SURVEY OF OPHTHALMOLOGY0 VOLUME 32. NUMBER 2 * SEPTEMBER-OCTOBER 1987

HISTORY OF OPHTHALMOLOGY DANIEL ALBERT, EDITOR

Lest We Forget: Notes on Reading Verhoeff’s Early Correspondence

DAVID G. COGAN, M.D. National Eye Institute, Bethesda, Maryland

Abstract. Dr. Verhoeffs life and work are reexamined by the author in the light of his early correspondence. The letters remind us of the significant contributions of Dr. Verhoeff to opthal- mic pathology in America. His personal qualities, such as candor, ingenuity and intellectual honestv are recalled bv his successor in the Howe Laboratory. Surv Ophthalmol32:131-135, 1987) ‘

,

Key words. Verhoeff, Frederick Herman

At the time of Dr. Frederick Verhoeffs death in

1968, I was bequeathed a small cardboard box, filled with letters, browned with age and for the

most part enclosed in envelopes similarly brown and fragile. With few exceptions the letters were

addressed to Dr. Verhoeff during two critical peri-

ods: first, when he was about to take up his first

position, as Pathologist at the Massachusetts Chari-

table Eye and Ear Infirmary (1900), and second, when he was called into the Army during the First World War (1917). The letters, about 150 in all,

apparently meant something to Dr. Verhoeff, and they tell us something about him as a person and

about ophthalmology 50-75 years ago. I intend to

present excerpts from those letters which seem to me most meaningful and then deposit them in the Ar- chives of the Massachusetts Eye and Ear Infirmary. Although, the correspondence is one-sided, since little indication is given of Dr. Verhoeffs replies,

those of us who knew him well, as I did, may be

permitted a few inferences. As a native of Louisville, Kentucky, and an alum-

nus of Yale’s Sheffield Scientific School (1895),

131

Frederick Herman Verhoeff came to Baltimore with a letter of introduction from the headmaster of his former school in Louisville, who commented in the

usual flowery style of the time: “he has the good sense to apply his talents and energy to self-im-

provement - sterling qualities of mind and heart. A

diligent, conscientious student - he is in every re-

spect a most noteworthy fellow.” He was the first graduate of Johns Hopkins Medical School ( 1899) to be interested in optics and the first Hopkins grad-

uate to become an ophthalmologist. I suspect he was also the first person to present a paper while still a medical student before the prestigious American Ophthalmological Society. The subject of that pa-

per was heterophoria, reflecting his planned studies in physiologic optics.

Although he was characterized as “a young gen- tleman of ample means ” in the 1895 letter of intro-

duction, Dr. Verhoefffelt the financial constraints of any academically oriented person trying to make ends meet while pursuing intellectual interests. As a result, when an opportunity for a remunerative PO-

sition as Pathologist at the Infirmary in Boston ap-

132 Surv Ophthalmol 32(2) September-October 1987 COGAN

peared, which was made possible by a recommen- dation from William H. Welch, Professor of Pathology and former Dean of Hopkins, Dr. Ver- hoeff found it a very tempting proposition.

Accordingly he went to Boston for an interview and, as related by Dr. James Bordley, he made a “good showing (before) the great men there.” He was appointed Pathologist to the Infirmary and As- sistant Ophthalmic Surgeon (1900) with a yearly salary of $400 and board. In a letter from FB Mal- lory we learn this was to be supplemented by $250 per annum from Harvard University for participa- tion in teaching at the Medical School during one semester each year. He also received $5 to $20 for occasional lectures at the School for Health Officers sponsored by Harvard University and Massachu- setts Institute of Technology. A bit of advice from a Baltimore colleague on undertaking his new job was “be careful not to do it all at once as there is more glory to be gotten from stringing it out.”

Prior to the Boston commitment he apparently had planned to enter private practice in Louisville. He performed at least one cataract extraction in preparation for this while still in Baltimore. Dr. James Bordley’s follow-up report on the operation states, “The patient is doing fairly well, can count fingers at 2 feet,” but Dr. Bordley adds, “You made your ‘corneal’ cut too far back and went into the ciliary body,”

It is not clear whether it was this patient or an- other patient whom Dr. Verhoeff was later so anx- ious to get into the hospital that he sent $5 for her trip from Casanova, Va. The intermediary who was to arrange for the trip wrote that Dr. Verhoeff would recognize the patient as a “small copper-colored woman who would probably be wearing a black dress and a black hat. - If you stand at the exit you cannot miss her.” The picture of Dr. Verhoeff stand- ing at the hospital door waiting for a patient corre- sponds to an episode of my vintage when a Boston dowager entering his office found Dr. Verhoeff on his hands and knees looking for a screw that had fallen from one of the instruments.

