- Email: [email protected]
Biography: Bernard Becker, M.D.
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BERNARD BECKER
editorials and the development of new theories of the nature of binocular visual space and its application to perspective in painting through the ages. Throughout, his love of people, his modest unassuming man ner, and his dry subtle humor won him the respect and affection of his peers, his coworkers, and his students. That attribute of Jonas Friedenwald that I would select as most outstanding and worthy of emulation was his life as the perpetually receptive student. He had an un canny capacity for rapid retention. On many occasions the information sought, the solu tion of a laboratory problem, or the develop ment of far-reaching concepts, resulted from his ability to recall data, patients, ideas, or the appropriate literature or expert that he had seen or heard days, months, or even years before. He advocated the "textbook under the tree" and "learn by doing" ap
proach to the acquisition of basic knowledge. Stimulated by ideas, experimental results, pa tients, or literature, it was his conviction that any unfamiliar methodology or discipline could be learned readily and applied to the problem at hand. This liberal approach to education and the atmosphere of academic freedom which pervaded his laboratory made it a fertile ground for scientific productivity. This was an important part of the genius that was Friedenwald. Much of what is presented at a research association meeting today rests on the solid foundations established by Friedenwald. In addition his profound comments provide a fundamental background for a number of the practical and philosophic problems confront ing the research worker, the educator, the administrator, and the clinician today. In this fashion his spirit continues with us. 640 South Kingshighway (10).
BIOGRAPHY: BERNARD BECKER, M.D. In 1947, Dr. Jonas Friedenwald formally announced to his colleagues that a brilliant young man would soon make his presence felt in the ophthalmologic world. Dr. Bernard Becker has so quickly fulfilled this prophecy that even this early in his career the problem is not how to find enough material to fill a biography, but what to exclude to prevent its being too long. At 37, this represents a con siderable achievement. He was born in Brooklyn on August 21, 1920. In 1937, following graduation from a public high school in Brooklyn, he attended Princeton University. Majoring in chem istry, he did a significant piece of work during his junior year on the variations of fluid viscosity with changes in temperature. In his senior year he became interested in the molecular structure of proteins; this led to studies of nylon and wool fibers, involving the construction of elaborate models. His work won him the annual prize in physical
chemistry. In 1941, after leading his class for four years, he graduated summa cum laude, carrying away the scholarship given for post graduate work at Harvard. During the next summer, he worked at the Bureau of Standards in Washington, D.C., where he studied stress-strain curves of pro tein and plastic fibers, and the underlying intra- and intermolecular mechanisms in volved. He went on to Harvard Medical School, graduating in 1944 with honors. The Mount Sinai Hospital in New York City claimed him for nine months of rotating internship, following which he entered the U. S. Army. He served a 28-month tour of duty in various induction and separation centers, as an army psychiatrist. Part of his tour was spent in Washington, D.C., where, having become in terested in histochemistry, he attended a lec ture given by Dr. Friedenwald. After the lecture he talked to Dr. Friedenwald and was
BIOGRAPHY subsequently invited to Baltimore, where their mutual interests led Dr. Friedenwald to offer him a position in his laboratory at the Wilmer Institute. Although ophthalmology had not been his major interest, because of his fascination for histochemistry and his liking for Dr. Friedenwald, he became suf ficiently interested to apply for the residency training program. In 1948, after working for one year in the laboratory, he became a mem ber of the Wilmer Institute house staff. In 1947, he learned of the periodic-acid fuchsin stain for the histologic demonstra tion of mucoids. Being interested in the mucoids of the vitreous, he attempted to use this stain on sections of the eye. Seeing these slides, Dr. Friedenwald suggested that a nice delineation of the vascular pattern of the retina might be obtained by making flat preparations of the retina. He set Dr. Becker to work, devising a method of making flat preparations and modifying the HotchkissMcManus stain for better visualization of the vessels. Dr. Friedenwald had hypothesized that the apparent aneurysmal dilatations of blood ves sels seen in diabetics by benzidine staining of red cells were in reality endothelialized, small hemorrhages. With these superior techniques, he was easily convinced that the lesions were indeed aneurysms. During the next two years. Dr. Becker pursued further work on diabetes and other retinal vascular pathology, including work on the association of aneurysms with clinical and experimental retinal vein occlusions. It was at this time also that Dr. Becker pre sented a paper implicating the adrenal glands in the etiology of diabetic retinopathy. In 1950, he worked for a number of weeks with Ernst Barany and Eric Linner in Up psala, Sweden, on the rate of aqueous secre tion, the alterations of ciliary blood flow, and the effects of ACTH on aqueous humor ascorbate. From there, he went to the Carlsberg Laboratories in Copenhagen, where he spent several weeks studying microchemical techniques. He ended by visiting most of the
339
