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Full text of "The Wilmer Ophthalmological Institute at the Johns Hopkins University and the Stanford Medical School : oral history transcript"

a 



OPHTHALMOLOGY 




ORAL HISTORY SERIES 







A Link With Our Past 



An Interview with 



A. Edward Maumenee, MD 


















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OPHTHALMOLOGY 



ORAL HISTORY SERIES 



A Link With Our Past 




Portrait of A. Edward Maumenee II, MD 

Painted by Wayne Ingram, 1972 

On display at the Portrait Room of the Wilmer 

Ophthalmology Institute at Johns Hopkins University 



A. Edward Maumenee, MD 



The Wilmer Ophthalmological Institute 
at the Johns Hopkins University 
and the Stanford Medical School 



An Interview Conducted by 

Sally Smith Hughes, PhD 

1990 

With Introductions by 

Lewis Ort 

Stephen J. Ryan, MD 
Sir John Wilson 



The Foundation of the American Academy of Ophthalmology, San Francisco 
Regional Oral History Office, University of California at Berkeley 



It is recommended that this oral history be cited as follows: 



A. Edward Maumenee. MD. Ophthalmology Oral History Series, A Link With Our Past, an oral history 
conducted in 1990 by Sally Smith Hughes, Regional Oral History Office, University of California, 
Berkeley, in cooperation with The Foundation of the American Academy of Ophthalmology. 



Copyright 1994 by The Foundation of the American Academy of Ophthalmology and the Regents of the 
University of California. All rights reserved. All uses of this manuscript are covered by a legal agreement 
between A. Edward Maumenee, MD, and The Foundation of the American Academy of Ophthalmology. All 
literary rights in the manuscript, including the right to publish, are reserved to The Foundation of the 
American Academy of Ophthalmology and The Bancroft Library of the University of California at Berkeley. 
No part may be reproduced, quoted, or transmitted in any form without written permission from the Executive 
Vice Chairman of The Foundation of the American Academy of Ophthalmology or the Director of The Bancroft 
Library of the University of California at Berkeley. Requests for permission to quote for publication should 
include identification of the specific passages to be quoted, anticipated use of the passages, and identification 
of the user. The legal agreement with A. Edward Maumenee, MD, requires that he be notified of the request 
and allowed thirty days in which to respond. 

Cover & Title Page Design: Romaniello Design 
Printed in the United States 



The Foundation of the American Regional Oral History Office 

Academy of Ophthalmology The Bancroft Library 

655 Beach St University of California 

P.O. Box 429098 Berkeley, CA 94720 
San Francisco, CA 94101-6988 



San Francisco Chronicle 
1/21/98 



Alfred Maumenee Jr. 

Port Clear, Ala. 

Dr. Alfred Edward Maumenee 
Jr., a world-renowned ophthalmol 
ogist and former director of the 
Johns Hopkins Wilmer Eye Insti 
tute, died in his sleep Sunday at his 
home here. He was 84. 

Dr. Maumenee was considered 
both a pioneer in the treatment 
and prevention of eye disease and 
the foremost corneal transplant 
and cataract surgeon in the world, 
colleagues said. 

In a career that spanned more 
than 50 years, he managed to 
touch every facet of ophthalmolo 
gy. He made significant discover 
ies in the detection and treatment 
of retinal malfunctions, macular 
degeneration and several other 
eye diseases including glaucoma, 
the leading cause of blindness. 

During his tenure as director of 
the institute from 1955 to 1979, Dr. 
Maumenee trained more academi 
cians and future directors of de 
partments of ophthalmology than 
anyone else in the world. 

He was also instrumental in the 

founding, in 1968, of the National 
Eye Institute at the National Insti 
tutes of Health and the establish 
ment of a nationwide system of 
eye banks. 

In 1948 he was named profes 
sor of surgery in ophthalmology 
and chief of the division of oph 
thalmology at the Stanford Uni 
versity School of Medicine, a posi 
tion he held until being appointed 
the third director of Wilnrr in 

1955. Baltimore Sun 



CATALOG INFORMATION 



MAUMENEE, Alfred Edward born 1913 Ophthalmologist 

A. Edward Maumenee, MD: The Wilmer Ophthalmological Institute at the 
Johns Hopkins University and the Stanford Medical School, 1994, xxx, 
267pp. 

Ophthalmology Oral History Series. 

The Foundation of the American Academy of Ophthalmology and 

The University of California at Berkeley. 

Born, Mobile, Alabama, 1913, to parents Alfred Edward Maumenee, 
ophthalmologist, and Lulie Radcliff Maumenee; undergraduate, University 
of Alabama, 1930-1934; University of Alabama Medical School, 1934-1936; 
Cornell University School of Medicine, 1936-1938; internship and 
residency, Wilmer Ophthalmological Institute, Johns Hopkins School of 
Medicine, 1938-1943; early research projects; faculty member, Wilmer 
Ophthalmological Institute, 1943-1948; World War II research; military 
service, U.S. Navy, 1944-1946; chairman, Division of Ophthalmology, 
Stanford Medical School, 19481955; chairman, Wilmer Ophthalmological 
Institute, 1955-1979; raising funds for the Wilmer Institute; discussions 
on: basic scientists at Wilmer, history of surgical techniques for glaucoma, 
tonography, hypotony, congenital glaucoma, theories on loss of visual field, 
photocoagulation, the resident training program at Wilmer; contributions 
to research on the cornea; initiating vitreous surgery; discussions on 
cataract extraction, the intraocular lens, uveitis, eye donation, bleeding 
episodes in the eye; formation of Spectra Pharmaceutical Services, Inc.; 
origins of the National Institute of Neurological Diseases and Blindness; 
founding of the National Eye Institute; activities in Ophthalmological 
organizations. 

Introductions by Lewis Ort, Stephen J. Ryan, MD, and Sir John Wilson. 
Interviewed in 1990 and 1991 by Sally Smith Hughes, PhD. 
ISBN 1-56055-068-6 



VI 



OPHTHALMOLOGY ORAL HISTORY SERIES 

Dohrmann Kaspar Pischel, MD 1988 

Phillips Thygeson, MD 1988 

Harold Glendon Scheie, MD 1989 

Thomas David Duane, MD 1989 

David Glendenning Cogan, MD 1990 

Paul Boeder, PhD 1990 

DuPont Guerry III, MD 1993 

A. Edward Maumenee, MD 1994 



The Foundation of the American Academy of Ophthalmology , 
San Francisco, California 

Oral Histories Committee: 

Stanley M. Truhlsen, MD, Chairman 
Arnall Patz, MD 
William H. Spencer, MD 
H. Stanley Thompson, MD 

Staff: 

Jill Hartle 
David J. Noonan 
Donna Seism 
Litia Wells 



Regional Oral History Office, The Bancroft Library, 
University of California, Berkeley, California 

Project Staff: 

Willa K Baum 
Sally S. Hughes, PhD 
Chris DeRosa 
Elizabeth Kim 
Shannon Page 



Vll 



DONOR REGISTRY 



The oral history of A. Edward Maumenee, MD, has been made possible 
through the generosity of the following contributors: 

Thomas E. Acers, MD 
Oklahoma City, OK 

Charles J. Blair, MD 
Richmond, VA 

Thomas F. Carey, MD 
Seattle, WA 

Francisco Contreras, MD 
Lima, Peru 

Monte A. Del Monte, MD, and Kristen G. Del Monte 
Ann Arbor, MI 

Joseph Dessoff, MD, and Augusta S. Dessoff 
Washington, DC 

John E. Eisenlohr, MD 
Dallas, TX 

Jared M. Emery, MD, and Juliet B. Emery 
Houston, TX 

Daniel Finkelstein, MD 
Baltimore, MD 

Robert N. Frank, MD, and Kami W. Frank, MD 
Bloomfield Hills, MI 

J. Donald M. Gass, MD, and Margy Ann Gass 
Key Biscayne, FL 

Herman K. Goldberg, MD 
Baltimore, MD 



vm 

Morton F. Goldberg, MD 
Baltimore, MD 

Rufus C. Goodwin, MD 
San Francisco, CA 

David L. Guyton, MD, and Janet Singletary Guyton 
Baltimore, MD 

Allan D. Jensen, MD 
Baltimore, MD 

Robert E. Kennedy, MD 
Rochester, NY 

AH Khodadoust, MD 
Guilford, CT 

Irving H. Leopold, MD 
Newport Beach, CA 

George F. Magee, MD 
Reno, NV 

Enrique S. Malbran, MD, and Ana Maria E. de Malbran 
Buenos Aires, Argentina 

Frank E. OT)onnell, Jr., MD 
St. Louis, MO 

Lewis J. Ort 
LaVale, MD 

David Paton, MD 
New York, NY 

Arnall Patz, MD 
Baltimore, MD 

Walter C. Petersen, MD 
Seattle, WA 

Frederick H. Reeser, MD 
Milwaukee, WI 

David A. Rosen, MD, and Gloria Rosen 
Roslyn Heights, NY 

Stephen J. Ryan, MD 
Los Angeles, CA 

Robert N. Shaffer, MD, and Virginia M. Shaffer 
Greenbrae, CA 



IX 



Ronald E. Smith, MD 
Los Angeles, CA 

Robert C. Snip, MD 
San Antonio, TX 

Alfred Sommer, MD 
Baltimore, MD 

Bradley R. Straatsma, MD, and Ruth Straatsma 
Los Angeles, CA 

Albert Strauss, MD, and Stella G. Strauss 
North Palm Beach, FL 

Gunter K. von Noorden, MD, and Betty L. von Noorden 
Houston, TX 

C. P. Wilkinson, MD 
Oklahoma City, OK 

Stewart MacKay Wolff, MD 
Baltimore, MD 

Dr. and Mrs. William J. Wood, MD 
Lexington, KY 



Alfred Edward Maumenee, MD 



CONTENTS 



PREFACE xv 

INTRODUCTION by Lewis J.Ort xvii 

INTRODUCTION by Stephen J. Ryan, MD xix 

INTRODUCTION by Sir John Wilson xxiii 

INTERVIEW HISTORY by Sally S. Hughes, PhD xxvii 

BIOGRAPHICAL INFORMATION xxx 

I. FAMILY BACKGROUND AND EDUCATION 1 

Family Background 1 

Maumenee Family Roots 1 

Grandparents and Parents 1 

Parents 3 

Growing Up in Mobile, Alabama 4 

The Move to Birmingham, Alabama, 1927 5 

Undergraduate, University of Alabama, 1930-1934 7 

Shipping Out, 1933 8 

University of Alabama Medical School, 1934-1936 10 

Cornell University School of Medicine, 1936-1938 11 

Extern at Various New York Medical Institutions 12 

II. THE WILMEROPHTHALMOLOGICAL INSTITUTE, 1938-1948 . 17 

Intern and Resident, 1938-1948 17 

The Physical Setup of the Institute 18 

Research on Retinal Lesions 20 

Prominent Ophthalmologists at Wilmer 21 

Jonas S. Friedenwald 21 

Alan C. Woods 22 

Frederick H. Verhoeff 26 

Early Research Projects 27 

The Halsted Residency System 29 

John McLean 30 

William H. Wilmer 33 

Monday and Thursday Rounds 35 

Pressure to Publish 37 

Dr. Woods's Cataract Operation 38 

The Wilmer Meetings 39 

Focal Point 40 

Taking the American Board of Ophthalmology Examination .... 41 



XII 



III. WORLD WAR II RESEARCH, 1944-1946 43 

Chemical Warfare 43 

Bacterial Warfare 44 

Serving on a Hospital Ship 46 

IV. PROFESSOR AT THE WILMER INSTITUTE, 1946-1948 49 

V. CHAIRMAN, DIVISION OF OPHTHALMOLOGY, STANFORD 
MEDICAL SCHOOL, 1948-1955 51 

Offer of the Chairmanship 51 

Changing Procedures in the Division 53 

Stanford Faculty Members 56 

San Francisco Ophthalmologists 58 

The Eye Bank 60 

Eye Pathology 61 

Treating Epithelial Invasions 62 

Fluorescein Angiography 67 

Macular Degeneration 70 

Treating Glaucoma with Goniotomy 72 

The Possibility of an Eye Institute on the Stanford Campus, 

PaloAlto 73 

Marriage (July 1949) and Children 74 

PHOTOGRAPHS 77 

VI. CHAIRMAN, WILMER OPHTHALMOLOGICAL INSTITUTE, 
1955-1979 87 

Return 87 

Policies Regarding Race and Sex 88 

Debate over the Use of Profits from Clinical Care 89 

Departmental Fellowships 91 

Rounds and Conferences 92 

Administrative Work 94 

Basic Scientists 95 

Maurice E. Langham 95 

Arthur M. Silverstein 97 

John E. Dowling 98 

The New Outpatient Department 100 

The Alan C. Woods Research Building 100 

Louise L. Sloan 103 

Large-Scale Clinical Trials 104 

Informing Patients 105 

Glaucoma 106 

History of Surgical Techniques 106 

Failure in Filtration Surgery 108 

Harold G. Scheie 109 

Recessed-Angle Glaucoma 110 



Xlll 



Tonography Ill 

Hypotony 112 

Otto Barkan and Congenital Glaucoma 113 

Theories on Loss of Visual Field 114 

Low-Tension Glaucoma 117 

The Resident Training Program 119 

Encouraging Residents to Enter Academic Medicine 119 

Selecting Residents 121 

Program Structure 123 

Guiding Residents 126 

Subspecialization in Ophthalmology 129 

Retinal Surgery 130 

Photocoagulation 131 

Research on the Cornea 134 

Research on Rejection 134 

Immunologic Privilege 136 

AH Khodadoust 138 

Cortisone Treatment 138 

Corneal Hypersensitivity 140 

Contesting the Theory of the Corneal Endothelium Pump . . 142 
Developing Media, Sutures, and Instruments for Corneal 

Transplantation 143 

Vitreous Surgery 146 

Cataract Extraction 148 

Extracapsular Extraction 148 

Intracapsular Extraction 149 

Cataract Extraction under the Microscope 150 

Surgical Techniques in Cataract Extraction 152 

The Intraocular Lens 152 

Harold Ridley's Posterior Chamber Lens 152 

Anterior Chamber Lenses 154 

Complications with the Intraocular Lens 156 

Uveitis 157 

Uveitis and Tuberculosis 157 

Classification of Uveitis 161 

Immunologists' Interest in Uveitis 163 

Histoplasmosis 164 

Eye Donation 164 

Bleeding Episodes in the Eye 166 

Differentiating Nevi and Melanomas 168 

Keratinization and Vitamin A 169 

Spectra Pharmaceutical Services, Inc 171 

Spectra's I-Scrub 173 

Scientific Research and Financial Enterprise 174 



XIV 



Dr. Maumenee's Approach to Research 175 

The National Eye Institute 178 

The National Institute of Neurological Diseases and Blindness 

(NINDB) 178 

Founding the National Eye Institute (NEI) 179 

The National Advisory Eye Council 182 

VH. ACTIVITIES IN OPHTHALMOLOGICAL ORGANIZATIONS ... 185 

International Congress of Ophthalmology 185 

History 185 

Sir Stewart Duke-Elder 187 

Jules Franpois 187 

Dr. Maumenee's Offices 188 

Changing the International Council of Ophthalmology .... 190 

Honorary Life President 191 

Prevention of Blindness Programs 192 

Jerusalem Seminar on the Prevention of Blindness, 1971 193 

International Agency for Prevention of Blindness 195 

Controlling Onchocerciasis 196 

Pan-American Association of Ophthalmology 197 

Moacyr Alvaro Fund 198 

Benjamin F. Boyd 198 

American Academy of Ophthalmology 199 

Palmer House Days 199 

Separation into Two Academies, 1979 201 

American Association of Ophthalmology 203 

President of the American Academy of Ophthalmology, 1971 205 

The American Board of Ophthalmology 206 

Reorganization 206 

Examiner for the Board 207 

American Ophthalmological Society 207 

VIII. REFLECTIONS 211 

Motivation 211 

Qualities of a Good Physician 213 

Leisure Activities 214 

Regrets 215 

Greatest Contribution 215 

APPENDICES 217 

Curriculum Vitae 218 

Bibliography 235 

INTERVIEWER BIOGRAPHY 255 

INDEX . 257 



XV 



PREFACE 

Ophthalmology Oral History Series 

American ophthalmology has undergone striking changes since World 
War II, not only in terms of basic science, diagnosis, and therapy, but also 
in terms of its internal organization and relationship with the rest of 
medicine and with the federal and state governments. Aware of the need 
to document these changes, the Foundation of the American Academy of 
Ophthalmology sought a means to preserve the memories, experiences, and 
insights of individuals who had lived through them. 

The result was the inauguration in 1986 of the Ophthalmology Oral 
History Series, an ongoing series of in-depth interviews with senior 
ophthalmologists and others who have made significant, contributions to 
the specialty. Aside from providing enjoyment and inspiration, the series' 
intent is to preserve a fund of historical information that might otherwise 
be lost and to give ophthalmologists a sense of their discipline's heritage. 

In January 1986, an Oral Histories Committee, consisting of William H. 
Spencer, MD (chairman), Stanley M. Truhlsen, MD, Susan E. Cronenwett, 
Patricia I. Meagher, and David J. Noonan, was formed to facilitate 
collection of oral histories. A selection subcommittee, with an anonymous 
membership of three senior ophthalmologists, was appointed to select 
individuals to be interviewed from nominations by the Foundation Board 
of Trustees and the Academy Board of Directors. 

In selecting individuals to be interviewed, the subcommittee considers the 
individual's age, prominence in and contributions to ophthalmology, and 
ability and motivation to participate in the project. An effort is made to 
select interviewees from different areas of the country and with different 
subspecialty interests. Colleagues in the interviewee's geographic region 
provide information and assist in fundraising for the oral history series, 
which is entirely supported by private contributions. 

Production of the oral histories is a collaborative effort of the Regional 
Oral History Office of the University of California at Berkeley and the 
Ophthalmic Heritage Department of the Foundation of the American 
Academy of Ophthalmology. For over thirty years the Regional Oral 
History Office has conducted interviews with West Coast leaders in all 
walks of life and is pleased to have the opportunity to expand nationally to 



XVI 



document the history of American ophthalmology. Sally Smith Hughes, 
PhD, a medical historian with the Regional Oral History Office, conducts 
the research, interviewing, and editing, and confers with the Foundation 
on final production of the oral history volumes. Willa K. Baum, director 
of the Regional Oral History Office, serves as consultant. Licia Wells, 
director of the Foundation's Department of Ophthalmic Heritage, is 
responsible for the management and administration of the series. 

