Carl Theodor, Duke in Bavaria (1839-1909): A royal ophthalmologist.

Carl Theodor (1839-1909), a royal Duke in the ruling house of the Kingdom of Bavaria, was born to a life of wealth, privilege, and leisure. As was usual for sons of the nobility, he trained as a military officer. He fought in the Franco-Prussian War (1870-1871) and was decorated for his service in battle. Inspired by the tragedies he observed during the War, he decided to become a physician and received his medical degree from the Ludwig Maximilian University in Munich. After working in general medicine, he embarked on an extensive post-graduate program of study in ophthalmology. Starting in 1880, he practiced ophthalmology full time and devoted his life to his patients. He performed most of his work gratis and he personally underwrote most of the costs for his practice. His wife, the Duchess Marie José (1857-1943), a princess of the royal house of Portugal, was as committed to his medical career and philanthropy as he was, and she served as his assistant in the clinic and the operating room. Her untiring support made it possible for Carl Theodor to maintain his busy schedule. After his death, she established a Foundation to administer his clinic and operating facility in Munich.

Henry R. Viets, MD, and the History of Myasthenia Gravis.

Henry R. Viets (1890-1969) was both a noted neurologist and medical historian. While at Harvard Medical School, from which he graduated in 1916, he attracted the attention of Harvey Cushing who directed Viets into these disciplines. Cushing arranged for Viets to take a fellowship in Oxford in the year after his graduation. With Cushing's recommendation, he lived with Sir William and Lady Osler and did research with the famous neurologist Sir Charles Sherrington. Viets was in London in 1935 when he heard about the remarkable success of Mary Walker in treating myasthenia gravis, first with physostigmine and then with neostigmine (Prostigmin). Securing an ampoule of this drug, he took it to the Massachusetts General Hospital where he was an attending neurologist and in March 1935 injected it into a myasthenic patient with great success. He established the first Myasthenia Gravis clinic in the world and was a pioneer in the treatment of this once obscure disease; he evaluated hundreds of patients and published many articles on myasthenia. He continued this association for more than 30 years. Under the tutelage of Cushing and Osler, Viets became a medical historian and bibliophile, publishing hundreds of articles and several books on many different subjects in the history of medicine. He was a president of the American Association for the History of Medicine and curator of the Boston Medical Library that eventually joined with the Harvard Medical School Library. Viets served on the Editorial Board of the New England Journal of Medicine for 40 years.

Francis I. Proctor, MD and his wife Elizabeth C. Proctor: Their lives and legacy.

The Francis I. Proctor Foundation for Research in Ophthalmology is internationally recognized for its research in the fields of ocular inflammatory and infectious diseases. Although the name of one of its founders, Francis I. Proctor, MD (1864-1936) is memorialized, the legacy of his wife, Elizabeth C. Proctor (1882-1975) is not as well known. They were both full partners in this endeavor. Francis, a successful and wealthy ophthalmologist, retired to Santa Fe, New Mexico. After their marriage, they became interested in the problem of blinding trachoma, then an endemic problem on the Native American Indian reservations. The couple selected Phillips Thygeson, MD (1903-2002), a young ophthalmologist with an interest in infectious diseases, as their lead investigator. Using their own funds, the Proctors paid for Thygeson and themselves to study trachoma in Egypt, and then establish a trachoma research laboratory in Arizona where the causative agent of trachoma was identified. Not only did the Proctors fund these studies, they also studied bacteriology so they could help in the laboratory themselves. After Francis' death, Elizabeth endowed the Foundation in 1947 and continued to support it. She also established the Proctor Medal for The Association for Research in Vision and Ophthalmology.

William Wallace (1860-1940): British ophthalmologist and classical music composer.