As judged by these letters, written communica- tions among colleagues of this time were handwrit- ten without secretarial assistance, and were only slightly more legible than physicians’ notes in mod- ern hospital records. Noteworthy is the merciful lack of acronyms which flourish in our modern ver- nacular. Even as late as 1925 Duke-Elder’s letter to Verhoeff was written in longhand. The envelopes were frequently addressed in a manner that would confound a modern postman. One letter was ad- dressed to him in Baltimore simply at “Fairmount Ave., near Broadway.” Another letter, this time from G.L. Maddox of Bournemouth England, was

Fig. 1. Dr. Verhoeff, about 1958-1960, shortly after as- suming the Directorship of the Howe Laboratory. Al- though he continued consultative activities in pathology, as indicated by his treasured monocular Zeiss microscope in the background, his primary interest at that time and subsequently was physiologic optics.

addressed simply to “Dr. Frederick H. Verhoeff, Boston USA.” Nevertheless they had obviously reached their destination (Fig. 1).

In general, the letters were more candid than in the litigiously conscious society of today. A peripa- tetic ex-student of Dr. Verhoeffs, spending some months in a New York City center (1917), noted “artificial leeches are used for everything” and add- ed “you get no support here.” Another ophthalmol- ogist, visiting Philadelphia, was impressed by the use of gold balls for implantation after enucleation, and says, somewhat ambiguously, “Whether this is because of the wealth of the city, or because glass would be endangered at their ward meetings I am unable to say.”

Any ChiefEditor would be impressed by Dr. Her- man Knapp’s “Dear Sir” reply in 1899 to a manu- script submitted by the young Verhoeff describing a new instrument. Dr. Knapp requested that the in- strument be sent along as well as the manuscript so that he might try it out because “instruments are often well conceived but do not work.” In a letter three years later, Dr. Knapp commented on another

VERHOEFF’S EARLY CORRESPONDENCE I33

Verhoeff manuscript as showing “a decided scientif-

ic stamp but whether I can answer its admission to

an ophthalmological journal is not yet clear to me.”

Was Dr. Knapp pondering the perennial quandary of an editor in deciding how much basic research can be judiciously included in a clinical journal?

Letters in and shortly after 1917 abound with references to the Verhoeff electrolytic treatment for

detached retinas. An apostolic champion of this method tried to introduce it to New York without

much success: “suggestions seem out of order espe- cially if they come from Boston - they are such routinists in their treatment and so terribly conser-

vative at trying the electrolysis.” In later years Dr. Verhoeff felt this method of coagulation did not re-

ceive due credit. He commented to me several times that Gonin’s recognition of the significance of a ret-

inal hole, some years later, eclipsed his own pioneer- ing methods of treatment.

Dr. Verhoeff was the sort of person about whom

legends arise and grow in the telling. His irrepres-

sible candor spawned tall tales. He was said, for instance, to have left “a trail of blood” on his multi-

clinic visits through Europe during the Wandjahre of 1903. And a friend in Baltimore, Dr. Edgar R.

Strobel, undoubtedly meant well when he ad-

dressed a letter to Dr. Verhoeff in Zurich with the

following advice: “I hope you will employ your time

cultivating a less pugnacious disposition so that when you come back you will find fewer people to

scrap with.” The consummate candor underlying

some of the common tales was also evident in sever- al manuscript reviews in which his evaluations are

highlighted with such words as “absurd,” “silly,” or

“the work of a dilettante.”

If candor had a high place in the Verhoeff values it was matched by his respect for originality. He

insisted on proper recognition of priority and could

be vitriolic when his own contributions were at is- sue. Personal considerations were then secondary.

In a mid-century letter to a respected friend, Dr. Algernon Reese, he wrote: “I note with great sur-

prise in the abstract of your paper - you do not

mention my work on the subject - the pathogenesis of disciform degeneration of the macula.” He then provided the pertinent references and warned Reese

that he was putting him on notice so that, “I shall

not need to criticize you at the meeting.” Perhaps it was a similar warning that prompted Dr. Zent- mayer, then Professor of Ophthalmology in Phila-

delphia, to get off a letter (1910) apologizing for similar oversights in his paper on vicarious mac- ulae. The correspondence (1907) on priority for the discovery of the organisms in Parinaud’s conjuncti- vitis was less friendly, and resulted in each contes- tant demanding an apology from the other. George

H. Simmons, the Editor of the Journal of the Ameri-

can Medical Association, who became involved in

the dispute wrote to Dr. Verhoeff, “You seem to have opened a hornet’s nest.”

