26th Annual Meeting Abstracts-2013-Kansas City, Kansas
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.
The Inaugural Meeting of the Cogan Ophthalmic History Society of 1988
George M. Bohigian, M.D.
Introduction or Purpose: To review and document the genesis of the Cogan Ophthalmic History Society
Historical approach or resources: Correspondence of David G. Cogan, M.D., review of the first program 1988, group photo of the first members, American Academy of Ophthalmology archives, and a letter to the editor of the Archives of Ophthalmology by James Ravin, M.D. and Ronald Fishman, M.D. (July 2009)
Body of Paper: This paper will present the original correspondence of Dr. David Cogan to Dr. Daniel Albert proposing a formation of a society to study the history of ophthalmology.
The first meeting was held in 1988 at the National Library of Medicine on the National Institute of Medicine Campus in Bethesda Maryland. It has been held on an annual basis without any lapses and the membership has grown from 22 to 60.
The Cogan Ophthalmic History Society provides a scholarly forum for presentation and discussion of research on the history of ophthalmology and its associated fields. Organized in memory of Dr. Cogan a pioneer in the study of history of ophthalmology, the society sponsors a yearly meeting.
Summary or conclusions: The origins of the Cogan Ophthalmic History Society are based on an idea by David Cogan, M.D. to help ophthalmologists be more aware of their heritage. P*
Early American Strabismus Surgery: 1840-1846, Part 2
Benjamin D. Currie, MD
Introduction: The development of effective surgical therapy for strabismus was one of the outstanding triumphs of 19th century ophthalmology, prior to the discovery of the ophthalmoscope in 1850. Priority for this belongs to Johann Friedrich Dieffenbach of Berlin in 1839. We explore six early American pioneers in this field during the time of the first burst of enthusiasm for this treatment.
Historical Resources: The main resources employed are the original publications by the surgeons themselves. Secondary sources were also consulted.
Results: Samuel David Gross (1805-1884), of the University of Louisville, in February 1842 delivered “A Clinical Lecture on the Nature, Causes, and Treatment of Strabismus,” reviewing his experience from operating on 33 patients. A renowned general surgeon, Gross was elected as one of the U.S. delegates to the First International Ophthalmological Congress in 1857.
James Bolton (1812-1869), after training at the New York Eye and Ear Infirmary, performed his first strabismus surgery in November 1840, two months after Dix. In 1842 he published “A Treatise on Strabismus with a Description of New Instruments Designed to Improve the Operation for its Cure, in Simplicity, Ease and Safety,” reporting universal success of surgery in eight selected cases of esotropia. Bolton later served as a general surgeon in the Confederate Army.
Frank Hastings Hamilton (1813-1886) of New York, published in 1845 his “Monograph on Strabismus,” detailing 59 of his surgical cases. Hamilton's work quantified four “degrees” of strabismus and suggested surgical approaches for each, frankly discussed surgical complications, and stressed the importance of long-term outcomes.
Conclusions: Of these six early American pioneers in strabismus surgery, Hamilton was most comprehensive in his approach and follow-up of his patients. Although early American surgeons were active in performing and reporting their experience with the surgical therapy of strabismus, they did not make any major advances in this field.
Part One: 1891 Thoughts on Cataract Surgery
Part Two: Father and Son Minsky
Ira Eliasoph, M.D., FACS
Part one is about an extraordinary letter to the editor, published in the American Journal of Ophthalmology in 1891 about what was and what was not done about cataracts. W. J. Lampton, The mysterious non- physician author was extraordinary.
Part two concerns the ophthalmologist Henry Minsky, his many talents and contributions, and his son Marvin Minsky, a true visionary, and inventor of the confocal microscope.
Edward Coleman Ellett, MD, 1869-1947, Physician, Citizen And Soldier
Robert W. Enzenauer, M.D., MPH
Body of Paper: Dr. Edward Coleman Ellett, was an internationally known ophthalmologist at the turn of the 20th century, who died as he lived – en route to yet another medical meeting. A superb clinician, noted scholar, and proud veteran, Dr. Ellett is a man little known today, but well known a century ago by most US ophthalmologists and nearly all Tennessee physicians.
