THE EYE IN HISTORY A compilation of articles on Instruments, Books and Individuals that shaped the course of Ophthalmology Mr. Richard KEELER FRCOphth (Honorary) Professor Harminder S DUA Chair and Professor of Ophthalmology, University of Nottingham MBBS, DO, DO (London), MS, MNAMS, FRCS (Edinburgh), FEBO, FRCOphth, FRCP (Honorary, Edinburgh), FCOptom. (Honorary), FRCOphth. (Honorary), MD, PhD. 4 EDITION Edited by: Laboratoires Théa 12 Rue Louis Blériot - ZI du Brézet 63017 Clermont-Ferrand cedex 2 - France Tel. +33 (0)4 73 98 14 36 - Fax +33 (0)4 73 98 14 38 www.laboratoires-thea.com The content of the book presents the viewpoint of the authors and does not necessarily reflect the opinions of Laboratoires Théa. Mr. Richard KEELER and Prof. Harminder S DUA have no financial interest in this book. All rights of translation, adaptation and reproduction by any means are reserved for all countries. Any reproduction, in whole or part, by any means whatsoever, of the pages published in this book, is prohibited and unlawful and constitutes forgery without the prior written consent of the publisher. The only reproductions allowed are, on the one hand, those strictly reserved for private use and not intended for collective use and, on the other hand, short analyses and quotations justified by the scientific or informational nature of the work into which they are incorporated. (Law of 11 March 1957, art. 40 and 41, and Penal Code art. 425) 5 6 PREFACE For seven years (2007-2014) Dr. Arun D Singh and I served as editors-in-chief of the British Journal of Ophthalmology (BJO), published by the BMJ publishing group. Even before we were formally appointed to the post we had discussed the cover image and its concept. A cover image should serve to attract the attention of the ‘passer-by’, to arouse curiosity sufficient to make him or her reach out to pick up the journal and find the answer to the question that fleets across the mind, what is that on the cover? The answer is tactically hidden in the content of the journal requiring the individual to flip through the pages. The expectation being that an article or two might also attract attention and be read. We decided to depict images from the ‘eye in history’ and the ‘eye in mythology’ on alternate months. For the former, it did not take us long to discover a gold mine of material and a golden mind of information in Richard Keeler, who was then and still is, the honorary curator of the museum, which includes the antique instruments and the antiquarian library, of the Royal College of Ophthalmologists, UK (see Richard's biography on page 10). For seven years, with unfailing regularity, Richard provided material and information to adorn the cover of the BJO. On conclusion of my term in office, Richard and I decided to compile and enhance the cover images and related text into a book, for posterity. Though always available through online archives, the material will be lost in bound volumes of hard copies stored in libraries, where the covers are usually not included. This book however, is not merely a representation of old material in a different format. Modern curricula for ophthalmic qualifications tend to place little emphasis on history. They ignore the quotes “ignore history at your peril” and “Those who do not learn history are doomed to repeat it” (George Santayana, philosopher). Most of the things we take for granted today, did not just happen. They followed a course of trials and tribulations and modifications and improvements in small increments. The history of each instrument and treatment illustrates that “Success is the culmination of failures”, a lesson that applies not only to the devices depicted but also to Life in general. A message that every student should keep in mind while treading their professional path. Failure is only a corner; around which Success could be waiting. The advent of the direct ophthalmoscope is regarded as the starting point of modern ophthalmology. Today it is used far less often, being superseded by sophisticated imaging modalities. Such is the pace of change, that a new device, medicine or surgery will be introduced, used and rendered obsolete several times in a professional lifetime. We are creating history and living through history while we march in to the future. “Today is the yesterday of tomorrow”, “What is today state of the art will tomorrow be relegated to the dustbin of history” (HS Dua). Equally, advances in knowledge and understanding can resurrect ideas and principles from History that were far ahead of their times. This book will put in perspective the thoughts expounded above and empower the reader to better deal with the future while providing some knowledge on what used to be. Harminder S DUA 7 ABOUT THE