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William Thomson (1833-1907). Military Surgeon, Pioneer Photomicrographer, Clinical Ophthalmologist
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poor socioeconomic strata to which these chil dren belong, mothers are generally an im portant source of infection for the children, especially u p to the age of six years. SUMMARY
A group of 391 cases showing Stage I V trachoma were clinically examined for P r o wazek-Halberstaedter inclusion bodies. I n not one case were these bodies found. Active trachoma was found in only three of the 770 children of these 391 m o t h e r s ; all 770 were clinically examined. All three of the children with active trachoma were above the age of five years. T h e results of this investigation in-
dicate that this stage of trachoma can be re garded as noninf ective. ACKNOWLEDGMENTS
I thank Professor I. C. Michaelson for his ad vice and encouragement, Dr. Z. Zakai-Rones for her help in preparing the immunofluorescent anti body examination, and the nurses of Mother and Child Care Clinic. REFERENCES
1. Hanna, I., Dawson, C. R., Briones, O., Thygeson, P., and Jaivetz, E. ; Latency in human infec tions with trachoma agents. J. Immunol. 101:43, 1968. 2. Katzenelson, E., and Bernkopf, H. : Serologie differentiation of trachoma strains and other agents of the psittacosis-lymphogranuloma venereumtrachoma group with the aid of the direct fluores cent antibody method. J. Immunol. 94:3, 1965.
W I L L I A M T H O M S O N (1833-1907). M I L I T A R Y S U R G E O N , PIONEER PHOTOMICROGRAPHER, CLINICAL OPHTHALMOLOGIST L O R E N Z E.
ZIMMERMAN,
M.D.,
J O E M.
D A N I E L M.
BLUMBERG,
A L B E R T , M.D.,
AND
M.D.
Washington, D.C. Dr. William Thomson is perhaps best known today as the subject of a portrait by Thomas Eakins 1 (fig. 1) that hangs in the Philadelphia Museum of Art, a part of an exhibit entitled " A r t in Philadelphia Medi cine." This striking painting was first viewed by us in 1965. Since that time we have reviewed Thomson's contributions to military medicine, photomicrography, and ophthalmology. 2 " 4 During his lifetime, Thomson was a leading figure in these fields. From the Ophthalmic Pathology Branch, Armed Forces Institute of Pathology, Washington, D.C. Dr. Zimmerman is Chief, Ophthalmic Pathology Branch, Armed Forces Institute of Pathology; Doctor Albert's address is now Section of Ophthal mology, Department of Surgery, Yale University School of Medicine. He is a former Special Fellow in Ophthalmic Pathology at the Armed Forces In stitute of Pathology, and sponsored by the National Institute of Neurological Diseases and Blindness, NIH (Grant NB 1873). Dr. Blumberg was formerly the Director, Armed Forces Institute of Pathology, Major General, MC, USA. (Retired) Reprint requests to Dr. Lorenz E. Zimmerman, Armed Forces Institute of Pathology, Washington, D.C. 2030S.
W h e n his impressive achievements are con sidered in the perspective of the develop ments that have followed his passing, his ob scurity today seems ill deserved. William Thomson was born in Chambersburg, Pennsylvania, J a n u a r y 28, 1833. H e received his medical degree from Jefferson College in 1855, and for several years was a general practitioner in the suburbs of Phila delphia. I n 1857 he married Miss Rebecca George of Merion, Pennsylvania. W i t h the outbreak of the Civil W a r , Thomson entered the United States A r m y as assistant surgeon with the rank of Lieuten ant (fig. 2 ) . H e served with the A r m y of the Potomac and then, in 1862, became Chief of Staff to D r . Jonathan Letterman, who was General McClellan's Medical Director. A t the Battle of South Mountain, D r . Thomson was left in sole charge of the field and was obliged to find food, shelter, transportation, and surgical aid for 2500 wounded men. I n addition, he was responsible for burial of the dead of both Union and Confederate troops.
Fig. 1 (Zimmerman, Albert, and Blumberg). Oil portrait of William Thomson by Thomas Eakins (1907). Reproduction by courtesy of the College of Physicians of Philadelphia and the Philadelphia Museum of Art
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Fig. 2 (Zimmerman, Albert, and Blumberg). Photograph of William Thomson taken during the Civil War period, courtesy of National Library of Medicine (Neg. 65-489).