Dr. Ellett died in Atlantic City Hospital, June 8, 1947, following an attack of coronary thrombosis, suffered on the train while en route to the Centennial celebration of the American Medical Association. During the previous week at the annual meeting of the American Ophthalmology Society in Hot Springs, Virginia, he had participated freely in discussions and seemed as usual.
Early American Strabismus Surgery: 1840-1846. Part 1 P*
Robert M. Feibel, M.D.
Introduction: The development of effective surgical therapy of strabismus was one of the outstanding triumphs of 19th century ophthalmology, prior to the discovery of the ophthalmoscope in 1850. Priority for this belongs to Johann Friedrich Dieffenbach of Berlin in 1839. We explore six early American pioneers in this field during the time of the first burst of enthusiasm for this treatment.
Historical Resources: The main resources employed are the original publications by the surgeons themselves. Secondary sources were also consulted.
Results: William Gibson (1788-1868), while Professor of Surgery at the University Of Maryland, in 1818 performed four cases of myotomy of the medial rectus muscle. In the last case, a severe secondary exotropia developed and, as a result, he did not pursue or publish his results until many years later, after Dieffenbach had published his successful cases.
John Homer Dix (1811-1884) of Boston was one of the first physicians in American to devote his practice to ophthalmology and otology. Dix was the only surgeon performing early strabismus surgery who was not a general surgeon with a passing interest in ophthalmic surgery. He performed his first myotomy for strabismus in 1840, the earliest case recorded on this side of the Atlantic. In 1841, he published his “Treatise on Strabismus” which was one of the earliest books on ophthalmology printed in America.
Alfred Charles Post (1806-1886) of New York was a general surgeon who wrote a small treatise on “Strabismus” in 1841. His text is notable for the colored illustrations executed by Nathaniel Currier before he became associated with Ives and developed the famous lithographic company which bore their names.
Conclusion: American surgeons were at the forefront in the surgical therapy of strabismus, but did not make any major advances in this field.
Eye Disease in the Old West
Ron Fishman. M.D.
Summary: In honor of our meeting at the origin of the Oregon Trail, this will be a brief survey of some of the eye problems encountered by these pioneers.
Sources include material from the archives of the Missouri Historical Society, the Kansas State Historical Society, and the Arkansas Historical Association.
Hermann Martin Burian M.D., the Gentleman of Amblyopia
Albert Franceschetti, M.D., FRCOphth.
Introduction : Hermann Burian was the heir of a long tradition of physiology of vision in Prague (Tschekoslovakia). His remarkable insight in amblyopia and binocular vision is still the basis of our strabismus knowledge, but not too many still know his influence on this subject.
Historical Approach or Resources: I had the chance to work with him for nearly three years. Documents have been obtained from the Department of Ophthalmology in Iowa-City. I have a full collection of his papers.
Body of presentation: His Life, achievements and papers will be presented, including the story of the Dartmouth Eye Institute, where he started his career in the United States. Later, at the Ophthalmology Department of Iowa, he developed the squint clinic and the electrophysiology department. He was also one of the members of the Squint Club. He always supported the orthopist profession and taught their course for many years. In addition, he was one of the early leaders of electrophysiology and the Secretary General of the International Association for many years.
Conclusions: Hermann Burian was the leader in physiology of vision, in particular binocular vision and amblyopia for many years. His influence on the strabismus specialists was major and should be acknowledged.
Lovers’ Eyes
Alice (“Wendy”) T. Gasch, M.S., M,D,
Introduction or purpose: …to review the history and purpose of “lovers’ eyes.”
