28th Annual Meeting Abstracts - 2015- New York City
Titles marked with a P* are available in the Proceedings volume for the year of presentation. Contact Jenny Benjamin, at the Truhlsen-Marmor Museum of the Eye (jbenjamin@aao.org) for further information.
Papers noted as being “Published as…” may not be identical to the Cogan Society presentation or the content in the Proceedings volumes.
Life's Lessons Learned: Frederick Blodi, M.D. at the Columbia University Harkness Eye Institute
Christopher F. Blodi, M.D. and Barbara A. Blodi, M.D.
Purpose: The presentation reviews Frederick Blodi's time at the Columbia University Harkness Eye Institute (1947 - 1952) and his interaction with two prominent ophthalmologists: Algernon Reese, M.D. and Alson Braley, M.D.
Methods: Oral and written interviews with participants and review of the literature.
Results: The influence of two physicians on Frederick Blodi shaped his professional future by providing a template for academic and interpersonal success. Reese showed Blodi that in Medicine every opinion is valued and important, even from those far below in the "pecking order". Braley showed Blodi that in life everyone can be your friend, even those that you just met. Using these two traits, Blodi accomplished a successful academic medical career.
Conclusion: Frederick Blodi's relatively short time at the Columbia Harkness Eye Institute provided him with experiences that guided him throughout the rest of his life and allowed him to achieve a fruitful career in academic ophthalmology.
Stevens-Johnson Syndrome: It's Discovery and Clinical Description
George M Bohigian, M.D.
Purpose: To illuminate the lives of Albert Stevens, M.D. and Frank Johnson, M.D. who first reported the syndrome named for them.
Methods: The pertinent medical literature on this subject was fully reviewed and evaluated utilizing the Bernard Becker Rare Archives and Books, Library of Congress, Columbia University Libraries and obituaries in local hometown newspapers.
Results: Drs. Albert Stevens and Frank Johnson first characterized and published this syndrome in 1922 of two boys ages 7 and 8 who had a full body rash along with inflammation and blistering of the mouth and eyes (Stevens A, Johnson F. A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Archives of Pediatrics and Adolescent Medicine 1922;24:526).A rare disease of unknown etiology with predominantly ocular symptoms, signs, morbidity which may also have systemic manifestations. The differential diagnosis and treatment will be discussed. The lives and careers of both will be discussed. Dr. Johnson, a pediatrician tragically fell to his death collecting rock specimens as an amateur geologist. Dr. Stevens, a surgeon quietly retired to Hawaii to start a plantation of tropical fruits and teach school. P*
Ophthalmology and the Nobel Prize
John D. Bullock, M.D.
Introduction: There are a variety of ways in which ophthalmology has been associated with the Nobel Prize.
Resources: Internet searches, library research; site visits.
Results/Summary: Given the great importance of the eye to human existence, it is not surprising that this award has been presented to numerous scientists for their contributions to vision research. The first such Nobel Laureate was Allvar Gullstrand in 1911 (the only ophthalmologist-winner for an ocular subject) for his studies of geometric and physiological optics. In 1967 non-ophthalmologists Hardline, Granit, and Wald received prizes for their discoveries concerning physiological and chemical visual processes and in 1981 Sperry, Hubel, and Wiesel were honored for their work concerning the functional specialization of the cerebral hemispheres and information processing in the visual system. What is almost universally unappreciated, however, is the fact that three other ophthalmologists have received Nobel Prizes for subjects unrelated to ophthalmology. They will be discussed. Four ophthalmologists have been nominated but rejected for Nobel Prizes: Hjalmar Schiotz (tonometer), Karl Koller (cocaine anesthesia); Jules Gonin (retinal surgery); and Carlos Finlay (transmission yellow fever by mosquitoes.
Conclusion: Ophthalmologists are an amazing group of individuals and the understanding and treatment of ocular disorders has benefitted enormously from the scientific advances contributed by them and other recipient of the Nobel Prize.
Tianrong Miao and the First School of Ophthalmology and Optometry in China
Chi-Chao Chan, M.D., Tiantian Ye, M.D. and Fan Lu, M.D.
Purpose: To report the life and contribution of Prof Tianrong Miao, the creator of the Standard Visual Acuity Chart used in China and the four of the first Chinese Ophthalmology and Optometric School.
Methods: Literature search on articles and artifacts by Prof. Tianrong Miao; personal interviews and communications with Prof. Miao's colleagues, friends and family; visit School of Ophthalmology and Optometry, Wenzhou Medical University.
Results: Prof. Tianrong Miao (1913-2005) is the creator of the Standard Visual Acuit Chart that became the standard vision chart in 1984 and was widely used throughout the country by 1990. The chart will be discussed. The history of he Wenzhou Medical University, and the School of Ophthalmology and Optometry, the first of its kind in China will be discussed.
onclusion: Prof. Tianrong Miao created thewidly used standard visual acuity chart in China and is considered the founder of the Ophthalmology and Optometry School in China.