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All of this was completed in seven days. For these accomplishments he was complimented by President Lincoln. Thomson then proposed two reforms for overcoming the defects of the medical field service. One was a system of brigade sup plies to prevent the loss of medical stores; the other, a system of Division Hospitals by which the position of every medical officer during and after an engagement was fixed in order. In 1863 Thomson was placed in charge of the Douglas Hospital in Washington, and under his management it became a model for other army general hospitals. The following year he was appointed inspector of all hos pitals in the Washington area. During his service these hospitals contained over 23,000 beds, and in the year of 1864 alone they cared for over 113,000 patients. In 1866 he organized and had charge of a hospital for cholera, which was then epidemic in the Washington area. Having received two bre vets for distinguished service, Thomson was promoted in 1867 and reassigned to Loui siana. The following year he tendered his res ignation and returned to the practice of ci vilian medicine in Philadelphia. During the six-year period that he was stationed in Washington, Thomson contrib uted significantly to the development of the recently organized Army Medical Museum, the parent organization of our present Armed Forces Institute of Pathology. The museum had been established by Surgeon General William A. Hammond in his Circu lar No. 2, dated May 21, 1862. In one of the early catalogues of the Army Medical Museum, Thomson is credited as having been the largest single contributor of speci mens and papers, especially those dealing with osteomyelitis, pyemia, and wounds of the knee joints. Even more significant than this for the subsequent growth of prestige of the museum were his pioneer contributions to photomicrography. Early in 1863, when the Army Medical Museum was barely one year old, Thomson, in collaboration with Dr.
MARCH, 1970
William F. Norris, demonstrated to the Army Surgeon General the practical value of photography in preserving and distribu ting valuable surgical records; he sent the Surgeon General a series of prints illustrat ing wounds of soldiers being treated at his hospital, and these prints stimulated the Sur geon General to establish a Photographic Bureau at the museum. Over the years, this has evolved into the Medical Illustration Service of the Armed Forces Institute of Pathology. At about this same time, Thom son and Norris also began their experiments in photomicrography and in May, 1864, demonstrated to the Surgeon General that prints of microscopic fields magnified 15 to 250 times could be made.6 This is said to have been the first successful effort to make practical use of the negative process of pho tography by wet collodion in microscopy at high powers. Shortly before his death in 1965, Dr. George W. Norris, son of William F. Nor ris, described to the authors the technique used by his father and Dr. Thomson to ob tain their photomicrographs: The micro scope was placed in a horizontal position, and the objectives to be used were coated with oil a day or two before photographing. Light from a Welsbach gas burner was di rected through the slide and objective lens. The image arising from the eyepiece was fo cused and centered on an 8 X 10-inch plate of film. A 10-hour exposure was required.6 This pioneer work soon attracted the at tention of Dr. Joseph Janvier Woodward,7 a pathologist from Philadelphia who was one of the key figures in the early development of the Army Medical Museum. Woodward took up the work that Thomson and Norris had begun, and he is the one who subse quently brought international fame to him self and to the Museum for his refinements of technique and practical application of photomicrography to histopathology.8 Thomson never published a description of his techniques, nor were his original photo micrographs published. Woodward, on the
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WILLIAM THOMSON, M.D.
other hand, wrote a number of papers on photomicrography, the first of which ap peared in 1866 ("On photomicrography with the highest powers, as practiced in the Army Medical Museum"). 9 Thomson's original work, however, was displayed at the Na tion's Centennial Celebration in Philadelphia in 1876, and it is still available for review along with Woodward's more famous pic tures at the Armed Forces Institute of Pa thology. A letter from Woodward to Thom son, dated 1876 (fig. 3), however, suggests that even at that early date, Thomson's pri macy in photomicrography was being usurped—publish or be forgotten ! Led by his interest in photography to a study of optics, Thomson upon his return to civilian life in Philadelphia, began that spe cial work to which he devoted the rest of his life with so much success. His first practical observation in refraction was the discovery that, on account of his high hyperopia (+5.00 D ) , he could read with much less discomfort by contracting his pupils with a candle flame held between his eyes and the book, which he did habitually until he learned enough to properly correct his re fraction with lenses.s In Philadelphia, he was one of the first physicians to limit him self to the practice of a specialty (ophthal mology) , and he rapidly acquired a large and lucrative practice. Ten massive volumes of Thomson's case books are in the possession of the College of Physicians of Philadelphia. Upon reviewing his records, we were impressed by the fre quent and detailed notes regarding refrac tion and funduscopic examination. Accord ing to Harlan and de Schweinitz,10 it was Thomson's example, together with the ef forts of William F. Norris, S. Weir Mitch ell, and William Osier, that convinced Phila delphia physicians of the necessity of a sys tematic ocular examination of every patient. The ophthalmoscope was a relatively new and little-used instrument. In commending its use to medical students of the day, Thom son offered this succinct commentary on the
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practice of ophthalmology prior to the intro duction of this instrument : The ophthalmoscope consists, as you are aware, of a mirror and various lenses, by means of which the interior of the eyeball can be fully illuminated and subjected to visual inspection from the anterior surface of the cornea to the optic nerve entrance; and all changes of struc ture, whether congenital or acquired, can be easily seen. Imagine yourselves obliged to sub mit your watches, when out of order, to me chanics who, although familiar with their con struction, were unable to open their cases and subject them to scrutiny, and you will com prehend that an antiphlogistic course of freezing mixture might empirically be employed for one gaining time in the 24 hours, or a judicious boiling might stimulate one running too slowly, whilst endless formulae, including that panacea for all vague ills, electricity, might produce an alternative effect ; when they had all failed, you would condemn the useless machines to a con dition of hopeless inaction, with no doubt a few heartfelt but profound maledictions and be able to picture to yourselves how diseased eyes suffered previous to the discovery of the oph thalmoscope."
