Fifty-Fifth Annual Session of the Academy

AMERICAN JOURNAL OF OPHTHALMOLOGY Published Monthly by the Ophthalmic Publishing Company EDITORIAL STAFF DERRICK VAIL, Editor-in-Chief

S. RODMAN IRVINE

9730 Wilshire Boulevard, Beverly Hills, California

700 North Michigan Avenue, Chicago 11 WILLIAM H. CRISP, Consulting Editor

JAMES E. LEBENSOHN

1276 Emerson Street, Denver 3

4010 West Madison Street, Chicago 24

LAWRENCE T. POST, Consulting Editor

DONALD J. LYLE

WILLIAM L. BENEDICT

WILLIAM A. MANN

640 South Kingshighway, Saint Louis 10

601 Union Trust Building, Cincinnati 2 30 North Michigan Avenue, Chicago 2

The Mayo Clinic, Rochester, Minnesota

JOHN V. V. NICHOLLS

FREDERICK C. CORDES

1414 Drummond Street, Montreal

384 Post Street, San Francisco 8

ALGERNON B. REESE

73 East Seventy-first Street, New York 21

SIR STEWART DUKE-ELDER

63 Harley Street, London, W.l

PHILLIPS THYGESON

87 North 6th Street San Jose, California

EDWIN B. DUNPHV

243 Charles Street, Boston 14

M. URIBE TRONCOSO

F. HERBERT HAESSLER

500 West End Avenue, New York 24

561 North ISth Street, Milwaukee 3

ALAN C. WOODS

PARKER HEATH

Johns Hopkins Hospital, Baltimore 5

243 Charles Street, Boston 14

KATHERINE FERGUSON CHALKLEY, Manuscript Editor

Lake Geneva, Wisconsin

Directors: WILLIAM L. BENEDICT, President; FREDERICK C. CORDES, Vice-President; WILLIAM A. MANN, Secretary and Treasurer; WILLIAM H. CRISP, LAWRENCE T. POST, DERRICK VAIL.

Address original papers, other scientific communications including correspondence, also books for review to Dr. Derrick Vail, 700 North Michigan Avenue, Chicago 11, Illinois; Society Proceedings to Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Manuscripts should be original copies, typed in double space, with wide margins. Exchange copies of medical journals should be sent to Dr. F. Herbert Haessler, 561 North 15th Street, Milwaukee 3, Wisconsin. Subscriptions, application for single copies, notices of changes of address, and communications with reference to advertising should be addressed to the Manager of Subscriptions and Advertising, 664 North Michigan Avenue, Chicago 11, Illinois. Copy of advertisements must be sent to the manager by the 15th of the month preceding its appearance. Change of address notice should be received not later than the 15th of the month prior to the issue for which the change is to go into effect. Both old and new addresses should be given. Author's proofs should be corrected and returned within forty-eight hours to the Manuscript Editor, Mrs. Katherine F. Chalkley, Lake Geneva, Wisconsin. Twenty-five reprints of each article will be sup­ plied to the author without charge. Additional reprints may be obtained from the printer, the George Banta Publishing Company, 450-458 Ahnaip Street, Menasha, Wisconsin, if ordered at the time proofs are returned. But reprints to contain colored plates must be ordered when the article is accepted. FIFTY-FIFTH ANNUAL SESSION O F T H E ACADEMY One of the most brilliant meetings of the American Academy of Ophthalmology a n d Otolarnygology was held at the Palmer House, Chicago, from October 8th to 13th. The total registration was 4,828, only 20 less than t h e record made last year when Sir Stewart Duke-Elder was the guest of honor. The president, J . Mackenzie Brown, M.D., of Los Angeles, California, opened the joint session of the scientific section with an able address on " A half century of oto-

laryngology," in which h e reviewed the pioneer work of many otolaryngologists, with emphasis on the Americans w h o had contributed so much to this specialty. T h e familiar names he mentioned recalled to many, in a wave of nostalgia, the glorious days of ingenious surgery in this branch of medicine before the discovery of the antibi­ otics. The guest of honor this year w a s the dis­ tinguished otolaryngologist, J o h n D . K e r -