The Earliest Clinical and Histopathological Descriptions of the Aging Macular Disorder (AMD)
Paulus T. V. de Jong
Introduction: For a long time, I had assumed that the earliest descriptions of AMD, known by other names as well, were by Hutchinson who wrote in 1874: "Symmetrical central choroidal-retinal disease occurring in senile persons." Pagenstecher and Genth are credited with having shown the first histopathology of AMD in an eye with adherent leucoma in their atlas of 1875. Haab (1885) coined the term senile macular degeneration while Junius and Kuhnt are well known for having described disciform AMD in their monograph in 1926.
Methods: A literature search, mostly European, on the original descriptions of AMD.
Results: In 1855 Donders had already described both retinal pigment epithelial atrophy and also macular degeneration associated with drusen in older individuals. Donders mentioned that he had no data on the visual functions of the eyes that came to his laboratory. A previously unknown description of the symptoms and signs of AMD in a 64 year old woman was published in 1868. Six years later a follow-up of this patient was provided, together with the histopathology. The descriptions of these two authors will be demonstrated. Indeed, Junius and Kuhnt described disciform macular degenerations, but not in association with drusen or AMD. Others wrongly stated that they had described senile disciform macular degeneration.
Conclusions: The first descriptions of AMD appeared 20 years earlier than had been assumed. Junius and Kuhnt only described disciform changes in the macula.
Not To Be Forgotten - Thomas Hall Shastid, M.D. (1866 - 1947)
Ira Eliasoph, M.D.
None of the Ophthalmic Historians with years of work and writing, including members of the Cogan Ophthalmic History Society, can match the productivity of our predecessor Thomas Hall Shastid. The extent of his output and the broad range of his subjects is awesome. Frank Newell called him "America's Forgotten Historian of Ophthalmology", but he is Not to be Forgotten. Thomas' father was a physician and his family in Pittsfield, Illinois, hosted Abraham Lincoln on many occasions. Thomas practiced ophthalmology for many years. The American Encyclopedia of Ophthalmology, edited by Casey Wood, contained three thousand entries provided by Shastid. Educated in law, he was a member of the Michigan Bar and Federal Courts. He translated vonHelmholtz's paper on Augenspiegels - or Ophthalmoscope - into English, and Daviel's description of the first actual removal of a cataract from French into English. His paper, "Our Own and Our Cousin's Eyes, is a thorough, learned and thoughtful comparative anatomy. His sixty-four page piece, "Light - the Raw Material of Vision", from 1936 remains a remarkable, insightful, document.
Eye Surgeons Who Became Generals and Admirals
Robert W. Enzenauer, M.D., MPH, MSS, MBA
Purpose: To describe some unique military ophthalmologists.
Methods: Internet searches of civilian and military databases.
Results: Since the American Civil War, 22 ophthalmologists have risen to the "flag rank" of general/admiral, including ten (10) army officers, seven (7) air force officers, and five (5) naval medical officers. One eye surgeon became Surgeon General. Two major academic leaders became general officers in the Reserve Component after wartime military service. Three surgeons served as "General Officer of The Line" in Non-medical leadership positions.
Sympathectomy for Glaucoma: Its Rise and Fall (1898-1910) P*
Robert M. Feibel, M.D.
Purpose: To review and evaluate the use of excision of the superior cervical sympathetic ganglion as a treatment of glaucoma from 1898 to 1910.
Methods: The worldwide literature about sympathectomy for glaucoma was reviewed and the key articles summarized and evaluated.
Results: The influence of the autonomic nervous system upon intraocular pressure (IOP) has been the subject of intense interest since 1727, when the first experimental oculosympathetic paralysis was produced in dogs. By the middle of the nineteenth century, it had been documented that cutting the sympathetic nerve chain lowered IOP, and that electrical stimulation of the chain increased IOP in various animals. From these observations, it was thought that such extraocular surgery could replace or supplement the available operations for glaucoma of which iridectomy was the most popular. Iridectomy was acknowledged to be of great value in acute and subacute glaucoma, but much less use in chronic glaucoma. However, iridectomy was associated with significant surgical complications and long term failure, so that the appeal of a remote operation which avoided intraocular manipulation was considerable. Beginning in 1898, sympathectomy became a widely performed operation around the world, with most surgeons very enthusiastic about its results, at least initially, and many publications from 1898 to 1905 claimed excellent results. Opponents of the procedure emphasized that the effect on IOP was transient, and documented that the cases published were biased by short term followup and inadequate clinical data. The popularity of this operation gradually diminished by 1910 as more effective surgical techniques such as filtering surgery and cyclodialysis were developed.
Conclusion: The reasons that cervical sympathectomy received such initial enthusiasm, but then was questioned and discarded, are evaluated. Reasons included bias from the surgeons promoting this surgery, placebo effect on the patients, short term followup, inaccurate and variable measures of the surgical results, and development of more modern and effective procedures.