Historical approach or resources: literature review
Body of paper: Miniature portraits incorporated into brooches and pendants were highly fashionable jewelry in 18th-century England. Late in the century, an unusual variation became popular: miniature paintings of eyes, usually watercolor on ivory, set as jewelry. Although originating in France, the popularity of the latter has been attributed to a scandalous affair between the Prince of Wales (later King George IV) and Maria Fitzherbert, a twice-widowed commoner. In 1784, when attending an opera, the Prince first encountered Mrs. Fitzherbert and became infatuated. According to British law, marriage of the two was illegal because Maria was Catholic. Nonetheless, the Prince made determined advances that initially were rebuffed. In 1785, he commissioned Richard Cosway, an eminent artist, to paint a miniature of his right eye, that was mounted in a locket and sent to Maria, along with one of many pleas for marriage. The eye miniature was intended to maintain secrecy of the love affair by not revealing the entire face and thus obscuring identification of the Prince. The following month the two clandestinely wed, and soon afterwards the Prince commissioned a miniature of one of Maria’s eyes, that he wore hidden under his lapel. Leakage of this story to the public led to a short-lived surge in popularity of eye miniatures. From 1790 until 1820, affluent individuals in England, France, and Prussia commonly commissioned eye miniatures – not just of secret lovers, but mostly of relatives and friends. One renowned artist, George Engleheart, was commissioned to paint eyes of entire families. Eye miniatures also were commissioned, though far less frequently, in America. Settings were decorative, functional, and often symbolic. Most eye miniatures were set as jewelry, including “mourning jewelry,” worn after a loved one’s death. They also were mounted in other objects, often ones intended to be worn or carried, such as snuff boxes, toothpick cases, and canes. Furthermore, some were painted on porcelain ware, such as teacups. Eye miniatures went out of vogue in the 1820’s, perhaps at least partly due to the Industrial Revolution, which made mass-produced jewelry readily available. Nevertheless, though out of style, eye miniatures of family and friends, many incorporated into gifts, were commissioned by Queen Victoria soon after being crowned in 1838.
Relatively recently, about 1970, Edith Weber, an antiques dealer, coined the term “lovers’ eyes” for eye miniatures. This term still is used to designate all eye miniatures, even though most portray eyes of loved ones, rather than lovers.
Today, eye miniatures from the Georgian and Victorian periods have significant value and thus have generated renewed production of eye miniatures – that are counterfeit. .
Thomas Young Revisited
John W. Gittinger, Jr., M.D.
Introduction or purpose: Dr. Thomas Young has been the subject of a prior presentation at this Society and a number of publications. He was, in fact, the cover person for the 2008 Proceedings. His scientific contributions were remarkable, but his reputation in his own time in England was far more modest than his accomplishments warranted.
Historical approach or resources: Even biographers who wrote soon after his death acknowledged the basic reasons for this lack of recognition
Body of paper: He had difficulty communicating his ideas in lectures, and he published much of his research anonymously. A catalogue of his accomplishments is truly astounding, leading a recent biographer, Andrew Robinson, to designate him, “The Last Man Who Knew Everything.”
Summary or conclusions: He was trained as a physician and tried to build a practice, but he never accomplished this, despite his attempts to hide his erudition because he thought this would alienate potential patients. He is the paradigm of an individual too intelligent to succeed at clinical practice. Fortunately the leisure this afforded him allowed him to exercise his phenomenal mind in other ways.
Justification: There is almost too much to say about Dr. Young.
The Helmholtz Theory of Accommodation: The Ciliary Muscle and the Lens
David G. Harper, M.D.
Introduction: Hermann von Helmholtz and Antoine Cramer, working simultaneously but independently during the early 1850s, proved that the anterior surface of the crystalline lens becomes more convex during ocular accommodation for near vision.