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EDITORIALS nan, M.D., of New York, who later on in the Section on Otolaryngology gave his address on " T h e pathology of carcinoma of the larynx based on serial sections." T h e premiere showing of the motion pic­ ture on the "Embryology of the eye," by Dr. George W . Corner of Baltimore and D r . George Smelser of New York, was, so far as the ophthalmologists were concerned, the hit of this or any other session so far. Marvelously planned and beautifully exe­ cuted, this film, in two parts, revealed the development of the normal human eye from first to last. T h e picture lasted just an hour and, as the creation of the eye unfolded by means of animated drawings and colored photographs of actual embryologic sections, a skilled narrator explained in clear and con­ cise terms what was going on. Although sponsored by the Academy, the authors of the film were given entire free­ dom in the execution of it. Each of these men is an authority in human embryology, and no effort was spared to make the film as accurate as possible. T h e photography, under the skilled direction of Dwinnell Grant of the Sturgis-Grant Corporation of New York, was superb. The Academy plans to have copies of the film prepared for sale at a reasonable price to universities and hospitals that may be interested. It is hoped, by this way, to re­ cover, in part at least, the heavy expense of its preparation. It is impossible to say enough about the teaching value of this splendid work. T h e officers and members of the Academy are very proud of this ex­ traordinary production, completed entirely without the heavy and crushing hand of governmental bureaucracy taking part. There was no dialectical materialism here. There were several symposia on the pro­ gram of ophthalmology. T h e major one on "Corneal diseases," under the able chair­ manship of Frederick C. Cordes of San Francisco, covered the applied anatomy and physiology of the cornea by David Cogan,

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inflammation by James H . Allen, degenera­ tions and dystrophies by F . Phinizy Calhoun, Jr., classification of corneal diseases by Edwin B. Dunphy, and treatment by Kenneth C. Swan. Another symposium on A C T H and corti­ sone in ocular diseases gave us important reports by Henderson and Hollenhorst of Rochester, Minnesota, John M. McLean of N e w York, Sol Rome of Los Angeles, and Frederick C. Blodi of New York, on the extraordinary results of the use of these substances in a variety of ocular diseases, including retrolental fibroplasia and sympa­ thetic ophthalmia. T h e general use of A C T H and cortisone and the local use of cortisone by instillation and subconjunctival injection were described. It appears to be the consensus that these substances act on intraocular inflammatory processes by shielding the collagen tissue of the eye as a buffer against the disease proc­ ess. They do not act directly on the disease process and, when withdrawn, the disease recurs. W i t h each course of treatment, how­ ever, the condition of the eye, as a rule, improves. Old pathologic processes are not affected and thus the earlier these substances are used, the better the result. Local use of cortisone seems to be effective and is cheaper to use, simpler to administer, and is free of the danger of serious side effects. A s a background for this symposium, H o w a r d F . Polley of Rochester, Minnesota, discussed the general subject of collagen diseases, and Leonard Christensen of Port­ land, Oregon, that of the ocular pathology of collagen diseases. A splendid and illuminating review of the viruses was given by Thomas Francis, Jr., of A n n Arbor, and Perrin H . Long brought us up-to-date on the antibiotics, with particular reference to aureomycin. T h e annual Jackson Memorial Lecture was given by F r a n k B. Walsh, of Baltimore, on "Optic nerve sheath hemorrhage." This splendid essay on a poorly understood sub-

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EDITORIALS

ject will, as is customary, appear in an early issue of the JOURNAL. Two papers on brucellosis were given. One by Alan C. Woods of Baltimore re­ viewed the ocular conditions found in this disease. Among them he mentioned nummular keratitis and periodic ophthalmia in horses. The general subject of human bru­ cellosis was completely reviewed by Wesley W. Spink of Minneapolis. Among the outstanding papers was that by William Banks Anderson of Durham, North Carolina, on fundus changes before and after the rice diet prescribed for hyper­ tensive cardiovascular renal disease. The author conclusively showed, by a series of beautiful colored slides of the ocular fundus, that severe changes, even that of papilledema, found in advanced cases are capable of being reversed by this treatment. A. L. Kornzweig of New York discussed the pathology of the eye in old age, basing his findings upon the post-mortem examina­ tion of 120 eyes from aged individuals. His paper and his scientific exhibition on the subject attracted much attention. Mrs. Helenor C. Wilder of Washington, D.C., described an impressive series of cases of nematode endophthalmitis. Almost all of the patients were children under 10 years of age, most of whom lived in southeastern United States. The eyes had been removed, clinically diagnosed as retinoblastoma. Her lantern slides, beautifully colored, showed up the nematode larvae in a striking fashion. Another startling paper was that by L. R. Duszynski of New York in which he showed that 73 percent of eyes removed fol­ lowing glaucoma surgery revealed serious contamination of the wounds with cotton fibrils and talc. He proved that these parti­ cles of foreign material initiated an inflam­ matory reaction in the ocular tissue in each instance. They were invisible in ordinary illumination under the microscope, but were strikingly seen when polarized light was used. There seems to be no doubt that

