DERRICK TILTON VAIL

M. ELLIOTT RANDOLPH, M.D. Baltimore, Maryland

Derrick Tilton Vail was born in Cincin­nati, Ohio, May 15, 1898, the son of Der­rick and Delia Harriss Vail and the middle of five children. During his adolescent years he resented this position as his two older brothers continually ganged up to make him babysit for the two younger sisters (fig. 1). He went to a very small private school where he was a member of every athletic team—an accomplishment he modestly at­tributes to the smallness of the school rather than to his athletic prowess. At the age of eight he began violin lessons and instruc­tion in wood carving, two hobbies which are still a happy part of his extra-academic life.

His father was a distinguished ophthal­

mologist, and his older brother, Harriss, an equally distinguished otolaryngologist. With this medical background, he had always wanted to go into medicine. He entered Yale University in the fall of 1915. His activities began quite quickly. He became a member of the freshman mandolin club and the freshman crew, the latter being clobbered by Harvard.

His sophomore year found him joining the Zeta Psi fraternity and also taking part in the productions of the Yale Dramatic Club. He was once overhead minimizing his participation in the latter by saying: "I think I carried a spear in a large pageant."

As a junior, he was tapped for Elihu, a

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Fig. 1. D. V. and playmates. 955/15

956/16 M. ELLIOTT RANDOLPH

Fig. 2. D. V. was awarded his "Y."

hallowed senior society. During this time he was directing his athletic activities toward crew and was awarded his "Y" (fig. 2) . It is probable that his rowing interlude was the only time he looked backward in his life (fig. 3).

1 It is also recorded that, as a senior, he be­

longed to the Ouijies and the Haydivers. Extensive research has failed to uncover the purpose or activities of either of these orga­nizations although it is fairly certain that neither was concerned with Y.M.C.A. work or the religious life at Yale. At sometime during his college career, he was awarded a Second Colloquy, an honor indicating that he was well above average in his academic achievements.

Following a short stint in ROTC, he was graduated from Yale in 1919 and immedi­ately entered the Harvard Medical School. Fortunately, he was not a complete grind and belonged to a number of extracurricular organizations. He took an active part in the Stork Club, "a free-drinking group of stu­dents which met every once in a while for a stag party." The famous song "The Ballad of Chambers Street" was written during one of these meetings and is still resurrected on occasions. He was also a member of the Lancet and Aesculapian Clubs, the former an excommunicated fraternity. Each put on an annual ribald show in which he was an active participant. However, lest one get the impression that he spent his medical school years absorbing the pleasures of one club after another, let the words of a close con­temporary be noted : "You might think that with all this, he never had time to study. Such was not the case. He was an excellent student and graduated well up in his class."

He had always known Elizabeth Yeiser

Fig. 3. The Yale crew. D. V. is No. 7.

DERRICK TILTON VAIL 957/17

(affectionately called Bebe) and during the summer of his second year in medical school they became engaged. This occurred during a family trip to Hot Springs, and the en­gagement ring was given her while they were on horseback on the familiar trail par­alleling the Homestead golf course (fig. 4) . She is a charming, lovely person with great magnetism, and they are a mutually depen­dent, devoted couple.

Derrick III was born during medical school days. Early in 1940 he enlisted as a pilot in the Royal Canadian Air Force, and was lost over the Irish Sea as his plane was returning from a raid over the continent in February, 1942. David, their second son, is a psychiatrist and is director, Division of Medical Services of the Minnesota Depart­ment of Public Welfare. Ann, their only daughter (and oh! so beautiful!) is now Mrs. William Roberts of Chicago. Peter, their youngest child, is a successful chemical engineer in Racine, Wisconsin.