James Elzar Lebensohn: A Universal Man Worthy of Being Remembered
Gerald Allen Fishman, M.D. and Marlene Fishman
Purpose: Beginning with a biographical overview of the personal and academic histories of Dr. James Lebensohn, homage to his eclectic interests and contributions to the field of ophthalmology will be summarized with attention paid to the unique features of his innovative near-vision chart that has been utilized by visual practitioners since its development in 1936.
Dr.Lebensohn's numerous publications bare witness to his vast scholarly knowledge of a wide spectrum of ophthalmic diseases, evidencing his creativity, industriousness, clinical acumen, and commitment to advancement of treatment options for the visually impaired. Also apparent from his publications is a dedicated interest in ophthalmic history.
Methods: Extensive review of journal articles, family pedigree, newspaper clippings, obituaries, and a discussion with an elderly contemporary of Dr. Lebensohn.
Results and Conclusions: The presenter will substantiate the justification that James Lebensohn has made numerous contributions to the field of ophthalmology on a wide variety of topics including both clinical ophthalmology and ophthalmic history. He is indeed a man worthy of being remembered.
The Slow Adoption of Surgical Gloves
Ronald S. Fishman, M.D.
Purpose: Lessons about innovation in Medicine can be had from observing the travail associated with the use of gloves in surgery.
Methods: Consultation with contemporary articles, later books, personal communications and recollections.
Results and Conclusion: To be held in reserve for the actual presentation at the meeting.
Professor A. Franceschetti (1896 - 1968) - A Tribute to my Father
Albert Franceschetti, M.D., FRCOpht
Purpose: To remind that the XXth century was the basis of the development of modern ophthalmology. Professor A. Francheschetti was one of the founders of Genetics in Ophthalmology and also promoted several of today's techniques, such as keratoplasty, fundus photography, fundus coagulation, orthoptics, etc.
Methods: The paper is based on a review of the last 100 years of ophthalmology and on the remembrance of my personal conversations with my father. It also researches why the department he headed up to 1996 began to decline after his death and is now headless, the last director having been dismissed quite recently.
Results: Thanks to Franceschetti's achievements, the Geneva Department of Ophthalmology became one of the best known of his time. The reasons why will be discussed. And also why the department failed to continue in his tradition.
Conclusion: In the last decades of the XXth century a trend has become noticeable in Europe whereby strong personalities are not necessarily chosen for university jobs as hospital managers and politicians tend to prefer office holders they can control.
From Hirschberg to the two European Societies of History of Ophthalmology
Albert Franceschetti, M.D., FRCOpht
Purpose: To present to our American Colleagues the birth of the both French and the German Society of the History of Ophthalmology
Methods: A review of the history of these two societies and of the documents they produced.
Results: The French and German societies have managed to collect a large amount of historical data. They usually meet in places of great historical interest.
Conclusion: The sharing of experience between these two societies and the Cogan society and some form of collaboration should bring about a world recognition of the importance of history in the continuous education of ophthalmologists.
Guide Horses: An Alternative to Guide Dogs
Alice ("Wendy") T. Gasch, M.S., M.D.
Purpose: To provide an overview of the use of minature horses as service animals to facilitate the mobility of visually impaired individuals.
Methods: Review of material on the internet and in print, and personal communications with relevant organizations.
Results: In 1998, while horseback riding in New York City, Janet and Don Burleson of Kittrell, North Carolina, were amazed at how calmly and facilely their mounts dealt with chaotic Manhattan traffic. Thus the seed was planted for the establishment of The Guide Horse Foundation, the only organization in the U.S. to train and provide miniature horses as service animals to facilitate the mobility of visually impaired individuals. Their successful, and confirmed, feasibility study in 1999 led to the first use, in 2002, of a miniature horse as a guide animal by a blind individual. There are many reasons to use miniature horses as guide animals, including their natural guide instinct, docile nature, remarkable memory, excellent vision, strong focus that is not easily distracted, natural propensity to choose safe routes, stamina, long lifespan, cleanliness, lack of fleas, and limited shedding (biannually). In addition, miniature horses can be trained to be housebroken and to ride in various passenger vehicles, including airplanes, and to negotiate elevators, escalators, and stairs. They also can be trained to disregard commands from their handlers that would be unsafe for the guide horse or handler. Miniature horses are especially appropriate guide animals for individuals who love horses or who have an allergy or phobia to dogs, or difficulty with dealing with the grief of losing animals, or certain disabilities. Furthermore, feeding a guide horse costs a maximum of about $1.25 per day. Moreover, as of 2011, miniature horses and dogs are the only animals that legally qualify as service animals. However, use of miniature horses as guide animals is not without drawbacks and controversy.
Conclusion: Minature horses can safely, cost-effectively, and reliably facilitate the mobility of certain visually impaired individuals.
The Quest for a Medical Treatment of Cataract
John W. Gittinger, M.D.