Resources: 19th- and 20th-Century Ophthalmic Literature
Summary of paper: This presentation outlines the struggle that took place in the middle of the 19th century to finally come to an understanding of the physiological changes that occur during the process of accommodation. In the decades leading up to 1850, there was a gradual acceptance by most investigators that the lens played a crucial role in accommodation. Beliefs that the corneal curvature was increased or that the eyeball was lengthened by simultaneous contraction of all of the rectus muscles, while still prominent, were fading. Concerning the role of the lens, some believed that it was a muscle and that it became thicker front to back upon contraction. Thomas Young closed out 18th century believing this to be true, though he failed to find any nerves leading to the lens. Many researchers, including both Young and ultimately Helmholtz, experimented with direct stimulation of the lens with electric current, but none of these attempts resulted in any change in its topography. A competing idea, held by William Clay Wallace in the 1830s and by William Bowman in the 1840s, was that the entire lens moved forward during accommodation, making any change in its topography unnecessary. Finally, during the early 1850s, Antoine Cramer and Hermann von Helmholtz would independently demonstrate, with instruments designed for the purpose, that the anterior surface of the lens becomes more convex during accommodation. Cramer, whose health had never been robust, died in 1855, thus ending his research career. By 1856, when Helmholtz published Volume I of his treatise on ocular physiology, he had repeated many of the experiments carried out by his predecessors, thereby satisfying himself that the lens was not a muscle, that corneal topography did not change, and the that the eyeball did not lengthen during accommodation. Moreover, he showed mathematically that the increase in plus power resulting from any forward displacement of the entire lens was significantly less than that required for sufficient accommodation to near objects.
Conclusion: By the mid-1850s, research into ocular accommodation by Antoine Cramer and Hermann von Helmholtz showed conclusively that during accommodation the front surface of the crystalline lens becomes more convex. Helmholtz satisfied himself that all other prominent theories of accommodation, such as forward displacement of the lens and lengthening of the eyeball by simultaneous contraction of all of the rectus muscles, were incorrect. He ultimately reasoned that ciliary muscle contraction pulled the base of the ciliary processes and zonular membrane complex forward, thus relieving centrifugal pressure on the lens equator and allowing the lens to become centrally thicker, resulting in the required increase in its focusing power.
The Snyder Lecture: The Origin of Viscosurgery
Danny Hirsch-Kauffmann Jokl, M.D.
Endre Balazs (b. 1920) while a medical student in pre-World War II Budapest, was fascinated with the extracellular matrix. He identified hyaluronic acid (HA) as a compound that had the property of stimulating regeneration of cartilage in injured dog knee joints, a discovery that led to its use in leg joint injury in race horses.
His findings drew the interest of Dr. Charles Schepens, a pioneer in the field of retinal detachment surgery and in the role of vitreous in its etiology. Balazs’ finding that human vitreous was composed of collagen and hyaluronic acid- the highest concentration in the human body – persuaded Schepens to recruit him to Boston as a research scientist at his newly founded Retina Foundation, to work on a replacement vitreous that Schepens believed would solve the problem of complex retinal detachments not then amenable to conventional retinal surgery.
After 10 years, a purified HA was obtained, received a patent, and was manufactured by Pharmacia, a small Swedish company. Initial clinical trials in this pre- vitrectomy era showed it to be effective as a vitreous replacement only in retinal detachments uncomplicated by adherent vitreous membranes though in these uncomplicated cases there was no clinical advantage to its use as a vitreous substitute. Its use in race horses’ leg joints proceeded until local steroid injections proved to be equally effective in temporary pain relief. Pharmacia intended to close its factory production due to lack of clinical use.
At that same time, intraocular lens use began, though with great controversy, due to the serious corneal endothelial complications that accompanied its surgical placement in the anterior chamber often requiring a later keratoplasty. Such a complication occurred in Boston where, serendipitously, Balazs’ vitreous substitute was employed successfully as an aqueous fluid substitute in the insertion of an intraocular lens. Controlled studies followed and with the obvious benefit of the purified HA, now named “Healon”, clearly apparent, Pharmacia quickly reversed its decision to cease its manufacture.
“Healon” became the mainstay for all anterior segment surgical procedures. Ironically, its initial use as a vitreous substitute was soon limited in the new age of vitrectomy surgery to an important but limited adjunct role.
Mansour F. Armaly, M.D., Founder of Glaucoma Service at the University of Iowa
John C. Lee, M.D.