An oral history memoir is a recorded and transcribed series of interviews 
designed to preserve the recollections, knowledge, and reactions of a 
person who has played or observed a significant role in important events. 
It represents an important way to preserve information and opinions 
that the narrator alone is able to provide. The transcriptions are edited, 
reviewed by the narrator, retyped, indexed, and bound with photographs 
and illustrative material, and placed in appropriate research libraries. 

The finished product is both a record of a conversation and a primary 
research source. It should not be regarded as having the polish and 
finality of a published book. It is not intended to present the final, verified 
and complete account of events. Rather, it reflects the narrator's view, 
sometimes recounted with partisanship and passion, sometimes with 
impartiality and objectivity, but always vivid, immediate, and 
irreplaceable. 

Oral history in one sense is an informal art, one that relies on the 
give-and-take between two individuals holding a directed conversation. 
Thus the reader should not expect a studied, impersonal, and invariably 
exhaustive and factual discourse in the pages that follow. Instead, the 
good oral history offers a close-up view of the narrator and his or her 
opinions, expressed with the immediacy, appeal, and occasional errors and 
distortions of everyday conversation. 

Indexed and bound transcriptions of the interview are available to readers 
at the Foundation of the American Academy of Ophthalmology, The 
Bancroft Library at the University of California at Berkeley, the National 
Library of Medicine, and other medical and manuscripts libraries. The 
interview tapes and supplementary material relevant to each interview are 
on deposit at the Foundation. Oral history volumes may be ordered from 
the Foundation. 

Sally Smith Hughes, PhD Stanley M. Truhlsen, MD 

Senior Interviewer-Editor Oral Histories Committee 

Regional Oral History Office The Foundation of the 

University of California, Berkeley American Academy of 

Ophthalmology 

June 1992 



XV11 



INTRODUCTION 

Lewis J. Ort, Founder and Owner of Ort's, Inc. 

Occasionally, in this topsy-turvy world we live in, we encounter the 
unusual person. It would seem that the Almighty who has created us all, 
pauses in the creation of a particular individual, and at that moment 
creates an extraordinary human being. Dr. Ed Maumenee is certainly 
that kind of man! 

There have been many great persons in the medical field for over a 
hundred years. We salute these individuals who sacrificed so much study, 
time, and moments of heartbreaking research to achieve their healing goal. 
To have the talent for teaching the world about the miracle of healing and, 
at the same time, have a personality that reflects nothing but love for the 
individual is truly a gift to the human race. 

Ed is naturally held in deep respect and, at the same time, his deep and 
resonant laughter is inspiring. My four daughters and I were being hailed 
as the givers of the first chair to the Wilmer Institute in Baltimore. There 
in the amphitheater Ed took his place in order to praise the family and tell 
of some of the conquests we had made in the baking field. He was extolling 
the fact that I had created the first dietary loaf of bread in three thousand 
years of bread making. His sentence was, "Lew made wonderful strides in 
the creation of a loaf of bread that was sharply reduced in calories and 
contained much wood!" There was a hush over the crowd and then a 
pealing laughter. Ed, puzzled, wanted to know what had provoked the 
laughter. When I called from the row the family occupied, "Ed, stick to 
medicine and stay out of the baking business," his resonant laughter 
boomed out. 

Any opportunity for a moment with this wonderful person, whose skillful 
hands make miracles and whose sympathetic heart reflects so much love 
through his eyes, is an honor. Many physicians remain very deep in 
medicine, but when my heart was broken with the early loss of my wife, Ed 
saw to it that I was an invited guest at their home during the holidays. He 
has that rare caring for his fellow human beings which, combined with his 
unparalleled skills for healing, has truly earned him the term of "great." It 
is hard to describe how he re-establishes the feeling of confidence in those 
who are afraid of losing God's greatest gift of sight. The depth of feeling for 
him was demonstrated a few years ago when all the world of eye care came 



XV111 



to Baltimore to pay him tribute and celebrate bis knowledge, but moreover, 
to be eternally grateful to him. 

Recently, at a hospital I am building in Santo Domingo for the treatment 
of burns, I came in contact with a doctor who had studied under Dr. 
Maumenee. Proudly, I told him that Ed Maumenee and I are close 
personal friends. This older doctor straightened up and looked me in the 
eye and told me in Spanish, "Please sir, you do not address him as Ed, but 
as Dr. Maumenee wherever he is in the world." 

I am happy to introduce him not only as the "great man," but equally 
important my dear friend! 

March 24, 1992 



XIX 



INTRODUCTION 
Stephen J. Ryan, MD 



Wilmer Institute residents at Johns Hopkins Medical School who had the 
privilege of training under A. Edward Maumenee held "The Prof in the 
very highest regard. He was our inspirational leader. Although all the 
faculty, fellows, residents, and students at Hopkins profited from his 
talents and guidance, we did not, as residents, fully appreciate his 
profound influence upon ophthalmology on both the national and 
international levels. Dr. Maumenee is a living example of the statement 
that "great men are like mountains in that they are even more impressive 
from a distance." As we acquired (with time and age) a national and 
international perspective of ophthalmology, it has become clear that The 
Prof truly became the world leader of ophthalmology for his generation of 
ophthalmologists. 

As a first-year Hopkins medical student, I entertained thoughts of being 
a cardiac or neurosurgeon. However, once The Prof made a summer 
research job available to me at Wilmer, my future course in following my 
ultimate role model, Ed Maumenee, had begun. On a very personal basis, 
he is the reason I look forward to going to work every day in academic 
ophthalmology. 

On a professional basis, most ophthalmologists are aware that Ed has been 
president or chairman of virtually every ophthalmological organization in 
the United States, including the American Academy of Ophthalmology. 
He has been instrumental in the creation or improvement of many 
now-flourishing organizations, such as the Association of University 
Professors of Ophthalmology, the Association for Research in Vision and 
Ophthalmology, and the National Eye Institute. However, my intent in 
this introduction is not to recite Ed's tremendous accomplishments and 
contributions to ophthalmology and other organizations; rather, I will focus 
upon the personal side of this extraordinary individual and great human 
being. 

Ed Maumenee is a great tennis player and the absolute, ultimate 
competitor, which accounts for his many tennis trophies, including the 
American Ophthalmological Society championships. My own introduction 
to tennis came as a Wilmer resident when Ed assigned his administrator, 
Gene Wilson, a good player, to teach us residents some aspects of tennis on 



Saturday mornings. Since I had never previously even stepped onto a 
tennis court, I did not fully realize how much fun this sport would be or the 
extent of Ed's interest in cultivating such extracurricular activities in his 
residents. He is a shrewd tennis player. I cannot tell you how many times 
I found myself an opponent of Ed's and not invited to be his partner! Ed 
always understood the essential strategy of winning tennis doubles by 
picking a good partner and, thus, I would find some of my fellow residents 
(and better tennis players) on the opposite side of the net. He was always 
a tireless competitor, regardless of age, time of day, or jet lag. For 
example, Ed once flew into Los Angeles for a Doheny Institute meeting, 
making a stopover while on his way to Moscow. This is obviously not the 
most direct route to Russia, but was a way to help out his ex-residents here 
in Los Angeles. Dan Jones was also a visitor for this Doheny meeting. Ron 
Smith, Dan, Ed, and I played tennis as rotating partners, but after four 
sets, three of us were ready to retire. Naturally, Ed was the only one who 
wanted to continue playing. Later that evening, he still had more energy 
around midnight than Dan, Ron, and I put together. 

As first-year Wilmer residents on rounds, we were constantly stimulated to 
challenge The Prof. This active give-and-take was a real highlight of my 
training and one which promoted enthusiasm and intellectual excitement. 
The faculty at the Wilmer Institute in the late 1960s and early 1970s 
consisted of Ed Maumenee and the Wilmer residents with three other 
full-time faculty members. The Profs rounds on Thursdays and the 
Monday morning conferences were the highlights of the academic week. 
Throughout my residency, Ed's strong personal encouragement was 
apparent to me, and it was available to every Wilmer resident. As chief 
resident, my own personal, sometimes unbridled, enthusiasm would create 
"challenges" for the Wilmer staff, and even at times for The Prof. 
Fortunately for me, Ed channeled my energies into academic 
ophthalmology in a variety of ways. 

On one occasion, the opportunity to drive with The Prof from Baltimore 
to Walkersville, Maryland, for Ron Smith's epidemiologic study of the 
presumed ocular hi stoplasmosis syndrome gave me the opportunity for 
a personal, in-the-car visit, complete with counseling and guidance. 
Likewise, on the trips to Walter Reed and the U.S. Naval Hospital in 
Bethesda, the opportunity to visit with The Prof was a real highlight for all 
residents and again emphasized the role-model method of teaching. He 
had a unique way of inspiring young residents and could discuss any and 
all aspects of life as a mentor, a colleague, and a true friend who cared 
about the welfare and career of each of his residents. Those years as 
residents became very special ones for all of us, establishing friendships 
and values that we cherish to this day. 

Ed still occasionally recalls his own days as a resident with Dr. Alan 
Woods as professor and Dr. Jack Guyton as a good friend. Their 
extracurricular exploits created some of the fabric of Wilmer legend. Ed 
clearly enjoyed his residency at Wilmer and knew that Dr. Woods would 



xxi 



look out for his residents. In like fashion, The Prof looked out for all of us 
who had the privilege of training with him. 

As a new junior faculty member at Wilmer, it was my particular pleasure 
to have my office, and therefore my practice, across the hall from The Prof. 
Ed freely shared his patients and constantly contributed to my learning 
experience by calling me in to see his interesting and challenging cases. 
His ability to make original observations continues to amaze me. I well 
recall his initial observations in relation to birdshot choroidopathy and 
his calling me in to see a collection of patients with this particular 
constellation of findings and then allowing me to co-author the paper 
with him. 

Ed has always been an effective advocate for ophthalmology and used his 
contacts in a constructive manner, benefiting all ophthalmologists. For 
example, his relations with congressional leaders, such as Senator Lister 
Hill, in conjunction with his coordination with Jules Stein and Research 
to Prevent Blindness, were the key to the founding of the National Eye 
Institute (NEI) at the National Institutes of Health. His persuasive 
powers, his organizational abilities, and his own enthusiasm were critical 
to the success of the NEI initiative, which continues to benefit all of us in 
the national vision research effort. NEI-sponsored laboratory and clinical 
research has had a profound effect on the care of patients we all serve. 

Travels, especially international jaunts, always occasioned great fun 
in being with Ed Maumenee, who was always at the center of both 
professional and social activities. In a recent Congress in Curitiba, Brazil, 
Ed was the last one to leave the dance floor each evening and the only 
American who seemed to keep up with the hospitality of our charming 
Brazilian hosts. As president at the most recent International Council 
meeting in Singapore, Ed was gracious in dealing with government leaders 
and the president of the country, as well as with leading colleagues from 
international ophthalmology. In the evenings, he took advantage of the 
very active Chinese social life. Into his seventies, Ed pursues such 
vigorous activities as chopping down trees and building new houses. He 
remains full of energy, enthusiasm, and commitment. 

Ed is truly the professor's professor in academic ophthalmology. He has 
trained more chairmen of more ophthalmology departments than anyone 
else. The Prof is the reason that many of us from Wilmer have pursued 
academic ophthalmology today and the reason that I and many others find 
such great satisfaction in our professional careers. The enthusiasm I 
experience every day in my work is a direct result of the effects of his 
inspiration. 

It is my belief that this same opportunity was available to every Wilmer 
resident. Ed Maumenee's involvement explains, in significant part, the 
remarkable track record of the Wilmer Institute in inspiring its graduates 
to pursue careers in academic ophthalmology and to be excellent clinical 
ophthalmologists in practice. He has always had the highest standards for 



mi 

himself and expected the same in others, as he delivered the very best care 
for his patients and nurtured each of his residents. We try to follow his 
example and, in turn, to pass along his spirit of inspiration to the next 
generation of ophthalmologists and his highest standard of care to our own 
patients. 

June 18, 1992 



XX111 



INTRODUCTION 
Sir John Wilson 



Ed has been, and is, such a central figure in international ophthalmology 
that his influence is imprinted on almost every positive development in 
that field over the past twenty years. He has a unique combination of 
talents. He is one of the world's great ophthalmic clinicians and teachers, 
shrewd of judgement, politically aware, and with a capacity for friendship 
and for giving encouragement to others that has enabled hi to be an 
influential and well-loved leader in so many movements. I have had the 
privilege of working with him in the formation of the International Agency 
for the Prevention of Blindness and also in connection with the World 
Health Organisation's Global Programme for the Prevention of Blindness 
and its development of projects and organisations in so many countries. 

More recently, having just been appointed a member of the International 
Council of Ophthalmology, I have, from the inside, seen the impact of his 
remarkable leadership in that organisation and in the Federation of 
Ophthalmic Societies. 

I am sure that in this oral history you are getting many tributes to those 
aspects of his work, so perhaps I could add a few personal notes and 
anecdotes of a less formal kind. 

When Dr. Maumenee retired from the Wilmer Institute, he invited me to 
Baltimore to take part in a commemorative seminar at which I gave an 
anecdotal speech recalling many of the journeys and occasions in which we 
had both taken part. Here are some of the quotations from the notes I 
retained: 

The last time my wife, Jean, and I were at a public occasion we 
were the public and Ed was the occasion was a few weeks ago in 
Westminster Abbey in London. The spring sunshine, which we 
get occasionally in London, was warming the great east window. 
The trumpeters were poised heraldically like candelabra, going 
through that extraordinary inflation routine before sounding the 
royal salute. 

Down the central aisle there came a great procession of scientists 
and academicians wearing the plumage and academic regalia of 



XXIV 



universities across the world. And appropriately, towards the 
head of that procession, representing the ophthalmologists of 
America and the world, walked Dr. Maumenee. 

As the great procession passed down the central aisle of the 
cathedral, with the fragrance of incense and mothballs, I asked 
Jean what was the colour of the Johns Hopkins gown which Ed 
was wearing so proudly. She said, "I didn't notice. I only saw his 
smile." 

One of Ed's attributes, which he possesses to a rare degree, is that, in the 
pomp and protocol of a great occasion, he retains his casualness and an 
extraordinary outreach of warm human contact. 

I remember an occasion, it must have been in the mid-'70s, when, at one of 
the meetings of the WHO Advisory Group, we were together in West Africa 
at a place with the improbable name of Ouagadougou in the Upper Volta. 
It was a depressing place, a grubby hotel with oven temperature and zero 
humidity. Ed was the most cheerful person over breakfast, though he 
confessed that this was not the sort of place he would recommend for a 
holiday. His only complaint was that his hotel room had a shower but 
no shower curtain and no water outlet and that he had watched, with 
apprehension, as the water rose in the contraption and flowed over into the 
room and through the ceiling. He had wondered, mildly, whether Jean and 
I were in the room beneath. 

Whilst at that meeting in the Upper Volta, Jean and I went with Ed to 
some of the "river blindness" villages. In one of them there were some 
twenty children on their way to blindness, and I remember the sensitivity 
and delicacy with which Ed examined their eyes though, at that time, 
there was little any of us could do about it. Those villages at that time 
were silent, depressing places at the bottom of every development cycle, 
but I remember Ed saying, as we walked through one of them, "I wish 
Rene [Irene Maumenee] and the kids could be here to see this village and 
know how lucky we all are." 

An incident that is perhaps not generally remembered is that Ed played a 
very large part in getting the World Bank involved in the West African 
campaign for the control of onchocerciasis. On behalf of the International 
Agency for the Prevention of Blindness, or perhaps it was its predecessor, 
the International Association of the Prevention of Blindness, he attended a 
World Health meeting in New York and talked about the onchocerciasis 
problem, which at that time was little understood. I have been involved in 
it for some time because the Royal Commonwealth Society for the Blind, of 
which I was director, had done some essential research in that region, and 
I had sent the details of this to Ed, who presented them brilliantly at the 
meeting and later went on to persuade the World Bank that they should 
fund the programme. At the time, this was a courageous act, because 
many ophthalmologists thought the whole project was a dubious 



XXV 



investment and there was much controversy about means of controlling the 
disease. 

I recall also an earlier meeting in Jerusalem; it must have been in the late 
'60s. It was at that meeting that we first conceived the possibility of a 
global strategy for the prevention of blindness. I remember a long night 
in the King David Hotel in Jerusalem, where, over a duty-free bottle of 
Scotch, Ed and I worked on the document which declared that, if we could 
mobilise the resources and political will and multidisciplinary vision, there 
certainly now existed a technology, capable by the end of the century, 
of controlling some of the major causes of blindness throughout the 
developing world. In the intervening years, in many WHO meetings 
which Ed dominated intellectually and, in the best sense, politically, that 
inspiration has come to reality. Subsequently, Ed has often referred to 
that inspiring bottle of Scotch. 

On the final day of that visit to Jerusalem, Ed and I shared a taxi to 
the airport. Whether it was the inspiration of the conference, or the 
incomparable freshness of an Israeli dawn, I quoted to Ed from the Song of 
Solomon, "The time of the singing of birds has come, and the voice of the 
turtle[dove] is heard in our land." Ed, who evidently hadn't read the 
Song of Solomon recently, said, "Yes, we have exactly the same sort of 
environmental problem in Mobile, but there it's buzzards." He sang to me 
a song which began, "Buzzards they fly high in Mobile," and it went on to 
say how these buzzards had unpredictable habits but a very sure aim. On 
a number of occasions since then, he has said to me, as we waded through 
interminable meetings, "You know, those buzzards can't win." 

At another meeting in Baghdad, where we formulated the four priorities of 
the Global Programme for the Prevention of Blindness, Ed and Jean and I 
went out to a village near Babylon, which is reputed to have been the site 
of one of the world's first medical training centres some two thousand 
years ago. We found, attached to one of the buildings, a plaque which 
described the work of an ancient eye specialist. It said that if the specialist 
did an operation on a nobleman and restored his sight, he would be 
rewarded by forty pieces of silver. If, however, the operation destroyed 
the sight, the surgeon would have his right hand cut off. I remember Ed 
saying that this was a splendid way to retain standards and motivation 
amongst the ophthalmic professions. 

Ed is a splendidly experienced chairman. When taking a meeting, 
particularly an international one with different languages, it's often 
difficult to get someone to initiate a proposal. After a due amount of 
silence, Ed would say, "Do I hear someone making this proposal?" And it 
would only take a cough, a squeak of a chair, or a tick of the clock to carry 
forward the business. 