Purpose: Introduction: A non-surgical cure for cataracts remains a Holy Grail of ophthalmology.
Methods: Historical approach, resources: The ophthalmic and popular literature.
Results: Summary: Two New York City professors pursued this Holy Grail in the first half of the 20th. century. Dr. Achilles Edward Davis (1866-1941) developed "lens antigen" that was prepared by the H. K. Mulford Company on its campus outside of Philadelphia. He was convinced that a course of fifty injections of the substance halted or reversed senile cataracts. In his writings he approached his subject with a messianic zeal. By contrast, Dr. Daniel B. Kirby (1891-1953) studied another medical treatment of cataract - "ionization" - and concluded that it was of no value.
Conclusion: In the 21st. century there are still those who think they have found a medical cure for cataract, notably Dr. Marios Kyriazis, a British "Bio-gerontologist" who advocates "the new Russian breakthrough N-acetylcarnosine." The quest goes on.
St. Dunstan's: Hostel for Blinded Servicemen
Richard Keeler
Introduction or Purpose: Much has been written about the First World War that started 100 years ago. British servicemen who were wounded in the trenches of this cruel war returned home to find that little had been prepared for them in their new plight. The exception however was for those who were blinded and this was due to one man. This talk records the life of an extraordinary entrepreneur and philanthropist, Sir Arthur Pearson, who founded St Dunstan's in 1915 to look after the welfare of these men.
Historical approach or resources: The request for a photograph of Sir Arnold Lawson, an ophthalmologist, who worked voluntarily at St Dunstan's during and after the war, came from the author of a biography on Sir Arthur Pearson published in 2009. The introduction to this book and Lawson's own retrospective account in 1922 of St Dunstan's proved a rich source of material for the subject of this paper.
Body of paper: The book, Father of the Blind, recounts how Pearson built up a newspaper and publishing empire only to lose his sight at the age of 48 at the peak of his career. Not to be daunted he devoted his considerable talents to found a hostel where blinded servicemen would be welcomed and learn to be blind. That hostel was St Dunstan's. It was here that the servicemen were trained in Braille and a whole range of occupations.
Summary or conclusion: Without the drive and brilliant administration of Sir Arthur Pearson in his second career, many young blinded servicemen would have faced a dismal future. St Dunstan's thrives today and is now called Blind Veterans UK.
Borri, the Prophet, on Lens Aspiration and the "Restitutio Humorum" in the 17th Century
Hans-Reinhard Koch, M.D.
Purpose: To trace the life and ophthalmological achievements of the Italian physician, alchemist, prophet and founder of a sect, Giuseppe Francesco Borri (1627-1695)
Historical Approach: Research of the contemporary literature by and about Borri.
Results: The son of a renowned Milan physician, Borri was educated by Jesuits in Rome. After experiencing an epiphany of St. Michael he became a prophet and founded a sect. Persecuted by the inquisition and condemned to death he fled to Strasbourg, later to Amsterdam, Hamburg and Copenhagen. In each place he started with the highest protection but was later expelled. On his last journey from Copenhagen to Istambul he was taken captive in Austria and extradited by the Emperor to Rome where he died a papal prisoner.
In Amsterdam Borri cut open the eye of a dog, expressed the lens together with the aqueous and vitreous, installed a liquid and showed that the eye regained its shape and the humors were reformed. He later repeated his experiment in Copenhagen on a goose. Borri's experiment was widely discussed by the 17th. century scientific community. In Copenhagen he also claimed that it was possible to aspirate the lens through a cannula, after mashing it up with a brush of metal wires, which was inserted into the eye through the cannula.
Conclusions: Thus, Borri was one of the first to show that the three "humors" - aqueous, lens and vitreous" - were not needed for seeing. He envisaged the techniques of small incision lens removal after intraocular lens destruction and of lens replacement by surgery, ideas that were realized 300 years later by Kelman and Ridley.
The First Cataract Surgeons in Anglo-America
Christopher T. Leffler, M.D. with Stephen G. Schwartz, M.D.; Andrzej Grzybowski, M.D. and Puneet Braich, M.D.
Purpose: We tried to identify the earliest cataract surgeons in the English-speaking ares of America.
Methods: In 1751, couching was performed on the Caribbean island of Montserrat by John Morphy. William Stork of England, who couched cataracts, practiced in Jamaica in 1760 and then in the cities from Annapolis to Boston between 1761 and 1764. Frederick William Jericho of Germany, upon completion of his training at Utrecht, published his 1767 treatise on his preferred surgical technique of extra capsular extraction. Jericho had practiced in the Leeward islands by 1776 and then in the cities from Charleston to Boston between 1783 and 1785. The French surgeon Lewis Leprilete was the first to advertise cataract extraction in the United States in 1782 and probably passed on the skill to his protege, Nathaniel Miller of Massachusetts. Leprilete was also the first to publicize Benjamin Franklin's invention of bifocals.
