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The Wilmer Residents Association Meeting
EDITORIALS Child, 1947, pp. 138-142), while in some other localities, the incidence seems lower. My colleagues in other countries, including France, Austria, and Australia, tell me that they do not encounter the condition except as a rare sporadic case. Furthermore, in the fundi of these patients there are clinical manifestations over the areas accessible to examination which indicate that a choroiditis of a mild nature has existed. This manifests itself as a diffuse, mild, pigment disturbance. Also, some of the eyes having retrolental fibroplasia show evidence of an iridocyclitis. This manifests itself as posterior synechiae, atrophy of the iris, and the sequela of exudate around the pupillary margin of the iris. Moreover, from 40 to 60 percent of the mothers of these patients give a history of vaginal bleeding during pregnancy, and some give evidence of having had infection of some kind during their pregnancies. This may be a history of fever or of intercurrent infection such as brucellosis, German measles, ulcerative colitis, and so forth. It. is known that certain mild clinical, or even subclinical, infections of the mother affect the offspring. Toxoplasmosis is a subclinical infection of the mother which produces in the offspring chorioretinitis as well as congenital anomalies. Measles, and perhaps other virus diseases of the mother, can produce abnormalities in the offspring. There must be still other clinical and sub clinical infections of the mother acting in similar fashion. In retrolental fibroplasia, therefore, it seems reasonable to postulate that a maternal infection of some nature is responsible for the variations in the inci dence in different localities, for the vaginal bleeding and consequent premature birth, and for the signs of inflammation in the eyes of the offspring such as chorioretinitis and iridocyclitis. As pediatricians now save premature infants which would previously have been lost, the sequelae of this maternal infection on the infant now manifests itself as an increased incidence of this lesion which
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formerly appeared only sporadically. The increased incidence might also be attributed in part at least to an increase in the prev alence of some maternal infection. The problem of retrolental fibroplasia is the most acute one in ophthalmology today. Is there not some way we can prevent the birth of so many blind infants whose parents, too frequently young and of modest means, can ill afford to have their resources deci mated and to carry the tremendous burden of such a child? Often the affected child is the first one of young parents who, though they accept their plight, are terribly handi capped and plan to have no more children. Those concerned in this problem, including the ophthalmologist and the various public organizations and institutions, are not suf ficiently aroused to, or conscious of, the im portance of the problem. One of the first steps toward clarifying the issue should be a thorough and accurate accounting of pre mature children with regard to the incidence of retrolental fibroplasia, mental retarda tion, and other abnormalities. Then it can be decided whether or not the saving of pre mature infants should be entered on the credit or debit side of medicine. Algernon B. Reese. T H E WILMER RESIDENTS ASSOCIATION M E E T I N G The seventh annual meeting of the Wilmer Residents Association was held at the Wilmer Ophthalmological Institute, Johns Hopkins Hospital and University, on April 14, 15, and 16, 1948. The total registration, including guests, was 181. Those privileged to attend came from many places in the United States. The Residents Association is composed of former residents of the Wilmer Ophthal mological Institute. The purpose of their annual clinical meeting is to provide an op portunity for the returning residents, former house officers, assistant residents, and guests
626
CORRESPONDENCE
to review the work done in the Wilmer Institute during the past year, and to follow the activities of the former residents. It has been the custom to invite a number of oph thalmologists from other cities to attend these meetings. There were 26 papers or presentations by former residents, past and present mem bers of the staff, and from members of other departments of the university. Thus, a most impressive array of authors and subjects was paraded before the keenly interested audience during the three delightful days of the meeting. The quality of the work and its impor tance to ophthalmology was most striking. It is impossible here to do adequate justice or to describe in detail the individual con tributions. Many of them will appear in subsequent issues of the JOURNAL. However, the papers by Woods on "Antibiotic and Chemotherapy in Experimental Ocular Tu berculosis," Owens and Owens, on "Retrolental Fibroplasia," Walsh on "Nasopharyngeal Carcinoma," Woods and Wood on "Bacterial Hypersensitivity and Its Relation to Ocular Disease," and Kuffler on "Synaptic Transmission with Reference to the Ret ina," were particularly worthy of note. Dr. Alfred Blalock discussed the "Surgi cal Treatment of Coarctation of the Aorta and Pulmonic Stenosis," and showed a breath-taking motion picture in Kodachrome of his spectacular and life-saving operation in these conditions. Dr. Jonas Friedenwald brilliantly presented some of his recent work on "Enzymatic Histochemistry and Its Ap plications to Ophthalmic Research," and did his best to simplify the complexities of the subject for his overwhelmed listeners. Dr. William G. Marr debunked and devastated the cyclodiathermy operation for glaucoma. Dr. Samuel D. McPherson, Jr., and Dr. Ronald Wood exhibited convincing evidence that solutions of the usual drugs used in ophthalmology in 1:5,000 Zephiran remain sterile for weeks thereafter. Dr. M. Elliott Randolph read an excellent paper on "Re
current Erosion of the Cornea," and sug gested the value of histamine desensitization for this stubborn condition. The paper by Bruno and McPherson, Jr., on "Harada's Disease," was thought-provoking and stimu lating. These and the other papers on the program showed careful observation, work, and skill in presentation. One cannot praise the meeting too highly. There were many lighter moments and times for relaxation and entertainment dur ing the evenings. A skit, ably performed by the active house officers and residents, poked harmless fun at their betters (in age at any rate) and slyly probed into the foibles and dignities of their directors. The actors' lines were clever and were relished by the on lookers, particularly those who were not in the line of fire. Derrick Vail. CORRESPONDENCE REPLY TO DR. CRISP