Thomson's own ophthalmoscopes (fig. 4) are in the collection of the Mütter Museum of the College of Physicians of Philadelphia. In 1872 Thomson was the first physician in Philadelphia to use the ophthalmoscope in diagnosing a brain tumor. 12 The patient sub sequently died, and Thomson took photomi crographs of sections revealing the swollen optic discs. Most of Thomson's experiments and pub lications were concerned with optics and re fraction. He was associated with Dr. S. Weir Mitchell in the epoch-making publica tions calling attention to the effect of ocular fatigue as a cause of headache and other nervous disturbances and introducing the term "eye strain" into the literature. Thom son was a strong advocate of the use of mydriatics in refraction and of full correction. He advanced views on the subject of full correction and was one of the first to recom mend it for myopia. His patience, persever ance, and skill in refraction were shown by his success in the correction of cases of coni cal cornea by spherocylinders, and his opin ion was that many of such cases may be bet-
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Fig. 3 (Zimmerman, Albert, and Blumberg). Letter from Joseph J. Woodward, M.D., to William Thomson, M.D., dated 1876 (on file in AFIP). ter managed in this way than by operation, which was still an experimental procedure r . , . .... during much of Thomson s professional life. Thomson was also well known for his . . ,, . x .· , . ,· J work in the detection ofr color blindness. _.. . ^ x j , . ,, , . , . ,. This interest was undoubtedly related to his „,,.,,. . .< position as Ophthalmic cSurgeon to the tl , I. ., , , . . . y, , Pennsylvania Railroad, of which Frank J Thomson, a close relative was president. Railroad safety at that time depended in part upon the ability of trainmen to see colored . , ..I j 4.1 u n. · A signals promptly and correctly, both in day..... j 4 . [4 T , .t. ui light and at night. The scope off the problem 4. J u ^ u · i 4.4. 4 m was noted by Thomson in a :letter to fellow ophthalmologists, dated 1894 The last report of the International State Commerce Commission states that during the year previous 2727 employees and 299 passengers were killed, and 31,729 employees and 3229 pas-
sengers were injured on the railways of this . . y· ^ny effort to prevent this human suffenng and financial loss is to be commended, a n d i s t h e m o t i v e o f t h i s communication. „,, . . . . . . . Inomson developed a simplified form of . TT . ,t , , . , the Holmgren wool test and invented a lan, β . . tern-color test. During one period of exami. , ,,„, j 4. · r nation of 1383 conductors, engineers, fire, .1. , men, and brakemen, Thomson found 55 ab solutely color blind by his methods of c ou ntr
13
™ . , , „ Thomson was appointed Surgeon to the .... „ „ ,, . . .. °. Wills Eye Hospital in Philadelphia and subr r / . sequently was unanimously elected Emeritus Surgeon. In .1873 ^ „ _ , he wasJ appointed . . .clinical . . . T lecturer on diseases of eye and ear at the Jefferson Medical College. Subsequently he ' ,-,<-I-.7 , TT became Honorary Professor, Professor, and Emeritus Professor of Ophthalmology at the
OF OPHTHALMOLOGY
MARCH, 1970
and faultlessly trimmed Van Dyke beard were sufficient to make him a prominent figure, but when enhanced by the scarlet skull-cap which he affected to ward off draughts, his appearance became particularly striking. In public or pri vate, Doctor Thomson was decidedly individual." Dr. Thomson died in 1907. SUMMARY
Fig. 4 (Zimmerman, Albert, and Blumberg). Oph thalmoscopes used by William Thomson, courtesy of the Mütter Museum, College of Physicians of Philadelphia. same institution. He was a member of the American Ophthalmologic Society, the American Philosophical Society, the Acad emy of National Sciences, the Philadelphia College of Physicians, the New York Neu rological Society, and the Loyal Legion. Thomson edited an American edition of Nettleship's "Diseases of the Eye" and wrote the section on ophthalmology in Samuel D. Gross's "Surgery." He loved all the arts, could sketch and paint, and was a good shot. When he could no longer go hunting and camping, he took to riding a bicycle, and when that proved too strenuous, he played golf. William Campbell Posey, who in 1902 succeeded Thomson as attending surgeon in his clinic at the Wills Hospital, recalled of the older surgeon : In appearance and in dress Doctor Thomson was an outstanding figure. Being very musical in his taste, he rarely missed a performance of grand opera in Philadelphia. Sitting in a front row with one of his daughters, his white hair
William Thomson, who was born in Chambersburg, Pennsylvania, and who re ceived his M.D. at Jefferson College in 1S55, entered the U. S. Army at the outbreak of the Civil War and served with the Army of the Potomac. Having gained the attention of President Lincoln for his superior organiza tion of medical service and care for 2500 wounded men, Thomson was subsequently placed in charge of the Douglas Hospital, which, under his management, became a model for other Army general hospitals. There he also pioneered in the medical appli cation of photography and in the develop ment of photomicrography. Through his ef forts and influence on the Surgeon General, a Photographic Bureau was established at the Army's then one-year-old medical museum. This bureau subsequently evolved into the Medical Illustration Service of The Armed Forces Institute of Pathology. There is ample reason for believing that at least some of the credit generally given to Dr. Jo seph Janvier Woodward for having devel oped photomicrography at the Army Medical Museum belongs instead to Dr. Thomson. A letter from Woodward to Thomson acknowl edging the latter's primacy is reproduced. Led by his interest in photography to a study of optics, Thomson, upon his return to civil ian life in Philadelphia, took up ophthalmol ogy and became one of the nation's first phy sicians to limit himself to one specialty. He acquired a large and lucrative practice but nevertheless managed to keep careful re cords containing detailed notes regarding re fraction and ophthalmoscopy, fields in which he also pioneered. He is believed to be the first physician in Philadelphia to have used the ophthalmoscope in diagnosing a brain
WILLIAM THOMSON, M.D.