major eye clinics in Europe, from which he carried away much useful experience. He returned to Hopkins to complete his residency and to continue his work on aque ous flow, tonography, and mechanisms of aqueous secretion (see Bibliography). Dur ing this period he also made probably his best known, single contribution: the discovery of the effects of Diamox on intraocular pres sure. After his training, he remained on the staff of the Wilmer Institute, as an assistant professor. Six months later, be became the Head of the Department of Ophthalmology at the Washington University School of Medicine in Saint Louis. Here, despite ex tremely time-consuming administrative and teaching duties, and an active consultation practice, he has continued his work as chief of the research laboratores. When he came to Saint Louis, the research budget was small, and there were two full-time staff men. The research budget has grown in a period of four years, and there are now eight members of the full-time staff. The house-staff now num bers 16 as contrasted with six formerly. Un der his expert guidance, a great deal of sig nificant work continues to come out of the department. Outside the Department of Ophthalmol ogy, Dr. Becker is currently active on many committees: he has served for four years on the Sensory Diseases Study Section of the National Institutes of Health, and he is also a member of the Ophthalmology Training Grants Committee and a consultant to the Glaucoma Detection Program of the same organization; he serves on the National Com mittee for Research in Ophthalmology, the Scientific Advisory Committee of the Na tional Council to Combat Blindness, and the Glaucoma Committee of the National Society for the Prevention of Blindness. He is on the Tonometer Calibration Committee of the American Academy of Ophthalmology and Otolaryngology, on the editorial staff of T H E AMERICAN JOURNAL OF OPHTHALMOLOGY,
and has for three years written the glaucoma annual reviews for the A.M.A. Archives of
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BERNARD BECKER
Ophthalmology. H e has participated in the Macy Foundation Conference on Glaucoma, and he is currently president of the Wash ington University Medical Society. H e has presented the Schneider Foundation Lecture, the M a r k Schoenberg Lecture, and he has received the E d w a r d Lorenzo Holmes Award. I n 1950, he married Janet Rosenwald, from Philadelphia. H e and Janet have four children: Diana Joan, age s i x ; Stephen Jonas, age five; John Lawrence, age four; and Bernard, Jr., age two. Steve, of course, is named for Jonas Friedenwald, who, at the time of his birth, sent him an autographed copy of the Armed Forces Institute Atlas of Pathology, "to be kept in escrow" for him because "he came off the press simultane ously with this book." T h e demands on Dr. Becker's time are be yond belief. H e is active on medical school and hospital committees and serves in an advisory capacity for a number of local or ganizations. H e has so many invitations to speak that he has been forced to make a rule to speak nowhere, except under the rarest circumstances. However, he makes it a point to find relaxation by swimming regularly, and takes great pride in the fishing at his country home. H e has a great fund of knowledge. Every month he makes a series of trips to the library, to read all of the major journals published in other fields of medicine. H e
seems to know of new developments almost as soon as they occur. His knowledge of ad vances in other fields, his awareness of the latest thinking in his own, combined with his own remarkable inventiveness, give him an endless supply of research ideas. T o have such a man around, is to keep a research de partment continually active and producing. H e is also a born teacher. H e can talk at any level, and his discussion of a subject on the spur of the moment would suggest a week's careful preparation. H i s patience is endless. H e has a way of walking into a laboratory and within a few minutes putting his finger on the crux of a problem, suggest ing improvements in techniques and changes in approach. All this is done with a warmth and understanding which make the people who work in his laboratories completely de voted to him. Unselfishness is characteristic of him, and he is jealous only of his research time. H e will give unstintingly of his time to anything which furthers basic scientific knowledge. At least 10 years ago, he expressed himself unenamored of the honors that go to the suc cessful scientist, and this is as true today as it was then. Such an attitude lends itself to objectivity; about him the spirit of competi tion fades into one of co-operation. This is the epitome of his philosophy of life.
P U B L I C A T I O N S OF BERNARD B E C K E R ,
Lawrence
T. Post,
Jr.
M.D.
1. The spermicidal times of samples of commercial contraceptives secured in 1942. Human Fertility, 8:65, 1943. (With Brown, R. L., and Levenstein, I.) 2. The spermicidal times of samples of commercial contraceptives secured in 1943. Human Fertility, 9:6, 1944. (With Gamble, C. J.) 3. The spermicidal times of contraceptive jellies and creams. Human Fertility, 11:111, 1947. (With Gamble, C. J.) 4. The histochemical localization of glucuronidase. J. Cell. & Comp. Physiol., 31:303, 1948. (With Friedenwald, J. S.) 5. The inhibition of glucuronidase by ascorbic acid and by heparin. Arch. Biochem., 22:101, 1949. (With Friedenwald, J. S.) 6. The histochemical localization of glucuronidase in ocular tissues and salivary glands. Am. J. Ophth., 33:673, 1950. (With Friedenwald, J. S.) 7. Retinal vein occlusion: Clinical and experimental observations. Am. J. Ophth., 34:677, 1951. (With Post, L. T , Jr.) 8. Rate of turnover of ascorbic acid in aqueous humor in rabbits. A.M.A. Arch. Ophth., 45:654, 1951. (With Linner, E., and Barany, E.)