Following Derrick Vail's graduation from the Harvard Medical School in 1923, he started his residency in ophthalmology at the Massachusetts Eye and Ear Infirmary, where among others, he came under the spell

of the immortal Verhoeff. His immediate superior was Edwin Blakeslee Dunphy (who assisted him with his first cataract). He was known as Dunphy's "pup," and in succession, Paul Chandler was Vail's "pup" —a term synonymous with the traditional "peck system" at the Infirmary. Dunphy, Vail and Chandler, with Dr. Verhoeff un­doubtedly calling the signals, is a pretty fair backfield on any team. In 1926, upon com­pleting his residency, he was given a party by his house staff. Here he played his vio­lin. While this accomplishment was a great addition to the party, it came as a great shock to Elizabeth Vail, who in all the years she had known him had been completely unaware of this talent.

After a residency of 16 months, the Vails went to Shikarpur, India, where his father, many years before, had spent a most fruit­ful period. There under the guidance of his father's old friend, Sir Henry Holland, he did hundreds of operations during his three months' visit. On one session, he did 98 cat­aract extractions in one day. Only ap­proaching night prevented him from com­pleting 100 cases. Their stay in India was a thrilling and fascinating experience.

Elizabeth Yeiser and D. V., Hot Springs, Virginia,

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Fig. S. "From my father, I learned the art of ophthalmology."

In the winter of 1925, they returned to Cincinnati where he became an active mem­ber of the Vail Hospital with his father and brother, Harriss (figs. 5 and 6) . He took time off in 1927 for a three-month stay at Oxford where he received the degree, Di­ploma in Ophthalmology. In addition, he began his teaching duties at the University of Cincinnati Medical School, mounting the academic ladder from instructor to profes­sor in 1937.

World War II brought a sudden change in the lives of the Vails. In 1942, when he and Sanford (Sandy) Gifford were guests of their close friend Fred Cordes at the Bo­hemian Grove encampment near San Fran­cisco (fig. 7), he received a call from the Surgeon General's Office in Washington ask­ing him to be the Army's senior eye consul­

tant in the European Theater. His decision was an immediate affirmative. So, back to Cincinnati—the hurried seeing of last pa­tients, closing the office, uniforms, farewells —and suddenly a long plane flight to Eng­land; and just as suddenly a far, distant cry from the busy stream of life and loved ones.

So—to London and thence to Cheltenham (fig. 8) , the headquarters of the chief sur­geon, Maj. Gen. Paul Hawley. In his early days there, he first met Brigadier Sir Stew­art Duke-Elder, and in one of his postwar reminiscences he has this to say of his Brit­ish counterpart: "He was most cordial, im­mediately took me in hand and guided me through those first bewildering days of inexperience with kindly advice and help. He and his charming wife, Phyllis, did more than that: They adopted me and wel­comed me into their household as a broth­er." Ever since, there has been a delightful­ly congenial and happy friendship between the Duke-Elders and the Vails.

What with the increasing number of men and equipment and the expansion of hos-

Fig. 6. Brother Harriss and D. V., 1926.

DERRICK TILTON VAIL 959/19

Fig. 7. D. V., Charles Morton, Fred Cordes and Sandy Gifford at Bohemian Grove encampment in 1942.

pitals, the eye problems of 1943 were tre­mendous, frustrating and seemingly insur­mountable. Derrick Vail's organizational ability never shone brighter and, as far as was humanly possible in such a situation, a relative calm and order was established. He has always been generous in his praise of the fellow ophthalmologists who helped him through these difficulties. He soon saw to it that all major eye problems were sent to designated eye centers staffed by the most competent and well-trained ophthal­mologists. He organized an ETO (Euro­pean Theater of Operations) Eye Club, and a nucleus of 29 attended its first meeting at Oxford. Successive gatherings were held, and 200 attended the last one, when Gen. Hawley, as D-Day was approaching, reluc­tantly called a halt to further meetings.

Around July, 1943, as the limited supply of artifical glass eyes began to be depleted, the Dental Department of one of our hos­pitals in England developed the acrylic eye. Derrick Vail was quick to see its wide­

spread possibilities, and at his suggestion the chief of the Dental Division started a train­ing school for dental officers to learn this technique. This was most successful, and shortly afterward, following the impetus in the ETO, similar programs were established

Fig. 8. Elliott Cutler and D. V. Cheltenham, England, October 1, 1943.