Purpose: Mansour F. Armaly, M.D. was a pioneer in glaucoma research. The purpose of this paper is to depict his life’s events and his research enthusiasm that led him to become one of the most quoted researchers in ophthalmology and one of the world’s leading ophthalmologists.
Historical approach or resources: autobiographical notes, historical records, video recorded interviews of his contemporary faculty at the University of Iowa, internet
Body of paper: Mansour F. Armaly (1927-2005), son of a business man, was born in Palestine. In spite of the political unrest, he was able to complete his early education with honors and his medical education in Lebanon. During his third year of residency at the American University in Beirut, he became “obsessed” with the idea of doing research in ophthalmology which led him to the University of Iowa.
After fifteen years in Iowa, Dr. Armaly accepted the position of professor and Chairman of the Department of Ophthalmology at The George Washington University School of Medicine in Washington, DC. He served this position until his retirement in 1996.
Summary: Throughout his career, Mansour F. Armaly, M.D. made many contributions to the definition of glaucoma, the early detection of glaucoma, monitoring glaucoma patients for vision loss, the influence of steroids causing a rise of intraocular pressure in some patients (i.e. steroid responders), and the genetic associations of glaucoma. He trained many residents and fellows. The results of his research are invaluable today for the detection and treatment of glaucoma.
Evolution and Impact of Eye and Vision Terms in Written English.
Christopher T. Leffler, MD, MPH, Stephen G. Schwartz, MD, MBA, Russell Stackhouse, MD, Byrd Davenport, MD, Karli Spetzler, MD
Objective. To trace the evolution and impact of eye-related terms common in written English during the past two centuries by the study of digital resources.
Methods. Eye-related words and phrases (n-grams) occurring in English books at a frequency of 0.00001% for at least 25 years between 1790 and 2008 were identified from the Google n-gram database by searching for 254 strings such as “eye” or “ophth”. The first known English use of these n-grams was identified from historical articles and from multiple digital resources.
Results. Eye color was not commonly described as brown or green before 1840. Many common bigrams, such as bright eyes, suggested light emanating from the eyes, consistent with the extramission theory of vision. Based on word frequency, the impact of the revolutionary 1850 ophthalmoscope exceeded that of the stethoscope for sixty years. Glaucoma was not commonly written until the ophthalmoscope permitted visualization of the characteristic optic neuropathy. Green spectacles gave way during the early 1900’s to dark glasses, subsequently renamed sunglasses. Until the mid-1900’s, an eye surgeon was more often described as an oculist than an ophthalmologist, and inflamed eyes were said to suffer from ophthalmia more often than uveitis. Macular degeneration was rarely written about for over a century after 1850 because it was labelled choroiditis. Of the 135 n-grams in the dictionary, an earlier written instance was identified in 92 cases (68%).
Published as: Leffler CT, Schwartz SG, Stackhouse R, Davenport B, Spetzler K. Evolution and impact of eye and vision terms in written English. JAMA Ophthalmology 2013; 131:1625-31. PMID 24337558
George Berkeley and the New Theory of Vision
Presenter: Curtis E. Margo, M.D.; Co-author: Lynn E. Harman, M.D.
Introduction: Bishop George Berkeley (1685-1753) was a philosopher and member of the British empiricism movement during the 18th century. He was renowned for his radical views denying the existence of matter. Before Berkeley wrote his major works arguing that objects exist only in the mind, he publishedAn Essay Towards a New Theory of Vision (1709). The essay marked his precocious entry into an erudite group of natural philosophers, but as the age of science progressed, Berkeley’s reputation suffered because of his denial of matter.
Historical Approach: Review of Berkeley’s seminal works, with emphasis on the Essay Towards a New Theory of Vision.