Conclusions: These pioneers exposed American doctors and the public to cataract surgery. Shortly after their arrival, evidence emerges of other surgeons performing these procedures in America. P*
Published as: Leffler CT, Schwartz SG, Grzybowski A, Braich PS. The first cataract surgeons in Anglo-America. Survey of Ophthalmology 2015; 60:86-92. PMID 25444521
The New York Ophthalmic Hospital's Early History
Charles Letocha, M.D.
Purpose: Since the meeting will be held in New York City, I felt a history of a little-known ophthalmic institution in that city would be an appropriate topic.
Methods: Since no study of this institution has been done previously, I have relied on primary source material: annual reports, newspaper articles and advertisements, journal articles, interviews with descendants of the founder, etc.
Results: This hospital was founded at a time of great need for ophthalmic services, as New York's population was burgeoning with immigrants from abroad as well as other parts of the United States. It also was in existence at the time of the battles between allopathy and homeopathy and its board of directors replaced the allopathic physicians with homeopaths in 1867. The institution survives today as the ophthalmology department of the New York Medical College in Valhalla.
Conclusion: The New York Ophthalmic Hospital, founded in 1852, was a source of eye care for thousands of patients for many decades. It was front-and-center in the tension between allopathy and homeopathy and is instructive how, even in the 19th. century, politics played a large role in medical care.
James Watson White, M.D.: Strabismologist Par Excellence and Former Chair of Ophthalmology at Columbia University
Donelson R Manley M.D. with Rizwan Alvi, M.D.
Purpose: To review the career of James Watson White who was one of the foremost strabismologists of the last century.
Methods: Reviewing his many articles, the obituary written by Dr. John Dunnington and contacting Columbia University.
Findings: James Watson White was born in New Hamburg, New York in 1877. After receiving his MD agree in 1905 he spent eight years in general practice in New York and then decided to specialize in ophthalmology. In 1914 he joined the practice of Dr. Alexander Duane and the association continued until Duane's death in 1926. He then continued the teachings of Duane and became widely know as a result of his teachings and expertise in consultations. He was interested in the Inferior Oblique and popularized operating the muscle at its insertion. This is the preferred technique today. With the coming of World War II there was a need for physicians. Although he was past the retirement age he accepted the position of Chair of the Department of Ophthalmology in 1939. He continued in this position during the war. He died in 1946 from a cerebral hemorrhage
Conclusions: James Watson White is remembered today for his many interesting articles and for popularizing operating the inferior oblique at its insertion.
The Dark Side of Those who Guard the Light: Ophthalmologists in Crime
Mark J. Mannis, M.D.
Purpose: To review the history of ophthalmologists who engaged in criminal activity.
Methods: Examination of historical texts. public legal transcripts, newspaper articles, and records of the American Board of Ophthalmology.
Findings: Although generally a noble profession that is practiced by high-minded and dedicated physicians, ophthalmology has been tainted on occasion by a few individuals who have engaged in unethical or blatantly criminal activity. In this paper, we review examples of ophthalmologists from the 18th. century to the present who committed indiscretions ranging from simple immoral behavior to serious crimes. These have included quackery, political crimes, crimes of greed, crimes of passion, crimes of lust and crimes of sheer stupidity. Virtually all of these individuals were outside the norm of ophthalmic practioners.
Conclusions: Ophthalmology is a noble specialty in medicine, which deals with the treatment of vision loss - one of the most significant fears of patients. As such, the ophthalmologist commands respect and power and is generally well remunerated for services. For a small minority, these rewards have led to abuse and misbehavior.
Rudolf Virchow's Medical School Dissertation on Rheumatism and the Cornea: An Overlooked Tribute
to the Cornea in Biomedical Research?
Curtis E. Margo, M.D. and Lynn E. Harman, M.D.
Purpose: To critique Rudolf Virchow's medical shoot dissertation on rheumatism and the cornea, and to determine whether it might have anticipated his remarkable career in medicine.
Method: Review of the English translation of Rudolf Virchow's de Rheumte Praesertim Corneae written in 1843.
Results: The dissertation is over 7000 words long. Virchow believed rheumatism was an irritant disorder not induced by acid as traditionally thought but probably by albumin. He concludes inflammation is secondary to the primary irritant, and that the "seat" of rheumatism is "gelatinous" (connective) tissue, which includes the cornea. He divides rheumatism of the cornea into several varieties. The outcome of keratitis is mutable as it encompasses various forms: "scrofulosis, syphilis, or arthritis of the cornea."
Conclusions: Virchow's dissertation characterizes rheumatism in terms of chemical and tissue interactions that make little sense based on today's knowledge of rheumatic disease and keratitis. Ironically, many of these concepts were eventually made obsolete by the cellular model of disease that Virchow enthusiastically championed. Virchow decided to pursue the study of rheumatism through the cornea because he thought the cornea was an ideal tissue to study disease. This discernment was passed on to future students whose seminal contributions to general pathology were based on research with the cornea. Whether Virchow's insight into the importance of the cornea in biomedical research at such an early stage of his career could have predicted his monumental contributions to medical science is debatable.