I have, over the years, met so many ophthalmologists who were Ed's 
students. They praise the outstanding quality of his research, but even 
more, his power as a teacher. He has an extraordinary ability to explain 



XXVI 

difficult and sophisticated procedures in simple, non-technical language. I 
noted this especially at a meeting in Singapore in March of this year, 1990, 
when he described to a highly specialized audience a simple change in the 
standard procedure of lens implant which would make unnecessary the 
subsequent laser treatment that would often be impossible in a developing 
country except at a major hospital. 

Perhaps I may end these notes as I ended the lecture I gave on the occasion 
of his retirement at Wilmer. It went something like this: 

It is difficult to add any tribute to one whose honour is in every 
tradition of this great hospital. I could praise Ed's skill as a 
surgeon, but that is far better done by his peers. I could praise 
his gift as a teacher, but that is for you, his students. But I can 
praise his art as a spokesman and an advocate for all of us. And 
beyond that, something almost inexpressible: a sensitive, 
searching sympathy, an outflowing cordiality, at times a very 
private reticence, a humour that can puncture pomposity but 
always with a healing touch. A generosity of spirit, a caring 
grace and, above all, a God-given gift of encouragement. 

After that occasion in Wilmer, I sent back to Ed a small and not very 
competent verse that I made up on the aircraft back to England. I think it 
went like this: 

To some are given sure skill of hand, 
To some the charm of art. 
But the rarest gift at God's command 
Is the grace of a human heart. 

June 27, 1990 



xxvii 



INTERVIEW fflSTORY 
SaUy S. Hughes, PhD 



This oral history of Alfred Edward Maumenee is the eighth in the 
Ophthalmology Oral History Series, which consists of comprehensive 
interviews with individuals who have made major contributions to 
American ophthalmology. Dr. Maumenee is an obvious choice. For 
twenty-five years he was director of the Wilmer Ophthalmological 
Institute at Johns Hopkins University School of Medicine at a time 
when "Wilmer" and "Hopkins" were arguably the most prestigious 
ophthalmological and medical institutions in the country. 

As the oral history attests, Dr. Maumenee has also made contributions 
in diverse areas of ophthalmological research, in the process publishing 
almost 350 papers. He has held office in virtually every major American 
ophthalmological society and continues to be a significant force in 
international ophthalmology. Of his many professional roles, the one in 
which he takes most pride is that of teacher. He has trained, he recounts 
in the oral history, more residents who went on to become department 
chairmen than any other figure in American ophthalmology. 

Dr. Maumenee talked easily and at length in the soft accent of his 
Alabama childhood, dwelling with obvious pleasure on his upbringing as 
the son of a hard-working ophthalmologist father and a socially prominent 
mother. He tells of his desultory academic career until he reached the 
University of Alabama where a series of circumstances transformed 
him into a motivated, goal-directed student who subsequently took full 
advantage of the opportunities offered at Cornell University School of 
Medicine. 

Starting a residency in ophthalmology at Wilmer in 1939 with the idea of 
eventually going into private practice in Alabama, he was soon captivated 
by academic medicine. Jonas Friedenwald, renowned for his quality of 
mind and research, was responsible for the young man's conversion. The 
nights the two spent examining pathological specimens resulted in a fund 
of knowledge about ocular pathology that Dr. Maumenee considers his 
greatest clinical asset. The association with Friedenwald may also have 
fired his protege's ambition. "I had the nerve," Dr. Maumenee admits in 
the oral history, "to tell somebody when I was a second- or third-year 
resident that I wanted to be the best ophthalmologist in the world." 



xxvm 



He was soon on his way. In 1948, five years after completing his residency, 
he was appointed chairman of the Division of Ophthalmology at Stanford. 
He was thirty-four. He set about to transform the division, which reflected 
the hierarchical Viennese system in which Hans Barkan, who preceded 
him as chairman, was trained. Dr. Maurnenee emphasized basic research, 
encouraged residents to debate their seniors, set up an eye bank and 
ophthalmic pathology laboratory, and developed a large referral practice. 

But Stanford, despite the transformations, was not Hopkins. In 1955 
Dr. Maumenee returned to Baltimore to accept the chairmanship of the 
Wilmer Institute, drawn by Hopkins' strong tradition of basic medical 
research. He was excited by the prospect of a collaborative enterprise, he 
running the clinical side and Friedenwald the research. His plans were 
shattered by Friedenwald's death within months of Dr. Maumenee's 
return. Dr. Maumenee nonetheless saw to it that basic research was 
institutionalized at Wilmer, attracting basic scientists and eventually 
constructing a building dedicated exclusively to ophthalmic research. Dr. 
Maumenee's other achievements as chairman, as well as his committee 
work and offices in national and international organizations, are best told 
in his own words in his oral history. 

Oral History Process 

Three interviews were recorded at Johns Hopkins, and one in the garden of 
the Maumenee home in Stevenson, Maryland, between May 14 and May 
18, 1990. Three additional interviews were recorded between October 14 
and 16, 1991, at a hotel in Anaheim, California, where Dr. Maumenee was 
attending the annual meeting of the American Academy of Ophthalmology. 

The tapes were transcribed, edited, and the transcripts sent to Dr. 
Maumenee for editing. Because of the one-year interval between the 
Maryland and California interviews, duplications were inevitable. These 
were eliminated, or the information integrated, and the corrected 
transcripts sent to Dr. Maumenee for final approval. The audiotapes 
and verbatim transcripts are on deposit at the Foundation of the 
American Academy of Ophthalmology. 

I thank Mr. Lewis J. Ort, Dr. Stephen J. Ryan, and Sir John Wilson for 
their insightful introductions, and Ms. Jo Ann L. Young, Dr. Maumenee's 
former administrative assistant, for her help with the project. Background 
information for the oral history was collected through interviews with the 
following colleagues, friends, and relatives of Dr. Maumenee, to whom I 
am very grateful: Thomas Acers, MD, Jerome W. Bettman, Sr., MD, 
Frederick C. Blodi, MD, Benjamin F. Boyd, MD, Walter Dandy, MD, 
Morton F. Goldberg, MD, W. Richard Green, MD, William Grose, MD, 
Alfred E. Maumenee III, Irene H. Maumenee, MD, Neil R. Miller, MD, 
Frank W. Newell, MD, Edward W. D. Norton, MD, David Paton, MD, 
Arnall Patz, MD, Harry A. Quigley, MD, Arthur M. Silverstein, PhD, 
Ronald E. Smith, MD, David F. Weeks, and Frank C. Winter, MD. 



XXIX 



Marvin L. Sears, MD, and Sir John Wilson provided information by 
correspondence. 

Dr. Maumenee from one perspective seems the essence of the stereotypical 
surgeon supremely self-confident, assertive, dominant, ambitious, a man 
of action and the quick fix. But there is another side: the teacher who 
takes almost paternal pride in the achievements of his residents, holding a 
favored few as dear as sons; the leader who inspired and encouraged and 
assisted others to perform their best by his bounding optimism and faith in 
their abilities; the physician who took the time and effort to explain fully to 
his patients their diagnosis and treatment. There is also an unexpected 
vulnerability, revealed particularly in the recent Spectra incident, when 
Dr. Maumenee was stung and mystified by the criticism of some of his 
colleagues. It has not all been easy. Yet the buoyant optimism remains. 
The multifarious contributions remain. The enthusiasm remains. 

December 1993 



Regional Oral History Office University of California 

Room 486 The Bancroft Library Berkeley, California 94720 

BIOGRAPHICAL INFORMATION 

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I. FAMILY BACKGROUND AND 
EDUCATION 



Family Background 



Maumenee Family Roots 

[Interview 1: May 14, 1990, Wilmer Ophthalmological 
Institute, The Johns Hopkins University School of 
Medicine, Baltimore, Maryland] 

Hughes: I think we should begin with the derivation of your last name. 

Maumenee: It's a bit of a story. Many of my patients throughout the years 
have asked me, "Are you an American Indian? Just what are 
you?" My grandfather [Alfred Nicholas Maumenee] came 
from France, so I always thought that I was of French descent 
on the paternal side. 

As I went along, we started an exchange residency between 
the Wilmer residents at [Johns] Hopkins [Medical School] and 
Shiraz, Iran. Ah Khodadoust had been a fellow here and a 
resident, and he was one of the best surgeons I ever trained. 
We didn't have enough surgery so we were sending our 
residents over there and he was sending his residents here to 
get scientific background. The Shah promised him $2 million 
to put up a new eye hospital. I had to go to the Shah's palace 
to sign this contract. I didn't meet with the Shah but I met 
with the treasurer. I walked in and he said, "You don't look 
like an Iranian." I said I thought my grandfather was from 
France. He said, "Well, Maumenee is a common name in 
Iran. It's also with a slight difference a very common Arabic 



name. It means very holy man." I said, "How do you spell it?" 
He said, "Of course, we write in Farsi and you write in Roman 
script." So after that, as long as the Shah was alive and 
things were prosperous, a number of Iranians came over to 
Wilmer and they'd say, "I want to see the Iranian eye doctor." 
[laughter] 

I guess what happened is that my family at one time migrated 
from the Middle East and went to France. I've never found 
the name Maumenee in any telephone directory in London, 
Berlin, New York, or any other large city, except two names 
in Paris. It turns out that in Perigueux, which is in the 
southern part of France, there are a lot of Maumenees. So I 
imagine that's where my grandfather on the paternal side 
came from. The Menominee tribe and the Maumee River in 
Indiana sound like Maumenee, so a lot of people think that's 
where the name came from. 

Grandparents and Parents 

Maumenee: My grandmother on the paternal side [nee Farmer] was 
Scottish, but she died early and I never knew her. My 
grandfather moved to this country in the late 1800s or early 
1900s, I don't know which. He was a little man, very nice, 
talked with a French accent. That's about as much as I know 
or can remember about him. 

Hughes: Do you know what he did? 

Maumenee: He was an optician. My father, Alfred Edward Maumenee, 
was an ophthalmologist and professor of ophthalmology and 
otolaryngology at the University of Alabama when it was in 
Mobile. His father didn't like to work very much so, as a 
young person, my father had practically no money. I don't 
think my grandfather graduated from college. 

My father worked his way through medical school. When 
he got out he then went to Vienna, and since he didn't have 
any money, he ate nothing but eggs. He got really terrible 
atherosclerosis and was a very stern, very determined, and 
very hard-working guy. 

Hughes: Wouldn't becoming an optician have required some special 
schooling? 

Maumenee: Well, my father taught him, and I guess he learned on the job. 
This all occurred when I was two or three, or not even born. 
So I really don't know much about it. 



On my maternal side, they're primarily English. My 
grandmother [Emma Radcliff] lived until she was about 
eighty-four, and my grandfather [Stenson Smith Radcliff] died 
quite young, in his thirties, from a gastric ulcer hemorrhage. 

I didn't know anybody on my maternal grandmother's side 
except my grandmother. She had a very hard time because 
her husband died so early and the War [Between the States] 
had disrupted the South. She had four children. Uncle 
Herndon was the oldest, and he was in the sand and gravel 
business. Jim Radcliff was in the lumber business, and my 
Aunt Lily married the president of the Merchants National 
Bank. 

Parents 

Maumenee: My father was ten to fifteen years older than my mother 
[Lulie Martha Radcliff Maumenee]. He was practicing 
ophthalmology when they married. 

Hughes: Was he at the university at that stage? 

Maumenee: As was true in every eye department, there were no full-time 
professors of ophthalmology. They were all in private 
practice, but he was head of the eye, ear, nose, and throat 
department. 

My father was very, very strict, and very hardworking. He 
worked every day Saturday, Sunday, every day. He had a 
good practice in Mobile. He set a good example of hard work 
for us and made us "toe line." In later years he took great 
interest in our athletic and academic interests. 

Mother was very social. Actually, Truman Capote, when he 
described in a book the people from various sections of the 
country who were the most delightful hosts and the most 
wanted guests, he listed Mother as the most wanted guest in 
the southeastern part of the country. So she kept the social 
side going, and my father complained about having to go out 
all the time, [laughs] 

Mother was one of the most remarkable women I've ever 
known. I guess everybody thinks their mother is that. She 
was written up as one of the beauties of the South when 
she was younger, and a picture of her carrying me up the 
stairs was in Vogue or some similar magazine. We kept that 
picture for a long time. 



In Birmingham [where the family moved in 1927], my mother 
was also very social. She was active in charity balls and 
things, and she had quite an imagination. She put on a 
Russian ball with wolfhounds and Russian costumes which 
was talked about in the town for many years. She was 
extremely popular. 



Hughes: I know you have a brother [James RadcliffMaumeneeJ. 
he close in age? 



Was 



Maumenee: He's about a year and a half younger than I and a much nicer 
person. We played a lot together and we got along fine. I 
think most older brothers complain. But we were competitive 
and got along well otherwise. 

Hughes: You had similar interests? 

Maumenee: Pretty much. He joined in all our activities and had lots of his 
own friends. He finished law school at Alabama, joining the 
air force in World War II. He returned to Mobile and became 
a leader in the town. He later became president of the 
Alabama Drydocks and Shipping Company and brought the 
company out of the red. 

Growing Up in Mobile, Alabama 

Hughes: Tell me something about your growing up. 

Maumenee: I don't remember too many things about my life before we 
started school. 

In our early years we lived in Mobile. It was a relatively 
small town at that time, probably fifty thousand people at 
the most. The Alabama River empties into Mobile Bay, and 
Mobile Bay is about thirty-five or forty miles long and about 
twelve miles wide. It was an ideal place. To get across the 
bay, where we had a summer home, you had to take a ferry. 
We would load up the Model T Ford along with a cow and 
various things, and from the time school was out we would go 
across the bay and just be totally free. There were no paved 
roads and practically no cars. We fished all day and swam 
and sailed and had a great time. It was only about thirty 
miles away from the Gulf of Mexico. Periodically we'd go 
down and rent a boat with a captain and fish for tarpon and 
mackerel and the larger fish and have great fun. We were 
just totally free; we lived in our bathing suits. 



Hughes: Did your father spend time there also? 

Maumenee: He would come over on the weekends. We had a house not 
too big a house. The Ladds, my uncle and Aunt Lily, were 
much wealthier and they had a larger house with a beautiful 
lawn, and my grandmother had a house. So the whole family 
practically moved across the bay, and my uncle and aunt and 
dad used to come over on the weekends. I took a friend and 
my brother took a friend to stay with us. 

The times over the bay in Fairhope were just great because 
we could go camping; we'd have bonfires on the beach and 
would be just turned loose. We had sailboats, and we raced 
and sailed in the bay all the time. 

I think we did some of the first scuba diving that was ever 
done. Sheepshead are a type of flat, striped fish with a teeny 
mouth, so you can't hook them because they just suck the bait 
off the hook. So what we invented was to fill a bucket full of 
air and turn it upside down and put the handle under our 
chin. We would dive down along the pilings and breathe the 
air out of the bucket and watch for the sheepshead to come for 
the bait. We'd give the line a jerk and catch them. 

Hughes: Where did you go to grammar school ? 

Maumenee: I went to Wright's Military Academy. It was very strict. Mr. 
Wright was a great disciplinarian, and if you moved or talked 
during the morning session before you had prayers, you got a 
demerit. If you got so many demerits I've forgotten the 
number he would give you a lashing on the palm with a 
leather strap. You had to wear a uniform with white gloves 
and polished shoes, and if your clothes or shoes were dirty, 
you got a demerit. It was a good school; rated very highly. 

When we moved from Mobile to Birmingham, I was about 
twelve or thirteen, and they thought I was advanced enough 
that I should skip a grade. It was a mistake, because the 
public schools in Birmingham taught a lot more English than 
the academy. 

The Move to Birmingham, Alabama, 1927 

Hughes: Now, when and why did you move to Birmingham? 

Maumenee: I don't really know the full answer to that. One rumor was 
that my father got involved in politics. He wanted somebody 
to be mayor so he worked for him very hard, and he lost. 



6 

He always said that Mobile was a small town and wouldn't 
be the best place for us to develop. Birmingham was an 
up-and-coming manufacturing town because it had steel and 
iron ore and coal. 

My father moved in '27, and we followed him shortly after 
that. I was born on September the 19th, 1913, so that would 
make me thirteen. Just as we moved, the Depression hit, and 
Dad had a very hard time getting along. We went to a public 
school instead of the private school in Mobile. 

Hughes: There just wasn't the money for a private school in 
Birmingham? 

Maumenee: We just didn't have enough to get along. We had a very nice 
house, and we belonged to the country club. Mother kept up 
her activities and was friends of most of the millionaires in 
Birmingham, but we didn't have any funds. As a matter of 
fact, I did some selling. I worked for my uncle, Frank 
Bromberg, who owned a jewelry store. I also tried to sell 
inexpensive insurance house-to-house, and I did not do well. 
So I caddied at the Birmingham Country Club. I was the only 
white caddy. It was a little embarrassing when my fraternity 
brothers played golf and Fd have to carry their bags around. 
But in another way it was a great advantage because the 
assistant pro played nine holes of golf with me many, many 
mornings, before school. So by the time I was fifteen or 
sixteen I was fairly good at golf because I'd had good lessons 
playing with him. 

Hughes: How were you doing in high school 1 ? 

Maumenee: I didn't do very well. I didn't study. Mother had a half-sister 
[Mary] who came over to spend a few days with us and 
decided to stay. She got married in our house and lived with 
us. We had a large enough house that could accommodate 
two families. She would help me study, and mother would 
help my brother study, but neither one of us would really 
concentrate, so my grades were not the best. I don't think I 
ever failed anything but Latin. I failed Cicero three or four 
times, [laughter] But my other grades were only fair, and I 
was almost pathologically shy. 

Hughes: Even with a very social mother. 

Maumenee: Well, she pushed me to be socially active, but I just really 
didn't have the fighting spirit, and I was very shy. 



I was in the gym class at Philips High School and did quite 
well. I climbed ropes hand over hand up to the ceiling 
without using my legs and did pushups and things. Mr. 
Sellers Stough, who was the principal and taught one of the 
classes, took a great interest in me and became a good friend 
of my father. He helped me tremendously to get started 
academically. 

One day, when I was a junior, they had a mile run. I'd never 
run a mile race before, and I beat everybody so badly they put 
me on the track team. I won the state championship and 
broke the state record of 4:48 for the mile. It just turned my 
whole personality around. When I found out that I could 
accomplish something and do better than other people, I 
changed my attitude about things. I studied harder. I did 
much better my junior and senior years because I began to 
study. 

