach and resources: I have reviewed the pertinent literature. In addition, my personal communications with Drs. Philip Knapp, Frank Costenbader, Edward Dunlap, Hiram Hardesty, Frances Adler and Marshall Parks have given me greater insight into the controversy. To this I have added my 43 years of personal experience in strabismus.
Body of Paper: When an individual develops a hyperdeviation as well as vertical and torsional diplopia it can be a diagnostic challenge to identify which cyclovertical muscle is affected. As each of these muscles may be affected by a variety of diseases it is important to identify the affected muscle, which may then allow the disease to be treated.
Historically, it remained controversial as to how to properly identify the affected muscle. The Three Step Test was developed to resolve this. The historical evolution of this test will be discussed.
Summary or conclusion: Use of the Three Step Test allows the identification of the affected cyclovertical muscle. It should be used in any individual who presents with a hyperdeviation.
Physicians – Poisons – Pupils and a Bella Donna
The Evolution of Forensics
Medow, Norman B., M.D.
Introduction: Life always ends in death – at least that is what most people understand to be true. Not all deaths occur naturally.
Purpose: This paper will explore the early beliefs that unnatural deaths were due either to accidents, or devil possession. Illness and disease were poorly understood.
Body of Paper: Occasionally, death occurred on the field of honor – rarely, suicide occurred. When it did it was usually a depressed or dishonored person who used poison to do himself in – Medical Legal investigation was unknown – a murderer needed to have direct visual confirmation of his deed – without this, murderers would never be found guilty. Poison use was not uncommon – exploration into murders by use of science, later to be forensics or the body of medical knowledge which will be used to administer the law – began in earnest in the early 19th century. One of the seminal cases in this evolution revolved around a Physician accused of poisoning his pretty wife. The examination of the decedent showed that her pupils had some unusual findings. This would lead the best known chemical experts of the time to prove to the jury that the husband killed his wife – This case is one of the earliest legal cases to use circumstantial evidence, chemical, medical and demonstrable, to convict the accused. This case, prosecuted by the finest litigators of the period would point to the important role that toxicological analysis would play in the future of forensics.
Summary: Caution! There are few, if any, chemicals that cannot be detected and analyzed today!!
Wm. Hyde Wollaston, optic chiasm, and the Big Bang
Harry H. Mark, MD.
Introduction or purpose: Illustrate the versatility of the inductive method as applied by an M.D. scientist.
Historical approach or resources: primary and secondary sources
Body of paper: lecture
Summary or conclusions: Wollaston was the first to clinically describe hemianopia as well as discover new chemical elements, and the absorption lines in optical spectra. The latter phenomenon lead eventually to the theory of the Big Bang.
The birth of fluorescein angiography: 50 years ago
Michael F. Marmor, MD
Co-author: James G. Ravin, MD
Introduction or purpose: It has been 50 years since fluorescein angiography was developed as a clinical procedure, by two medical students at Indiana University. The story of its discovery, and its acceptance by ophthalmology, is both engrossing and instructive. Both insight and serendipity played a role, and as for many medical discoveries, its ultimate value was dependent on dissemination and recognition as well as science (especially as it was originally rejected by the Amer J Ophthalmol).
Historical approach or resources: Prior articles and visual material were reviewed, and the original discoverers were interviewed anew. Both Novotny and Alvis are alive and well….although neither uses the test! Our focus is less on what happened (which is well known), than on why and how the test became practical for ophthalmology.
