Notes on history of ophthalmology in Spain

Notes on history of ophthalmology in Spain

1082 CORRESPONDENCE are reminded of Sir John Parsons' won­ derful work "The Pathology of the Eye", by the great number of journal articles referred ...

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are reminded of Sir John Parsons' won­ derful work "The Pathology of the Eye", by the great number of journal articles referred to in the text and in the bibliographies, which are appended to every topic in the chapters. Not only have original articles been searched out, and studied but there has been a selec­ tion of their most important points, which are briefly but clearly set down. Where there is controversy, each view has been set forth with the author's judgment; often when it was simply that neither view had been established. Almost as striking as the bibliog­ raphies, are the cross reference notes, at the foot of each page, which enable the reader to turn at once to the related ideas, set forth elsewhere, without waste of space by repetition. The work might be called encyclopedic, but its ar­ rangement in natural logical order, re­ moves it as far as possible from the brief, pigeonhole, patchwork plan, of an encyclopedia ; while the cross references render alphabetical arrangement of topics quite unnecessary for reference purposes. Still more exceptional in books on ophthalmology—almost un­ known, except in some published by a few American, or British firms, is the full index of 38 double column pages. This gives all the advantages for refer­ ence, that can be afforded by the alpha­ betic arrangement of an encyclopedia or dictionary. The book has been printed on highly finished paper. This is necessary for the best reproduction of the many halftone pictures it contains. But the regular re­ flection from its surface will compel the ophthalmologist to adopt the plan he often advises to patients; to arrange the position of book and source of light, so that such reflection will not be thrown in his eyes. Any inconvenience on this account will be compensated by the splendid photographic portraits of some of the great leaders in modern ophthal­ mic science: Bowman in the chapter on anatomy, Gregor Mendel and Edward Nettleship with that on heredity, Leber with metabolism, Donders with accom­ modation and movements of the eyes, and Helmholtz and Gullstrand with op­ tical imagery. In the chapter on embry­

ology the reproductions from the recent book of Ida C. Mann, and the other at­ lases on the developments of the eye, must be counted to the credit of the plan of photographic reproductions. The price of a great book like this must be high; and to the publisher's three guineas, American readers must add the tariff, by which a paternal gov­ ernment penalizes the reader who in­ dulges a liking for world science. But for the ground it covers, this book has practically the value of a whole library. It should be found in every library that purports to contain books on ophthal­ mology. Edward Jackson. CORRESPONDENCE Notes on history of ophthalmology in Spain Apropos of Dr. Crisp's recent edi­ torial on Medical South America I wish to share with those who plan to attend the next International Congress at Madrid some notes gathered by me in preparation for my own visit. Spanish is not so widely read as French or German, and the history of Spain, medical and other, is not too well known. The contributions of Arabic, Jewish and Christian physicians of the Iberian Peninsula to medicine, their in­ fluence on the establishment of the School of Montpellier, during the middle ages and the Renaissance, is general medical history. Garcia del Real's Ilistoria de la Medicina en Espana deals meagerly with the history of ophthalmology. Ilirchberg's Geschichte der Augenheilkunde is more complete but not up to date. The history of Spanish ophthalmology goes back as far as the thirteenth century, when Petrus Hispanus, afterwards Pope John XXI, according to Walsh in "Popes and Science," wrote a treatise on "Diseases of the Eyes." Garcia del Real mentions a Jewish physician operating on King Juan of Aragon (fourteenth century) for a double cataract, and, during the Siglo de Oro (Golden Age) of Spanish civilization—the sixteenth and seven­ teenth centuries—a Historia del Ojo (a treatise on the eye) by Bartolome Hidalgo de Aguero, a De Sensibus Ex-


ternis by Luis Mercado, and a treatise on the use of spectacles (El Uso de los Anteojos) by Daza. With the decline of Spanish culture in the seventeenth century, little is noted of the cultiva­ tion of ophthalmology. By the middle of the eighteenth cen­ tury we find the Medical School of Cadiz sending six of its best students abroad to study ophthalmology, among them Vidal, Nadal, and Gimbernat who later practice this specialty. The first eye dispensary was established at Cadiz in 1830 by Espaha and Sola. The first textbook on ophthalmology was written by Santana in 1850. The In­ stitute Oftalmico of Madrid was estab­ lished in 1857 with Delgado Jugo, a pupil of Desmarres, as its first director. Cervera and Cayetano del Toro are also counted among the founders of Spanish ophthalmology. On the whole however, science lagged in the nine­ teenth century in Spain. It was a troub­ lous period for Spain with the Napole­ onic invasion, the Carlist wars, revo­ lution, loss of most of its colonies, and war with the United States. Of the twentieth century Spanish contributions, Fielding H. Garrison, in his admirable Epitome of the History of Spanish Medicine, writes in the Au­ gust, 1931, Bulletin of the New York Academy of Medicine: T h e impersonal scientific contributions of such men as Cajal, A c h u c a r r o , H o r t e g a , Tapia, and B a r r a q u e r have gone far to lift Spanish medicine out of the same tedious provincialism which once obsessed the medi­ cal literature of our own country, and pre­ lude, let us hope, the dawn of a fairer day for Spanish medicine.