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tumor, and he is certainly the first to have confirmed his clinical diagnosis of papilledema by histopathologic study and photomicrographic documentation of the swollen optic discs. Thomson became Surgeon, and subsequently Emeritus Surgeon at the Wills Eye Hospital, and Professor and subse quently Emeritus Professor at the Jefferson Medical College. While today his name is not well known among military surgeons, pioneer photomicrographers, or ophthal mologists, his portrait by Thomas Eakins was included in an exhibit on "Art In Phila delphia Medicine" at the Philadelphia Museum of Art and his medical records and instruments are preserved in the Mütter Museum of the College of Physicians of Philadelphia. REFERENCES
1. Bell, W. J., Jr. : The Art of Philadelphia Med icine. Philadelphia, Philadelphia Museum of Art, 1965. 2. Atkinson, W. B. : A Biographical Dictionary of Contemporary American Physicians and Sur geons. Philadelphia, Brinton, 1880. ed. 2, 344. 3. Mitchell, S. W., Thomson, W. : In Kelley, H. A. : A Cyclopedia of American Medical Biography. Comprising the Lives of Eminent Deceased Physi
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cians and Surgeons from 1610 to 1910. Philadel phia, Saunders, 1912, vol. 2, 446. 4. Harlan, G. C. : Dr. William Thomson. Trans. Am. Ophthal. Soc. 12:16, 1909. 5. Henry, R. S. : The Armed Forces Institute of Pathology, Its First Century, 1862-1962. Washing ton, D.C., Government Printing Office, 1964, p. 36. 6. Norris, G. W. : Personal communication. 7. Billings, J. S. : Biographical memoir of Joseph Janvier Woodward. Nat. Acad. Sei. Biog. Mem. 2:295,1886. 8. Schlumberger, H. G. : J. J. Woodward and photomicrography during the Civil War. Bull. In tern. Assoc. Med. Museums 25:81, 1945. 9. Woodward, J. J. : On photomicrography with the highest powers, as practiced in the Army Medi cal Museum. Am. J. Sei. Arts 42:189, 1866. 10. Albert, D. M., and Scheie, H. G. : A History of Ophthalmology at the University of Pennsylva nia. Springfield, 111., Thomas, 1965. 11. Thomson, W. : Relation of Ophthalmology to Practical Medicine. Delivered to the Medical Stu dents, Jefferson Medical College, March 29, 1875. Philadelphia, Lippincott, 1875. 12. Mitchell, S. W., and Thomson, W. : Cases il lustrative of the use of the ophthalmoscope in the diagnosis of intracranial lesions. Am. J. Med. Sei. 66:345, 1873. 13. Thomson, W. : The practical examination of railway employees as to color-blindness, acuteness of vision and hearing. In Nettleship, E.: Diseases of the Eye. Philadelphia, Lea Bro., 1890, ed. 4, p. 461. 14. Posey, W. C, and Brown, S. H. : The Wills Hospital of Philadelphia. Philadelphia, Lippincott, 1931.
OPHTHALMIC MINIATURE
The Church had distinguished figures interested in eye care: Pope John XXI (1226-1277) wrote the "De Aegritudinibus oculorum et Curis" on ocular hygiene; John Peckham, Archbishop of Canterbury (1279), on visual optics, "Perspectiva Communis"; and Saint Louis ( X I ) , King of France founded the Quinze-Vingts in 1260. This hospital was to house and treat fifteen score crusaders blinded in Egypt, and functions actively as both hospital and "Asile des Aveugles" to this day. John Foster, Curiosa Ophthalmica University of Leeds Medical Journal 8:34, 1959.