Undergraduate, University of Alabama, 1930-1934 

Maumenee: When I graduated from high school, I went to the University 
of Alabama. Nineteen-thirty was still the Depression, and 
Dad's practice was still very slow. About 1932 or '33 it picked 
up very much and he was doing fine, but then, unfortunately, 
he had a mild coronary. So about '36, 1 guess it was, he had to 
slow down some. 

I joined the Deke fraternity because my cousins from Mobile 
had all been Dekes. Bo Oliver, a good friend of mine, also 
joined. That was the most social fraternity on the campus. 
During Prohibition they kept kegs of whiskey hidden in the 
basement. Bo and I built a room in the attic where we'd be 
quiet and study. So I really studied hard and worked hard 
and ran on the track team. I began to make good grades. 
It was just really fun to be able to concentrate. I'd never 
concentrated before in my life. I got to where I could 
concentrate enough so that if I went to a party I could 
remember everybody's face and name, just after being 
introduced. I was a little bit dyslexic. I read slowly and 
would have to read very carefully, but I could remember what 
I read and practically recite it back. I did not make Phi Beta 
Kappa. I later was selected an honorary Phi Beta Kappa here 
at Hopkins. 

Hughes: Based on the years at the University of Alabama? 

Maumenee: No, based on my accomplishments in ophthalmology. I got 
honorary Phi Beta Kappa and honorary AOA [Alpha Omega 



8 

Alpha], which is the same as Phi Beta Kappa in medical 
school. 

Hughes: Were you headed towards medicine at this point? 
Maumenee: No, not particularly. I just was taking a regular course. 
Hughes: With no idea of what you eventually wanted to become? 

Maumenee: Not particularly. But I studied very hard. I didn't drink, I 

didn't smoke, and I didn't date. I just worked. When I wasn't 
studying, I was running. I made the track team my first year 
and for two additional years. In my junior year, I ran a 4:20 
mile and won the Southeastern Athletic Track Conference. 
Since I had made the team in a major sport and won a major 
meet, I was made a member of the A Club and got an A for my 
sweater. 

I became more social then because the sorority girls loved to 
go out with an A Club man because we'd have special dances 
for A Club members only. I met a young lady, Elizabeth Steel, 
and we became very close. That was in my junior and senior 
year. 

It was a great experience to be doing well in school and also 
being an athlete, because most of the athletes didn't care too 
much about academia; the faculty would pass them to keep 
them on the team. So in my junior year I was taken into ODK 
[Omega Delta Kappa], which is an honor society based on 
all-round scholastic, moral, and athletic ability. I was elected 
president of ODK for my junior and senior years, and then I 
was taken into the Jasons, which was another honorary 
society. I was elected president of the senior class. Because 
of these activities the university elected me for the Rhodes 
Scholarship. I went to the final selection in New Orleans but 
was not chosen. 

Shipping Out, 1933 

Maumenee: At the end of my junior year in college, the economic situation 
still wasn't in full swing. That was in '33. You could get a job 
out of Mobile on a freighter as a work-away, and you would be 
paid a dollar a month and all you could eat of the food that 
was picked up in Hamburg on the previous trip and not 
refrigerated. You got one orange a week to keep you from 
getting scurvy. You had to go over the side of the boat and 
chip the paint, holystone down the teak decks, climb up in the 
rigging and fix things. 



9 



So I asked Aunt Lily if she could get me a job on a freighter 
and she did. The ship was named the Copa-Copa. As soon as 
I found out about it, she arranged to get me a passport, and I 
left home while my mother was playing bridge and my father 
was at work, without telling them where I was going. I 
hitchhiked down to Mobile to get to the boat. 

It was a real experience because the seamen hated us 
work-aways, because we were taking their jobs away from 
them, and gave us the toughest jobs. Fortunately, I got put 
on deck. There were about six of us work-aways on the boat. 
They put three or four of us in the engine room, where it was 
hot and you couldn't see anything. On deck I had to steer 
the ship, and one of the real difficult things was steering it 
around the end of Florida because of the cross-currents. The 
gulf and the ocean met there and they would throw the boat 
in all directions. The captain was screaming at me for not 
keeping the boat in a straight line. 

The first day I went on, I just about died. The temperature 
in Mobile must have been 100, 105, and we had to go into the 
front hold of the boat where they had sawdust. They were 
packing food there, and the sawdust was supposed to keep 
it fairly cool. The temperature was so hot, it just was 
impossible. The food was so terrible, you couldn't imagine 
how bad it was. 

Hughes: Did you lose weight? 
Maumenee: Yes. I was 135 pounds. 
Hughes: And how tall? 

Maumenee: Six feet one. But I was quite strong; I chinned myself five 
times with my left arm only. 

I thought I was smart; I picked out a bunk right next to the 
engine room thinking it would be warm crossing the North 
Atlantic. But it turned out to be a mistake because that's 
where all the bedbugs like to stay, too. [laughter] I was so 
eaten by the bedbugs, I poured gasoline down the pipes that 
held the bunks up. Finally I took my mattress and put it up 
on deck, and I slept on deck all the way across the Atlantic. 

We had a very interesting time. We stopped at the East 
Indian docks in London. They said, "Don't come back here at 
night by yourself or you'll be murdered. Always come back 
two or three together, and you'll probably be safe." It was 
really a tough place. But I got to see London, because the 



10 



work-aways were allowed to go off the ship when we went to 
port, and the seamen had to unload and load the ships. There 
were no seamen's unions at that time; that's how they could 
get by with it. So we visited all over London, which was 
exciting, and then we went to Bremen and Rotterdam and 
Hamburg. 

Everybody along the street in Hamburg had to say, "Heil 
Hitler!" We knew that there was going to be a war. They 
told us, "When you go down to the bars, if you say one word 
against Hitler they'll throw you in jail, and there's no way the 
U.S. consul can get you out." Our ship was carrying rosin and 
guncotton to make gunpowder in preparation for World 
War II. Everybody down on the waterfront knew that there 
was going to be a war, but Chamberlain and the French 
seemed to ignore it. 

I went to the medical school in Hamburg, and the director 
took me out in the yard. He said, "I have to take you out here 
because I can't tell who's listening and who might report me. 
We've got a politician who's just an absolute maniac Hitler 
but I think we'll get rid of him soon and get back to normal. 
But it's really terrible now; we're under absolute, strict 
control; we have to say *Heil Hitler' instead of 'hello' every 
time we go down the street." 

I got back late to school that year. But it was a very, very 
broadening experience for a boy who'd never been outside of 
Alabama. 

University of Alabama Medical School, 1934-1936 

Hughes: What decided you on medicine? 

Maumenee: Well, in my junior year, my father gave me a microscope. I 
began to look down the microscope at all sorts of things. I 
had applied for both law school and medical school, and I was 
accepted in both. At the last minute I decided to go to medical 
school, probably because of the microscope. 

Hughes: Do you think that your father's career had anything to do with 
your decision? 

Maumenee: I'm sure it did. He was very anxious for me to take over his 
practice. I figured I was better at science than I was at 
arguing. Law was just arguing and didn't have any inventive 
aspects to it. I was always interested in doing something 
different. 



11 



Hughes: Did you consider going anywhere other than the University of 
Alabama for medical school? 

Maumenee: Money was tight. I don't believe they charged tuition at that 
time. I got out of the fraternity so I would not be distracted so 
much and boarded in a house. 

I did fairly well in medical school. I applied to Harvard and 
was put on the wait list. That was my first choice. I also 
applied to Pennsylvania, Cornell, and Tulane, and I was 
accepted by all three. Alabama was only a two-year school 
and located in Tuscaloosa at that time. It's since become a 
four-year school and moved to Birmingham. 

Hughes: Were there any teachers at Alabama of whom you have 
particular memories? 

Maumenee: Dr. Emmett Carmichael was very interested in the honorary 
society for medical students. He was a chemist, and I got 
along quite well with him. Then there was Dr. DuBoise, an 
anatomy professor who was brilliant. 

Cornell University School of Medicine, 1936-1938 

Hughes: You had two final years of medical school at Cornell. What is 
there to say about that period? 

Maumenee: Well, I went up to New York on the day coach, which 
took about two and a half days. The seats were made 
out of bamboo, so it was kind of uncomfortable. It was a 
coal-burning train and so it was dirty. As I mentioned, my 
mother had been active in all kinds of social things. Elise 
Yorky, the wife of Tom Yorky who owned the Boston Red Sox, 
was from Alabama. Mother had previously been her sponsor 
and took her up to Atlantic City to the beauty contest, which 
she won. When I arrived in New York after two days of no 
water to bathe, Elise Yorky and a good friend of my mother's 
who was very wealthy, Mrs. Gage Bush, met me at the train. 
From there we went to the 21 Club, which was the club, and I 
was this dirty, grimy hick from Alabama, [laughs] 111 never 
forget; we went to see the Rockettes right after that. 

I got an apartment with some friends whom Fd known quite 
well in Birmingham. It was on the seventh floor across from 
the Rockefeller Institute. I had a big steamer trunk, and I 
took the taxi out to the apartment house and tried to get 
the taxicab driver to help me carry up the trunk. New York 
taxicab drivers didn't go for that, [laughs] 



12 

Cornell was a great experience. I never went home while in 
school because I didn't have the money. 

Extern at Various New York Medical Institutions 

Maumenee: The senior year at Cornell was divided into four periods. 

One was elective, and then you had classes during the other 
quarters. But you didn't have to go to class unless you 
wanted to. You could substitute as an extern. 

During the summer between my junior and senior year, I 
substituted on obstetrics and gynecology, and I delivered a 
hundred babies. The worst experience that summer was in 
the Berwin Clinic in Harlem. The house officers would drink 
beer at night and see if they could stack the beer cans all the 
way to the ceiling. The students had to go to homes and 
deliver the babies. We were told, "Carry a dollar pocket watch 
with you, your black delivery bag, and just enough for subway 
fare. If anybody holds you up, just give it to them. Don't 
argue." But it was relatively safe. No one bothered me at all. 

You'd go into a room and the whole family would be sleeping 
there. Someone would have to take them outside while the 
baby was being born. One night I went out to deliver a 
forty-year-old primi[gravida]. That's always a very difficult 
thing. She should have been admitted to the university, 
where they had better facilities. But the resident didn't do it. 

I got there and I couldn't get the baby to come out; so I called 
the assistant resident. He finally arrived, and he said, "You 
catch the head and Til get up top and push and see if we can 
get him out." All of a sudden I heard something crack, and I 
thought, "Oh, my God, I've broken the baby's neck." It was 
the collarbone that was broken, getting him out. So we got it 
fixed, and they said, "That's nothing unusual. It happens 
with forceps in even the best of hospitals." 

Hughes: What were you expected to do if there were an emergency? 

Maumenee: I'd call the resident. 

Hughes: Well, it took time to get somebody over to the house. 

Maumenee: I know. Well, obstetrics is not a very fast specialty. It's a 

tedious one of sitting around waiting. The mother would call 
and say, "I think I'm just about to deliver," and you'd go sit 
there and wait and wait. 



13 



These patients were all screened beforehand at the clinic. 
Most of the women had had normal deliveries before, and the 
staff thought they were perfectly safe to be delivered at home. 

We spent part of the time at the Berwin Clinic and part of the 
time in the hospital in ob/gyn. The only air-conditioned place 
at Cornell at that time was the delivery room, so I slept on the 
delivery table. They'd wake me up to deliver somebody, 
[laughter] 

Hughes: You'd hope there weren't too many deliveries in the night. 

Maumenee: It was a great experience, because at Hopkins, if they 
delivered half a dozen babies, that was a lot. 

During my senior year, I substituted on surgery at Bellevue 
Hospital instead of going to lectures on surgery at Cornell. 
The first night I was there, a patient came in with acute 
appendicitis. We called the attending doctor, and he said, 
"This is not that golden palace of Cornell. This is a real 
hospital. The first one who grabs the knife gets to do the 
cutting." So I did my first appendectomy, [laughs] After that 
I did a number of amputations and other things in surgery 
and had a great experience with it. 

I then substituted on a tuberculosis ward under Dr. [James 
Burns] Amberson, who was from Columbia and a leading 
person in tuberculosis. Somehow, he didn't think that 
tuberculosis was contagious, so we just wore face masks. 
We had so many people with tuberculosis that they had to 
have a barge pull up alongside Bellevue to house these people. 
Being in charge of the TB ward, I was the consultant on a 
patient who had lung disease, for the residents and the senior 
residents who were in general medicine. If they had a patient 
with a lung problem, they'd have to consult me to see what to 
do. And here I was, a medical student [laughs] who didn't 
know anything, who was in charge of all these patients. 

Hughes: What was done for tuberculosis before antibiotics'? 

Maumenee: They just put patients in bed or they sent them to 

sanitariums. If they were bad enough, they would collapse 
the lung. It was more placebos than anything else. 

Hughes: Who was of note on the Cornell faculty 1 ? 

Maumenee: At Cornell, we had Tolstoy in diabetes. I substituted on the 
medical wards at Cornell also, and worked with him. He was 



14 

very good. We had Harold Wolff, who was a neurologist, one 
of the best. And Dr. Bronson Ray, a top neurosurgeon. I 
substituted on his service, so I got to assist in a lot of brain 
surgery. 

Hughes: Was this common practice for Cornell medical students ? 

Maumenee: Yes. 

Then I went up to the cancer clinic at Memorial Hospital, 
which was on 168th Street [in New York City]. It wasn't 
called Sloan-Kettering until later, when it moved to 68th 
Street and York Avenue. There I met [James] Ewing and 
Hayes and all of the big people in cancer. We saw more 
cancer than Fve ever seen the rest of my life. We went to 
all the clinics and saw how they were treating cancer. 

Hughes: Was there a heavy emphasis on radiation therapy? 

Maumenee: Yes. 

Hughes: There was very little chemotherapy? 

Maumenee: There was no chemotherapy. It was surgery and radiation. 

Hughes: Were these experiences giving you ideas about what you 
wanted to specialize in? 

Maumenee: Yes, in way. I really thought about going into general 

surgery. On Saturday, I would go down to the rounds of 
Foster Kennedy and [Samuel Bernard] Wortis, who were 
neurologists at Bellevue. On Sunday, I went down to 
[Marion B.] Sulzberger, who was a great dermatologist, 
and we saw leprosy and all kinds of rare skin diseases. 

There were three of us medical students: Gus Damon, who 
later became professor and chairman of the Department of 
Pathology at the Peter Bent Brigham Hospital in Boston 
and one of the most famous pathologists in the country, and 
Fred Hughes, who went into the army and later became 
surgeon general. The three of us would go up to the New York 
Academy of Medicine at night and listen to the talks, because 
we thought they were a lot better than our teachers were 
giving. Gus Damon was a big guy, about six four, and he only 
slept about two or three hours a night and worked all the rest 
of the time. He was the leader of the group. 

Hughes: Were you doing well ? 



15 



Maumenee: I did well. I got first prize in obstetrics. Since I had 

transferred, I did not make AOA at Cornell. But everything 
else went along fine. 

My father and my brother were coming up to my graduation, 
and my father had a stroke while on the train and died in 
Greensboro, North Carolina. 

He was coming up about a week before graduation to visit the 
clinics to see if there was anything new in eye surgery. I went 
home then without taking any final examinations. The only 
two final examinations they wanted me to take were public 
health and ob/gyn. Henrich Stander, who was chief of 
obstetrics and gynecology, called me in and quizzed me. 

I found out later that Stander took time off from work and 
came down to Johns Hopkins and talked to Dr. Alan Woods 
about taking me onto the house staff at Wilmer. I applied at 
the New York Eye and Ear Infirmary and I also applied for 
general surgery, because I wasn't sure which I wanted to do, 
particularly after my father died. 

Hughes: You wouldn't be going back to his practice. 

Maumenee: I couldn't go back to his practice because I had to take a 
residency. 



16 



17 



II. THE WILMER OPHTHALMOLOGICAL 
INSTITUTE, 1938-1948 



Intern and Resident, 1938-1943 



Maumenee: [Henrich] Stander came down and talked to Dr. Woods and 
obtained a residency for me at the Wilmer Institute. So I 
went straight from medical school into ophthalmology. 

Hughes: As an intern? 

Maumenee: We were called interns. We could do that then without 

taking a medical internship. I had rotated through so many 
specialties during my senior year, I practically had a rotating 
internship. 

Hughes: But the internship at the Wilmer, of course, was just 
ophthalmology. 

Maumenee: Straight ophthalmology. That's right. 

Hughes: In many cases, a medical student wouldn't have had that 
broad experience. Would it still be possible to be an intern 
strictly in ophthalmology 1 ? 

Maumenee: A regular internship is now required before you can take the 
American Board of Ophthalmology exam. 

Hughes: Did you consider your lack of a formal internship a handicap ? 

Maumenee: I never did, and when I became chairman, I took many people 
straight from medical school. If you really want a medical 



18 

ophthalmology practice, then you should specialize in 
medical ophthalmology. When you're ten years out of 
medical school, you're so far behind in other specialties, 
you really aren't up to date in anything but ophthalmology. 
So I didn't feel that it was any great advantage to take an 
internship. You did all the scut work; you were in the lab 
doing the urinalysis and the blood work and bacteriology. 
In many places, you were the lowest on the totem pole when 
you were an intern, so you didn't really get to do very much. 

I'd gotten to do more as a substitute than the interns had, so 
I never felt that a rotating internship was necessary. If you 
want to be a medical ophthalmologist, then learn something 
about medical diseases, like Frank Walsh did. He then wrote 
a book on neuro-ophthalmology and became so famous he was 
called the father of neuro-ophthalmology. 

Hughes: You mean learn on your own. 
Maumenee: That's right. 

The Physical Setup of the Institute 

Hughes: What was the physical setup of the Wilmer Institute when you 
arrived? 

Maumenee: [Dr. William Holland] Wilmer had insisted on three 

things teaching, basic care of patients, and research 
all to be done under the same roof. That's the combination 
that made the Wilmer Institute great. 

Hughes: Do you think that was his idea, or had he gotten it from 
William H. Welch or somebody else? 

Maumenee: He probably got it from Vienna, because that's the way they 
ran their clinics in Vienna. But none of the clinics were run 
like that in the States. His was the first. 

You asked me about the physical setup. There was a research 
area. We had two clinics side by side; they were very big 
rooms. All the patients would sit in the back of the room. 
There were five or six desks where physicians would sit and 
take histories. It was very embarrassing to say, "When was 
the last time you had gonorrhea?" [laughter] 

Hughes: To the whole room. 



19 



Maumenee: "When did you get syphilis?" [laughter] Those words, in 

those days, were not said in polite company. You couldn't even 
ask about tuberculosis; it was a forbidden thing to mention. 

Hughes: But you did, didn't you ? 