The Amazing Pinhole
Harry H. Mark, M.D.
Purpose: To expound on the development of our understanding of the images formed by pinholes, and similar small apertures, on the way to enhancing knowledge of visual perception.
Method: Search of archival resources together with actual visual experiments with single and double small apertures.
Results: Pinhole images cast on the back wall of a dark cavity are inverted and independent of the shape of the aperture, contrary to direct vision through these apertures. Double pinholes offer insight into refractive errors and the mechanism of accommodation.
Morbid Sensibility of the Retina
Michael F. Marmor, M.D.
Purpose: Few today are aware of this "disorder." It was well known in ophthalmic practice in the United States during the early 1800s, and was alluded to (sometimes by different names) in textbooks at the time. More detailed description will be deferred until the presentation, but I can tell you that it still challenges us today to clarify this disorder.
Methods: . A limited review and search of early materials was made, but the primary sources were a book on the subject by John Dix, a lengthy NEJM article by George Bethune, and discussion in famous British texts such as MacKenzie and Travers.
Results: This disorder was minimized in British texts, leading one author to consider it more prevalent in the United States. A number of case examples will be presented, along with the historical interpretation, and definitive management (including control of light, nostrums, blistering, leeches, and plenty of purgatories). You can judge for yourself whether these might continue to have value, in our modern interpretation of the symptoms and etiology.
Conclusions: This wonderfully-named condition reminds us of how medicine struggles to find commonality in ill-defined disease, and how certain symptoms are by nature difficult to manage. Was this a disorder of the new World, or a symptom itself of medical perspective? But a spoiler warning: you will see this condition in your practice.
Devices and Aids for the Teaching and Demonstration of Ophthalmoscopy in the 19th Century
Ian L. McAllister, M.D.
Purpose: This presentation will review the development of the devices and aids involved in the teaching of ophthalmoscopy following the invention of the ophthalmoscope in 1850.
Methods: Historical monographs, instrument instructional literature produced by various inventors, information from catalogues of the day, Der Augenspiegel by Alfred Schett, Liebreich and Follin atlases.
Results: The invention of the ophthalmoscope by Hermann von Helmholtz in 1850 is rightly regarded as one of the major achievements in medicine in the nineteenth century despite the fact that only very skilled practitioners were able to see the fundus with this original instrument. Subsequent modifications by Adolph Coccius and others greatly improved its practicality but overall the ophthalmoscopes of the nineteenth century remained difficult to use due to the poor illumination devices of the day, small mirrors used to reflect the light into the eye and inadequate mydriatic agents. Direct teaching of ophthalmoscopy on patients under these circumstances was challenging and various devices and aids were utilized to enable students to acquire the basic principles and skills, and to identify disease characteristics. The various aids and devices available for this can be divided into a number of broad categories.
-Stand ophthalmoscopes.
-Demonstration ophthalmoscopes both stand and hand held
-Atlases of fundal disorders.
-Model or Mannequin eyes.
-Ophthalmoscopes which because of their unique design were remarkably
easy to use compared to others of the day.
Conclusion: This paper will document the development of the various devices and aids utilized in the teachings of ophthalmoscopy. These include instruments that allowed an observer to view the image. Instruments that because of the design allowed a stabilized image or superior illumination and a fixed working distance, atlases that demonstrated the disorders to be seen in the eye and finally practice models that replicated the optical characteristics of the eye and allowed the refractive characteristics and fundal images to be interchanged.
The Ophthalmologist Joseph Schneider, M.D. (1845 - 1927) - a Fascinating German-American Career
Andreas Mettenleiter
Purpose: The biography of the poor Silesian orphan Joseph Schneider who ended his life as a wealthy ophthalmologist in Wisconsin reads like a modern fairy tale - or an impressive example of the "American Dream". It took me about twenty years to trace this extraordinary life between both continents and to prove that the nearly forgotten "fairy tale" relies on hard facts.
Methods: Various archives in Würzburg, Berlin and Milwaukee as well as many printed sources were screened. (The most interesting findings were encountered coincidentally in the most unexpected places!).
Results: Thanks to the Würzburg ophthalmologist Professor Robert von Welz, the penniless Joseph Schneider was able to study medicine and work as an assistant to his teacher. After the death of his mentor in 1879, he met a rich American eye patient whom he accompanied to the United States. Schneider settled in Milwauke and got married where he earned a fortune as a renowned ophthalmologist. Thankful to his studies in Würzburg and his new hometown Milwaukee he donated unbelievably high sums of money and financed, among others, a street car line to the new university clinics in Würzburg.
Conclusion: Joseph Schneider, a great benefactor both to Würzburg and to Milwaukee, has unjustly fallen into oblivion. Combining the traces he left in Germany and in the United States, his fascinating biography could be largely reconstructed, even if some questions still remain.