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poor socioeconomic strata to which these chil dren belong, mothers are generally an im portant source of infection for the children, especially u p to the age of six years. SUMMARY
A group of 391 cases showing Stage I V trachoma were clinically examined for P r o wazek-Halberstaedter inclusion bodies. I n not one case were these bodies found. Active trachoma was found in only three of the 770 children of these 391 m o t h e r s ; all 770 were clinically examined. All three of the children with active trachoma were above the age of five years. T h e results of this investigation in-
dicate that this stage of trachoma can be re garded as noninf ective. ACKNOWLEDGMENTS
I thank Professor I. C. Michaelson for his ad vice and encouragement, Dr. Z. Zakai-Rones for her help in preparing the immunofluorescent anti body examination, and the nurses of Mother and Child Care Clinic. REFERENCES
1. Hanna, I., Dawson, C. R., Briones, O., Thygeson, P., and Jaivetz, E. ; Latency in human infec tions with trachoma agents. J. Immunol. 101:43, 1968. 2. Katzenelson, E., and Bernkopf, H. : Serologie differentiation of trachoma strains and other agents of the psittacosis-lymphogranuloma venereumtrachoma group with the aid of the direct fluores cent antibody method. J. Immunol. 94:3, 1965.
W I L L I A M T H O M S O N (1833-1907). M I L I T A R Y S U R G E O N , PIONEER PHOTOMICROGRAPHER, CLINICAL OPHTHALMOLOGIST L O R E N Z E.
ZIMMERMAN,
M.D.,
J O E M.
D A N I E L M.
BLUMBERG,
A L B E R T , M.D.,
AND
M.D.
Washington, D.C. Dr. William Thomson is perhaps best known today as the subject of a portrait by Thomas Eakins 1 (fig. 1) that hangs in the Philadelphia Museum of Art, a part of an exhibit entitled " A r t in Philadelphia Medi cine." This striking painting was first viewed by us in 1965. Since that time we have reviewed Thomson's contributions to military medicine, photomicrography, and ophthalmology. 2 " 4 During his lifetime, Thomson was a leading figure in these fields. From the Ophthalmic Pathology Branch, Armed Forces Institute of Pathology, Washington, D.C. Dr. Zimmerman is Chief, Ophthalmic Pathology Branch, Armed Forces Institute of Pathology; Doctor Albert's address is now Section of Ophthal mology, Department of Surgery, Yale University School of Medicine. He is a former Special Fellow in Ophthalmic Pathology at the Armed Forces In stitute of Pathology, and sponsored by the National Institute of Neurological Diseases and Blindness, NIH (Grant NB 1873). Dr. Blumberg was formerly the Director, Armed Forces Institute of Pathology, Major General, MC, USA. (Retired) Reprint requests to Dr. Lorenz E. Zimmerman, Armed Forces Institute of Pathology, Washington, D.C. 2030S.
W h e n his impressive achievements are con sidered in the perspective of the develop ments that have followed his passing, his ob scurity today seems ill deserved. William Thomson was born in Chambersburg, Pennsylvania, J a n u a r y 28, 1833. H e received his medical degree from Jefferson College in 1855, and for several years was a general practitioner in the suburbs of Phila delphia. I n 1857 he married Miss Rebecca George of Merion, Pennsylvania. W i t h the outbreak of the Civil W a r , Thomson entered the United States A r m y as assistant surgeon with the rank of Lieuten ant (fig. 2 ) . H e served with the A r m y of the Potomac and then, in 1862, became Chief of Staff to D r . Jonathan Letterman, who was General McClellan's Medical Director. A t the Battle of South Mountain, D r . Thomson was left in sole charge of the field and was obliged to find food, shelter, transportation, and surgical aid for 2500 wounded men. I n addition, he was responsible for burial of the dead of both Union and Confederate troops.
Fig. 1 (Zimmerman, Albert, and Blumberg). Oil portrait of William Thomson by Thomas Eakins (1907). Reproduction by courtesy of the College of Physicians of Philadelphia and the Philadelphia Museum of Art
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• &'· '-i^'"'""*
•"niïé; '
Fig. 2 (Zimmerman, Albert, and Blumberg). Photograph of William Thomson taken during the Civil War period, courtesy of National Library of Medicine (Neg. 65-489).