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Fig. 9. Oxford Ophthalmological Congress, 1943. (Left to right) P. C. Livingston, Ida Mann, D. V. and the Master, P. G. Doyne.

in all 10 army Eye Centers in the United States.

Shortly before D-Day, Vail called a meet­ing in London of all his ophthalmologists. He gave them a 90-minute briefing, review­ing the current and future problems. As a tribute to their appreciation, they presented to him a beautiful "matched set" of English eye instruments.

A fellow consultant offers this intimate portrayal of Derrick Vail during the days overseas :

"My associations with him were ones of the greatest pleasure. He was always vari­able and human, with an acute sense of humor—and a towering annoyance when things did not go to his liking. He was a complete Tory with a wide knowledge and great appreciation of the best aspects of English life and culture. He was punctilious to a high degree in his relations with his fel­low officers, the enlisted men, and English secretaries and other workers.

"He gave his full energies to the promo­

tion of the best ophthalmologic treatment at all possible levels, he was especially cogni­zant of the need for training the inexperi­enced medical officer in the care of wounds affecting the eye. He was constantly travel­ling about the theater visiting hospitals, mak­ing rounds, and having discussions with his medical officers. There was no doubt that here was a dedicated person."

Another consultant recalls a different side to Derrick Vail :

"I was a lieutenant colonel and had ar­rived at the Plough Hotel in Cheltenham late at night. The next morning, I timidly made my way to the frigid breakfast room and sat among my new friends in the only vacant chair. Suddenly a full colonel, whom I had never before seen, burst into the room, pointed a finger at me and shrieked: 'Get the hell out of that chair! It's mine, and has been, and will be as long as I am here!' I might add, it was the only chair next to the fire.

"Later that same day, I experienced my

DERRICK TILTON VAIL 961/21

first air-raid. At the blast of the siren, each veteran dashed to his favorite shelter. I be­latedly did likewise, having my eye on the cavelike security of the safest looking bed in our quarters. But that bed was not for me. A snarl came from beneath it, and I recog­nized a familiar figure, and remembering my morning introduction, dared not ask him to share his shelter with me !"

It is also said that Derrick Vail was al­ways the first of the consultant group to hear of rumors. This was particularly so be­fore the move of the chief surgeon's office to Paris. He saw to it that he was the first to be on his way, and his contacts with the billeting officer produced astonishingly spa­cious and comfortable quarters in the Prince of Wales Hotel for his brother-officers and himself.

For his services, our country awarded him the Bronze Star and the Legion of Merit ; France with the Medaille de Recon­naissance ; and Belgium with the Order of the Crown.

Derrick Vail returned to this country in December, 1944, and for a few months served as chief consultant in ophthalmology in the Surgeon General's Office (fig. 10). While he was overseas, he had been offered the chair of ophthalmology at Northwestern, and during his first few months back in this country he was going through the struggles of decision as to whether, at the age of 47 years, it would be the wisest move to leave the completely secure but engulfingly hectic life of practice in Cincinnati for what might be a life of more leisure and academic stim­ulation in Chicago. Lawrence Post com­mented editorially on this in T H E AMERICAN JOURNAL OF OPHTHALMOLOGY: "To make this decision must have required great courage, for anyone who has built up a large practice knows what effort this has required and how long it has taken, and to abandon it for an ideal is not easy. About one man in a thousand has the courage to let the larger viewpoint prevail."

Chicago life soon became even more full than Cincinnati. Besides giving a great deal

Fig. 10. Miss Helen Keller and D. V.

of time to his department and the training of his residents, he became involved in a most amazing variety of ophthalmologic projects. He found time to write almost 50 papers on many different subjects, having written about 50 before World War II . In addition, he revised Gifford's Ocular Thera­peutics (1947), wrote a short, clear lay­man's treatise, The Truth About Your Eyes (1950 and 1959), and contributed numerous chapters to ophthalmologic textbooks. From 1940 to 1965, he was the most capable ed­itor-in-chief of T H E AMERICAN JOURNAL OF OPHTHALMOLOGY. Almost without excep­tion, each number would contain a pertinent editorial written in his crisp, unique, matter-of-fact style, so easily recognized as being his that his name need not have been added. An additional demanding task was his ed­itorship of the Year Book of Ophthalmol­ogy from 1949 to 1959. Here again his edi­torial comments showed the wide range of his reading and his sound clinical insight and judgement.