Body of Presentation: Irish polymath George Berkeley’s most famous work Treatise Concerning the Principles of Human Knowledge, published in 1710, rejected material substances. For Berkeley, the physical world existed only in the mind. Since his Treatise was misinterpreted and ridiculed he published a second, more accessible book titled Three Dialogues Between Hylas and Philonous in 1713. This work clarified and solidified his thinking on Idealism, but the philosophical argument still left many academics and clergy bewildered. The controversy surrounding Berkeley’s idealism overshadowed his earlier work on vision, which dealt with the visual comprehension of space, form and orientation. Visual understanding of distance, for instance, was a learned experience through touch, which required integration of ideas. In other words, visual perception was inseparable from intellect. He dismissed the existing geometric explanation of “seeing” with a concept that considered sight as a combination of sensory reception and mental interpretation. Much of his early discussion about the interaction of tactile and visual senses, however, seemed to contradict his later work denying the existence of matter. These inconsistencies plagued Berkeley who was forced to deny or rationalize some of his vision theory.
Conclusions: Berkeley’s contributions to the British empiricism movement have been marginalized by his counterintuitive concept of physical matter. His radical ideas about the physical world also have detracted from his youthful insights into the complexity of vision, which described the notion of visual perception as a mental or psychological process. Berkeley’s New Theory of Vision represents one of the founding works in the field of cognitive science.
The Site of the Optical Image in the Eye
Harry Mark, M.D.
Purpose: To bring the audience up to date on the site of the optical image in the eye by historical review. "No subject relating to the theory of vision was more canvassed within this period, or indeed in any period, than that concerning the proper seat, or instrument of vision." Early observers saw the optical image of the world on the surface of the cornea, which thus was thought to be the proper site of vision. Vision ensued either by feelers projecting from the eye, or images from objects radiating into the eye. Galen assigned to the lens the site of the image, from whence it was communicated to the brain, a belief held till the renaissance.
Felix Plater believed the retina to be the proper site. The subject became very controversial when Edme Mariotte discovered the blind spot, where the retina existed but no choroid, so the choroid was the site of vision. The issue was finally settled for a while when Kepler in 1604 showed that the paths of rays from an object to the eye projected on the retina, where it ended inverted. A convincing proof of it was given in 1855 by Heinrich Müller using the entropic image of the retinal vessels. To this day the optical image is believed to reside in the outer segments of the rods and cones.
The Grotthuss-Draper law of physics, and clinical circumstances such as retinal detachment, mitigate against this belief. "When the 11-cis-retinal chromophore absorbs a photon it isomerizes from the 11-cis state to the all trans state." This occurs in the pigmented layer of the retina. The action is then transmitted by a G protein-coupled receptor through the cell's membrane of the rods and cones to their inside, where by dint of a cascade of chemical activities the image finally arrives at retinal nerves and the brain.
The Curious Tale of Baccio Bandinelli
Michael F. Marmor, M.D.
Purpose: To examine an ophthalmologic twist (first suggested by Philippe Lanthony) in the history and art of Baccio Bandinelli, a Florentine Renaissance artist. Bandinelli was famous in his day, especially for drawings and sculpture, but he was also universally reviled for his jealousy and vindictiveness (including dirty tricks) towards rival artists. Curiously, despite his skills, he could never master painting: whence our story.
Historical Approach: Bandinelli’s life was reviewed in historical writings, and his few extant paintings have been carefully examined including works in storage at the Pitti Palace. Current literature has been reviewed, and issues discussed with curators and Renaissance experts in Florence. Images of his paintings have been compared with both a normal and an altered color spectrum.
Results: Vasari’s book on Lives of artists extols Bandinelli’s draughtsmanship, but comments in several different places about his inability to paint with colors. Even after he got friends to show him proper techniques, his coloring was deemed of poor quality. Bandinelli finally gave up painting by himself, and hired other artists to color his designs. There are only a few of his canvases known, and these show a remarkable lack of color: faces and figures are in a monotone yellow or ochre, and the backgrounds largely in blue/black. These are typical characteristics of the color-blind artist. Simulations of a deuteranopic view make little difference with Bandinelli’s works, but flatten the works of other artists.