AUTHORS BY THE AUTHORS Mr. Richard KEELER It was when I retired that I became fascinated in the history of ophthalmology from both an instrument and literature standpoint. The turning point was when I was invited to become Honorary Curator at the College of Ophthalmologists in 1997. Since then I have built up, through gifts and purchases, a large collection of instruments and antiquarian books that feature in this book. My whole life has been spent in the world of optics and ophthalmic instruments. From the start I have been imbued with a love of optics, anatomy of the eye and ophthalmological instruments. One can say that the Keeler ophthalmic instruments business really started in 1906 when my grandfather Charles Davis Keeler, at the age of 30, arrived with his family in England from Philadelphia. This was very much against the flow of migration but he had a purpose. He was to establish, as the manager, a branch in London of the Standard Optical Co of Geneva, NY which manufactured machinery for making lenses and spectacle frames. This move proved successful but his career took a different course in 1910 when he went into partnership with John Reiner to set up a Dispensing Optician practice, Reiner (later Rayner) and Keeler Ltd, in the West End of London. The partnership lasted until 1916 when my grandfather broke away and opened his first Dispensing Optician establishment nearby the following year in 1917. I was born in 1937 at Windsor, twenty five miles from London, in a large house surrounded by paddocks, stables and an indoor riding school that my father had bought a few years before. Very soon this property was to prove a fortuitous purchase when the Second World War broke out in 1939. The manufacture of spectacles, lenses and instruments then in London was hastily moved from there into converted stables and the indoor riding school. Today the Keeler Group now owned by Halma Ltd, a FTSE quoted company, still operates from a modern factory within the grounds of this property. The articles in this book cover a wide variety of subjects. A theme that runs through the History of the Eye is that experimentation, research, invention, risk-taking and sometimes luck moved the profession forward sometimes quite slowly and at other times in great leaps. Those that are ignorant of the rich history of the evolution of ophthalmology are missing out on the fascinating and timely discoveries that make up the profession today. They would find it very advantageous to study ophthalmic history so that they can learn from the successes and failures of the past. For me re-reading the account of the discovery by the young Professor Hermann von Helmholtz in 1850 of how to view the fundus of the eye still makes my heart beat a little faster. The design and manufacture of ophthalmoscopes was an important part of my working life and now the collecting of old ophthalmoscopes, other instruments and books has taken over my waking hours resulting in one of the most comprehensive collections in the world which is on display at The Royal College of Ophthalmologists. Richard KEELER 8 Professor Harminder S DUA My father Inder Singh Dua, retired as an Air Commodore in the Indian Air Force. My mum, Kulwant Kaur, was a specialist in food preservation. My siblings and I followed our dad through his transfers to different bases. I must have changed seven schools before joining the Government Medical College and Hospital in Nagpur, India. After MBBS I specialized in Ophthalmology with a Diploma (DO) and Masters (MS) degree; and pursued basic research in uveitis for a PhD, whilst being employed as a Lecturer and then Reader in Ophthalmology. I married Rita, who was specializing in anaesthesia and spent a memorable year in Pune (Poona) before deciding to quit government service and pursue a career abroad. I arrived in the UK on a cold winter night in December 1983 to take the professional and linguistics assessment board examination of the General Medical Council. My first placement was as an observer in York and my first paid job was as a locum in St Helens, which lasted a couple of weeks before joining Huddersfield as senior house officer with Mr Jawaharlal Agarwal and Mr Murphy. The education and training that I had received in India provided a solid foundation on which I built my career with the numerous positives that the British system had to offer. From Huddersfield I moved to Aberdeen in December 1984 to work under the supervision of Professor John Forrester and also obtained an MD from the Aberdeen University. I completed my training as I moved from Registrar to Senior Registrar and then took an opportunity that presented, to spend time with Professors Larry A. Donoso and Peter Laibson, at the Wills Eye Hospital, Philadelphia.