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9. Increased ascorbic acid level in the aqueous humor after administration of A C T H . Acta Physiol. Scand., 25:77,1951. (With Barany, E , and Linner, E.) 10. Ascorbic acid as a test substance for measuring relative changes in the rate of plasma flow through the ciliary processes. III. The effect of preganglionic section of the cervical sympathetic in rabbits on the ascorbic content of the aqueous humor at varying plasma levels. Acta Physiol. Scand., 26:79, 1952. (With Linner, E.) 11. Diabetic retinopathy. Ann. Int. Med., 37:273, 1952. 12. The effect of adrenal cortex hormonal therapy on experimental brucella uveitis. Am. J. Ophth., 36:1025, 1953. (With Wood, R. M., and Woods, A. C.) 13. Vitamin B-12 excretion and diabetic retinopathy. J. Clin. Nutrition, 1:417, 1953. (With Lang, C. A., and Chow, B. F.) 14. Clinical aqueous outflow. A.M.A. Arch. Ophth., 50:557, 1953. (With Friedenwald, J. S.) 15. Decrease in intraocular pressure in man by a carbonic anhydrase inhibitor, Diamox. Am. J. Ophth., 37:13, 1954. 16. Studies in experimental ocular tuberculosis. X V I I . Effect of isoniazid in the normal nonimmune rabbit. A.M.A. Arch. Ophth., 51:242, 1954. (With Woods, A. C , and Wood, R. M.) 17. The adrenal cortex and B-vitamins in diabetic retinopathy. Diabetes, 3:175, 1954. (With MaengwynDavies, G., Rosen, D., and Friedenwald, J. S.) 18. Recent work in aqueous outflow. Sight-Saving Review, 24: No. 2, 1954. 19. Diamox and the therapy of glaucoma. Am. J. Ophth., 38:109, 1954. 20. The role of the adrenal cortex and vitamin B-12 in diabetic retinopathy. Am. J. Ophth., 38:53 (July, Pt. I I ) 1954. 21. T h e influence of heparin on the cortisone nephropathy of the rabbit. Bull. Johns Hopkins Hosp., 95:144, 1954. (With Rosen, D., Maengwyn-Davies, G. and Friedenwald, J. S.) 22. Chlorpromazine. Am. J. Ophth., 38:576, 1954. 23. Retinal complications of diabetes mellitus. Bull. Chic. Med. Soc, Nov. 6, 1954. 24. The mechanism of the fall in intraocular pressure induced by the carbonic anhydrase inhibitor, Diamox. Am. J. Ophth, 39:177 (Feb., Pt. I I ) 1955. 25. The evaluation of glaucoma therapy by tonography. Acta, X V I I Cone. O p h t h , 3:1557, 1954. 26. The short-term administration of Diamox in the therapy of the glaucomas. Acta, X V I I Cone. Ophth, 2:1109, 1954. 27. A comparison of the acetylating capacity of normals and diabetics with and without retinopath> Bull. Johns Hopkins H o s p , 96:150, 1955. (With Maengwyn-Davies, G, Rosen, D , and Friedenwald, J. S.) 28. The present status of the clinical use of Diamox in the management of the glaucomas. Southern M . J , 48:866, 1955. 29. Long-term Diamox administration in the therapy of the glaucomas. A.M.A. Arch. Ophth, 54:187, 1955. (With Middleton, W.) 30. Experimental tonography. I. The effect of the carbonic anhydrase inhibitor, acetazolamide, on aqueous flow. A.M.A. Arch. Ophth, 54:321, 1955. (With Constant, M. A.) 31. The effects of the carbonic anhydrase inhibitor, acetazolamide, on the composition of the aqueous humor. Am. J. O p h t h , 40:129 (Nov., Pt. I I ) 1955. 32. Xanthurenic acid excretion studies in diabetics with and without retinopathy. Proc. Soc. Exper. Biol. and Med, 88:321, 1955. (With Rosen, D. A , Maengwyn-Davies, G , Stone, H. H , and Frieden wald, J. S.) 33. Diabetic retinopathy: Diabetes mellitus in infants and children. Report of the Twelfth M & R Pediatric Research Conference (1955). 34. Tonography in the management of the glaucomas. Eye, Ear, Nose, and Throat Monthly, 35:249, 1956. 35. Aqueous humor dynamics: Theoretical considerations. A.M.A. Arch. O p h t h , 54:799, 1955, and Am. J. Ophth, 41:383, 1956. (With Friedenwald, J. S.) 36. The effects of acetazolamide on ascorbic acid turnover: An application of the theory of aqueous humor dynamics. Am. J. O p h t h , 41:522, 1956. 37. The Zeiss operating microscope. Am. J. Ophth, 42:302, 1956. 38. Alterations in aqueous humor lactate concentrations following systemic carbonic anhydrase inhibi tion. Am. J. Ophth, 42:406, 1956. (With Constant, M. A.) 39. The facility of aqueous outflow: A comparison of tonography and perfusion measurements in vivo and in vitro. A.M.A. Arch. O p h t h , 55:305, 1956. (With Constant, M. A.) 40. Beta-hypophamine (Vasopressin) : Its effect upon intraocular pressure and aqueous flow in normal and glaucomatous eyes. A.M.A. Arch. Ophth, 56:1, 1956. (With Christensen, R. E.) 41. Experimental tonography: I I . The effects of vasopressin, chlorpromazine, and phentolamine methanesulfonate. A.M.A. Arch. Ophth, 56:19, 1956. (With Constant, M. A.) 42. Friedenwald's contribution to our knowledge of diabetic retinopathy. Diabetes 5:151, 1956. 43. Hypersecretion glaucoma. A.M.A. Arch. Ophth, 56:180, 1956. (With Keskey, G. R , and Christen sen, R. E.)