Body of paper: Fluorescein was discovered by Paul Erhlich in 1882, and has been used as a stain for nearly a century in ophthalmology. Maumenee gave it intravenously to visualize hemangiomas, but didn’t realize the potential for monitoring circulation. His junior faculty member at Stanford (in San Francisco), Milton Flocks, began to study circulation in the cat with fluorescein, and even made some human images showing leakage in macular degeneration. But he didn’t use a barrier filter, and tried cinematography (for which there was insufficient light). It was a pulmonary expert, John Hickam at the Indiana Univ, who envisioned that fluorescein might help his studies on oxygen saturation, bought a Zeiss camera, and gave two medical students the task of working out technical details. Novotny and Alvis played with the camera, and had the insight that a barrier filter would enhance photography of fluorescence in the blood stream. In an era before IRBs, they used themselves, friends and patients to try injections, and by timing with a stopwatch they got angiograms remarkably like we do today. They observed leakage in diabetes and hypertension. But the AJO thought the work was not original (since Flocks had shown circulation in cats), and rejected it—and only through Hickham’s connections did the report get published in Circulation. The value to ophthalmology was never recognized in Indiana, but it was picked up by Dollery in England, and studied by Noble David at Duke, where Johnny Justice was a tech. Both moved ultimately to Miami, and the Bascom Palmer group with Ed Norton and Don Gass published seminal papers that put fluorescein on the map.
Summary or conclusions: Anecdotes will highlight the serendipity and brilliance that combined to make angiography a reality. Medical discovery takes a prepared mind, but also good ideas, a bit of good luck, and some good advertising down the road!
Martin Urist, MD, A Man Always A Little Out Of Step With His Profession
Marilyn T. Miller, MD
Introduction or purpose: To relate many of the significant contributions to ophthalmology, especially in the field of strabismus, by an ophthalmologist considered by many as the prototype “most unforgettable character.”
Historical approach or resources: Interviews with some ex-residents, faculty and friends who knew Dr. Urist and were usually free to add their humorous vignettes from their contact with this colorful man, his Ledgers where he summarized all of the patients he examined, and some letters written about him.
Discussion: Dr. Urist was a home-grown physician from the University of Illinois. He graduated from the University of Illinois Medical School and after a time as a general practitioner, he returned as a resident in otolaryngology (1936) and later as a resident in ophthalmology (1941) at the Illinois Eye and Ear Infirmary. He then stayed on as an unpaid volunteer ophthalmologist in the Strabismus Service 2+ days a week, commuting from South Haven, Michigan where he had a private practice. Teaching was his greatest love and as all ex-residents remember, learning was exciting and entertaining. He was a great observer, an avid reader of the literature, and never bothered by what the experts said was dogma in strabismus. His greatest academic contribution was the recognition of the fact that many patients with concomitant strabismus showed a different deviation in the up and down position. Later this phenomenon was given the name “A and V pattern.” He wrote many papers on various fields of strabismus usually as the lone author and based on reviewing all of his patients in his Ledger books. At the time of his death he was clinical professor emeritus at the University of Illinois College of Medicine, attending ophthalmologist at Cook County Hospital and lecturer at Stritch School of Medicine (Loyola U.) and the Hines Veterans Hospital.
Summary: Dr. Urist made significant contribution to the field of ophthalmology and will be remembered by his excellent teaching and scholarship, and colorful personality.
Base Hospital 5 and Ophthalmology with the American Expeditionary Force in World War I
Steven A. Newman, MD
Introduction or purpose: Discuss the advent of the base hospital system in WWI and its implications for ophthalmology.
Historical approach or resources: Records of Base Hospital 5 (The Harvard Unit lead by Harvey Cushing) and papers and writings of George S. Derby Senior Ophthalmic Consultant for AEF and member of the Base Hospital 5 Unit. Additional data was obtained from Volume XI Section III of the Medical Department of the United States Army in the World War concerning ophthalmology.
Body of paper: Although Allen Greenwood had served in the Spanish-American War (and reprised his role as the Senior Ophthalmic Consultant during WWI), it wasn’t until 1917 with the deployment of the American Expeditionary Force to France that the new system of base hospitals was put in place. The logistics of unit deployment can be illustrated through the records of Base Hospital 5 which contained an ophthalmic division lead by George S. Derby (son of Hasket Derby). His writings on Trachoma and the effects of mustard gas mirror some of the advances in ophthalmology occurring during the later part of the conflict.