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All of this was completed in seven days. For these accomplishments he was complimented by President Lincoln. Thomson then proposed two reforms for overcoming the defects of the medical field service. One was a system of brigade sup plies to prevent the loss of medical stores; the other, a system of Division Hospitals by which the position of every medical officer during and after an engagement was fixed in order. In 1863 Thomson was placed in charge of the Douglas Hospital in Washington, and under his management it became a model for other army general hospitals. The following year he was appointed inspector of all hos pitals in the Washington area. During his service these hospitals contained over 23,000 beds, and in the year of 1864 alone they cared for over 113,000 patients. In 1866 he organized and had charge of a hospital for cholera, which was then epidemic in the Washington area. Having received two bre vets for distinguished service, Thomson was promoted in 1867 and reassigned to Loui siana. The following year he tendered his res ignation and returned to the practice of ci vilian medicine in Philadelphia. During the six-year period that he was stationed in Washington, Thomson contrib uted significantly to the development of the recently organized Army Medical Museum, the parent organization of our present Armed Forces Institute of Pathology. The museum had been established by Surgeon General William A. Hammond in his Circu lar No. 2, dated May 21, 1862. In one of the early catalogues of the Army Medical Museum, Thomson is credited as having been the largest single contributor of speci mens and papers, especially those dealing with osteomyelitis, pyemia, and wounds of the knee joints. Even more significant than this for the subsequent growth of prestige of the museum were his pioneer contributions to photomicrography. Early in 1863, when the Army Medical Museum was barely one year old, Thomson, in collaboration with Dr.
MARCH, 1970
William F. Norris, demonstrated to the Army Surgeon General the practical value of photography in preserving and distribu ting valuable surgical records; he sent the Surgeon General a series of prints illustrat ing wounds of soldiers being treated at his hospital, and these prints stimulated the Sur geon General to establish a Photographic Bureau at the museum. Over the years, this has evolved into the Medical Illustration Service of the Armed Forces Institute of Pathology. At about this same time, Thom son and Norris also began their experiments in photomicrography and in May, 1864, demonstrated to the Surgeon General that prints of microscopic fields magnified 15 to 250 times could be made.6 This is said to have been the first successful effort to make practical use of the negative process of pho tography by wet collodion in microscopy at high powers. Shortly before his death in 1965, Dr. George W. Norris, son of William F. Nor ris, described to the authors the technique used by his father and Dr. Thomson to ob tain their photomicrographs: The micro scope was placed in a horizontal position, and the objectives to be used were coated with oil a day or two before photographing. Light from a Welsbach gas burner was di rected through the slide and objective lens. The image arising from the eyepiece was fo cused and centered on an 8 X 10-inch plate of film. A 10-hour exposure was required.6 This pioneer work soon attracted the at tention of Dr. Joseph Janvier Woodward,7 a pathologist from Philadelphia who was one of the key figures in the early development of the Army Medical Museum. Woodward took up the work that Thomson and Norris had begun, and he is the one who subse quently brought international fame to him self and to the Museum for his refinements of technique and practical application of photomicrography to histopathology.8 Thomson never published a description of his techniques, nor were his original photo micrographs published. Woodward, on the
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WILLIAM THOMSON, M.D.
other hand, wrote a number of papers on photomicrography, the first of which ap peared in 1866 ("On photomicrography with the highest powers, as practiced in the Army Medical Museum"). 9 Thomson's original work, however, was displayed at the Na tion's Centennial Celebration in Philadelphia in 1876, and it is still available for review along with Woodward's more famous pic tures at the Armed Forces Institute of Pa thology. A letter from Woodward to Thom son, dated 1876 (fig. 3), however, suggests that even at that early date, Thomson's pri macy in photomicrography was being usurped—publish or be forgotten ! Led by his interest in photography to a study of optics, Thomson upon his return to civilian life in Philadelphia, began that spe cial work to which he devoted the rest of his life with so much success. His first practical observation in refraction was the discovery that, on account of his high hyperopia (+5.00 D ) , he could read with much less discomfort by contracting his pupils with a candle flame held between his eyes and the book, which he did habitually until he learned enough to properly correct his re fraction with lenses.s In Philadelphia, he was one of the first physicians to limit him self to the practice of a specialty (ophthal mology) , and he rapidly acquired a large and lucrative practice. Ten massive volumes of Thomson's case books are in the possession of the College of Physicians of Philadelphia. Upon reviewing his records, we were impressed by the fre quent and detailed notes regarding refrac tion and funduscopic examination. Accord ing to Harlan and de Schweinitz,10 it was Thomson's example, together with the ef forts of William F. Norris, S. Weir Mitch ell, and William Osier, that convinced Phila delphia physicians of the necessity of a sys tematic ocular examination of every patient. The ophthalmoscope was a relatively new and little-used instrument. In commending its use to medical students of the day, Thom son offered this succinct commentary on the
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practice of ophthalmology prior to the intro duction of this instrument : The ophthalmoscope consists, as you are aware, of a mirror and various lenses, by means of which the interior of the eyeball can be fully illuminated and subjected to visual inspection from the anterior surface of the cornea to the optic nerve entrance; and all changes of struc ture, whether congenital or acquired, can be easily seen. Imagine yourselves obliged to sub mit your watches, when out of order, to me chanics who, although familiar with their con struction, were unable to open their cases and subject them to scrutiny, and you will com prehend that an antiphlogistic course of freezing mixture might empirically be employed for one gaining time in the 24 hours, or a judicious boiling might stimulate one running too slowly, whilst endless formulae, including that panacea for all vague ills, electricity, might produce an alternative effect ; when they had all failed, you would condemn the useless machines to a con dition of hopeless inaction, with no doubt a few heartfelt but profound maledictions and be able to picture to yourselves how diseased eyes suffered previous to the discovery of the oph thalmoscope."