William Wallace (1860-1940) received the degrees MB, MCh, and MD from the University of Glasgow, and qualified as an ophthalmologist in 1888. Even as he was training in eye surgery, he was already composing music, and Wallace became more attracted to the ear than to the eye and abandoned medicine to become a classical music composer. He never practiced ophthalmology after 1889, except during First World War when he volunteered to serve in the Royal Army Medical Corps. He studied briefly at the Royal Academy of Music in London, but was mostly self-taught. Wallace was influenced by the music of Franz Liszt and Richard Wagner, and thus became a champion for late Romantic music. He wrote many types of music: his most successful were symphonic or tone poems. He was a playwright, music critic, translator, artist, and advocate for composers' copyright interests in Parliament. After the War, he never again composed but held important positions in organized music such as Professor of Harmony and Composition at the Royal Academy of Music. Only about 30% of his compositions were performed or published in his lifetime, but recently, there has been increased interest in performing and recording his music.

Mortimer Frank, Johann Ludwig Choulant, and the history of anatomical illustration.

Mortimer Frank (1874-1919) was an ophthalmologist in Chicago, Illinois. He published a number of papers on the history of medicine, and was secretary of the Chicago Society of the History of Medicine and editor of their Bulletin. His major contribution to the history of medicine relates to the history of anatomical illustration. The classic book on that subject had been published in 1852 in German by the physician and historian, Johann Ludwig Choulant (1791-1861). However, by Frank's time this text was both out dated and out of print. Frank took on the tremendous project of translating Choulant's German text into English as History and Bibliography of Anatomic Illustration in Its Relation to Anatomic Science and The Graphic Arts. He improved Choulant's text with the results of his and other scholars' research, greatly enlarging the text. Frank supplemented the original book with a biography of Choulant, essays on anatomists not considered in the original text, and an essay on the history of anatomical illustration prior to those authors discussed by Choulant. This book, now referred to as Choulant/Frank, has been reprinted several times, and is still useful as a reference in this field, though some of its research is now dated.

Cuban Epidemic Optic Neuropathy (1991-1993) and José Saramago's Novel Blindness (1995).

PURPOSE: This article reviews the history of Cuban epidemic optic neuropathy (1991-1993), which caused visual loss, peripheral neuralgias, and other neurologic symptoms in over 50,000 persons, an incidence of almost 0.5% of the entire population. The clinical findings, etiology, and treatment are described. We then relate the Cuban epidemic to the fictional epidemic of contagious blindness depicted by Nobel Laureate José Saramago in his 1995 novel Blindness. This novel describes an unnamed modern city in which all inhabitants, except the ophthalmologist's wife, are affected with a white, not black, blindness. DESIGN: Historical review and literary essay. METHODS: The sources for the Cuban epidemic were an extensive review of the published literature and personal communications with physicians who treated these patients. Both authors have analyzed the novel and the critical literature about Saramago's writings. RESULTS: Though Saramago uses the epidemic of blindness as an allegory to comment on human weakness and immorality, he may also have known of the actual Cuban epidemic. Saramago was a lifelong member of the Communist party, as well as a friend of Fidel Castro and admirer of the Cuban government. We have no proof that Blindness was influenced by the Cuban epidemic, but we find it plausible. CONCLUSION: It is valuable to examine the real and fictional epidemics side by side, not least because Saramago's novel depicts the actions of an ophthalmologist during an epidemic of blindness. Ophthalmologists may be interested in a novel that uses the language of eyes, vision, sight, and blindness extensively.

James Moores Ball: Ophthalmologist, medical historian, bibliophile.

James Moores Ball (1862-1929) was an ophthalmologist in St. Louis, Missouri, who excelled as a medical historian and collector of rare and historic books about the history of anatomy. During his lifetime, he was best known as the author of a comprehensive, authoritative, and popular textbook titled Modern Ophthalmology First published in 1904, there were five further editions. Ball was very interested in the history of anatomy and wrote two books on this subject, the first being a biography of Andreas Vesalius, one of the earliest in English, and the second a history of the resurrection men or grave robbers who sold corpses to professors of anatomy and surgery for teaching purposes. His legacy today is the 470 volumes of his personal library, which are now in the Archives and Rare Books department of the Becker Medical Library of the Washington University School of Medicine. These texts are one of their major collections, concentrating on the history of anatomy, beginning with a first edition of Vesalius's De Humani Corporis Fabrica and holding many important and beautiful landmark volumes of anatomical atlases.