Summary or conclusions: Military conflict often leads to an accelerated development in medical care. Ophthalmology in WWI was no exception. The logistics of handling a large number of ophthalmic problems and new developments in the treatment of traumatic and chemical injuries are discussed in the setting of the writings of the ophthalmologists present.
What were they thinking?
James G. Ravin, MD
Introduction/purpose: To understand opinions ophthalmologists were voicing on critical issues in the field at the beginning of the 20th century
Historical approach: Evaluation of volumes of the Archives of Ophthalmology from 1900 through 1911
Body of paper: To obtain understanding of issues in ophthalmology at the beginning of the last century, I read the dozen volumes published from 1900 through 1911. Original articles often provided new information, but speakers at conferences frequently offered lucid opinions on topics relevant to practitioners that were not found elsewhere in journals from that era. These reports give us a sense of their thinking, especially about therapeutic practices and knowledge of cataract and glaucoma.
Summary and conclusions: The topics covered a century ago remain relevant today: progress in cataract surgery, the development of modern glaucoma surgery, refractive surgery, the difficulty of repairing retinal detachment, and early work on corneal transplantation.
Robert Machemer, A World Leader In Vitreoretinal Surgery
George O.D. Rosenwasser, M.D.
Introduction or purpose: Present his biography and achievements
Historical approach or resources: Retrospective research using family photos, oral history and videos
Body of paper: Robert Machemer, a world leader in vitreoretinal surgery, passed away in December of 2009. The presentation chronicles his family, life during childhood in Germany, education in medicine and emigration to the United States to begin his research career. Through audio and video clips the many contributions he made to the field of vitreoretinal surgery are described and demonstrated. Excerpts of his AAO oral history are used to give a unique view into his perception of events as they unfold, including his recruitment to the chairmanship at the Duke University Eye Center. Robert’s legacy is his family, the physicians he trained, and the tremendous accomplishments of his life as a physician scientist.
Back to the Future: Resources for the Study of Ophthalmic History
Pamela C. Sieving, MA, MS
Introduction or purpose: That libraries and their holdings are changing (or have changed) is hardly news; even the word ‘holdings’ no longer describes reality. The challenge is to understand and take advantage of new opportunities, and manage changes that do not take us to the future we want.
Historical approach or resources: Survey of popular press, and of library and medical literature, including grey literature. Primarily United States-based resources are used, but some international resources are also explored.
Body of paper: Libraries and archives have served many functions, among them both the rapid adoption and promotion of technologically-driven changes, while simultaneously acting as a brake, maintaining the status quo and preserving the past.
Technological changes, particularly in electronic storage capacity and computing time, force both libraries and resource sources (publishers, vendors, scientific and scholarly societies) to re-examine their priorities, the interests and needs of their users, customers and members, and opportunities to do better what they have always done: creating, acquiring, organizing and archiving information, and providing access to it. Other changes are being driven by corporate decision-makers, those who fund libraries and archives, sociological forces, and shifts in approaches to education and knowledge.
This paper examines changes in sources for the study of ophthalmic history and access to them. The objective is both to introduce new techniques and resources for study, and to raise concerns and their possible solutions.
Summary or conclusions: The future is bright, but if we see only the seductively shiny surface of the new, we may miss depth of content beneath, and perhaps also miss the opportunity to assure the future we want.
A Quick Look at the Career and Publications of Sir William Lawrence
H. Stanley Thompson, MD
Introduction or purpose: Lawrence was a pillar of British ophthalmology during much of the 19th Century.
He was born in 1783 and he lived until he was 84, and he was always admired and respected. Lawrence had a lifelong association with St Bartholomew’s Hospital. In about 1820, when he was already a well-known surgeon, he suggested that since “knowledge”, “thought” and “feeling” depended on a healthy brain, then perhaps the idea of “soul” or even religion itself, in all of its various manifestations might also emanate from the brain – rather than from an external source. This got him into deep trouble with the C of E, and he was finally obliged to “withdraw” his book ! He then concentrated on ophthalmic surgery, and in 1824 he gave an important series of lectures, that were then published in a fat book. This book, (ATreatise on the Diseases of the Eye) together with Mackenzie’s opus, were the two main texts for a generation of English-speaking ophthalmologists.