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44. Water-drinking and tonography in the diagnosis of glaucoma. A.M.A. Arch. Ophth., 56:321, 1956. (With Christensen, R. E.) 45. The effect of moderate doses of X-ray irradiation on ocular tissue. Am. J. Ophth., 42:51 (Oct., Pt. II) 1956. (With Constant, M. A., Cibis, P. A., and Ter-Pogossian, M.) 46. Enzymatic activities of the lens. Am. J. Ophth., 42:342 (Oct., Pt. II) 1956. (With Wortman, B.) 47. Species variation in facility of aqueous outflow. Am. J. Ophth., 42:89 (Oct., Pt. II) 1956. (With Constant, M. A.) 48. Glaucoma, 1955-1956, A.M.A. Arch. Ophth., 56:898, 1956. 49. Routine tonometry, Trans. Am. Ophth. Soc, Am. J. Ophth., 43:21, 1957. (With Hildreth, H. R.) 50. Ocular lesions produced by iodoacetate. A.M.A. Arch. Ophth., 57:508, 1957. (With Cibis, P. A., Constant, M. A., and Pribyl, A.) 51. The rate of secretion of aqueous humor. Proc. Inst. Med. Chicago, March, 1957. 52. Newer diagnostic technics in the diagnosis of glaucoma. Post Grad. Med., 21:275, 1957. 53. Chemical composition of human aqueous humor: Effects of acetazolamide, A.M.A. Arch. Ophth., 57:793, 1957. 54. Misuse of acetazolamide. Am. J. Ophth., 43:799, 1957. 55. Vascular changes of diabetes. Diabetes, 6:180, 1957. (With Colwell, A. R., Sr., Alpert, L. K., Ken dall, F. E., and LeCompte, P. M.) 56. Congenital defects in infants following mumps during pregnancy. J. Pediat, 50:689, 1957. (With Holowach, J., and Thurston, D. L.) 57. The bicarbonate concentration in guinea pig aqueous humor: Effect of scurvy and acetazolamide. Am. J. Ophth., 44:402 (Nov., Pt. II) 1957. 58. Cataract extraction and aqueous flow. A.M.A. Arch. Ophth., 58:401, 1957. (With Miller, J. E., and Keskey, G. R.) 59. Clinical tonography: The scleral rigidity correction. Am. J. Ophth., 45:196, 1958. (With Moses, R. A.) 60. Glaucoma, 1956-1957. A.M.A. Arch. Ophth., 58:862, 1957. 61. Urinary excretion of citrate in humans following administration of acetazolamide. A.M.A. Arch. Ophth., 59:536, 1958. (With Shah, A. W., and Constant, M. A.) 62. Epinephrine and acetazolamide in the therapy of the chronic simple glaucomas. Am. T. Ophth., 45:639, 1958. (With Ley, A. P.) 63. Tonography and angle closure glaucoma: Diagnosis and therapy. Am. J. Ophth., 46:305, 1958. (With Thompson, H. E.) 64. The prognostic value of tonography in the miotic therapy of chronic simple glaucoma. Am. J. Ophth., 46:11, 1958. 65. Age variations in clinical tonography. Am. J. Ophth., 46:731, 1958.
CARBONIC ANHYDRASE AND T H E FORMATION O F AQUEOUS HUMOR* T H E FRIEDENWALD MEMORIAL LECTURE BERNARD BECKER,
M.D.
Saint Louis, Missouri In the Proctor Lecture on " T h e formation of the intraocular fluid" 10 years ago, Frie denwald' raised "the question as to whether more effort might not profitably be directed toward a reduction in the formation of aque ous in cases of glaucoma, in addition to the present approach which concerns largely an effort to increase the outflow of fluid from the eye." Research based largely upon the theories and groundwork described by Frie denwald in this lecture made his intuitive * From the Department of Ophthalmology and the Oscar Johnson Institute, Washington University School of Medicine.