Maumenee: We did, yes. 

In between those rooms, they had a place with a couple of 
perimeters where you could take visual fields and where you 
could take the tension with a couple of Schiotz tonometers. 
That was the way the clinic was run. The inpatient beds were 
on two floors. The second floor was for private patients. Here 
there were a few single-bed rooms, some two-beds, and two 
large six-bed rooms. The clinic beds were on the third floor 
for ward or resident patients. The wards were good, except 
for the fact that they had two large rooms that extended the 
whole length of the building. The patients were divided into 
four sections for white and black, and male and female. In 
the sections, only curtains separated the beds. 

Hughes: Was the medicine that was practiced in each of those 

sections black and white, male and female any different? 

Maumenee: No, except that each patient on the second floor had his or her 
own doctor, and the patients on the third floor were cared for 
by the residents. 

Hughes: The quality was the same? 
Maumenee: The same. 

Hughes: Segregation wasn't for a medical reason; it was for a social 
reason? 

Maumenee: Strictly social. 

When I came I had the whole second and third floors torn 
down, and I tried to get the whole place put into private 
rooms. But Russell Nelson, the director of the hospital, 
said, "No, you lose beds when you do that. We can't afford 
to lose beds." As it turned out, we are now down to about 
twenty-eight beds and we don't keep those filled, because we 
do almost all outpatient surgery. 



20 



Research on Retinal Lesions 



Hughes: Tell me about your first interest in research. 

Maumenee: Well, the first paper I wrote was on cytoid bodies that 
everybody had been calling tuberculosis.* I looked at 
the white lesions in the retina of people who later died, 
particularly of lupus erythematosus and scleroderma and 
other collagen diseases. In the literature, they were all called 
tubercles. There were no tubercles there; they were just 
swollen fibers. I made the mistake of calling them dendritic 
fibers and not neurofibers. It turned out it's blockage of 
axoplasm in the nerve fiber that makes the fibers swell and 
turn white. 

Hughes: You called them cytoid bodies. 
Maumenee: Yes, that was a general name for them. 

Hughes: I looked ' 'cytoid" up in the dictionary, and it sounded as 
though it was just a very general term for a structure that 
looks like a cell. 

Maumenee: It is a white lesion in the fundus which also occurs in people 
who have bacterial endocarditis. My interest in cytoid bodies 
strengthened my contacts with residents in medicine. They'd 
have a patient with a strange recurrent fever, and they 
wouldn't know what it was. They'd call me over as an intern 
to look at it. I'd look at the fundus and see the cytoid bodies 
and say, "Look, this is one of the collagen diseases." So it was 
a diagnostic method until they very soon got much better 
ones. But it was one of the key diagnostic methods for the 
so-called collagen diseases, which are scleroderma, lupus 
erythematosus, and dermatomyositis. 

At the time of my residency, Hopkins was so small, I knew all 
the house officers in medicine, I knew all the house officers 
in surgery, and I knew the instructors and the people doing 
research. I went to the school of hygiene and talked to Dr. 
Tommy Turner about vitamins and what vitamins did 
systemically. I learned a lot about tissue culture from 
working with Dr. George Guy. Hopkins was great because 
these were really world-renowned professors, and I was 
merely a house officer. They'd pitch right in and set up a 
problem for me to work on and then come instruct me on how 
to work it. 



Maumenee AE. Retinal lesions in lupus erythematosus. Am J Opkthalmol 1940; 23:971-81. 



21 



Prominent Ophthalmologists at Wilmer 

Jonas S. Friedenwald 

Maumenee: Friedenwald was the same way. He took great interest in 
what I was doing, and we became extremely good friends. I 
learned many things from trim by working a lot with him at 
night in pathology. We used to have lunch together every 
Thursday. We would have roundtable discussions about 
everything in the world. He was my ideal. He was so liberal 
and open-minded and so great, as well as being a real genius. 
I admire him more than anyone I've ever known. He's the 
only genius I ever knew. They had a memorial service for 
him which was published in the Johns Hopkins Bulletin. 
Justice Felix Frankfurter was one of the speakers, and he 
said that Jonas understood law better than most Harvard 
law professors. Abel Wolman, who was the great man in 
sanitation, said that Jonas was one of the best epidemiologists 
that he'd ever known. 

Hughes: Had he picked up these fields on his own? 

Maumenee: Yes, by reading. He loved theory. He argued mathematics 
with Einstein. They had lots of correspondence back and 
forth. He helped set up the Hadassah Hospital in Israel. 

His idea of a vacation was to go up to the Algonquin Hotel in 
New York and take two yards of books with him and sit down 
and read. 

Hughes: On everything, not just ophthalmology. 

Maumenee: Yes. He just had insight into everything, and he was so 
brilliant, it was just amazing. George Koelle, who later 
became professor of pharmacology at Pennsylvania, said 
that Jonas knew more pharmacology than any professor of 
pharmacology he had ever met. Dr. Wood, the chairman of 
the physics department at Hopkins, said he was an expert in 
that field. 

During World War II, when Friedenwald was trying to find an 
antidote for mustard gas, the head of synthetic chemistry at 
DuPont was working with us, and Friedenwald would correct 
his mistakes in chemistry. He was really a wonderful guy. 

Hughes: What was he doing in research in ophthalmology when you 
came on the scene? 



22 

Maumenee: He was working primarily in glaucoma. His work in 

glaucoma still stands as a model for all young researchers. 

[Sir Stewart] Duke-Elder was the great name in 
ophthalmology and had written tremendous volumes on 
every aspect. His writing is absolutely exquisite, and his 
books are unbelievably magnificent. How that man could 
do it, I don't know. He was a real genius in writing and 
organization not in ophthalmology research, because if there 
were the two sides of a question, Stewart frequently picked 
the wrong side. 

Hughes: I remember there was a long-standing argument about the 

formation of aqueous, and Duke-Elder turned out to be wrong. 

Maumenee: One theory concerned secretion and the other diffusion. If 
you put salt and water on one side of a barrier and water on 
the other, the salt, being hypertonic, will draw the fluid 
from the water side to the salt side. Since they knew that 
there was a very high ascorbic acid level in the aqueous, 
Duke-Elder thought that the aqueous was an ultrafiltrate. 
Jonas proved the aqueous to be secreted, not diffused. 

Alan C. Woods 

Maumenee: Alan Woods was a good teacher, too. He never took a 

residency in ophthalmology. He took an internship, and then 
he went into the service in World War I. When he got out, he 
worked for a year with [George E.] de Schweinitz in research, 
and then he went into practice with his father where he 
learned ophthalmology. It was common practice in those days 
to take a preceptorship with a good ophthalmologist. So he 
never took a formal residency in ophthalmology. The same 
was true of Jonas Friedenwald, Fred Verhoeff, and many 
other outstanding ophthalmologists of that time. 

Hughes: Was it evident that he lacked the residency? 

Maumenee: I think that he didn't have the all-around experience of a 
resident trained today. He was not a super surgeon or eye 
pathologist. He knew a lot about uveitis. He tried both 
clinical and laboratory studies, but the scientific technique 
used at that time would not be considered adequate today. 
Dr. Wilmer was also not a scientist; he was a very famous 
practitioner. 



23 



Every patient with uveitis, Alan Woods called tuberculosis. It 
turns out that tubercle bacilli have been found in only a few 
eyes with chronic uveitis. 

Hughes: Why would Woods diagnose uveitis as tuberculosis? 

Maumenee: Well, it was the fad of the day. Tuberculosis was a common, 
chronic granulomatous disease. He could produce a 
granulomatous uveitis by injecting animals with the tubercle 
bacilli. 

Hughes: Did he think of it as an allergic reaction, somewhat like 
phlyctenulosis ? 

Maumenee: No, he thought that the actual tubercle bacillus got into the 
uveal tract and caused the problem. 

Hughes: How could he explain the fact that he couldn't see the bacillus? 

Maumenee: Because the bacillus is very hard to find, even in people with 
known tuberculosis. It takes a very special stain, and the 
bacteria seem to disappear. It wasn't unusual not to be able 
to find it in many cases, but at least in the red hot cases, you 
should have been able to find it. And they were able to find it. 
There were people with tuberculomas in the eye. Those were 
inflammatory nodules that weren't chronic uveitis. They were 
inflammation. In the tuberculomas they found tubercle 
bacilli all the time. 

Hughes: I believe Woods had two classifications for uveitis. 
Maumenee: That's right. Anterior and posterior. 

Hughes: Was that it? I thought he had one category for cases in which 
he had found an infectious agent and a second category for 
those where he couldn't find an infectious agent. 

Maumenee: Well, that is not exactly right. His classifications were 

nongranulomatous uveitis, which he thought was due to an 
allergic response to some toxin, and a granulomatous uveitis, 
which was a response to a living bacillus or virus. 

I remember Grady Clay, who was one of the leading 
ophthalmologists in Atlanta, Georgia, sending a patient to 
Alan Woods with a note saying, "Dear Alan, I'm sending 
so-and-so to you for review for the cause of uveitis. I know 
you are going to call it tuberculosis. You call everything 
tuberculosis." [laughter] Sure enough, he did. 



24 

Woods inoculated animals with the tubercle bacillus and then 
treated them with various substances. Although he was 
trying his best, and at the time it wasn't too bad, he would 
ask Earl Burky, who was his laboratory man, "Okay, is this 
the animal we injected with tubercle bacillus or is this the one 
we didn't?" Then he would read the result. Well, that adds 
such a bias. I don't mean to criticize him for that, but it really 
sensitized me to his concepts of uveitis. 

One of Alan Woods's greatest attributes was that he was very 
loyal. If he didn't like you, you were nothing. He just couldn't 
stand you. If he liked you, there wasn't enough he could do 
for you. 

Alan Woods made rounds on patients on Mondays and 
Thursdays, and so did Wilmer. Wilmer had a whole 
entourage of nurses who carried candles so the light wouldn't 
hurt patients' eyes. It was a ceremony. Alan Woods was much 
rougher. He was very crude and rude when he wanted to be, 
which was a good bit of the time. 

Hughes: Even in front of patients? 

Maumenee: Yes. I can remember, he told a woman, "Your child has got 

retinoblastoma and he's going to die," and the woman started 
crying. He said, "Look, lady, if you want to cry, you can go 
ahead and cry all you want to. I want you to know it's costing 
you $50 an hour to sit there and cry in front of me, or you can 
stop that crying and listen." Some people just hated him, 
and others thought he was God. He could be so nice. He 
was absolutely wonderful to me. He did everything he could 
possibly do for me. I went down to his summer home to visit. 
I just really liked him. He couldn't have been nicer, except he 
wouldn't pay me anything. 

Hughes: [laughter] He didn't pay anybody anything. 
Maumenee: He didn't pay anybody much. That's right. 
Hughes: Would you describe him as a rough diamond 1 ? 

Maumenee: Very much so. His handwriting was totally impossible to 

read. You couldn't understand a word he said. I always said 
he did it on purpose because you had to think so hard about 
what he was saying, you couldn't think of an answer to 
combat him. [laughter] When he got the Gonin Medal, he 
gave his acceptance speech in French. The French people 
said, "What language is he talking? I wish he would talk in 



25 

English. I would understand him better." [laughter] He was 
a very charismatic guy that people either loved or hated. 

Hughes: Did Dr. Woods spark your interest in uveitis? 

Maumenee: Yes, to some degree. Not as much as he did in Jack Guyton. 
Jack was a year ahead of me in the residency program. The 
whole Guyton family has been written up in Reader's Digest. * 
The article says they're the Huxleys of America. They've all 
gone through medical school at the top of the class. Jack was 
at the top of his class, but he was much more interested in 
mathematics than he was in ophthalmology. 

He reviewed all of the charts of Dr. Woods's patients with 
uveitis. This was a herculean task which took many months. 
He said, "Ed, I can't believe it. Dr. Woods calls everything in 
the world tuberculosis, and he doesn't really have any proof." 
If the patient had a positive skin test for tuberculosis and 90 
percent of the people did in those days and he didn't find 
anything else specifically wrong with the patient, then he 
thought the uveitis looked like tuberculosis; but it looked like 
tuberculosis because the patient had a positive skin test. So 
it was a circular argument. 

[Helenor] Wilder Forster at the AFEP [Armed Forces Institute 
of Pathology] was a remarkable woman. She had a college 
degree and became a self-taught eye pathologist. She made 
marvelous discoveries, some of the best discoveries in uveitis, 
by just looking at the histologic specimens. She also found 
toxoplasmosis in the eye. Conditions that Verhoeff and 
Friedenwald had called tuberculosis, she found weren't 
tuberculosis but a toxoplasmosis in which the organism was 
located in the retina. 

Hughes: Why had everyone else missed these organisms? 

Maumenee: Because they hadn't really done the correct stains and 

carefully examined the immune reaction in the uvea which 
was secondary to the organism in the retina. Hellie found 
the free forms and encapsulated cyst of toxoplasma. She 
showed that toxoplasmosis was primarily an infection of the 
retina and that the inflammation in the choroid was only a 
secondary immune phenomenon. She was also the first to 
find nematodes in some eyes, especially of children, that had 
been diagnosed as tuberculosis. 



Bode R. Arthur C. Guyton: A doctor who's dad to seven doctors so far! Reader's Digest 121 
(December 1982), pp. 141^5. 



26 



Frederick H. Verhoeff 

Maumenee: Verhoeff was another brilliant person who went straight 
from being a medical student at Johns Hopkins to the 
Massachusetts Eye and Ear Infirmary as head of pathology. 
He made many fundamental discoveries in clinical diagnosis 
and treatment of eye disease. 

There is a story about Verhoeff and some famous Boston 
ophthalmologists visiting his laboratory. Verhoeff said, "I 
knew they didn't know a thing about pathology so I purposely 
put the microscope totally out of focus so they couldn't see 
anything." They looked down and said, "I agree with you; I 
think that's the correct diagnosis." [laughter] Verhoeff said, 
"I knew I had them, that they were just a total farce." 

Hughes: He was a real devil, wasn't he? 

Maumenee: Oh, he was. He was so smart. He was so capable. He was 
lots of fun. I always drove him back from the Ophthalmic 
Pathology Club, and we had great conversations. He said, 
Tin not mean like everybody says I am. It's just that those 
people are so wrong." 

Do you know the story about him and a very wealthy woman? 
Shortly before she died, she changed her will and left all 
her money to somebody outside the family. So the family 
contested the will in court, saying that she was senile and 
didn't really know what she was doing. So they brought 
Verhoeff in, and Verhoeff said she was very intelligent, very 
acute, and knew what she was doing and everything was fine. 
They said, "Dr. Verhoeff, you're a good ophthalmologist, aren't 
you?" "Yes." "Are you the best ophthalmologist in the world?" 
He said, "Yes, I am." "What makes you think this woman is so 
intelligent?" "Well, she came to me because she knew I was 
the best in the world." [laughter] That hit the headlines of 
the Boston papers. 

VerhoefFs famous statement is, "The only mistake I ever 
made is I thought I made a mistake one time, but I was 
wrong." [laughter] 



27 



Early Research Projects 



Hughes: Tell me about other research projects during your internship ? 

Maumenee: There was the work in pathology with Friedenwald and also 
the work with Lou Hellman, who later became the leading 
obstetrician in the country. We worked on newborn babies 
that had hemorrhages in the retina. 

The first project was a pathology project on lupus 
erythematosus. I spent every night in the pathology lab 
trying to make whole-mount preparations of the retina and 
stain them, so I could see what was happening. I went to see 
the head of the Carnegie Institute, Dr. [George W.] Corner, 
and he said, "You're not the first person to do this. People 
have been trying to do stains and look under the microscope 
at whole tissues forever, and nobody's ever been able to do it, 
so don't think you can do it." 

But I did anyway. I would take a pig or cow retina that we 
got from a slaughterhouse, and Fd stroke hematoxylin and 
eosin on the surface with a camel's hair brush, trying to get 
the stain into the tissues to look at them. I did that for the 
cytoid bodies in the retina. Then we'd section and look at 
them, and there were no tubercle bacilli in them. Jonas and I 
didn't know what the cytoid bodies were, but we guessed they 
were the smaller dendrites in the retina. We didn't know 
anything about axoplasmic flow at the time, or we might have 
gotten- it right. Norman Ashton later showed that the cytoid 
bodies were blocked axoplasm in the axon due to ischemia. 

My second research project was on babies with retinal 
hemorrhages. Lou felt that the hemorrhages might be due to 
lack of vitamin K. The women were taking mineral oil during 
their pregnancy and they didn't absorb enough vitamin K 
We gave the mothers vitamin K intravenously so it wouldn't 
be blocked by the mineral oil. I went over every night and 
saw the newborn babies of that day and dilated the pupils 
and looked at the fundi. It was interesting from the point of 
view of statistics. I didn't know which mothers were getting 
vitamin K and which weren't getting vitamin K It turned out 
that of the first fifty cases, twenty-five had gotten vitamin K 
and twenty-five hadn't. In those that got the vitamin K, I 
think there were two or three hemorrhages in the retina. In 
those that had not, some 80 percent had hemorrhages. I said, 
"We'd better do another fifty cases." The statistics came out 
the opposite way. So when somebody says something about 
small numbers and gives me all these fancy formulas, I say, 



28 



Hughes: 



"They don't convince me one bit." I don't care how fancy the 
formula is, you can't tell with small numbers when you're 
trying to find out whether something works. You've got to 
have large numbers. 

Anyway, we published that the use of vitamin K in the mother 
may have been the factor in the development of retinal 
hemorrhages in newborn babies, but it turned out not to be.* 

Was this the first time that an association between retinal 
hemorrhage and vitamin Khad been observed in the newborn? 



Maumenee: That was the first time and that was Lou's idea. 

Another study I did as a resident was an attempt to 
isolate the virus that caused a severe conjunctivitis, 
called shipbuilder's conjunctivitis, which is caused by an 
adenovirus.** Shipbuilder's conjunctivitis was a major 
factor in causing a slowdown in industrial plants. Guy 
Hayes was an intern in medicine, and Tom Hartman was in 
medicine, too. We tried to isolate this virus in chick embryos, 
and I started a lab with chick embryos to get the virus out. 
Actually, what we isolated was a herpes virus, so it turned out 
we didn't find the adenovirus.*** 

Hughes: Where had you learned virological technique? 
Maumenee: Just by reading it in a book. 



Maumenee AE, Hellman LM, Shettles LB. Factors influencing plasma prothrombin in the 
newborn infant. IV. The effect of antenatal administration of vitamin K on the incidence of 
retinal hemorrhage in the newborn. Bull Johns Hopkins Hasp 1941; 68:15868. 