Eventually Bowman’s work on the anatomy of the eye emboldened ocular surgeons to attempt new kinds of surgery, and the arrival of the ophthalmoscope soon made most eye textbooks seem old-fashioned.
A brief history of comparative ophthalmology For the past century and more there have been ophthalmologists and visual scientists captivated by the variation of the eye across species.
Special Guest Speaker: David Williams MA VetMB PhD CertVOphthal CertWEL FRCVS
Cambridge Centre for Comparative Ophthalmology,
Department of Veterinary Medicine,
University of Cambridge CB3 0ES , UK
Body of Paper: While we will consider Casey Albert Wood separately, he 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 Jonson 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 ten years earlier, he retired from clinical practice to devote his time to comparative ophthalmology. He was the first to recognise 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 colour vision on the one hand and of the evolution of ocular movement and extraocular muscle action on the other.
Casey Wood - ophthalmological and ornithological polymath
Special Guest Speaker: David L Williams MA VetMB PhD CertVOphthal CertWEL FRCVS
Cambridge Centre for Comparative Ophthalmology,
Department of Veterinary Medicine, University of Cambridge CB3 0ES , UK
Body of Paper: 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 Eye Hospital . 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 after his retirement in 1906, 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 ophthalmologist in Chicago , either at Northwestern University or the University of Illinois joining the faculty in 1899 and becoming Head of Ophthalmology in 1909, when the College of Physicians and Surgeons of Chicago became the University of Illinois College of Medicine. He was described 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 from the College in 1920 and thenceforth travelled 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 was 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 .
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Tadeusz Krwawicz and the discovery of cryoextraction of catarct.
Introduction or purpose: Introduction of cryoextraction had a great impact on the development of ophthalmology in the 60s and 70s of the last century. It not only facilitated cataract surgery decreasing the number of complications but also stimulated the development of many new techniques that were to apply low temperatures in ophthalmology and other branches of medicine. The purpose of this presentation is to show how the idea of applying freezing in eye surgery had originated and developed.
Historical approach or resources: The presentation is based on my own observations, statements by Krwawicz’s co-workers and available literature.
Body of paper: Tadeusz Krwawicz was Chairman at the Medical University Eye Department and Hospital in Lublin from 1948 till 1980. One of his ideas was interdisciplinary approach to eye research. He collaborated with biochemists, histologists, and other researchers. His team included my father, Kazimierz Zagórski, a pharmacist and chemist who should be remembered for bringing dry ice into the lab in the mid-fifties which had never been seen before by the rest of staff. He suggested starting studies on lyophilisation of tissues, especially the cornea, and developed special equipment to allow very delicate freezing and drying. The tissue retained many of its original features and some elements could even be revitalized. The method was applied clinically for lamellar keratoplasties. In 1959, after initial success with cornea preservation, Krwawicz wanted to apply it to the lens. As a rabbit lens removal in toto was too difficult, he had the idea of freezing it in situ. My father constructed a primitive device based on a small soldering tool with a copper tip. A mixture of dry eye and methyl alcohol was used to freeze the tool. After trying to freeze the lens it appeared it was so strongly attached that was removed when taking out the freezing device. This immediately gave Krwawicz the idea of applying it in cataract surgery, which proved very successful, dramatically decreasing the complication of capsular rupture. Krwawicz was describing his discovery as ‘serendipity’, but for more than two decades the cryoextraction was the most frequently used method in cataract surgery around the world.
Summary or conclusions: In the postwar Europe, even in a not totally sovereign country under communist rule, separated from the Western science, some researchers with open minds and the ability for interdisciplinary cooperation had outstanding achievements recognized and applied globally.