prediction a reality less than five years later. 2 - 3 The usefulness or carbonic anhydrase in hibitors in ophthalmology has not been limited to the therapy of the glaucomas, for the availability of such agents as research tools has contributed greatly to our knowl edge of aqueous humor dynamics. Not only did Friedenwald suggest a need for carbonic anhydrase in the secretion of aqueous humor, but he also provided us with a more complete theory of aqueous humor dynamics. 4 It is largely on the basis of these formulations as well as his work on standardization and cali-
BERNARD BECKER
editorials and the development of new theories of the nature of binocular visual space and its application to perspective in painting through the ages. Throughout, his love of people, his modest unassuming man ner, and his dry subtle humor won him the respect and affection of his peers, his coworkers, and his students. That attribute of Jonas Friedenwald that I would select as most outstanding and worthy of emulation was his life as the perpetually receptive student. He had an un canny capacity for rapid retention. On many occasions the information sought, the solu tion of a laboratory problem, or the develop ment of far-reaching concepts, resulted from his ability to recall data, patients, ideas, or the appropriate literature or expert that he had seen or heard days, months, or even years before. He advocated the "textbook under the tree" and "learn by doing" ap
proach to the acquisition of basic knowledge. Stimulated by ideas, experimental results, pa tients, or literature, it was his conviction that any unfamiliar methodology or discipline could be learned readily and applied to the problem at hand. This liberal approach to education and the atmosphere of academic freedom which pervaded his laboratory made it a fertile ground for scientific productivity. This was an important part of the genius that was Friedenwald. Much of what is presented at a research association meeting today rests on the solid foundations established by Friedenwald. In addition his profound comments provide a fundamental background for a number of the practical and philosophic problems confront ing the research worker, the educator, the administrator, and the clinician today. In this fashion his spirit continues with us. 640 South Kingshighway (10).
BIOGRAPHY: BERNARD BECKER, M.D. In 1947, Dr. Jonas Friedenwald formally announced to his colleagues that a brilliant young man would soon make his presence felt in the ophthalmologic world. Dr. Bernard Becker has so quickly fulfilled this prophecy that even this early in his career the problem is not how to find enough material to fill a biography, but what to exclude to prevent its being too long. At 37, this represents a con siderable achievement. He was born in Brooklyn on August 21, 1920. In 1937, following graduation from a public high school in Brooklyn, he attended Princeton University. Majoring in chem istry, he did a significant piece of work during his junior year on the variations of fluid viscosity with changes in temperature. In his senior year he became interested in the molecular structure of proteins; this led to studies of nylon and wool fibers, involving the construction of elaborate models. His work won him the annual prize in physical
chemistry. In 1941, after leading his class for four years, he graduated summa cum laude, carrying away the scholarship given for post graduate work at Harvard. During the next summer, he worked at the Bureau of Standards in Washington, D.C., where he studied stress-strain curves of pro tein and plastic fibers, and the underlying intra- and intermolecular mechanisms in volved. He went on to Harvard Medical School, graduating in 1944 with honors. The Mount Sinai Hospital in New York City claimed him for nine months of rotating internship, following which he entered the U. S. Army. He served a 28-month tour of duty in various induction and separation centers, as an army psychiatrist. Part of his tour was spent in Washington, D.C., where, having become in terested in histochemistry, he attended a lec ture given by Dr. Friedenwald. After the lecture he talked to Dr. Friedenwald and was
BIOGRAPHY subsequently invited to Baltimore, where their mutual interests led Dr. Friedenwald to offer him a position in his laboratory at the Wilmer Institute. Although ophthalmology had not been his major interest, because of his fascination for histochemistry and his liking for Dr. Friedenwald, he became suf ficiently interested to apply for the residency training program. In 1948, after working for one year in the laboratory, he became a mem ber of the Wilmer Institute house staff. In 1947, he learned of the periodic-acid fuchsin stain for the histologic demonstra tion of mucoids. Being interested in the mucoids of the vitreous, he attempted to use this stain on sections of the eye. Seeing these slides, Dr. Friedenwald suggested that a nice delineation of the vascular pattern of the retina might be obtained by making flat preparations of the retina. He set Dr. Becker to work, devising a method of making flat preparations and modifying the HotchkissMcManus stain for better visualization of the vessels. Dr. Friedenwald had hypothesized that the apparent aneurysmal dilatations of blood ves sels seen in diabetics by benzidine staining of red cells were in reality endothelialized, small hemorrhages. With these superior techniques, he was easily convinced that the lesions were indeed aneurysms. During the next two years. Dr. Becker pursued further work on diabetes and other retinal vascular pathology, including work on the association of aneurysms with clinical and experimental retinal vein occlusions. It was at this time also that Dr. Becker pre sented a paper implicating the adrenal glands in the etiology of diabetic retinopathy. In 1950, he worked for a number of weeks with Ernst Barany and Eric Linner in Up psala, Sweden, on the rate of aqueous secre tion, the alterations of ciliary blood flow, and the effects of ACTH on aqueous humor ascorbate. From there, he went to the Carlsberg Laboratories in Copenhagen, where he spent several weeks studying microchemical techniques. He ended by visiting most of the