Nevertheless, Dr. Verhoeff rapidly gained the re- spect of his colleagues, even of those whom he se- verely criticized. As early as 1903, Osler wrote that

he would like to get him back to Hopkins: “What inducements could we offer you to settle here and

take up some work at theJohns Hopkins Hospital and Johns Hopkins University?” He apparently re-

ceived an unfavorable reply because one week later

he wrote again: “What an ophthalmological Daniel

you are. I do not think there is anything we can offer here in compension with what you have got at pres-

ent, but do not forget that we have one eye on you.” R.L. Randolph (1900) sounded him out for a pro-

fessorship of Eye, Ear, Nose and Throat at a small Wesern University staffed in part by a Hopkins fac-

ulty (this turned out to be the University of Missou- ri). H. Gifford ( 1907) probed Verhoeff s potential

interest in succeeding Parker at the University of Michigan. A letter from a former student urged him

to accept a position in the new graduate school in Chicago. And considerably later ( 1924) R.S. Reese

solicited Verhoeff s possible interest in an appoint- ment as Pathologist and Surgeon at the New York

Eye and Ear Infirmary. Dr. Verhoeff apparently

declined all of these. That he was gaining a national and international

reputation was further indicated by letters from such notables as: RW Doyne (1910) inviting him to

demonstrate his glaucoma surgery at the Oxford

Ophthalmological Society; Edward Jackson ( 19 15) inviting him to address the Colorado Ophthalmo-

logical Society; J.M. Griscom (1940) inviting him to give the de Schweinitiz Lecture; and R.H. Elliot

(1910) inviting him to spend several months in In-

dia. This latter invitation, although declined, would have been an opportunity to test some of his increas-

ing interest in surgical instrumentation. There were undoubtedly many more such invitations which were not saved. One letter ( 1925)) from an admiring Dr. Maddox of England, complained only that the

“splendid and thoughtful work which you have

done (is) buried in periodicals which English read-

ers do not use.” He was referring to the Transactions

of the American Ophthalmological Sociehv and a former Annals of Ophthalmology. Then there is the compli-

mentary letter from A. Duane (1902) congratulat- ing him on the concept of the cyclopean eye. Dr. Verhoeff‘must also have been pleased by the occa-

sional personal letters from E. Fuchs whom he re- spected above all other ophthalmic pathologists

(“our beloved Fuchs”) .’ Especially noteworthy is a seven page letter

134 Surv Ophthalmol 32(2) September-October 1987 COGAN

Fig. 2. In 1975, Dr. Verhoeff, almost 90 and severely deaf, continued to at- tend the weekly pathology confer- ences at the Massachusetts Eye & Ear Infirmary. Left to right: David Co- gan, Arnold Kroll, Taylor Smith (at the projector), Dr. Verhoeff, and Toi- chira Kuwabara.

(hand written on personal stationery) from W.H. Welch (1910) commenting on Verhoeffs excellent

work, with special reference to his description of the unique external limiting membrane and the ques-

tion of epiblastic vs mesoblastic origins of the tu-

mors, which he and Flexner had called neuro-epith- elioma, but which Verhoeff named retinoblastoma. As an aside Welch critized Wintersteiner’s appro-

priation of Verhoeff s term with the comment: “It is

an old trick of many Germans to overlook American work in this way but to appropriate the results.”

In contrast to these far-flung letters only one or two letters of appreciation seem to have come from

the local scene. One was from W.B. Cannon thank- ing Dr. Verhoeff for the care of a young Cannon and noting, incidentally, the lack of inflammation in an

eye when deprived of its nerve supply. The other local letter was from W.T. Councilman ( 1906),

head of Pathology at the Massachusetts General Hospital, stating “your ordinary is very tine,” what- ever that means (Fig. 2).