Early American Strabismus Surgery: 1840-1845.

The discovery of effective surgical therapy for strabismus was one of the outstanding triumphs of the first half of 19th-century ophthalmology, just prior to the invention of the ophthalmoscope in 1850. Although priority for the development of strabismus surgery belongs to Johann Friedrich Dieffenbach of Germany, who first reported his surgical results in 1839, 4 cases of tenotomy of the medial rectus muscle had been performed in the United States by William Gibson in 1818 but never published. By 1840, the reports of surgery in Europe had rapidly spread to America where surgeons immediately began using these procedures. The first American surgeon to perform eye muscle surgery and publish his results was John Dix of Boston, and other surgeons were soon reporting their cases as well. We discuss 8 American pioneers in this field during the time (1840-1845) of the first burst of enthusiasm for this surgery. Although these surgeons were active in performing a large number of cases and carefully reporting their experiences and results, they did not make any major advances in the field.

Sympathectomy for glaucoma: Its rise and fall (1898-1910).

The influence of the sympathetic nervous system upon intraocular pressure (IOP) has been a subject of great interest since 1727, when the first experimental ocular sympathetic paralysis was produced in dogs. By the middle of the 19th century, it was known that excision of the superior cervical sympathetic ganglion lowered, and that electrical stimulation of the sympathetic nerve trunk raised IOP in various animals. From these observations, it was thought that excision of this ganglion 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 less useful in chronic glaucoma. Iridectomy, however, was associated with major surgical complications and long-term failure, so that there was considerable appeal of an extraocular operation that avoided the risks of intraocular surgery. Beginning in 1898, cervical sympathectomy became a widely performed operation around the world, with most surgeons enthusiastic about its results, at least initially, and many publications from 1898 to 1905 claimed excellent results for various types of glaucoma. Opponents of the procedure emphasized that the effect on IOP was transient, and that the published reports of successful results were poorly documented. The popularity of sympathectomy gradually diminished and by 1910 it was abandoned. I discuss the reasons why cervical sympathectomy received such initial enthusiasm but was then questioned and discarded. These included bias from the surgeons promoting this surgery; the placebo effect; short follow-up; inaccurate, subjective, and variable measures of the surgical results; and the development of more effective procedures such as filtering surgery and cyclodialysis.

Herbert Herbert: his corneal pits and scleral slits.

PURPOSE: To evaluate the life and professional work of the English ophthalmologist Herbert Herbert (1865-1942). DESIGN: Historical study. METHODS: The main sources for this investigation are Herbert's approximately 65 published papers and 3 monographs. Other sources are contemporary publications by other ophthalmologists and secondary historical reviews of this period. Written communications with some of Herbert's descendants revealed previously unknown information about his life. RESULTS: Herbert is now remembered for his description of the eponymously named limbal corneal pits as a sign of trachoma. This finding is essentially pathognomic of trachoma and was welcomed as a sign that could reliably diagnose trachoma from other external diseases. He also described the sinuous outline of the upper lid margin, sometimes called Herbert's sign, as a diagnostic finding of trachomatous infection. His diagnostic acumen in the field of trachoma has justly stood the test of time. However, his interest in trachoma was peripheral to his main professional work, which was the study of glaucoma filtration surgery, then in its early development from 1900 to 1920. He was among the major pioneers in the development of original techniques for this surgery. He emphasized the use of small incision sclerotomy to produce an even and diffuse filtration bleb, rather than the large incision sclerectomy proposed by other surgeons, which he felt produced too large and thin a filtering bleb subject to complications. This point has also stood the test of time. However, he erred in developing and championing the use of deliberate iris inclusion into the filtering sclerotomy (iridencleisis) to prevent closure of the sclerotomy, a technique that was questioned at that time and eventually discredited. The iris-free procedure of corneoscleral trephination developed by his contemporary Robert H. Elliot became the preferred glaucoma filtering procedure until the introduction of peripheral iridectomy with scleral cautery (thermal sclerostomy) in the 1950s and then trabeculectomy in the 1970s. CONCLUSIONS: Herbert should be remembered as an astute and original observer and as an innovative surgeon who developed some of the pioneering techniques in glaucoma filtering surgery.