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Of his clinical life at Northwestern, one of his residents writes: "During the years from 1949 to 1953, he was at the pinnacle of professional esteem and had an over­whelming surgical practice. He ran a tight ship. He demanded and got obedience and respect from his residents. There was little informality except for an occasional Sunday evening supper at his charming apartment. He and his lovely wife were gracious hosts, and these were memorable and pleasurable evenings. Monday morning he was all busi­ness again and the orders rang as usual. His tremendous drive impressed us all, but we had little perspective as to his impatient, tense nature. Since I have now been in prac­tice some years, I am now more tolerant. In­deed my admiration and respect for this re­markable man has increased as the years have gone by."

As a part of the residency training at Northwestern, each resident spent at least six months in his private office. One resi­dent states : "My stay in the office with him was a great experience although working in the shadow of a great man could be frus­trating." Another says: "A character, gen­tleman, scholar and physician. An old cliché, but it truly expresses my feeling toward him. My years with him have made a trea­sured, life-long impression on me." As he was just completing his residency, another resident recalls Derrick Vail saying : "Ah— so you disagree with me ! The young man is growing up ! He is finally learning to think for himself ! He is no longer my yes-man !"

Before he stopped operating around 1957, his extensive surgical practice required that he operate five mornings a week, starting promptly at eight o'clock. "He never used

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Fig. 11. Royal College of Surgeons England. D. V. receiving Honorary Fellowship from the president, Sir Cecil Wakeley.

DERRICK TILTON VAIL 963/23

gloves for an intraocular case," an associate reflects. "He was the most delicate man with instruments I have ever seen, and his dex­terity was remarkable. (The violin lessons must have paid off.) A routine cataract ex­traction would take about eight minutes. He would dissect down a small triangular con-junctival flap and place a double-ended su­ture through the base of the flap and the epi-sclera. A full Graefe section was followed by a complete iridectomy. The lens was de­livered by forceps and counter-pressure—oc­casionally by the Smith method. After 1952, the erisophake was used. An excellent tech­nician, he never introduced the same instru­ment into the eye and took special care never to bend the cornea."

He insisted that his assistants forego any unpleasant or disturbing news until the morning surgery was over. On rare occasions he would give vent to his emotions or frus­trations by kicking the scrub bucket around the room. This is quite understandable, par­ticularly when a new interne, in response to

the command: "Hurry up and lower the table," pushed the wrong pedal and tilted the patient into Derrick Vail's arms! Or— when on another occasion, when doing a tear sac operation, the entire bone drill turned and wrapped his glove around it!

His patient rounds were always instruc­tive and entertaining. His residents agree that they learned much from his attitude, and his sympathy and understanding were contagious. It is said that his staff were in­trigued with the charming way he handled a particularly "nasty patient." A tremendous admirer of his father, he used to say to his residents: "The science of ophthalmology can be learned from books, but the art of ophthalmology I hope you will learn from me—as I learned it from my father."

There is scarcely an office he has not held or an honor he has not received (fig. 11). He has been chairman of the Section on Ophthalmology of the American Medical Association (1946-47), and recipient of the Prize Medal in Ophthalmology (1952);

Fig. 12. The American Board of Ophthalmology, 1946. (Bottom) Beach, Kirby, Ellett. (Middle) Post, Theobald, Berens, Masters. (Top) Terry, Dunnington, Vail, Reese, Goar.