But more meaningful for Dr. Verhoeff than any of these, I believe, were the letters from his former student associates, such as Jonas Friedenwald (writing from London when he was studying neurol- ogy with Gordon Holmes) and Derrick Vail (then on a surgical orgy in India), expressing gratitude for interest in their behalf. When another such person’s candidacy for membership in the American Oph- thalmological Society was later threatened because he had displayed a card in his offrce window an- nouncing that he was a “practicing ophthalmol-

ogist,” Dr. Verhoeff sent a strong letter of protest (1913). According to Dr. Verhoeff, this practice,

considered unethical advertising by the Society, was

no longer an issue in this particular case because the candidate had done it out of ignorance, and in any

case had withdrawn the display 2’/2 years previous-

ly. Moreover “he has never had any statement on

his cards or stationery that he was a practicing

ophthalmologist.” One may suggest from these letters that Verhoeff

was less appreciated locally than elsewhere. It

seems curious to me that he was appointed as an ophthalmologist to the Carney Hospital staff in

1902 and yet the Board of Surgeons opposed his appointment as ophthalmologist at the Infirmary

until their opposition was overruled by the Board of Managers.3

The correspondence with George Derby as Pro- fessor of Ophthalmology, with Frederick Washburn

as Administrator of the Hospital, with David Edsall as Dean of the Medical School, with JO Green rep- resenting the Board of Surgeons, and with Robert

Homans and EH Bradford representing the Inlir- mary’s Board of Managers, was little more than coldly ollicial announcements with which Verhoeff often disagreed. The typically undisguised com- ments of Dr. Verhoeff on some of these decisions could not have endeared him to his administrative peers. However, in all fairness it must be admitted that Dr. Verhoeff might have been less than ideal in a heavily administrative post and, more to the point, it would have been a shameful waste of rare talents

VERHOEFF’S EARLY CORRESPONDENCE 135

to tether his creativity to administrative details.

Aside from these personal and ophthalmic ex-

cerpts, several letters in the early 1920’s contain notes of more general interest. Harvey J. Howard, who had been a student of Dr. Verhoeffs but was

spending several years at the Peking Medical Col-

lege, complained of the difficulty in getting things done because of the “constant wars” in China. Dr.

Howard later writes of his harrowing adventures when he was held hostage for 10 weeks by bandits

where “my chances of getting out alive were very slender.”

Of purely local interest is the correspondence with Walter B. Lancaster in 1916, wherein it is stat-

ed that the electric current at the Massachusetts Infirmary was 10 volts supplied by a generator in

the basement and providing an outlet at each pa-

tient’s bedside. (By 1934 the voltage had been

stepped up to 110 but was still DC). Dr. Verhoeffs scientific curiosity has often been

misconstrued as a lack of compassion. Those of us

who knew him well, and the many cordial letters from his former students can testify to his deep sen-

sitivity. He was for instance, devastated by the

death of his college-age daughter, Mary. Even the death of his dog, Buflie, evoked tears in the telling.

His distress of the latter was epitomized by a friend in the following poem which will fade into oblivion if

not presented here.

Good Bye Bufie!

“You didn’t hear my whistle today?

Is this what you are telling me my boy?

You say you are too far away

And you cannot chase your ball and play?”

Wasn’t it only yesterday

That you heard my lightest footstep on the stair?

Then I’d hear your happy barking

And you came dashing to me as if through the air.

Where are you Buflie, my dear little lad

Come close to me my boy so I’ll not be so sad

You have been my friend and little pal

Throughout the nights and days of many years

Place those dear clumsy paws on m); knee

While I brush away my tears

When many days at hospital were rugged

The kind of days my soul was sorely tired

You and I Bufflie would slip away from the madding crowd

I would drive along aimlessly and I soon

felt released and comforted with you by my side.

You see little pal, you didn’t whimper and complain

I sensed you thought me rather wonderful

You didn’t tell me you were disappointed in me

And described mmutely all your pain

I cannot get used to the fact

that our cameraderie is now at the end

I must tell you Bufie you were my little friend

I surely know if there IS a place in Heaven

N’here all good doggies go

There I’ll find my Buffle

Sitting right in the first row!

Gertrude .\,I. Pelham, 1952

The time is approaching when Frederick H. Ver- hoeffwill go down in austere history as the Father of

Ophthalmic Pathology in America, an innovative surgeon, and a character of the early and mid-twen-

tieth century. To those of us who knew him inti- mately and were inspired by him as a person as well

as a scientist and clinician, these letters are remind- ers of the role he played in our personal lives as well

as in American ophthalmology - lest we forget.

References 1. Cogan DG: Frederick Herman Verhoefl- - Personal recollec-

tions. Tram Am Ophthal Sot 67:9&109. 1969 2. Vrrhoeff FH: Ophthalmology as a career. j.4.M4 201:649-652.

1933 3. ivrst FJ: Ofeye and cars and men. Hanard .WedicalAlumni Bulletin

30:7-l I. 1956

Reprint requests should be addressed to David G. Cogan. M.D., National Eye Institute. Bldg. 10, Room 6C401. Bethesda, Maryland 20892.