339
major eye clinics in Europe, from which he carried away much useful experience. He returned to Hopkins to complete his residency and to continue his work on aque ous flow, tonography, and mechanisms of aqueous secretion (see Bibliography). Dur ing this period he also made probably his best known, single contribution: the discovery of the effects of Diamox on intraocular pres sure. After his training, he remained on the staff of the Wilmer Institute, as an assistant professor. Six months later, be became the Head of the Department of Ophthalmology at the Washington University School of Medicine in Saint Louis. Here, despite ex tremely time-consuming administrative and teaching duties, and an active consultation practice, he has continued his work as chief of the research laboratores. When he came to Saint Louis, the research budget was small, and there were two full-time staff men. The research budget has grown in a period of four years, and there are now eight members of the full-time staff. The house-staff now num bers 16 as contrasted with six formerly. Un der his expert guidance, a great deal of sig nificant work continues to come out of the department. Outside the Department of Ophthalmol ogy, Dr. Becker is currently active on many committees: he has served for four years on the Sensory Diseases Study Section of the National Institutes of Health, and he is also a member of the Ophthalmology Training Grants Committee and a consultant to the Glaucoma Detection Program of the same organization; he serves on the National Com mittee for Research in Ophthalmology, the Scientific Advisory Committee of the Na tional Council to Combat Blindness, and the Glaucoma Committee of the National Society for the Prevention of Blindness. He is on the Tonometer Calibration Committee of the American Academy of Ophthalmology and Otolaryngology, on the editorial staff of T H E AMERICAN JOURNAL OF OPHTHALMOLOGY,
and has for three years written the glaucoma annual reviews for the A.M.A. Archives of
340
BERNARD BECKER
Ophthalmology. H e has participated in the Macy Foundation Conference on Glaucoma, and he is currently president of the Wash ington University Medical Society. H e has presented the Schneider Foundation Lecture, the M a r k Schoenberg Lecture, and he has received the E d w a r d Lorenzo Holmes Award. I n 1950, he married Janet Rosenwald, from Philadelphia. H e and Janet have four children: Diana Joan, age s i x ; Stephen Jonas, age five; John Lawrence, age four; and Bernard, Jr., age two. Steve, of course, is named for Jonas Friedenwald, who, at the time of his birth, sent him an autographed copy of the Armed Forces Institute Atlas of Pathology, "to be kept in escrow" for him because "he came off the press simultane ously with this book." T h e demands on Dr. Becker's time are be yond belief. H e is active on medical school and hospital committees and serves in an advisory capacity for a number of local or ganizations. H e has so many invitations to speak that he has been forced to make a rule to speak nowhere, except under the rarest circumstances. However, he makes it a point to find relaxation by swimming regularly, and takes great pride in the fishing at his country home. H e has a great fund of knowledge. Every month he makes a series of trips to the library, to read all of the major journals published in other fields of medicine. H e
seems to know of new developments almost as soon as they occur. His knowledge of ad vances in other fields, his awareness of the latest thinking in his own, combined with his own remarkable inventiveness, give him an endless supply of research ideas. T o have such a man around, is to keep a research de partment continually active and producing. H e is also a born teacher. H e can talk at any level, and his discussion of a subject on the spur of the moment would suggest a week's careful preparation. H i s patience is endless. H e has a way of walking into a laboratory and within a few minutes putting his finger on the crux of a problem, suggest ing improvements in techniques and changes in approach. All this is done with a warmth and understanding which make the people who work in his laboratories completely de voted to him. Unselfishness is characteristic of him, and he is jealous only of his research time. H e will give unstintingly of his time to anything which furthers basic scientific knowledge. At least 10 years ago, he expressed himself unenamored of the honors that go to the suc cessful scientist, and this is as true today as it was then. Such an attitude lends itself to objectivity; about him the spirit of competi tion fades into one of co-operation. This is the epitome of his philosophy of life.
P U B L I C A T I O N S OF BERNARD B E C K E R ,
Lawrence
T. Post,
Jr.
M.D.
1. The spermicidal times of samples of commercial contraceptives secured in 1942. Human Fertility, 8:65, 1943. (With Brown, R. L., and Levenstein, I.) 2. The spermicidal times of samples of commercial contraceptives secured in 1943. Human Fertility, 9:6, 1944. (With Gamble, C. J.) 3. The spermicidal times of contraceptive jellies and creams. Human Fertility, 11:111, 1947. (With Gamble, C. J.) 4. The histochemical localization of glucuronidase. J. Cell. & Comp. Physiol., 31:303, 1948. (With Friedenwald, J. S.) 5. The inhibition of glucuronidase by ascorbic acid and by heparin. Arch. Biochem., 22:101, 1949. (With Friedenwald, J. S.) 6. The histochemical localization of glucuronidase in ocular tissues and salivary glands. Am. J. Ophth., 33:673, 1950. (With Friedenwald, J. S.) 7. Retinal vein occlusion: Clinical and experimental observations. Am. J. Ophth., 34:677, 1951. (With Post, L. T , Jr.) 8. Rate of turnover of ascorbic acid in aqueous humor in rabbits. A.M.A. Arch. Ophth., 45:654, 1951. (With Linner, E., and Barany, E.)