Thomson's own ophthalmoscopes (fig. 4) are in the collection of the Mütter Museum of the College of Physicians of Philadelphia. In 1872 Thomson was the first physician in Philadelphia to use the ophthalmoscope in diagnosing a brain tumor. 12 The patient sub sequently died, and Thomson took photomi crographs of sections revealing the swollen optic discs. Most of Thomson's experiments and pub lications were concerned with optics and re fraction. He was associated with Dr. S. Weir Mitchell in the epoch-making publica tions calling attention to the effect of ocular fatigue as a cause of headache and other nervous disturbances and introducing the term "eye strain" into the literature. Thom son was a strong advocate of the use of mydriatics in refraction and of full correction. He advanced views on the subject of full correction and was one of the first to recom mend it for myopia. His patience, persever ance, and skill in refraction were shown by his success in the correction of cases of coni cal cornea by spherocylinders, and his opin ion was that many of such cases may be bet-
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Fig. 3 (Zimmerman, Albert, and Blumberg). Letter from Joseph J. Woodward, M.D., to William Thomson, M.D., dated 1876 (on file in AFIP). ter managed in this way than by operation, which was still an experimental procedure r . , . .... during much of Thomson s professional life. Thomson was also well known for his . . ,, . x .· , . ,· J work in the detection ofr color blindness. _.. . ^ x j , . ,, , . , . ,. This interest was undoubtedly related to his „,,.,,. . .< position as Ophthalmic cSurgeon to the tl , I. ., , , . . . y, , Pennsylvania Railroad, of which Frank J Thomson, a close relative was president. Railroad safety at that time depended in part upon the ability of trainmen to see colored . , ..I j 4.1 u n. · A signals promptly and correctly, both in day..... j 4 . [4 T , .t. ui light and at night. The scope off the problem 4. J u ^ u · i 4.4. 4 m was noted by Thomson in a :letter to fellow ophthalmologists, dated 1894 The last report of the International State Commerce Commission states that during the year previous 2727 employees and 299 passengers were killed, and 31,729 employees and 3229 pas-
sengers were injured on the railways of this . . y· ^ny effort to prevent this human suffenng and financial loss is to be commended, a n d i s t h e m o t i v e o f t h i s communication. „,, . . . . . . . Inomson developed a simplified form of . TT . ,t , , . , the Holmgren wool test and invented a lan, β . . tern-color test. During one period of exami. , ,,„, j 4. · r nation of 1383 conductors, engineers, fire, .1. , men, and brakemen, Thomson found 55 ab solutely color blind by his methods of c ou ntr
13
™ . , , „ Thomson was appointed Surgeon to the .... „ „ ,, . . .. °. Wills Eye Hospital in Philadelphia and subr r / . sequently was unanimously elected Emeritus Surgeon. In .1873 ^ „ _ , he wasJ appointed . . .clinical . . . T lecturer on diseases of eye and ear at the Jefferson Medical College. Subsequently he ' ,-,<-I-.7 , TT became Honorary Professor, Professor, and Emeritus Professor of Ophthalmology at the
OF OPHTHALMOLOGY
MARCH, 1970
and faultlessly trimmed Van Dyke beard were sufficient to make him a prominent figure, but when enhanced by the scarlet skull-cap which he affected to ward off draughts, his appearance became particularly striking. In public or pri vate, Doctor Thomson was decidedly individual." Dr. Thomson died in 1907. SUMMARY
Fig. 4 (Zimmerman, Albert, and Blumberg). Oph thalmoscopes used by William Thomson, courtesy of the Mütter Museum, College of Physicians of Philadelphia. same institution. He was a member of the American Ophthalmologic Society, the American Philosophical Society, the Acad emy of National Sciences, the Philadelphia College of Physicians, the New York Neu rological Society, and the Loyal Legion. Thomson edited an American edition of Nettleship's "Diseases of the Eye" and wrote the section on ophthalmology in Samuel D. Gross's "Surgery." He loved all the arts, could sketch and paint, and was a good shot. When he could no longer go hunting and camping, he took to riding a bicycle, and when that proved too strenuous, he played golf. William Campbell Posey, who in 1902 succeeded Thomson as attending surgeon in his clinic at the Wills Hospital, recalled of the older surgeon : In appearance and in dress Doctor Thomson was an outstanding figure. Being very musical in his taste, he rarely missed a performance of grand opera in Philadelphia. Sitting in a front row with one of his daughters, his white hair
William Thomson, who was born in Chambersburg, Pennsylvania, and who re ceived his M.D. at Jefferson College in 1S55, entered the U. S. Army at the outbreak of the Civil War and served with the Army of the Potomac. Having gained the attention of President Lincoln for his superior organiza tion of medical service and care for 2500 wounded men, Thomson was subsequently placed in charge of the Douglas Hospital, which, under his management, became a model for other Army general hospitals. There he also pioneered in the medical appli cation of photography and in the develop ment of photomicrography. Through his ef forts and influence on the Surgeon General, a Photographic Bureau was established at the Army's then one-year-old medical museum. This bureau subsequently evolved into the Medical Illustration Service of The Armed Forces Institute of Pathology. There is ample reason for believing that at least some of the credit generally given to Dr. Jo seph Janvier Woodward for having devel oped photomicrography at the Army Medical Museum belongs instead to Dr. Thomson. A letter from Woodward to Thomson acknowl edging the latter's primacy is reproduced. Led by his interest in photography to a study of optics, Thomson, upon his return to civil ian life in Philadelphia, took up ophthalmol ogy and became one of the nation's first phy sicians to limit himself to one specialty. He acquired a large and lucrative practice but nevertheless managed to keep careful re cords containing detailed notes regarding re fraction and ophthalmoscopy, fields in which he also pioneered. He is believed to be the first physician in Philadelphia to have used the ophthalmoscope in diagnosing a brain
WILLIAM THOMSON, M.D.