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the Howe medal (1960). He has more re­cently been made president of the Concili­um Ophthalmologicum Universale, the high­est international office. He gave the de-Schweinitz Lecture (1945), the Proctor Lec­ture (1947), the Montgomery Lecture of the Royal College of Surgeons of Dublin (1952), and the Doyne Lecture at the Ox­ford Ophthalmological Congress (1957), also receiving this society's medal. He was also awarded the Leslie Dana Gold Medal of the National Society for the Prevention of Blindness (1959).

There seems to be some disagreement as to whether Derrick Vail has purposely slowed down his activities. Very probably not. Fortunately, he is not all ophthalmol­ogy. Each summer the Vails spend several months in Desbarats (fig. 13), which ac­cording to Time magazine (July 2, 1965) is "a tiny, nondescript village on the shore of the Canadian mainland just across Lake Huron from Michigan. It is not a place but a way of life. Desbarats makes a fetish of rusticity bordering on hardship . . ." Time named a few of its inhabitants and con­tinued" . . .another established resident is Dr. Derrick Vail, famed eye surgeon." To this sanctuary, mail comes twice weekly. There is no telephone and letters apparently

president of the American Ophthalmologi- are never answered. By the Vails' cottage cal Society (1958-59); and recipient of (or whatever passes for living quarters at

Fig. 14. Desbarats and the Ivory Tower.

Fig. 13. D. V. at Desbarats, circa 1960.

president of the American Academy of Ophthalmology and Otolaryngology (1951-52) ; president of the American Board of Ophthalmology (1954) (fig. 12); and

DERRICK TILTON VAIL 965/25

Desbarats) there is a small addition on a rock. This is known as his "Ivory Tower" (fig. 14). What he does there is his own business, be it woodcarving, editing, read­ing, violin playing, or perhaps scanning the horizon with a telescopic rifle guarding the seclusion and happiness the Vails so dearly love and deserve. It is with great sadness that October calls them back to Chicago and makes it necessary to say a reluctant fare­well to Desbarats and its feverish inactivity.

They have been quite aptly called "The Peregrinating Vails." There are few places in the world they haven't visited and aren't planning to visit next week or next month. On most of these jaunts, they stop by Lon­don for a visit with their devoted friends, the Duke-Elders.

At the last meeting of the International Congress in New Delhi, a head-on automo­bile collision in the countryside almost ended in tragedy. Fortunately, the Vails were not seriously hurt, though their hours under the merciless sun by the Indian road­side will not soon be forgotton. But the way Derrick Vail describes it in his vivid, imagi­native style can only be likened to one of Bob Hope's monologues. Thus he can pi­geonhole his problems and worries ; and when he does, no one enjoys the fun of life more than he. At parties, his violin is al­

ways ready, and its a safe bet that he rarely can be stumped on a popular tune from 1915 on. Occasionally, he will yield to the urging of his friends and do his skit of the Chinese nurse telling the story of Little Red Riding Hood to her young charges. It is said this truly unique performance had its origin when he babysat for his two younger sisters many years before.

Derrick Vail and retirement are simply not synonymous. Physical or mental inactiv­ity would be inconceivable. At the age of 67 years, he is still young and enjoying his life to the fullest.

Infinite tribute could be paid to him, but to round out this somewhat informal sketch, these lines of Robert Burns seem particular­ly appropriate :

The friend of man, the friend of truth, The friend of age, and guide of youth :

Few hearts like his-—with virtue warmed Few heads with knowledge so informed: If there's another world, he'll live in bliss; And if there's none, he made the best of this.

1020 St. Paul Street.

ACKNOWLEDGMENTS For their help in assembling much of this ma­

terial about Derrick Vail, I want to express my thanks to Blake Dunphy, Earl Merz, David Shoch, Paul Irvine, Robert Willard, Donald Pilsbury, Mather Cleveland and, most of all, Elizabeth Vail.

OPHTHALMIC MINIATURE

When toward night time, the daylight falling subdued through a window, a burning candle is so placed that a ruler or pencil will cast two shadows on a sheet of white paper, one from daylight, the other from the candlelight, each illuminating by light from the other sources, one of the shadows will appear yellow, the other a vivid blue.

Goethe, On Colored Shadows, 1792