Maumenee AE, Hayes GS, Hartman TL. Isolation and identification of the causative agent in 
epidemic keratoconjuncti vitis (superficial punctate keratitis) and hcrpetic keratoconjunctivitis. 
Am J Ophthalmol 1945; 28:823-39. 

For a description of the isolation of the adenovirus, see Phillips Thygeson, MD. Ophthalmology 
Oral History Series, A Link with Our Past. Interview conducted by Sally Smith Hughes. The 
Foundation of the American Academy of Ophthalmology, San Francisco, and The Regional Oral 
History Office, University of California at Berkeley, 1988, pp. 95-6. 



29 



The Halsted Residency System 



Hughes: Apparently there was a system at the Wilmer Institute for 

assigning duties to interns and residents. The senior resident 
assisted Dr. Wilmer, and there was a descending hierarchy. 
Was a similar system operative when you were there? 

Maumenee: There was a strictly pyramidal system. The Wilmer took 

four house officers the first year. At the end of the first year, 
two were dropped. At the end of the second year, one was 
dropped, and the final one went on to the senior residency. 
He got to do all the surgery and met Dr. Wilmer at the front 
door. The senior resident assigned duties to the junior house 
staff. As a junior house officer, you assisted [in surgery] and 
did everything except operate. You did all the work that 
the nurses do now, which was time consuming. We hated it 
because we had to clean all the instruments. They said they 
were too delicate for a nurse to handle, so we had to do it. It 
was the so-called Halsted system. That's the way [William S.] 
Halsted ran surgery. So Wilmer instigated the Halsted 
system into the ophthalmic residency. 

Hughes: I believe you kept the old Wilmer structure for the residency, a 
pyramidal structure, when you became chairman. 

Maumenee: Semi-pyramidal. 

Hughes: What do you mean by semi-pyramidal? 

Maumenee: Alan Woods started the semi-pyramidal system. We kept 
every resident for three years. Then one or two would be 
kept on for five years and become senior resident and run the 
residency program. Halsted had the exact pyramid system in 
general surgery. He took about ten residents and then got rid 
of five the first year, three the second year, and then he kept 
one for five or six years. 

Hughes: That's pretty cutthroat. 

Maumenee: It was awful, because the poor residents who had been there 
for two years just couldn't get any further training. So 
Wilmer [Institute] shifted over to a basic three-year program, 
and either one or two we kept for two more years. 

Hughes: Was it the chairman's exclusive decision to pick the senior 
resident? 



30 

Maumenee: Yes. 

Hughes: Were all the surgeons using gloves by the time you arrived as a 
resident? 

Maumenee: Not all. Some of the older surgeons still didn't wear gloves. 

Hughes: Dr. [Dohrmann KJ Pischel talked about that* and it didn't 
seem to change the results very much. 

Maumenee: No, but you have to take it in its full context. The Viennese 
ophthalmologists were very good and taught many of the 
leading ophthalmologists in the States. When they operated, 
they never introduced the same instrument into the eye twice, 
and they never used an instrument in the eye if it touched the 
outside of the eye. Most infection comes from the lid margins; 
it doesn't come from the surgeon. In the poorer countries, 
gloves still aren't used for ophthalmic surgery. 

Hughes: For economic reasons ? 

Maumenee: Yes. In general surgery, when you put your hands inside the 
skin incision, you get bacterial contamination. But you don't 
do that in eye surgery. 

Hughes: Who else was there when you first arrived at the Wilmer? 

Maumenee: Besides those I have mentioned, Frank Walsh, Louise Sloan, 
and many very good people in private practice. 



John McLean 

Maumenee: We worked hard during our residency. John McLean was my 
senior resident and he was certainly one of the best senior 
residents we ever turned out. He was an excellent surgeon 
and a wonderful teacher. I remember telling him when I was 
interviewed for the residency, "I don't know one thing about 
ophthalmology. I've worked a little with [Bernard] Samuels 
at the New York Eye and Ear Infirmary." He said, That's 
good. Then you won't have to unlearn something. You can 
start out fresh and learn it right." 



See Dohrmann Kaspar Pischel, MD. Ophthalmology Oral History Series, A Link with Our Past. 
Interview conducted by Sally Smith Hughes. The Foundation of the American Academy of 
Ophthalmology, San Francisco, and The Regional Oral History Office, University of California at 
Berkeley, 1988, p. 12. 



31 

Hughes: And he proceeded to teach you ? 

Maumenee: Yes. He was very good. 

John McLean was certainly the leader for the residents. 
All of us just had the greatest admiration for him He stayed 
on after the residency for a couple of years. During the 
residency period, you had a year off when you could visit 
other universities to see what they were doing, or you could 
do a piece of research. But you weren't bound down with a 
bunch of clinical duties. 

John and I roomed together on Broadway about four or five 
houses down [from the Wilmer Institute]. We had the top 
floor apartment, and we were the first people to have an 
automatic dishwasher. When we'd finish our meal, we'd put 
all of our dirty dishes in the bathtub and turn the shower 
on and let it run all day, and come back and clean it up. 
[laughter] We became very, very close friends, rooming 
together like that. He was an extremely bright guy, well 
versed in literature, and a very, very good surgeon. 

Alan Woods's specialty was medical ophthalmology, as was 
Frank Walsh's, so John taught us surgery. Corneoscleral 
sutures were used by [Karl D.] Lindner, by Verhoeff, by a 
number of people, but John popularized them. So everybody 
gives John credit for starting the corneoscleral suture. In his 
paper, he cites the people who used them before he did, but 
they still give him credit because he popularized them. The 
use of this type of suture prevented many postoperative 
complications. It allowed us to get the patients out of bed the 
day after surgery instead of using sand bags and keeping the 
patient in bed for a week or more. 

After two years at Wilmer, John went straight to the 
professorship at Cornell. They had a good department. 

John was at a meeting of the New York Ophthalmological 
Society, when Arnold Knapp said you should not use a knife 
that was too sharp because you might make a mistake and 
cut where you shouldn't cut. Knapp always had the last word 
to say about everything. Any talk that was given, he was the 
king in New York. John got up and said, "If you can't use a 
knife that's too sharp, you shouldn't be an ophthalmologist." 
If you didn't have any more skill at surgery than that, you 
shouldn't be operating. So John made enemies right away. 
He was really a very shy person underneath, but he was very 
cocky on the outside. So until people got to know him in New 
York, he wasn't very popular. Once they got to know that he 



32 

was really sincere and he was really smart and really good, 
they liked him very much. 

John and Jack Guyton were the two really smart people with 
me during the residency period. Bill Hughes was in the same 
year I was in, and there was a big question as to whether he 
or I should be the senior resident. We made an agreement 
that if Dr. Woods chose both of us and then gave us a chance 
to say who would go first, we'd flip a coin to decide. But what 
happened was Dr. Woods called me in and gave me the senior 
residency. Then he called Bill in and asked him if he wanted 
to wait a year to take it. I don't think Bill ever forgave me for 
not flipping a coin. But Dr. Woods appointed me first and Bill 
second, so if I'd flipped a coin, I don't know what Woods would 
have done. Probably kicked us both out. Bill was capable. 
He was an excellent artist and very smart. 

Hughes: The decision about who was to be senior resident was strictly 
up to the director of the institute? 

Maumenee: It was. You see, there was only one professor in any 

department at Hopkins and he was the chairman of the 
department. 

Hughes: Nowadays it would be done differently? 

Maumenee: Yes. 

When I came back in '55, 1 was the only person on the 
full-time staff. Walsh had gone into private practice, 
Friedenwald died from cancer of the colon a few months after 
I got back, and Howard Naquin went into private practice. 

Woods retired and said, "Let me stay and see a few patients," 
which had never been done before. The Hopkins rule was, 
once you finished your professorship you could no longer 
stay at Hopkins, because the former professor with his great 
prestige would run everything and the young guy coming in 
wouldn't have an opportunity to develop anything. 

Hughes: But didn't you let Woods stay? 

Maumenee: Yes, I went to the board and said, "Look, I want him to stay. 
He's not going to bother me. He's always been a tremendous 
help to me, and he would continue to be a great help to me. 
He can have an office." He never once interfered with 
anything I did. If I asked his opinion, he'd give it to me, but 



33 

never, never once did he come in and tell me what I should be 
doing or whether it was right or wrong. 

He carried on a good practice and wrote a book on uveitis. I 
could never get him to one of our conferences. 

Hughes: Why do you think that was? 

Maumenee: Well, I don't know. Maybe he thought if there was a 

difference of opinion the staff would defer to him and not 
tome. 

The one thing Woods taught us was to argue with him. 
When I went to California, I found that most of the senior 
ophthalmologists had been trained in Vienna where you could 
never argue with the professor. The professor says, It's so 
because I say it's so." Dohrmann K. Pischel, [Hans] Barkan, 
and Frederick C. Cordes were all trained in Vienna. I brought 
out the idea that you're supposed to argue. I had rounds on 
Monday morning, and many practitioners in town came to 
them. We would argue with the faculty and fight back and 
forth about things that went on. Woods encouraged that in all 
of us. 



William H. Wilmer 



Hughes: What about Wilmer? 

Maumenee: Wilmer was very much the Viennese type of professor. 

Hughes: You didn't ever argue with him. 

Maumenee: I never knew Wilmer. He died before I came to Hopkins. He 
was reputed to have been a very fine surgeon. 

Hughes: Well, he certainly had a prominent group of patients. 

Maumenee: Oh, he did. He was a charming gentleman. He had 

tremendous charisma. So did Dr. Woods in his own way. 
Dr. Woods was a really dynamic person. 

Hughes: Had Wilmer set up the institute with the idea that it was to 
have a heavy research interest? 

Maumenee: Yes. 



34 

Hughes: How did a man who had come straight out of practice get 
the idea that research was an important adjunct to 
ophthalmology ? 

Maumenee: He was in the armed services in World War I, and he was 

head of research for the air force, because flying a plane was 
done by vision, not instruments. The air force had people 
doing basic science, and I think he picked up the idea from 
that. 

Popsy [William H.] Welch was also extremely influential in 
developing the Wilmer Institute. He convinced Mrs. Aida 
de Acosta Breckinridge to build an eye institute like they 
had in Vienna. Welch gathered most of the money for the 
institute. Mrs. Breckinridge was able to collect only about 
$400,000 because Dr. Wilmer would not allow her to contact 
his patients. He thought it would be embarrassing to ask 
money of patients who were devoted to him because of the 
expert eye care they had received from him. 

Popsy Welch went out and got $2 million. 

One of the things that really irritated Wilmer and his family 
was that when he was sixty-five he was made to retire. 
Although Popsy Welch had gathered most of the $2 million 
that got the institute started, Wilmer, once he became 
chairman, collected $1 million or more for fellowships, 
research projects, and other things, from his patients and 
friends. He couldn't see why he wasn't allowed to stay on 
and practice here. Instead, he went back to Washington. 
He pointed out, "Well, why do you let Popsy Welch stay on 
and you don't let me stay on?" 

Hughes: Did they have an answer? 

Maumenee: No. 

Hughes: Welch emphasized the importance of research? 

Maumenee: Yes. He was a pathologist. So Dr. Wilmer set up a laboratory 
and hired basic scientists to work in Wilmer. One of the 
important things he insisted on before he would accept the 
chairmanship was that patient care, research, and teaching 
all would have to be under one roof. 

His residents did very well. Ben Rones had a big practice in 
Washington. Tbwnley Paton certainly became one of the 
leading ophthalmologists in New York. He started the first 
eye bank in the United States. 



35 



Hughes: Where was it? 

Maumen.ee: It was in New York City. He faced great opposition to taking 
eyes from the dead and using them, but he accomplished it. 

Wihner trained some very fine ophthalmologists. George 
Heidelman in Cincinnati was considered a very capable 
person. And Ed Burch from Minnesota was an excellent 
practitioner. Cecil Bagley had a big practice in town. Angus 
MacLean came from obstetrics and gynecology, and he was 
certainly the leading eye surgeon in town, until John McLean 
came along. 

Wilmer hired Clarence Ferree and Gertrude Rand to do 
physiological optics, and Arlington Krause in chemistry, and 
later Louise Sloan, also in physiological optics. Alan Woods, 
having trained with de Schweinitz, was even more interested 
in research. And Friedenwald came along and really did the 
research work. 



Monday and Thursday Rounds 



Hughes: Please comment on your experience with Monday and 
Thursday rounds. 

Maumenee: Well, rounds with the residents and the chief of staff started 
with Wilmer. Apparently they were very effective rounds. 
Then Alan Woods came along, and he had walking rounds, 
seeing all the patients, on Monday and Thursday. The 
resident would present the case and what had been done. 
And then Dr. Woods would make comments about the case 
and what he thought ought to be done. He would do very 
good teaching rounds. They are still done the same way in 
internal medicine. 

Hughes: Did internal medicine pattern itself after ophthalmology? 

Maumenee: No, I think we all patterned after Halsted. Bedside teaching 
was Halsted's way of teaching. 

Hughes: Was everybody more or less on an equal plane? Could anybody 
interject? 

Maumenee: Yes, at least in Wilmer. We were all equal except Dr. Woods, 
and he was equal to all of us. But he stimulated you to think 
and to ask questions and to disagree with him, and then he 



36 

would say what he felt about a problem, why he thought it 
was a certain diagnosis, and what should be done. 

Hughes: How do patients feel about being observed by a retinue? 

Maumenee: They don't seem to mind. They think they're getting a 

consultation from a great number of people. It's very seldom 
that we say anything that would really embarrass a patient. 

Only one time that I can remember and you'll have to 
excuse the unpleasant language a man had a basal cell 
carcinoma of his lid, and he'd let it go to the point where it 
had already eaten its way back into the orbit. We'd been 
trying to convince him to let us cut the tumor out. It doesn't 
metastasize; it just grows, infiltrates. But it can grow right 
into the brain and kill you. 

So finally Dr. Woods, who was kind of brusque, got down right 
next to the guy's ear, because the patient was a little deaf, and 
Dr. Woods said, "The tumor will eat your goddamn head off 
unless you are operated on!" He was operated on the next day. 

Our major teaching was through the senior resident, because 
he had had at least four years and I think we then extended 
it to five years of residency training. And he'd been away 
for a year learning a specialty in some place where they did 
something better than we were doing it. So he came back 
with new knowledge and new ideas. 

We feel very strongly that an important part of the residency 
system here is residents teaching each other. We pick 
the brightest people we can get, and they're intensely 
competitive with one another. We don't try to make it that 
way, but they've always been head of the class, they've been 
valedictorian, they've been magna or summa cum laude in 
medical school, so they are always trying to be tops. 

The senior resident guides things, and if he can't get the 
residents to do the work he wants them to do, he will come 
to the professor, or maybe one of the staff members now. But 
in my time they would come to me, and then I would talk to 
the house officer. But I would never talk to the house officer 
before the senior resident had tried to manage it, because that 
would take away his authority. 

The rounds were good and residents prepared for them. They 
read up on all the cases that they had to present. They were 
told the night before which cases to present. The professor 
was never told what the resident was going to talk about. It 



37 



was always a surprise to us what they would bring up. 
[laughs] 

Hughes: Did that ever catch you short? 

Maumenee: Several times. Particularly some of the bright guys like 
Bernie Becker when he was here. He knew so much more 
about glaucoma than I did. Every time I tried to explain the 
pathogenesis of glaucoma, Bernie would correct me. [laughs] 

Hughes: Were there courses that went along with the residency training 
program? 

Maumenee: Yes. The senior resident always arranged a group of lectures 
and would ask the attending men to lecture at five o'clock. 

Hughes: Presumably on their areas of expertise? 

Maumenee: That's right. And the resident and the staff would give 
lectures, too. That still goes on. It was a strictly in-the- 
auditorium, slides-on-the-screen, lecture format. The 
audience could ask questions, but it was and is more formal 
than the rounds. The rounds were a presentation, and then 
anybody in the crowd could speak up. 



Pressure to Publish 



Hughes: Was there pressure on you as a resident to publish ? 

Maumenee: No. There's no pressure on any of our residents to publish, 
except that their colleagues were doing it. 

Hughes: Does that apply to the staff as well? 

Maumenee: It depends on what the staffs doing. If you're going to be a 
PhD in basic science, then you have to get grants. I had a 
policy that if you couldn't get grants from the NIH, you were 
not doing good work and you belonged somewhere else. That 
means you should get another job. Likewise, if after three 
years in clinical work you couldn't get enough patients to take 
care of expenses, then you ought to go somewhere else. 

There are places where the chief does insist that the house 
staff publish papers. If they don't, they get forced out. I don't 
think that's right. If somebody doesn't have the imagination 
and the ability to do it, then they're not going to do it when 
they get forced out. There's an inner drive of inquisitiveness 



38 



that's born in people. They may be the most brilliant, student 
that ever went through Hopkins or Harvard or any other 
place, and they may not have an original thought in their 
mind. They can tell you everything in every book they know 
of, but they never have an original idea. People in the middle 
of the class may have all kinds of imagination. Of course, the 
great combination is to be the best in the class and to have 
imagination, too. But these people don't come along very 
frequently. 



Dr. Woods's Cataract Extraction 

Hughes: Do you want to tell the story of operating on Dr. Woods's 
cataracts? 

Maumenee: Sure. Jack Guyton was Dr. Woods's favorite resident. Jack 
and Dr. Woods got along just beautifully. As I have said, 
Jack was brilliant; he worked on papers with Dr. Woods. 
When Dr. Woods decided to have his cataracts done, we at 
Wilmer were using corneoscleral sutures when most of the 
ophthalmologists in the rest of the country weren't. Dr. 
Woods selected Jack, who was the senior resident, to do his 
cataract extractions, which just shocked everybody. But 
Dr. Woods was anxious for Jack to go ahead in academic 
medicine. He'd seen the results of Jack's surgery on rounds 
and how good the cases looked. 

Dr. Woods got John McLean to come down from New York 
to help Jack do Woods's first eye. When his second eye was 
operated, he asked me to help. I was so nervous about hitting 
his optic nerve or putting the needle in his eye, because he 
was somewhat nearsighted and had a long eye, I didn't do a 
very good retrobulbar novocaine injection. He let out a few 
yells during the operation. The operation hurt him, but he 
was very good about it, and he really stayed still, and Jack did 
a good job. It was a tremendous strain on Jack as a resident 
to be operating on the chief. 