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9. Increased ascorbic acid level in the aqueous humor after administration of A C T H . Acta Physiol. Scand., 25:77,1951. (With Barany, E , and Linner, E.) 10. Ascorbic acid as a test substance for measuring relative changes in the rate of plasma flow through the ciliary processes. III. The effect of preganglionic section of the cervical sympathetic in rabbits on the ascorbic content of the aqueous humor at varying plasma levels. Acta Physiol. Scand., 26:79, 1952. (With Linner, E.) 11. Diabetic retinopathy. Ann. Int. Med., 37:273, 1952. 12. The effect of adrenal cortex hormonal therapy on experimental brucella uveitis. Am. J. Ophth., 36:1025, 1953. (With Wood, R. M., and Woods, A. C.) 13. Vitamin B-12 excretion and diabetic retinopathy. J. Clin. Nutrition, 1:417, 1953. (With Lang, C. A., and Chow, B. F.) 14. Clinical aqueous outflow. A.M.A. Arch. Ophth., 50:557, 1953. (With Friedenwald, J. S.) 15. Decrease in intraocular pressure in man by a carbonic anhydrase inhibitor, Diamox. Am. J. Ophth., 37:13, 1954. 16. Studies in experimental ocular tuberculosis. X V I I . Effect of isoniazid in the normal nonimmune rabbit. A.M.A. Arch. Ophth., 51:242, 1954. (With Woods, A. C , and Wood, R. M.) 17. The adrenal cortex and B-vitamins in diabetic retinopathy. Diabetes, 3:175, 1954. (With MaengwynDavies, G., Rosen, D., and Friedenwald, J. S.) 18. Recent work in aqueous outflow. Sight-Saving Review, 24: No. 2, 1954. 19. Diamox and the therapy of glaucoma. Am. J. Ophth., 38:109, 1954. 20. The role of the adrenal cortex and vitamin B-12 in diabetic retinopathy. Am. J. Ophth., 38:53 (July, Pt. I I ) 1954. 21. T h e influence of heparin on the cortisone nephropathy of the rabbit. Bull. Johns Hopkins Hosp., 95:144, 1954. (With Rosen, D., Maengwyn-Davies, G. and Friedenwald, J. S.) 22. Chlorpromazine. Am. J. Ophth., 38:576, 1954. 23. Retinal complications of diabetes mellitus. Bull. Chic. Med. Soc, Nov. 6, 1954. 24. The mechanism of the fall in intraocular pressure induced by the carbonic anhydrase inhibitor, Diamox. Am. J. Ophth, 39:177 (Feb., Pt. I I ) 1955. 25. The evaluation of glaucoma therapy by tonography. Acta, X V I I Cone. O p h t h , 3:1557, 1954. 26. The short-term administration of Diamox in the therapy of the glaucomas. Acta, X V I I Cone. Ophth, 2:1109, 1954. 27. A comparison of the acetylating capacity of normals and diabetics with and without retinopath> Bull. Johns Hopkins H o s p , 96:150, 1955. (With Maengwyn-Davies, G, Rosen, D , and Friedenwald, J. S.) 28. The present status of the clinical use of Diamox in the management of the glaucomas. Southern M . J , 48:866, 1955. 29. Long-term Diamox administration in the therapy of the glaucomas. A.M.A. Arch. Ophth, 54:187, 1955. (With Middleton, W.) 30. Experimental tonography. I. The effect of the carbonic anhydrase inhibitor, acetazolamide, on aqueous flow. A.M.A. Arch. Ophth, 54:321, 1955. (With Constant, M. A.) 31. The effects of the carbonic anhydrase inhibitor, acetazolamide, on the composition of the aqueous humor. Am. J. O p h t h , 40:129 (Nov., Pt. I I ) 1955. 32. Xanthurenic acid excretion studies in diabetics with and without retinopathy. Proc. Soc. Exper. Biol. and Med, 88:321, 1955. (With Rosen, D. A , Maengwyn-Davies, G , Stone, H. H , and Frieden wald, J. S.) 33. Diabetic retinopathy: Diabetes mellitus in infants and children. Report of the Twelfth M & R Pediatric Research Conference (1955). 34. Tonography in the management of the glaucomas. Eye, Ear, Nose, and Throat Monthly, 35:249, 1956. 35. Aqueous humor dynamics: Theoretical considerations. A.M.A. Arch. O p h t h , 54:799, 1955, and Am. J. Ophth, 41:383, 1956. (With Friedenwald, J. S.) 36. The effects of acetazolamide on ascorbic acid turnover: An application of the theory of aqueous humor dynamics. Am. J. O p h t h , 41:522, 1956. 37. The Zeiss operating microscope. Am. J. Ophth, 42:302, 1956. 38. Alterations in aqueous humor lactate concentrations following systemic carbonic anhydrase inhibi tion. Am. J. Ophth, 42:406, 1956. (With Constant, M. A.) 39. The facility of aqueous outflow: A comparison of tonography and perfusion measurements in vivo and in vitro. A.M.A. Arch. O p h t h , 55:305, 1956. (With Constant, M. A.) 40. Beta-hypophamine (Vasopressin) : Its effect upon intraocular pressure and aqueous flow in normal and glaucomatous eyes. A.M.A. Arch. Ophth, 56:1, 1956. (With Christensen, R. E.) 41. Experimental tonography: I I . The effects of vasopressin, chlorpromazine, and phentolamine methanesulfonate. A.M.A. Arch. Ophth, 56:19, 1956. (With Constant, M. A.) 42. Friedenwald's contribution to our knowledge of diabetic retinopathy. Diabetes 5:151, 1956. 43. Hypersecretion glaucoma. A.M.A. Arch. Ophth, 56:180, 1956. (With Keskey, G. R , and Christen sen, R. E.)