Paul A. Cibis, MD: a pioneer of modern vitreoretinal surgery.

Paul Anton Cibis (1911-1965) was one of the pioneers of modern vitreoretinal surgery. He reasoned that the pathology of complex retinal detachments was intravitreal fibrosis and concluded that the optimum surgery was the injection of liquid silicone oil into the vitreous cavity to dissect fibrous membranes from the retinal surface and use the silicone for retinal tamponade. Prior to the invention of pars plana vitrectomy, such surgery was innovative, even daring. These surgical techniques were an important advance in directly operating on the vitreous in retinal detachment surgery. However, Cibis' contributions to vitreoretinal surgery only occupied the last 10 years of his tragically short life. Prior to his practice in retinal surgery, he made contributions to basic research in physiologic optics, local retinal adaptation, and the effect of ionizing radiation and atomic energy on the globe.

Count sir Luigi Preziosi and his glaucoma operation: the development of early glaucoma filtering surgery.

Count Sir Luigi Preziosi (1888-1965) was a famous ophthalmologist from the island Republic of Malta. He received his ophthalmic training in Rome and the United Kingdom. He practiced ophthalmology in Malta for 45 years and was a professor at the University of Malta. Like many physicians in Malta, he was active in the politics and governance of his country, serving as president of the Senate, president of the National Congress to draft a new constitution, and, finally, as president of the National Assembly of Malta. His most important ophthalmologic contribution was the development of the thermal sclerostomy filtering operation for glaucoma, which he first described in 1924. He referred to this operation initially as electro-cautery puncture and later simply as Preziosi's operation. Many surgeons considered this procedure an advance over the other available filtering operations such as sclerectomy, iridencleisis, and trephination. The operation was then further developed in 1957 by Harold G. Scheie of the University of Pennsylvania. Scheie referred to his procedure as peripheral iridectomy with scleral cautery, and it was a standard filtering operation for glaucoma for many years until the development of trabeculectomy.

Vincent (Censu) Tabone, an ophthalmologist and a president of the Republic of Malta.

Vincent Tabone may be unique in the history of ophthalmology. He practiced ophthalmology for 40 years in his homeland, the Republic of Malta. During that time, he became well known as a pioneer in the international effort to eradicate trachoma worldwide. At age 53, he began a long and successful political career as a member of parliament, then as a cabinet minister, and, finally, as the democratically elected president of the Republic. He was active in European diplomacy and made important contributions at the United Nations. He may be the only ophthalmologist who has made great contributions in the field of medicine and in the democratic development of his country.

Fred Loe, MD, and the history of trachoma.

Trachoma has been one of the most blinding diseases in the history of ophthalmology. From its initial description in antiquity until the late 1930s, no specific treatment or effective cure had been known, and the only expedient had been to destroy the diseased tissue containing the infectious agent, rendering the disease inactive. Virtually all medical, mechanical, and surgical treatments were unsatisfactory, with cure rates of approximately 20%. Therapy for trachoma had barely advanced from the measures used by the ancient Egyptian, Greek, and Roman physicians. All prior therapies became obsolete in 1938 when Fred Loe, MD, working on an American Indian reservation, introduced sulfanilamide as a treatment of trachoma, achieving a 90% cure rate. One of the most unusual aspects of Loe's career was that he had no formal training in ophthalmology and was completely self-taught as an ophthalmologist.