Dr. Woods had a complication that we should have discovered 
and reported. The vitreous is a jelly-like fluid in the eye, and 
when you take out the lens there's no support to prevent it 
coming forward, and the hyaloid face of the vitreous is not 
tough enough to hold it back. Dr. Woods was in Gloucester, 
Virginia, at his summer home, and he called up and said, "My 
vision in one eye has dropped down to nothing; I can hardly 
see." So we jumped in the automobile and went down with a 



39 

slit lamp to look at his eye. The hyaloid face of his vitreous 
had ruptured and gone into the anterior chamber. That 
creates a pull on the ciliary body, which gave him a cystoid 
macular edema. That's one of the most common complications 
of intracapsular cataract surgery. 

Later on, Don Gass, one of my former residents, gave a 
good, detailed description of the condition.* I published a 
histopathology picture of it several years before, but there 
was also a serous detachment of the sensory retina in the 
slide and I missed the cystic changes in the retina.** If you 
look at Figure 17 in this paper, it shows the most beautiful 
cystoid macular edema you ever saw. It was the first one 
published, but I didn't recognize it. I thought serous 
detachment of the retina was the problem. 



The Wihner Meetings 

Hughes: What is the history of the residents' May meeting, the Wilmer 
meeting? 

Maumenee: This was started at the suggestion of Frank Walsh in the late 
1930s. Frank decided we ought to have a one-time-a-year 
explanation of what research work we were doing at Hopkins. 
We held it in the little auditorium we have downstairs, and 
it was about halfway filled. This was in 1937 or 1938. It 
seemed to be very popular. So the next year we had it, the 
room was totally filled. Then about two years later it was so 
overcrowded we had to move into Kurd Hall. Then that got 
so crowded we had to move into the new building, the Turner 
Auditorium, which held eight hundred people. 

The meeting consisted of a series of papers on what we were 
doing in Wilmer in the way of clinical and basic research. 
Verhoefif came to each one because the Ophthalmic Pathology 
Club, later called the Verhoeff Society, met just before the 
Wihner meeting, and many of the members would come over 
to the meeting. I'd drive Verhoeff over; he'd sit in the front 
row, and he'd comment on every paper. He would say, "I did 
this twenty years ago. I did this forty years ago. It's nothing 
new." 



Gass JDM, Norton EWD. Cystoid macular edema and papilledema following cataract extraction. 
Arch Ophthalmol 1966; 76:646-661. 

Maumenee AE. Symposium: Postoperative cataract complications. Trans Am Acad Ophthalmol 
Otolaryngol 1957; 61:51-68, Fig. 17. 



40 



Anyway, the Wilmer meeting became a very, very popular 
thing. When I came back as chairman in '55, we had the 
auditorium totally filled, with people sitting on the steps. But 
then the Wills Eye Hospital, Columbia, the Mass Eye and 
Ear every big eye department started having a residents' 
day like ours. So spring was so full of meetings that the 
Wilmer meeting began to drop off in the number of people 
who attended. We were down to around three hundred people 
this year, including all the former residents who'd come back. 
So they're going to make it more clinical to see if we can 
attract more people. 

We think it's a very good way to let the world know what 
we're doing at Wilmer, work which probably won't be 
published for two or three years. Much of it will never 
be published, because it turns out to be wrong. I used to 
say, "What you hear today, three years from now you'll hear 
is all wrong, because we are really in the first phase of 
looking at this, and it may turn out to be totally wrong." 



Focal Point 



Hughes: Would you like to say something about what went on at Focal 
Point? 

Maumenee: Yes. The people at the Wilmer Institute have always gotten 
along extremely well and enjoyed being with one another, 
particularly the residents. I think it was Betty and Frank 
Constantine who thought of renting a house down on the 
water. We found we could rent it for $25 from each resident 
for the summer. There were probably eight or nine or ten of 
us that rented this house. We used to have a great time down 
there. It was on the Cattail Creek, which is a branch of the 
Magothy River which flows by Gibson Island and out into 
Chesapeake Bay. We got a couple of little sailboats that 
we put together, and we'd spend the weekend there. The 
facilities weren't the best in the world; nobody ever made the 
beds up, and cooking facilities weren't ideal, but we didn't 
starve. It was a place where we would get together and swim 
and party and have fun. Then the obstetricians started Fetal 
Rest, which was based on the same concept. 

We invited all the house officers down to a party once. We 
had a big crowd, and swam, and sailed, and drank beer, and 
pitched horseshoes, and generally just enjoyed one another. 



41 



Hughes: How many years did Focal Point last? 

Maumenee: It lasted the whole time I was a resident. During World 

War II, use decreased. And then the fellow who rented it to us 
decided he wanted to use it for himself. When I came back 
from California, I think it was not in existence anymore. But 
from around 1940 through '46 or so, we had it every year. 



Taking the American Board of Ophthalmology 
Examination 



[Interview 2: May 15, 1990, the Maumenees' home in 
Stevenson, Maryland] 

Hughes: Dr. Maumenee, do you have any stories about taking the ABO 
[American Board of Ophthalmology] exam in 1943? 

Maumenee: At Johns Hopkins we didn't have any particular classes or 
instruction for the board exam. You were on your own to 
study if you wanted to. About the only thing I studied for was 
optics, because I didn't know any optics at all. Bill Hughes, 
who later was head of the eye department at the University of 
Illinois, and I set up an optical bench and practiced on that 
enough to learn a little optics, not very much. 

I went to New York to take the exam. A pair of examiners 
examined you all day long. The examination was all oral and 
lasted for three days. Dr. [C. S.] O'Brien from Iowa was the 
bear of the American board. Everybody was deathly afraid 
that he would examine them, because he was so tough. Sure 
enough, my luck was to get Dr. O'Brien. John McLean, who'd 
been my roommate, was his assistant, so that made me feel a 
little more at ease. 

I had a very good time, and after half an hour or so I decided 
I'd argue with O'Brien just as I did with Alan Woods. O'Brien 
would ask me a question and Fd answer it, and he would act 
like it wasn't correct, and I would argue with him about why 
my answer was better. 

Hughes: Did he like the arguing? 

Maumenee: Yes, he got to where he enjoyed it. We had a great time. He 
was probably one of the brightest guys in ophthalmology of 
his time. He was one of the full-time academic people. 

Hughes: He was one of the first, wasn't he? 



42 

Maumenee: That's right. Wilmer was full time before him, but O'Brien 
was certainly one of the first. The department he built up in 
Iowa was certainly one of the two or three best in the country.* 

Next I got Al Braley as an examiner. He was interested in 
external diseases and infection. We had a great time because 
I was very interested in herpes, because I'd done research 
work on it. Braley thought that was fantastic. 

Hughes: I thought that examiners weren't supposed to examine in their 
field of expertise. 

Maumenee: I've always felt that they should. I feel that the poor 

examiners are the ones who don't know what they're talking 
about. If you're good, you can ask difficult questions. If a 
candidate's shaky, you can go back to easier questions that 
you think anybody should know. I used to hate to examine in 
optics because I didn't know any optics at all, and I was just 
miserable. If the answer was the same as the answer on the 
card, I passed them, [laughter] 

Hughes: You didn't have any choice about the subject in which you 
examined? 

Maumenee: No. 

I did all right on my board exam; I don't think I made the best 
grade over all. Al said he gave me the best grade of anybody 
there [on his part of the exam]. I don't know what grade 
O'Brien gave me. Then I went in to [John] Dunnington, and 
he examined me in optics and refraction. I made some stupid 
errors, because when I got out I remembered Fd said the 
wrong thing, [laughs] 

Hughes: Was refraction emphasized at Wilmer? 

Maumenee: No. The word was that the people at Wilmer never knew 

how to refract. We taught them surgery, and we taught them 
pathology, and we taught them basic medicine. We thought 
refractions should be done by technicians. So refractions were 
not our forte. 



For more on the Department of Ophthalmology at Iowa, see the oral histories in this series with 
Drs. Thomas D. Duane, Phillips Thygeson, and Paul Boeder. 



43 



III. WORLD WAR II RESEARCH, 1944-1946 



Chemical Warfare 



Hughes: Prior to your military service, you had done research on 
chemical warfare. 

Maumenee: I worked on two research projects with the OSRD [Office of 

Scientific Research and Development], a civilian branch of the 
armed forces. As a resident, I worked on chemical warfare 
with Jonas Friedenwald. We were trying to find a cure for 
mustard and nitrogen gas. Just after that, I worked on viral 
diseases. 

Hughes: Tell me about your work on mustard and nitrogen mustard 
gas. 

Maumenee: We weren't getting anywhere with an antidote for mustard or 
nitrogen mustard. We went up to Du Pont, and Friedenwald 
would correct the chemistry of its top-flight synthetic 
chemists, the brightest people they had. We got several 
other big companies to try to make an antidote, and we 
couldn't make one. 

It came out that the Germans had developed a nerve gas and 
were going to fly over and poison everybody in England. It 
turned out to be dinitrofluorophosphate, DFP. So we put 
that in the eyes of rabbits, and the pupils constricted right 
away. So Friedenwald said immediately, "This must be a 
parasympathetic product, and if we put atropine in, it'll 
neutralize it right away and it won't be harmful at all." 
So we put atropine in the animals and then dropped 



44 



Hughes: 



dinitrofluorophosphate in the eye, and the pupil didn't 
constrict and it didn't bother them at all. So that was our 
contribution to chemical warfare. 

In World War I, whole companies were knocked out with 
mustard because it was so irritating to the eyes that people 
couldn't see. A lot of people got it in the lungs, and it killed 
them. Mustard just neutralized the army. We were afraid 
that when the Germans invaded Normandy in World War II, 
that they were going to have the waters mined with mustard 
or nitrogen mustard gas. They are actually an oil that 
vaporizes very rapidly. 

We had a ship anchored in Algiers that had mustard gas on it. 
The Germans didn't know that and they bombed the ship. 
The mustard oil got in the water, and when the seamen 
jumped into the water, they got the mustard on their clothes. 
A destroyer picked them up, and within half an hour nobody 
on the destroyer could see because the air conditioning 
circulated the fumes. So they had to send out people with 
gas masks to rescue the ship. 

Weren't you also doing studies of the actual histological effect 
of the gases on the cornea? 



Maumenee: Yes. They didn't really help. We were trying to find products 
that would neutralize the gas. Irv Leopold, a good friend 
of mine, was doing the same thing at the University of 
Pennsylvania. 

Hughes: So were Drs. David Cogan and Morton Grant at the Howe 
Laboratory of Ophthalmology.* Did you have any 
communication with them? 

Maumenee: We would meet with them occasionally. Irv was the only one 
who thought he found something. He used antibiotics to cut 
down on the severity of mustard burns. 



Bacterial Warfare 



Maumenee: I went into bacterial warfare because of Murray Sanders, who 
was head of defense in bacterial warfare. He was at Columbia 
and I knew rnm. 

I bumped into Murray in Washington, and he said, "What 
are you doing?" I told Murray I was working on chemical 



See the oral history in this series with Dr. Cogan, pp. 50-51. 



Hughes: 
Maumenee: 
Hughes: 
Maumenee: 



45 



warfare, and I was getting tired of people asking me what 
ailment I had, why I wasn't in uniform like all my friends. He 
said, "If you go into the army or the navy, 111 get you into the 
most exciting research you've ever done." Well, I knew he was 
a bacteriologist, so I pretty well surmised what it was. It was 
bacterial warfare. He called up one day and said, "The navy 
will take you." So I went to Camp Detrick in Frederick, 
Maryland, specifically to do research on bacterial warfare. 
I entered as a lieutenant j.g. [1946] instead of lieutenant 
commander because I hadn't passed my American boards. 

That's where I did the study on tularemia.* 

You were working with tularemia with the idea that it might 
be used in warfare? 

Yes. We had botulism, we had a botulinum toxin, we had 
tularemia, we had bubonic plague. 

Why had these particular micro-organisms been chosen as 
potentially useful in bacterial warfare? 

I guess Fothergill, who was head of Camp Detrick, and the 
higher-up people decided those were the ones to work on. 



Hughes: How were you working on them? 

Maumenee: We were culturing them and putting them in animals and 
seeing what it took to kill them. For instance, in tularemia, 
we wanted to see if somebody wore a mask over the nose and 
didn't breathe in the organism, would he get tularemia if we 
put it in the eye? So we put the tularemia agent in the eye, 
and it ran down the nasolacrimal duct, and the animals died. 
I also injected it into the vagina of animals, and they absorbed 
it too. So it showed that mucous membranes absorbed the 
tularemia and you couldn't protect against it. 

When they took the micro-organisms up in an airplane and 
exploded them in a bomb, the heat from the bomb and the 
descent through the air made the organism sterile by the 
time it hit the ground. The only thing that would work was 
botulinum toxin. They went into the muddy fields where they 
had spread botulinum toxin around, and were taking the 
water and injecting it into the abdominal cavity of mice. It 
took the mice two or three days to die from botulism. They 



Downs CM, Coriell LL, Pinchot GB, Maumenee AE, et al. Studies on tularcmia. I. The 
comparative susceptibility of various laboratory animals. J Immunol 1947; 56:217-28. 



46 

also got bacterial infections because of a lot of micro 
organisms in the water. 

My only contribution in the year and a half that I was in 
bacterial warfare was that I read in Duke-Elder that chickens 
had striated muscle in the iris, and the botulinum toxin 
paralyzes only striated, not smooth, muscles. So I injected 
the toxin into the anterior chamber of chickens, and within 
five minutes the pupil dilated widely. 

Hughes: So that was a good test. 

Maumenee: It was a good test if you could get a needle into the anterior 
chamber of a chicken, [laughter] I wrote it up, and that 
became the official first test for botulism. We got word that 
the Germans were going to send buzzbombs full of botulinum 
toxin into the reservoirs and poison everybody in England. 

Hughes: Which they never did. 

Maumenee: Which they never did. 

Hughes: Hadn't biological warfare been outlawed after World War I? 

Maumenee: Oh, yes. 

Hughes: The United States government didn't believe that anybody was 
going to hold to the agreement? 

Maumenee: It's still doing research on bacterial warfare. I don't know if 
they've gotten any further, but I tell you, I got so fed up with 
it because it was worthless when we were doing it. 

Hughes: Was Camp Detrick the only place where such studies were 
going on? 

Maumenee: As far as I know. They were so secret that they wouldn't tell 
you anything. 



Serving on a Hospital Ship 



Maumenee: I was so bored with not getting anywhere at Camp Detrick 
that I told Dr. Woods. He said, "Let me see what I can do." 
There were four or five people who were consultants to the 
surgeon general of the army, and he was one of them. He 
got me on one of the five new hospital ships that came out 
towards the end of the war. My ship was the Tranquility, of 



47 

all names, and there was the Hope, that you probably know 
of, and the Benevolence, and I've forgotten what the others 
were. We were the first ship out. 

It was a good time on the ship. We had twenty-four nurses 
and eighteen doctors, [laughs] We had a mechanical cow [an 
apparatus for mixing powdered milk and water], and we had 
a safe aboard. Dr. Woods said, "Now, don't you get yourself 
cashiered out of the navy by ever drinking while you're there." 
We left Brooklyn, and everybody came out before dinner the 
first night with a cocktail except me. They said, "You dope, 
what do you think those safes are for in your cabin?" Each 
officer had a safe, and only you and the steward had the 
combination of your safe. 

We toured the South Pacific, and every time we got near 
Hawaii the engineer would blow up a boiler and we'd have to 
go in for repairs, [laughter] 

Hughes: What were you supposed to be doing? 
Maumenee: It was a hospital ship. We had a thousand beds. 
Hughes: So casualties were being flown in? 

Maumenee: Yes. There'd be a little makeshift hospital on an island, 
and we'd go in and take care of people. If it was a real 
catastrophe, we would take a thousand wounded soldiers back 
to San Francisco, because they had a good naval hospital 
there. Captain Bart Hogan, who was a psychiatrist, was the 
chief medical officer. He would let us operate. Bob Brown 
was head of surgery, and he had been a professor of surgery at 
the University of Pennsylvania. He was a very good surgeon, 
very capable. 

On one occasion, when one of the boilers blew up, one of my 
friends from Tulane that Fd run against on the track team 
was a commander and had a command car at his disposal 
whenever he came into Hawaii. So he gave me the keys to the 
car. When the ship went in for repairs, we'd get a couple of 
steaks and take the car and have a nice picnic on the beach 
with some of the nice nurses, [laughter] 

One exciting thing that happened is that we picked up the 
survivors of the Indianapolis that carried the atomic bombs to 
Guam. The Japanese hit it with torpedoes on both sides, and 
the ship went down in fifteen minutes with a crew of about 
1,500 people. Their communication was blown out and they 
didn't have time to get a distress signal off. So when the navy 



48 



Hughes: 
Maumenee: 



Hughes: 
Maumenee: 



Hughes: 
Maumenee: 



didn't hear from the ship, they started searching, and after 
three days they began to find people floating in the water. 
They picked them up and brought them to Guam, where we 
picked up several hundred of them. They were in terrible 
shape after being in the water that long. 

What could you do for them? 

A lot of them had photokeratopathy, like skiers get, because 
they were in the South Pacific where there was a lot of 
ultraviolet radiation off the surface of the water. It gave them 
cornea! burns. We gave them medication and kept the eyes 
closed until they healed after several days. The general 
medicine people took care of the pneumonia and the gangrene 
and the other problems until we got them into San Francisco. 

Did you learn anything medically or surgically from your 
experience on the hospital ship 1 ? 

No. It was as close to being in jail as anything, except that 
Bob Brown and I would invite a couple of nurses to sit out 
on the deck before dinner. We'd get a quart of ice cream, 
scoop half of it out, fill up the carton with whiskey, and have 
cocktails before dinner, [laughs] We'd come in and everybody 
would laugh; it was obvious that we were feeling pretty good. 
We played volleyball with a medicine ball to keep in condition. 
We practiced target shooting because medical officers could 
carry a pistol if we went to one of the islands. With the boat 
rocking back and forth, we hit the rail more than we did the 
target. 

We had a couple of scares. A submarine had sunk one of our 
hospital ships, and we had word a submarine was trailing us. 
We were headed back for San Francisco, and they turned us 
around and sent us a hundred miles off the coast of Tokyo 
soon after the atomic bombs had exploded. 

What was the idea 1 ? 

The Marines were going to invade Japan. The atomic bomb 
scared the Japanese so much they threw in the white flag 
right away. 



Hughes: Which is what was hoped. 



Maumenee: That's right. We would have had to invade and thousands of 
people would have been killed if it had not been for the bombs. 



49 



IV. PROFESSOR AT THE WILMER 
INSTITUTE, 1946-1948 



Hughes: Well, in 1946 you went back to the Wilmer as an associate 

professor.* Was there ever any thought in your mind of going 
somewhere else after the war? 