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tumor, and he is certainly the first to have confirmed his clinical diagnosis of papilledema by histopathologic study and photomicrographic documentation of the swollen optic discs. Thomson became Surgeon, and subsequently Emeritus Surgeon at the Wills Eye Hospital, and Professor and subse quently Emeritus Professor at the Jefferson Medical College. While today his name is not well known among military surgeons, pioneer photomicrographers, or ophthal mologists, his portrait by Thomas Eakins was included in an exhibit on "Art In Phila delphia Medicine" at the Philadelphia Museum of Art and his medical records and instruments are preserved in the Mütter Museum of the College of Physicians of Philadelphia. REFERENCES
1. Bell, W. J., Jr. : The Art of Philadelphia Med icine. Philadelphia, Philadelphia Museum of Art, 1965. 2. Atkinson, W. B. : A Biographical Dictionary of Contemporary American Physicians and Sur geons. Philadelphia, Brinton, 1880. ed. 2, 344. 3. Mitchell, S. W., Thomson, W. : In Kelley, H. A. : A Cyclopedia of American Medical Biography. Comprising the Lives of Eminent Deceased Physi
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cians and Surgeons from 1610 to 1910. Philadel phia, Saunders, 1912, vol. 2, 446. 4. Harlan, G. C. : Dr. William Thomson. Trans. Am. Ophthal. Soc. 12:16, 1909. 5. Henry, R. S. : The Armed Forces Institute of Pathology, Its First Century, 1862-1962. Washing ton, D.C., Government Printing Office, 1964, p. 36. 6. Norris, G. W. : Personal communication. 7. Billings, J. S. : Biographical memoir of Joseph Janvier Woodward. Nat. Acad. Sei. Biog. Mem. 2:295,1886. 8. Schlumberger, H. G. : J. J. Woodward and photomicrography during the Civil War. Bull. In tern. Assoc. Med. Museums 25:81, 1945. 9. Woodward, J. J. : On photomicrography with the highest powers, as practiced in the Army Medi cal Museum. Am. J. Sei. Arts 42:189, 1866. 10. Albert, D. M., and Scheie, H. G. : A History of Ophthalmology at the University of Pennsylva nia. Springfield, 111., Thomas, 1965. 11. Thomson, W. : Relation of Ophthalmology to Practical Medicine. Delivered to the Medical Stu dents, Jefferson Medical College, March 29, 1875. Philadelphia, Lippincott, 1875. 12. Mitchell, S. W., and Thomson, W. : Cases il lustrative of the use of the ophthalmoscope in the diagnosis of intracranial lesions. Am. J. Med. Sei. 66:345, 1873. 13. Thomson, W. : The practical examination of railway employees as to color-blindness, acuteness of vision and hearing. In Nettleship, E.: Diseases of the Eye. Philadelphia, Lea Bro., 1890, ed. 4, p. 461. 14. Posey, W. C, and Brown, S. H. : The Wills Hospital of Philadelphia. Philadelphia, Lippincott, 1931.
OPHTHALMIC MINIATURE
The Church had distinguished figures interested in eye care: Pope John XXI (1226-1277) wrote the "De Aegritudinibus oculorum et Curis" on ocular hygiene; John Peckham, Archbishop of Canterbury (1279), on visual optics, "Perspectiva Communis"; and Saint Louis ( X I ) , King of France founded the Quinze-Vingts in 1260. This hospital was to house and treat fifteen score crusaders blinded in Egypt, and functions actively as both hospital and "Asile des Aveugles" to this day. John Foster, Curiosa Ophthalmica University of Leeds Medical Journal 8:34, 1959.