these foreign bodies account for postopera­ tive complications and even failures. The exceedingly high incidence of their presence requires action on the part of each ophthal­ mic surgeon. As is recently customary, motion pictures of ophthalmic surgery and clinicopathologic case reports were interspersed here and there throughout the program of formal papers. These are valuable features of the program and, without exception, were well chosen, informative, and illuminating. In addition, a number of new instruments and ophthalmic devices were displayed and de­ scribed by their inventors. Of the 22 scientific exhibits, 17 pertained to ophthalmology. The first scientific award was to David D. Donaldson and David G. Cogan of Boston for their exhibit of stereophotographs of the anterior segment of the eye. The second award went to A. L. Korn­ zweig of New York for his exhibit of the pathology of the eye in old age; and the third award to B. D. Leahey of Lowell, Massachusetts, on transplantation of the cornea. Honorable mention awards were given to W. L. Benedict, Edith Parkhill, and Joseph Groom of Rochester, Minnesota, for their exhibit on gliomas of the retina, and to F. H. Theodore of New York, for his exhibit of office bacteriology of the eye. One hundred twenty-nine individual courses (including 11 home-study discussion periods) and 32 continuous courses in oph­ thalmology were given during the week. A faculty of 174 instructors gave 401 hours of instruction. The courses were crowded for the most part, and many of them were sold out. The daily scientific sessions were similarly crowded, sometimes not even standing room in the main hall, seating 3,000, was available. The eagerness with which the members at­ tended and the long hours of concentration they gave is a remarkable testimony to their thirst for knowledge and to the splendid character of the program.

EDITORIALS T h e new officers elected to serve in 1951 a r e : President, Derrick Vail, Chicago; president-elect, James Milton Robb, Detroit, Michigan; 1st vice-president, Francis E . Le Jeune, N e w O r l e a n s ; 2nd vice-president, Peter Kronf eld, Chicago; 3rd vice-president, Frederick A. Figi, Rochester, Minnesota. T h e new councillor is John H . Dunnington, N e w York. Members of the Academy will be de­ lighted to know that William L. Benedict has been elected executive secretary-treas­ urer to serve full time. H i s election assures us that the magnificent work of this ex­ traordinary organization will continue to thrive under his valuable direction. D r . George W . Corner and Dr. George Smelser were elected honorary members of the society in recognition of their outstand­ ing contribution and work on the film of the "Embryology of the eye." The social side of the meeting was not neglected. T h e usual smoker and banquet were attended in force, and, at the latter, 10 honor keys were presented to faithful instructors who have devoted many hours to the scientific work of the Academy. T h e next meeting of the organization will be held in the Palmer House, Chicago, October 14 to 19, 1951. Derrick Vail.

W E S T W A R D HO The American public is faced with the problem of achieving a better distribution of medical care. An equally pressing prob­ lem is that of making available adequate clinical material for the teaching of resident staffs. The fact that no part of this nation or its possessions is now farther away from any other part than two days by air suggests the possibility of transporting doctors still in training to areas where large quantities of clinical material are available and at pres­ ent inadequately cared for. The work of men still in their residencies must, of course, be

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supervised by qualified specialists, but this problem, though difficult of solution, need not prove insurmountable. Last year Duke University and the Alaska Department of Health collaborated in a note­ worthy educational experiment in ophthal­ mology and otolaryngology which may ulti­ mately be extended to other specialties. After completing the first year of the com­ bined residency in ophthalmology and oto­ laryngology offered at Duke, one of the young residents, Dr. A. W. Vogel, went to Alaska for a six-month period (July 1, 1949, to January 1, 1950) which he spent in the Territory as a clinical ophthalmologist and otolaryngologist under the supervision of a consultant certified in both specialties. The young doctor's first tour of duty was one month at the Mt. Edgecumbe Medical Center at Sitka where wards of the Alaska Department of Health and the Alaska Na­ tive Service come for certain types of special medical care and for certain educational needs that cannot be met in the smaller com­ munities. Here Dr. Vogel, in addition to learning how to carry on his work without the benefit of the equipment available in a large university medical school, was able to participate in a research project on phlyctenulosis which was being conducted under the auspices of the United States Public Health Service. During the remaining five months, Dr. Vogel worked in 10 widely separated com­ munities throughout the Territory, travelling as far north as Point Barrow, as far west as Nome, and as far south and east as Sitka. He encountered the same types of pathologic conditions which occur in the States but their relative frequency varied interestingly, the high incidence of phlyctenulosis being an outstanding variation. In his report he ex­ pressed great satisfaction with his service and with the challenge to his ingenuity. The success of this first experiment in widening the scope of a university medical center geographically much farther than is