Unusual Posterior Synechiae on the Bust of Peter the Great in the Russian State Museum, Saint Petersburg, and Their Legend
J. Fraser Muirhead, M. D., CM, FRCS
Introduction: The preparatory bust of the head of Peter the Great's big bronze monument in St. Petersburg was created by Marie-Anne Collot, age 22, who had been brought to Russia from Paris by Etienne-Maurice Falconet, a prominent French sculptor 32 years her senior, to help him with the task of creating the huge monument. This bust has heart-shaped pupils. This sculptural feature has given rise to a romantic legend for their origin that involves closely interrelated lives of these two French immigrants to Russia. Their biographies, and those of their associates, will be briefly presented. The legend giving rise to these bizarre synechiae will be described and presented.
Methods: Examination of relevant literature and evaluations of physical objects photographically and in-situ.
Results: The two principals lived together in St. Petersburg for about twelve years. Colette eventually married Falconet's son and bore a daughter. After they returned to France, she and her husband separated. She then lived with her mentor for many years, even after his massive stroke, until his death. In addition to Falconet's creation of a major symbolic St. Petersburg and Russian monument, he was also a figure in French intellectual circles of the late 18th. century. His difficult personality, however, made unstable relationships with his associates. Catherine did not invite hm to the unveiling of his enormous monument. Diderot eventual turn against him. But not Collot.
Scant study of pupils in sculpture exists. Before and during Falconet's and Collot's time, the usual practice appears to have been to other cut out a round or somewhat oval depression leaving a residual wedge superiorly to represent a corneal reflex, or to leave the eyes blank. I've found no other cardio-form pupils save Falconet's in the head of the bronze monument of Peter.
he Russian legend has it thats Collot made Peter's pupils her shaped as an expression of her love of Falconet.
Although the artist's daughter preserved many papers in her mother's estate, including letters of Tsarina Catherine, of Denis Diderot, of Voltaire and of Falconet, she destroyed all of her mother's. Forming a definite conclusion about the legend is thus severely hindered.
Conclusion: The legend of the origin of Peter the Great's deformed pupils as an expression of romantic love, although based on only circumstantial evidence, is charming and worthy of continued circulation.
Vesalius: 500th Anniversary of the Birth of the Author of The Fabrica. Early Practical Understanding of Head and Neck Anatomy
Steven A. Newman, M.D
Introduction: Although the Greek School of Medicine in Alexandria had studied practical anatomy, much of the Middle Ages and into the early Renaissance were dominated by the teachings of Galen (from the second century A.D.). Practical experience in anatomy was extremely limited. In early 1914 William Osler and one of his former students and colleague, Harvey Cushing, planned a 400th year meeting in Louvain, Belgium to celebrate the birth of Vesalius who 29 years later was to revolutionize the understanding and study of anatomy with the publication of the Fabrica.
Materials and Methods: Although the Fabrica has been the foundation of our understanding of anatomy, until the last few decades this was available only in its originally published Latin. The recent publication of two English translations of both the first and second editions of the Fabrica has permitted a better understanding of Vesalius' contributions to the evolution of our understanding of anatomy.
Results: Unfortunately, Osler and Cushing's quasar-centennial had to be cancelled because of the advent of the First World War (the Germans were in Louvain). A subsequent conference in Boston on the contributions of Vesalius barely scratched the surface of what was available. Although the spectacular dissection and plates demonstrating the bone and muscle system are well known, until their final destruction in Germany during World War II, the advance in understanding of head and neck anatomy was far less known. We will review the text and illustrations made by Vesalius on head and neck anatomy of consequence to the practice of orbital facial surgery.
Conclusions: This year marks the 500th anniversary of the birth of a remarkable physician and anatomist who, in his original dissections and spectacular plates, set anatomy on practical understanding. For those of us who practice a surgical subspecialty, surgery will always be anatomy plus hemostasis.
Management of Pterygium over the Centuries
VK Raju M.D, F.R.C.S., F.A.C.S., Leela V. Raju, M.D., Ahmad Kheirhah, M.D., and G. Madhavi, DNB
Purpose: To present the surgical procedure for pterygium in Sanskrit the literature as described by Susruta.
Methods: Review of the Sanskrit and English literature.
Results: In spite of extensive research and publications over the centuries, surgical management of pterygium remains daunting. The author's experience will be presented.
Conclusion: For centuries multiple procedures have been advocated for the excision of pterygium. While methods are varied, only time will tell if the PERFECT method is still the ideal one.
Purloined Parts
James G. Ravin, M.D.
Purpose: To describe several anatomic specimens that no longer rest with the remains of some notable individuals.
Methods: Searching the literature identifies several curious bits of absconded anatomy described in books, journal articles and even auction catalogs.