Conclusions: Jim Ravin and I have emphasized many times that it is hazardous to diagnose eye disease from art. One cannot prove from the art alone that Bandinelli did not choose his colors for artistic reasons (though it would be odd over a long career). I can only emphasize that historical documents and findings from his paintings are all consistent with the hypothesis that he was congenitally red-green color-blind. This would explain his unusual difficulty with colors, despite great skill with drawing. It would also explain his frustration and bitterness at not painting well, as he could neither see nor understand the problem (color blindness was not recognized as an entity until John Dalton’s report in
History of Orbital surgery. Evolution and Revolution
Steven A. Newman, M.D.
Introduction or purpose: Although ophthalmic surgery has the longest pedigree of any surgical subspecialty, certain areas have been, to a large extent, forbidden territory. This was certainly true of the vitreous prior to Machemer’s innovative approach in the 1960s. At least in the case of the vitreous however, Helmoltz’s ophthalmoscope and Gullstrand’s slit lamp had permitted us a view of this territory. The orbit, on the other hand has remained terra incognita for millennia. The limitations for the development of orbital surgery have not surprising including crowded anatomy, multiple critical structures located in a small space, and our inability to recognize the pathology and its extent preoperatively. Little orbital surgery, except enucleation and exenteration, predates the advent of anesthesia.
Historical approach: Early attempts at orbital approaches identified by case reports and primary source material from neurosurgery and orbital oculoplastic surgery have been reviewed, coupled with secondary discussions on the evolution of early orbital techniques.
Results: The earliest orbital procedures were based on external appearance and palpable lesions. Most lesions were removed by blunt dissection, often by the operator’s finger. Improved access was generally accepted following the 1888 description of Krönlein’s lateral orbitotomy. In the 1930s a secondary approach was pioneered by Walter Dandy using a trans-cranial approach through the orbital roof, which substantially improved visualization. Refinements in technique included more cosmetic skin incisions, as described by Berke and others.
True revolution in orbital surgery however awaited the advent of preoperative localization. Early attempts at radiography, angiography, and venography gave information that was useful in only exceptional cases. Ultrasound provided the first gross appreciation of pathology within the orbit, but the advent of CT scanning changed the entire landscape. This introduced to orbital pathology, even more than intracranial pathology, produced a complete change in planning and execution. These advances continuing today, underling tailoring of surgical approaches depending on the expected pathology, location, and goal of surgical procedure. These are still undergoing modifications.
Summary and conclusions: The development of orbital surgery offers a paradigm for the evolution in modern surgery based on imaging employing teams of physicians with various expertise, and tailored to the expected pathology, and goal of the surgical procedure.
Title: Louise Hervieu: How an Unfortunate Diagnosis Led to Adoption of the French Health Care Record
James Ravin, M.D.; Co-author: Guillaume d’Enfert, Paris, France
Introduction: A prize winning French author and artist fought a successful public health campaign.
Historical resources: Unpublished letters. Books, drawings, prints, paintings.
Body of paper: Louise Hervieu (1878-1954) suffered from chronic health problems including corneal and retinal abnormalities. Although she was treated by some of the best known physicians and surgeons in France, she was given a diagnosis that was probably incorrect – “hereditary” syphilis. The only evidence that remains is her correspondence, the many books she wrote, and her works of art. Her long political battle to have a unified health care record given to every child born in France resulted in establishing the Carnet de Santé in 1939.
Summary and conclusions: After bismuth, mercury, fever therapy, radiation, and surgery failed, determination gave a different type of success.
Published as: Ravin J, d’Enfert G. Louise Hervieu’s illness and campaign for a national medical record in France. Historia Ophthalmological Internationalis 2016; 2:73-81.
Physician Signers of the Declaration of Independence
William Tasman, M.D.
Introduction: Physicians have always been involved with the political process, perhaps now even more than ever. The same was true when this country was founded. Of the 56 signers of the Declaration of Independence, five were physicians. In this presentation, they will be named and their achievements described.