Editor, American Journal of Ophthalmology: In the March issue of the American Jour nal of Ophthalmology, there appears an editorial signed by Dr. W. H. Crisp, in which decided exception is taken to certain portions of an address delivered by me in Chicago at the recent meeting of the Ameri can Academy of Ophthalmology and Otolaryngology. Dr. Crisp elected to express his disap proval through the medium of an editorial rather than take the more conventional method of a letter to the editor. In adopt ing this more formal and official approach he avails himself of his position as consult ing editor of the Journal and in his use of the pronoun "us" implies general editorial approval. Thus his criticism immediately passes the boundary of personal disagree ment and assumes the tenor of an official re buke. Inasmuch as I have a natural reluc tance to endure chastisement meekly, and am moreover quite unrepentant, may I take this opportunity to point out certain points
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formerly appeared only sporadically. The increased incidence might also be attributed in part at least to an increase in the prev alence of some maternal infection. The problem of retrolental fibroplasia is the most acute one in ophthalmology today. Is there not some way we can prevent the birth of so many blind infants whose parents, too frequently young and of modest means, can ill afford to have their resources deci mated and to carry the tremendous burden of such a child? Often the affected child is the first one of young parents who, though they accept their plight, are terribly handi capped and plan to have no more children. Those concerned in this problem, including the ophthalmologist and the various public organizations and institutions, are not suf ficiently aroused to, or conscious of, the im portance of the problem. One of the first steps toward clarifying the issue should be a thorough and accurate accounting of pre mature children with regard to the incidence of retrolental fibroplasia, mental retarda tion, and other abnormalities. Then it can be decided whether or not the saving of pre mature infants should be entered on the credit or debit side of medicine. Algernon B. Reese. T H E WILMER RESIDENTS ASSOCIATION M E E T I N G The seventh annual meeting of the Wilmer Residents Association was held at the Wilmer Ophthalmological Institute, Johns Hopkins Hospital and University, on April 14, 15, and 16, 1948. The total registration, including guests, was 181. Those privileged to attend came from many places in the United States. The Residents Association is composed of former residents of the Wilmer Ophthal mological Institute. The purpose of their annual clinical meeting is to provide an op portunity for the returning residents, former house officers, assistant residents, and guests
626
CORRESPONDENCE
to review the work done in the Wilmer Institute during the past year, and to follow the activities of the former residents. It has been the custom to invite a number of oph thalmologists from other cities to attend these meetings. There were 26 papers or presentations by former residents, past and present mem bers of the staff, and from members of other departments of the university. Thus, a most impressive array of authors and subjects was paraded before the keenly interested audience during the three delightful days of the meeting. The quality of the work and its impor tance to ophthalmology was most striking. It is impossible here to do adequate justice or to describe in detail the individual con tributions. Many of them will appear in subsequent issues of the JOURNAL. However, the papers by Woods on "Antibiotic and Chemotherapy in Experimental Ocular Tu berculosis," Owens and Owens, on "Retrolental Fibroplasia," Walsh on "Nasopharyngeal Carcinoma," Woods and Wood on "Bacterial Hypersensitivity and Its Relation to Ocular Disease," and Kuffler on "Synaptic Transmission with Reference to the Ret ina," were particularly worthy of note. Dr. Alfred Blalock discussed the "Surgi cal Treatment of Coarctation of the Aorta and Pulmonic Stenosis," and showed a breath-taking motion picture in Kodachrome of his spectacular and life-saving operation in these conditions. Dr. Jonas Friedenwald brilliantly presented some of his recent work on "Enzymatic Histochemistry and Its Ap plications to Ophthalmic Research," and did his best to simplify the complexities of the subject for his overwhelmed listeners. Dr. William G. Marr debunked and devastated the cyclodiathermy operation for glaucoma. Dr. Samuel D. McPherson, Jr., and Dr. Ronald Wood exhibited convincing evidence that solutions of the usual drugs used in ophthalmology in 1:5,000 Zephiran remain sterile for weeks thereafter. Dr. M. Elliott Randolph read an excellent paper on "Re
current Erosion of the Cornea," and sug gested the value of histamine desensitization for this stubborn condition. The paper by Bruno and McPherson, Jr., on "Harada's Disease," was thought-provoking and stimu lating. These and the other papers on the program showed careful observation, work, and skill in presentation. One cannot praise the meeting too highly. There were many lighter moments and times for relaxation and entertainment dur ing the evenings. A skit, ably performed by the active house officers and residents, poked harmless fun at their betters (in age at any rate) and slyly probed into the foibles and dignities of their directors. The actors' lines were clever and were relished by the on lookers, particularly those who were not in the line of fire. Derrick Vail. CORRESPONDENCE REPLY TO DR. CRISP
Editor, American Journal of Ophthalmology: In the March issue of the American Jour nal of Ophthalmology, there appears an editorial signed by Dr. W. H. Crisp, in which decided exception is taken to certain portions of an address delivered by me in Chicago at the recent meeting of the Ameri can Academy of Ophthalmology and Otolaryngology. Dr. Crisp elected to express his disap proval through the medium of an editorial rather than take the more conventional method of a letter to the editor. In adopt ing this more formal and official approach he avails himself of his position as consult ing editor of the Journal and in his use of the pronoun "us" implies general editorial approval. Thus his criticism immediately passes the boundary of personal disagree ment and assumes the tenor of an official re buke. Inasmuch as I have a natural reluc tance to endure chastisement meekly, and am moreover quite unrepentant, may I take this opportunity to point out certain points