Results: Albert Einstein's eyes were removed during his autopsy in 1955 and were owned for a long time by his ophthalmologist in Princeton, New Jersey, Henry Abrams, M.D. Abrams is no longer alive, but the eyes are rumored to be in a safety deposit box in New York City. A particularly private part of the anatomy of Napoleon Bonaparte was removed from the rest of his body by his physician, Dr. Francesco Antomamachi in 1821. It was purchased at auction by a famous collector, Dr. A. S. W. Rosenbach and later was owned by the well known urologist at Columbia Presbyterian Medical Center in New York City, John Latimer, M.D. The middle finger of Galileo's right hand is preserved in a science museum in Florence, Italy. A large portion of the skull of a Chinese man said to be Confucius was made into a work of jewelry and was described at a meeting of the Ethnological Society of London with Thomas Huxley presiding, in 1861. It had been taken from the Imperial Summer Palace during the Second China War of 1860 and the gold ornamentation was melted down.
Other anatomical specimens are still known, including Dalton's eyes and Mohammed's whiskers. The brains of Einstein, Helmholtz, Lenin and Stalin have been studied too, but the results have been more curious than edifying.
Expanding a Cogan Society Paper into a Book (and Getting it Published) Days of Ticho: Empire, Mandate. Medicine and Art in the Holy Land
David Reifler M.D.
Purpose: To describe the process of expanding a previous 2008 Cogan Ophthalmic History Society paper about Avraham Ticho into a publishable book of biography and history. To present some of the additional research of sources and themes which connected islands of details into a smoother narrative with a consistent voice and a potentially wider audience.
Methods: After establishing a personal, biographical chronology, research into important institutions, events, and personalities was undertaken at various levels in order to understand the life and times of the protagonist. Sources included translations of primary source material, family histories and interviews, many newspaper articles, biographical and encyclopedic works etc. With the help of Dr. Don Blanchard, an English translation of an important article of particular historic importance - one doubly published in German and Hebrew - was included as an appendix. The rejection of a synopsis by an academic publisher led to additional writing and search for a commercial publisher. Acceptance of a submitted manuscript and the negotiation of a contract was followed by even more writing as suggested by the first editor, numerous smaller revisions by a second editor, production of a map of Jerusalem, and the gathering of copyrighted images and permissions.
Results: Published in English by Gefen Publishing House, the book's title was chosen to reflect the expanded themes: Days of Ticho: Empire, Mandate, Medicine and Art in the Holy Land (500 pp, including notes, bibliography, and index). The fruits of archival research in Vienna and Prague provided an interesting picture of Dr. Ticho's medical curriculum, training in ophthalmology, instructors and where he lived in those cities. Microfilmed and digitized newspapers in Hebrew were valuable sources of information about Ticho's practice and wartime conditions during the last years of the Ottoman rule in Jerusalem. Ticho's later open support for forensic studies of Hebron massacre victims and the archived reports of those studies shed light on the origins of the Arab Israeli conflict that continues to this day.
Conclusion: The Israeli launch of the book took place in Jerusalem at a historic venue in Jerusalem on January 15, 2015 and the U.S. launch took place last week on March 22nd in Grand Rapids, Michigan. The legacy of Dr. and Mrs. Ticho will continue with the reopening of the Ticho House in Jerusalem this spring after a nine-month renovation project.
Disclosure: The author has an interest in the proceeds from the sales of Days of Ticho.
The Eyes of Alice: From Eleanor of Aquitaine to Todd's Syndrome
Ivan R. Schwab, M.D.
Purpose: To understand the ocular diseases and influences on the story of Alice in Wonderland as first told to Alice Liddell in 1862.
Methods: Review of literature including Alice in Wonderland by Lewis Carroll, Through the Looking Glass by Lewis Carroll, The Seven Sisters of Sleep by Mordecai Cooke, Parallel Alices by Christopher Tyler, Hallucinations by Oliver Sachs. Phi: A Voyage from the Brain to the Soul by Giulio Tononi, and historical information from Charles Dodgson found on the internet at various sites such as the LewisCarrollSociety.org.uk.
Results and Conclusions: To be presented at the meeting.
A Brief History of Ophthalmic Genetics
Pamela C. Sieving, MA, MS, AHIP
Purpose: To explore the history of knowledge of genetic eye disease, from early concepts of disease transmission in families to current gene therapy.
Method: Searches of both the journal and monographic ophthalmic literature.
Results: Eye diseases were some of the first to be observed in families; ophthalmic genetic researchers and clinicians continue to play a leading role in developing knowledge of genetic diseases and their treatment.
Abstract: Observations of familial occurrence of eye diseases go back to early Biblical writings, as well as those of Hippocrates, Plutarch and Aristotle. In the 18th century, the pace of these observations quickened; they were documented in the new medical journals as well as in monographs, and reported at medical society meetings. All parts of the eye were observed to be affected by familial diseases. Gene therapy for ophthalmic diseases became a reality at the beginning of the 21st century. The genes and mechanisms of ophthalmic diseases continue to be discovered at a higher rate than that of any other organ.
Page last updated April 1, 2021