Historical Resources: National Park Service, Pennsylvania Historical Society, and Diary of Elizabeth Drinker.
Body of the Paper: the best known of the five physicians was Benjamin Rush who was not only a physician, but also a writer, educator, early proponent of psychiatry on the faculty of the University of Pennsylvania Medical School, and founder of Dickinson College in Carlisle, PA. From a personal perspective, he is important to Wills Eye because the Wills family bought their home and grocery between 2nd and 3rd Street on Chestnut from Benjamin Rush.
Among the many things for which he is known are his close relationships with John Adams and Thomas Jefferson. When these two fell out in 1800, it was Rush, purportedly as the result of a dream in 1809, who got the two to patch things up.
Of the remaining four physicians who signed the Declaration of Independence, Josiah Bartlett was first alphabetically. He was born in Amesbury Massachusetts and studied medicine as an apprentice to a Dr. Ordway . He married a first cousin and they had 12 children. Although not a lawyer, he became Chief Justice of the State Supreme Court and in 1791- 1792 Governor of the state, while still finding time to practice for 43 years.
Lyman Hall went to Yale where he studied theology and graduated in 1747. He was called to Pastor in a church near Bridgeport, Connecticut, but was dismissed in 1751 after allegations were made about his moral character. He then went back to Yale to study medicine. His first wife died, but he married again and, in 1756, moved to Sunbury Georgia.
Matthew Thornton was born in Ireland and immigrated to North America when he was three years old. Initially, the family settled in Virginia, but when their house was burned by native Americans, they moved to Worcester, Massachusetts. His medical studies were completed at Leicester and he practiced in Londonderry, New Hampshire. He was elected to the Continental Congress, but arrived in Philadelphia in November 1776 and was given permission to sign the Declaration.
The final physician, Oliver Wolcott, was born and died in Connecticut. He, too, attended Yale, graduating in 1747. His roommate at Yale was Noah Webster. He was elected to Congress in 1775, and because of illness in 1776, did not sign the Declaration until later. He became Governor in 1796, and held that post until his death.
In conclusion: Ten percent (5 signatories) of the Declaration were physicians.
Neuro-Ophthalmology at the University of Iowa
H. Stanley Thompson, M.D.
Body of paper: Academic Medicine in Iowa got a big boost from Abraham Flexner’s 1910 disparagement of the University of Iowa’s College of Medicine because it led, indirectly, to the construction of a major medical center in an agricultural state, and this in turn produced a strong and productive Ophthalmology Department, that wanted a strong Neuro-ophthalmology Section.
The Establishment of the Ophthalmology Museum of China (OMC)
Jialiang Zhao,MD, Department of Ophthalmology, Peking Union Medical College Hospital, Beijing 100730, China
IntroductionTo introduce the process and significance of establishment of Ophthalmology Museum of China. Historical approachAfter 8 years of preparation and efforts, under support by Chinese Medical Association and Nantong University, Chinese Ophthalmological Society established the OMC in China, which is the only medical professional museumin China. Body of paperThe purpose of establishing Ophthalmology Museum of China is to preserve the Chinese history of ophthalmology and investigate its unique contributions to medical science and health. Until now, the museum has collected more than 1000 items including cultural relics, ophthalmic devices, instruments, archives and rare books. The exhibits contain the ophthalmological art and cultural heritage from both ancient and modern China, which reflect the fruits of Chinese ophthalmological civilization. The museum consists of 12 sections, including Ophthalmology in Ancient China, the Introduction of Modern Ophthalmology from the West to China, Ophthalmology in Modern China, Ophthalmic Equipment and Instruments, History of Cataract Surgery, Spectacles Displays donated by Dr. Lihua Wang, Chinese Ophthalmological Society and Association, Hall of Fame, Chinese Ophthalmological Journals, Section of Public Education, Province Ophthalmological Society and Association and Multifunctional exhibition hall. Summary We certainly believe that Ophthalmology Museum of China will promote the development of ophthalmology in China.
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