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44. Water-drinking and tonography in the diagnosis of glaucoma. A.M.A. Arch. Ophth., 56:321, 1956. (With Christensen, R. E.) 45. The effect of moderate doses of X-ray irradiation on ocular tissue. Am. J. Ophth., 42:51 (Oct., Pt. II) 1956. (With Constant, M. A., Cibis, P. A., and Ter-Pogossian, M.) 46. Enzymatic activities of the lens. Am. J. Ophth., 42:342 (Oct., Pt. II) 1956. (With Wortman, B.) 47. Species variation in facility of aqueous outflow. Am. J. Ophth., 42:89 (Oct., Pt. II) 1956. (With Constant, M. A.) 48. Glaucoma, 1955-1956, A.M.A. Arch. Ophth., 56:898, 1956. 49. Routine tonometry, Trans. Am. Ophth. Soc, Am. J. Ophth., 43:21, 1957. (With Hildreth, H. R.) 50. Ocular lesions produced by iodoacetate. A.M.A. Arch. Ophth., 57:508, 1957. (With Cibis, P. A., Constant, M. A., and Pribyl, A.) 51. The rate of secretion of aqueous humor. Proc. Inst. Med. Chicago, March, 1957. 52. Newer diagnostic technics in the diagnosis of glaucoma. Post Grad. Med., 21:275, 1957. 53. Chemical composition of human aqueous humor: Effects of acetazolamide, A.M.A. Arch. Ophth., 57:793, 1957. 54. Misuse of acetazolamide. Am. J. Ophth., 43:799, 1957. 55. Vascular changes of diabetes. Diabetes, 6:180, 1957. (With Colwell, A. R., Sr., Alpert, L. K., Ken dall, F. E., and LeCompte, P. M.) 56. Congenital defects in infants following mumps during pregnancy. J. Pediat, 50:689, 1957. (With Holowach, J., and Thurston, D. L.) 57. The bicarbonate concentration in guinea pig aqueous humor: Effect of scurvy and acetazolamide. Am. J. Ophth., 44:402 (Nov., Pt. II) 1957. 58. Cataract extraction and aqueous flow. A.M.A. Arch. Ophth., 58:401, 1957. (With Miller, J. E., and Keskey, G. R.) 59. Clinical tonography: The scleral rigidity correction. Am. J. Ophth., 45:196, 1958. (With Moses, R. A.) 60. Glaucoma, 1956-1957. A.M.A. Arch. Ophth., 58:862, 1957. 61. Urinary excretion of citrate in humans following administration of acetazolamide. A.M.A. Arch. Ophth., 59:536, 1958. (With Shah, A. W., and Constant, M. A.) 62. Epinephrine and acetazolamide in the therapy of the chronic simple glaucomas. Am. T. Ophth., 45:639, 1958. (With Ley, A. P.) 63. Tonography and angle closure glaucoma: Diagnosis and therapy. Am. J. Ophth., 46:305, 1958. (With Thompson, H. E.) 64. The prognostic value of tonography in the miotic therapy of chronic simple glaucoma. Am. J. Ophth., 46:11, 1958. 65. Age variations in clinical tonography. Am. J. Ophth., 46:731, 1958.
CARBONIC ANHYDRASE AND T H E FORMATION O F AQUEOUS HUMOR* T H E FRIEDENWALD MEMORIAL LECTURE BERNARD BECKER,
M.D.
Saint Louis, Missouri In the Proctor Lecture on " T h e formation of the intraocular fluid" 10 years ago, Frie denwald' raised "the question as to whether more effort might not profitably be directed toward a reduction in the formation of aque ous in cases of glaucoma, in addition to the present approach which concerns largely an effort to increase the outflow of fluid from the eye." Research based largely upon the theories and groundwork described by Frie denwald in this lecture made his intuitive * From the Department of Ophthalmology and the Oscar Johnson Institute, Washington University School of Medicine.
prediction a reality less than five years later. 2 - 3 The usefulness or carbonic anhydrase in hibitors in ophthalmology has not been limited to the therapy of the glaucomas, for the availability of such agents as research tools has contributed greatly to our knowl edge of aqueous humor dynamics. Not only did Friedenwald suggest a need for carbonic anhydrase in the secretion of aqueous humor, but he also provided us with a more complete theory of aqueous humor dynamics. 4 It is largely on the basis of these formulations as well as his work on standardization and cali-