Three of the five names mentioned by Garrison have made notable contribu­ tions to ophthalmology. The year 1901 marks the establish­ ment of the "Soc.iedad Hispano-Americana de Oftalmologia", and the begin­ ning of the publication of the "Archivos de Oftalmologia Hispano Americanos" now in its thirty-second year. In look­ ing over these Archivos, certain names recur again and again: Arruga, Blanco, Castresana, Castillo, Cuevas, Marquez, Mejia, Rema, and more recently, Bar­ raquer, Balbuena, Lacarrere, Lopez


Enriquez, Palomar de la Torre, Perez Bufil, Poyales, Soria. Many of them were active contributors to the last International Conference of Ophthal­ mology, and their names are of course known to readers of ophthalmological literature. Cajal's contribution to ophthal­ mology, better known to histologists than to ophthalmologists, should be further dwelt upon. On reading Ramon y Cajal's "Recuerdos de mi Vida," which is in its second edition, one is struck by his fascination for the retina. It was his first love to which he re­ turned again and again in the course of his scientific career. The function of the retina in our development loomed very large to him. Of his birthplace, Petilla, he speaks as "the place where nature pierced my retina and awakened my brain". Needless to say, he con­ sidered himself a "visual", explaining thus his early artistic inclinations to­ ward the graphic arts, his curiosity about optics, and his devotion to pho­ tography, all of which so seriously in­ terfered with his studies that his father took him away from school and ap­ prenticed him to a shoemaker. These interests stood him in good stead how­ ever in his later activities as a microscopist and histologist, enabling him to do his own illustrating. A mere enu­ meration of his contributions to the histology of the eye and the physiology of vision: his law of dynamic and axipetal polarization, his discovery of association spongioblasts, of centri­ fugal nerves (nervi-nervorum) in retina and optic nerve, his researches on the structure of the optic chiasm and its decussation, and his studies of the visual cortex—indicates sufficiently to what extent ophthalmology is in­ debted to Ramon y Cajal. As a teacher he set out to correlate anatomy and physiology, creating "animated anat­ omy". It is interesting to note that as late as 1875 histology was disdainfully referred to by medical teachers in Spain as "celestial anatomy" and that microscopes served mainly as decora­ tions. Among his pupils the name of Rio Hortega, the discoverer of phagocytic



microglia and oligodendroglia in retina and optic nerve, is also better known probably to histologists than to clini­ cians. Cajal refers with sadness to the promising research workers among his pupils who became lost in what he calls "los desiertos de la clinica" (the wilderness of private practice). Among these however, Marquez, the Professor of Ophthalmology at the University of Madrid, and the President of the next Congress, has enriched our knowledge of cylinder skiascopy, binocular vision, decussation of the motor nerves of the eye, and surgery of the eye. CajaPs autobiography is not only a record of his life and scientific achieve­ ments, but is a cultural and medical history of Spain for the past half cen­ tury. Because of its excellent prose, the first part is available, for those who cultivate Spanish, as an annotated Spanish reader. There is also a book

of aphorisms translated by Garrison in the June, 1929, Bulletin of the New York Academy of Medicine in his ar­ ticle devoted to Cajal. Needless to say, Cajal was one of the regenerators of the generation of '98, which marks the awakening of a new nationalism, and stock-taking of the spiritual resources of Spain by the Spanish intellectuals following the debacle of the SpanishAmerican War. Cajal's voyages abroad, to receive the Nobel prize, to lecture at Oxford and in the United States, and his impressions of foreign countries, make up many delightful pages. He is in his eighty-first year now, and all will agree with Garrison who says: "In solid performance Ramon y Cajal is the greatest figure in the history of Spanish medicine, in point of character the most eminent man his country has produced in several centuries". M. Davidson.