Maumenee: I had thought of possibly going back to Birmingham to try to 
pick up my father's practice, but it had been so long from '38 
until the war ended that there wasn't much practice left. So I 
went back to Wilmer with the idea that Fd stay a year or two 
and then go into private practice. 

Hughes: So you weren't thinking of an academic career? 

Maumenee: Well, I was fifty-fifty. I didn't know whether I'd rather stay 
in academics or whether Fd rather go into private practice. 
The pay at Hopkins was $3,000 a year. After I returned to 
Baltimore, I went to the meeting at the National Society for 
the Prevention of Blindness [now called Prevent Blindness 
America] and was kind of daydreaming and remembered this 
article I'd read of Peter Medawar's and decided to work on the 
immune reaction. 

I went to Jonas Friedenwald. I said, "Jonas, look, Fm really 
bored to death here. Fm not doing anything. I'm just seeing a 
few patients, and it's terrible." He said, "Ed, let me tell you 
something. You make up your mind what you want to do and 
go do it, or somebody else will take up all your time and you 



Dr. Maumenee was an assistant professor at Wilmer from 1943 to 1946. 



50 

won't have any for yourself. Fll tell you what you do. You 
write the atlas on pathology.* That'll keep you busy." So I 
started working on that, and working in the lab. 

Hughes: How much pathology had you had at that point? 

Maumenee: We rotated through pathology for a period of three months, 
with Jonas Friedenwald. You did the rotation at night after 
seeing the patients, and you did all the eye pathology that 
came through the Wilmer. If you wanted to, you could go over 
to the pathology lab and continue to look at pathological 
specimens. I enjoyed pathology, so I would go over when Jonas 
was checking out the residents' reports on the specimens that 
had come in during the week. I guess Dick Green will tell you 
more about it than anybody.** 

Hughes: So you knew a fair amount of pathology. 

Maumenee: Well, I wouldn't be called an expert. I wouldn't be called a 

Lorenz Zimmerman or a Dick Green or a Norman Ashton or a 
Jonas Friedenwald, but I knew more than 90 percent of the 
ophthalmologists in the country. 

Jonas and I got along so well together; I just enjoyed him and 
admired him so much. If I have a mentor or father figure, he 
was it. I think he was the greatest guy I ever knew. 



Friedenwald JS, Wilder HC, Maumenee AE, et al. Ophthalmic Pathology. An Atlas and Textbook. 
Philadelphia: Saunders, 1952. 

Tapes of interviews recorded with W. Richard Green, MD, and others associated with Dr. 
Maumenee are on deposit at the Foundation of the American Academy of Ophthalmology. 



51 



V. CHAIRMAN, DIVISION OF 

OPHTHALMOLOGY, STANFORD 
MEDICAL SCHOOL, 1948-1955 



Offer of the Chairmanship 



Maumenee: It was interesting the way I was offered the job at Stanford. 
Emile Holman, a Hopkins graduate who became chairman of 
surgery at Stanford,* came to Baltimore to interview Jack 
Guyton about going to Stanford. Jack was the star who 
operated on Dr. Woods, and he was frequently invited as the 
guest lecturer at meetings, and he was brilliant. As an 
afterthought, Emile asked to see me. I didn't know who Emile 
Holman was, so I sent word to him that I was busy doing an 
experiment on rabbits, and if he wanted to see me he could 
come up to the fourth floor where I was working. That 
impressed him, because he'd done work on tissue 
transplantation. 

Hughes: He could have been offended. 

Maumenee: I know, but he was such a nice guy. 

I showed him what experiments I was doing on corneal 
transplants. Part of this experimentation was to demonstrate 
that the cells in the cornea, which were called keratocytes, 
were not specific cells but could be derived from macrophages 
from the bloodstream. These latter observations were done by 



For more on Holman and the history of Stanford Medical School before it moved to Palo Alto, see 
the oral history of Frank L. A. Gerbode: Pioneer of Cardiovascular Surgery. Regional Oral History 
Office, University of California, Berkeley, 1985. 



52 

freezing the cornea with a brass rod that had been dipped in 
absolute alcohol in which the temperature had been brought 
down to minus 78 degrees Centigrade with dry ice. The brass 
rod was then applied to the cornea, killing all the corneal cells 
in that area. Before the freezing, the animals had been given 
heavy injections of methylene blue intravenously so that most 
of the macrophages had phagocytized the dye. When the cells 
regenerated into the frozen area of the cornea, methylene blue 
could be seen in the cells that is, the new keratocytes thus 
showing the keratocytes were not specific cells but could 
be replaced by cells in the bloodstream. Later, people in 
microbiology and anatomy found that macrophages can 
convert into fibroblasts. Cells can convert depending 
on the media they're in. So when they grew into the 
mucopolysaccharide of the cornea, they became keratocytes 
and the cornea would clear. But I could tell where the 
cells came from because in the microscope I could see the 
methylene blue in them. 

Emile was very interested in all of that, so he practically 
offered me the job at Stanford on the spot. I said, Tin busy 
writing a book on pathology, so I can't come for a year." He 
said they'd wait. 

Hughes: Did Hans Barkan stay on as head of the division* for an extra 
year? 

Maumenee: Barkan stayed on until I got there. 

Hughes: Barkan didn't have much say in who was his successor? 

Maumenee: That's true in practically every school. They don't put the 
chairman of the department on the search committee to 
choose his successor. Many schools don't even have an 
ophthalmologist on the committee. 

Hughes: What's the thinking there? 

Maumenee: I don't know. They think that the ophthalmologist may have 
a friend who is a candidate for the position and be prejudiced 
in his favor. The committee reads all your publications and 
interviews people about how you administered things and 
how your students did and how you handled your department. 
It's much easier to become a chairman if you go away, like 
Morton Goldberg did, and develop a good department than it 

The Division of Ophthalmology at Stanford did not become a department until 1959 when it 
became a part of the Pacific Medical Center after Stanford moved its medical school to Palo Alto. 
For more on this subject, see the oral history in this series with Dohrmann K. Pischel. 



53 



is if you stay at Hopkins, because everybody knows you and 
all your faults, and doesn't want to take a chance on you. So 
they practically always take somebody from the outside. 
Besides, that stops inbreeding. 

I had to borrow $5,000 from my mother for the move to San 
Francisco. Dohrmann Pischel was so wonderful; he let me 
stay in his house for the summer months when I got there in 
July, because they went to their summer place. It gave me an 
opportunity to find an apartment and get settled. 



Were you the only one considered for the position at Stanford? 
I don't know; they don't tell you. 



Hughes: 

Maumenee: 

Hughes: You immediately thought Stanford was a good thing to do? 

Maumenee: 



I accepted it right away. I think I talked to Dr. Woods and Dr. 
Friedenwald, and they thought it would be a good experience 
for me. 



Hughes: You were very young to be head of a division. 

Maumenee: My birthday is September 19, 1913. I was offered the job in 

1947, so I was thirty-three. But I did not go until July of 

1948, so I was thirty-four until September 19. I didn't know 
California and thought it would be nice to live there. I 
decided to go out and try it, and see if I liked academic life. 



Hughes: 



Changing Procedures in the Division 

Did you go with the idea that you might make your career at 
Stanford? 



Maumenee: I was planning to stay there. I enjoyed it so much because, as 
I say, there was just so much I could tell them. None of the 
ophthalmologists at Stanford had had any experience in 
pathology. They didn't know any pathology at all. They were 
still operating in the old Viennese style from down below 
instead of up at the head of the table. 

Hughes: Why did the Viennese operate that way? 

Maumenee: They thought they could make a better section with the knife. 
They opened the eye with the knife. 



54 

Hughes: Where were they placed? 

Maumenee: They would sit at the operating table on the patient's right 
side at about the level of his shoulders. 

Hughes: Dr. Bettman told me that the tradition at Stanford before 
you came was for the surgeon to sit on the patient's right, 
regardless of which eye was being operated.* 

Maumenee: I made them sit at the head of the table so they could use 
either hand freely. 

Hughes: Another thing he said another Viennese tradition was that 
you didn't argue with the professor. The professor's word was 
law. 

Maumenee: That's right. 

Hughes: You changed that as well. 

Maumenee: That's right. Stanford had [Karl D.] Lindner come out from 
Vienna. Lindner made some remarks that some of the 
younger people didn't agree with, so they asked him why he 
thought that was so. Lindner said, "It's so because I said it is 
so." [laughter] I changed that. I got them to argue with me. 
I started the Monday conferences that became popular. 

Hughes: Tell me how the conferences worked at Stanford. 

Maumenee: I told the residents and participating ophthalmologists to 

bring their most interesting patients in, and told all the staff 
to come to the meeting on Monday mornings. We'd bring in 
the tough cases and look at them under the slit lamp. We'd 
discuss them and the treatment. It wasn't long before we had 
only standing room in the lecture room. Everybody in town 
and out of town, from Oakland and whatnot, came to the 
Monday conferences. 

Hughes: Was the resident given responsibility to work up the cases? 

Maumenee: We didn't have the senior residency system there. We just 

had three-year residents. They did work the patients up, yes, 
or the doctor could bring his own patient in. Many of the 
doctors who had patients they couldn't diagnose or handle 
would present them, and we would discuss them and tell 
them what to do. So they got a free consultation. 



Interview with Jerome W. Bettman Sr., MD, May 2, 1990. 



55 

At Stanford, I didn't have the choice of residents that I had at 
Hopkins. I primarily had people who wanted to live on the 
West Coast. They were smart and they were good, but they 
weren't nearly the caliber of the people who applied at 
Hopkins. I got Art Jampolsky to start a lab in strabismus. I 
got Frank Winter to start in pathology. I got several other 
residents to start research projects. 

Hughes: Research was new for Stanford, was it not? 
Maumenee: For the eye department anyway. 

Hughes: Both Dr. Pischel and Dr. Bettman are older than you. Had 
they been considered to head the division? 

Maumenee: I'm sure Dr. Pischel thought that he was going to get the job. 
Hughes: And of course he did, eventually. 

Maumenee: He did. He was such a gentleman. He always helped me as 
much as he possibly could. He had a big private practice in 
San Francisco, and I think he really enjoyed that more than 
having to teach ophthalmology. 

Hughes: He told me in the interviews that he hated administration* 

Maumenee: Yes. Jerry Bettman, I think, would have loved to have the job. 

They were all cooperative. I didn't have any feuds with any 
of them. In the first place, I wouldn't see any patient unless 
he was referred to me. I didn't want a refraction practice; I 
wanted a referral practice. So the first year, my secretary 
made more than I made, [laughs] Nobody referred patients. 
But after the Monday conferences got under way, then people 
began to refer patients, and it just snowballed until by the 
time I left I was doing twelve operations in the morning and 
had a very large practice. 

Hughes: Was there any resentment? You could have been looked upon 
as a young upstart from Hopkins turning things topsy-turvy. 

Maumenee: I think Fred Cordes was the only person who got furious 

with me. He invited Duke-Elder over to a conference. They 
brought in a patient with a tumor of the iris and the ciliary 
body, and they were all calling it tuberculoma. I looked at it 
and said, "That's a necrotic melanoma. It's not an infection at 



* See the oral history in this series with Dr. Pischel, p. 101. 



56 



all." Duke-Elder argued about it being a tuberculoma, and I 
argued with him. That irritated Cordes no end, that I would 
speak up to the great Duke-Elder [laughs] and not say, "Yes, 
sir," like they did in Vienna. Then when Jonas stayed with 
me instead of staying at the Bohemian Club, Cordes really got 
furious. 



Stanford Faculty Members 



Hughes: Did it concern you that ophthalmology at Stanford was a 
division rather than a department? 

Maumenee: Not really. 

Art Bloomfield was head of medicine, and he was trained at 
Hopkins too. He was one of Jonas Friedenwald's very good 
friends. He was a very brilliant, very capable guy. Becoming 
very good friends with the head of surgery and the head of 
medicine helped me tremendously with the faculty in general. 

Emile [Holman] said right away, "I don't know a thing about 
ophthalmology, not the first thing. Don't you come up here 
asking me any questions. If you want to do something, you go 
ahead and do it. Ill back you up. If it comes to finances, Fll 
have to get into the decision, but if it comes to running the 
department, you run it the way you want to run it." When I 
said, "Look, I want to run the eye pathology," the chief of 
pathology said, "No, we're not going to give up the eye 
pathology; the next thing you know, you'll have to have an 
ob/gyn pathologist and an orthopedic pathologist, and it will 
ruin our whole department. We won't give it up." Emile went 
up and talked to Him and got him to give it up. So we started 
the eye pathology department. 

Hughes: What comparison can you make between ophthalmology as 
you knew it at Wilmer and what you found when you arrived 
at Stanford? 

Maumenee: I think the principal contrast was that the staff at Hopkins 
was much more interested in basic science and in basic 
disease. It was certainly a better medical school than 
Stanford, and had really great people in every department. 
Stanford had a much better university than Hopkins. There 
was a general surgeon, Victor Richards, about my age, who 
was brilliant. 

Hughes: They were clinically oriented. 



57 



Maumenee: Yes. Nobody had a lab. Nobody had a grant from the 
National Institutes of Health. I had the first grant at 
Stanford from the National Institutes of Health. 

Hughes: Was NIH the major support for your research at Stanford? 

Maumenee: Yes. Money was pouring into the National Institutes of 
Health. They would call up and say, "Can't you think of a 
reason to ask for money? We've got all this money left over in 
the budget, and if we don't spend it, we won't get it next year." 
The staff at the Institute of Neurological Diseases and 
Blindness would call me and say, "Just write any kind of 
research grant, but get it in." 

We got money for animals and equipment. That's why we did 
all the cornea! transplant work. Nobody else had a lab for 
surgical research. 

Hughes: Did you get people at Stanford interested in research? 

Maumenee: I wouldn't say we became a Hopkins. Certainly the people in 
basic science were doing some research work. It wasn't a total 
void, but the clinicians were much more interested in clinical 
work and didn't go into the laboratory at all. 

Hughes: Were there any full-time departments at Stanford then? 

Maumenee: The clinical departments and divisions were all geographic 

full time. I was paid $5,000 a year and was allowed two days 
a week practice. 

Hughes : That was pretty standard ? 

Maumenee: Yes. It was great fun. I probably enjoyed that stage of my life 
more than any other. 

Hughes: Why do you say that? 

Maumenee: First of all, I was young and energetic. I could bring so 

many new things to the community that other people didn't 
know anything about. It's a big ego booster to tell great, 
outstanding people like Otto Barkan that he was all wrong. 



58 



San Francisco Ophthalmologists 



Maumenee: Otto Barkan's reputation in surgery for congenital glaucoma 
was such that patients were sent to him from all over the 
world, because he was getting great results. We got quite a 
large number of patients with congenital glaucoma because 
they didn't know the difference between Hans Barkan and 
Otto Barkan. I had quite a number of congenital glaucoma 
cases, and that's how I got interested in it. 

Hughes: Where was Otto Barkan? 

Maumenee: He was at St. Mary's Hospital [in San Francisco]. 

Hughes: He wasn't a presence any longer at Stanford? 

Maumenee: Otto Barkan never was. Hans was at Stanford, but Hans 
never did goniotomies. 

Hughes: What was Hans Barkan doing while you were head of the 
division? 

Maumenee: He saw private patients. He did practically no operations. 
Hughes: He didn't enter into any of the administrative activities? 

Maumenee: No. He had an office across the street and he never came 
over. I never saw him unless I went over to his office. 

Bob Shaffer and I were the best of friends. We played tennis 
together, and I stayed in his summer home when he went out 
of town. I have great respect for Bob. 

Hughes: Was he at Stanford? 

Maumenee: No, he was at the University of California. 

Mike Hogan was one of my best friends, and I knew Sam 
Kimura and Lee Garron and the whole group at the 
University of California. I used to tease them all the time 
that I was delighted they could do all the refractions; Fd do 
all the surgery, [laughter] 

Hughes: Did you have any contact with Phil Thygeson in the Proctor 
Foundation? 

Maumenee: Not too much. I knew the other people on the University of 
California staff better than I knew Phil. I respected what 



59 

he'd done. He had a fantastic knowledge of external diseases; 
he knew them all and was very good in diagnosis and 
treatment. But for someone as capable as he and who was 
primarily a microbiologist, he made few major breakthroughs 
in antibiotics or culturing the trachoma agent or the 
adenoviruses. But he wrote extremely clearly, and several 
external diseases are named for him I felt he was essentially 
a basic scientist and not primarily an ophthalmologist. I don't 
know if he saw patients except for external disease. 

Hughes: Dr. Thygeson had a private practice in San Jose. 

Maumenee: Well, I didn't know much about his practice except that it was 
primarily external disease. I don't think he operated, did he? 

Hughes: He didn't like surgery. 

Maumenee: I know at Columbia he was strictly in the lab, so he limited 
himself to external disease. 

Hughes: Did you regularly attend the meetings of the Pacific Coast 
Oto-Ophthalmological Society? 

Maumenee: Yes, I always went to them. I didn't have the money to go 
East to the AOS [American Ophthalmological Society], so I 
didn't initially join the AOS. I went to the Academy and gave 
papers at the Academy, and I gave papers at the ophthalmic 
section of the AMA, too. 

Hughes: The university wouldn't pay your way to those meetings? 

Maumenee: No, I had to pay my own way. 

Hughes: What was the quality of the papers at the Pacific Coast? 

Maumenee: They were pretty good. They were primarily clinical; there 
was not very much basic work being done. 

Hughes: Were you involved in the debate over whether Stanford 
Medical School should move to Palo Alto? 

Maumenee: Not really. 

Hughes: I know the move happened after you left,* but I thought maybe 
there was preliminary talk. 



Stanford Medical School moved in 1959 to Palo Alto, where the general campus is located. 



60 

Maumenee: And I was ready to move down there. Palo Alto is a wonderful 
place to live, and I was looking forward to moving down there. 



The Eye Bank 



Hughes: You started an eye bank while you were at Stanford. Was it 
the first one on the West Coast? 

Maumenee: No, there were several others. There were people running 
them out of their homes and charging for the eyes. There 
were no rules and regulations. It was terrible. 

Hughes: When you say an eye bank, you mean strictly to store material? 

Maumenee: No. It's really a misnomer because you could only keep the 

eyes for twelve hours. If they could get permission to take the 
eyes, the residents would go down at twelve or one o'clock at 
night and enucleate the eyes from the cadaver and bring them 
up and we'd operate. 

Hughes: So there was really no banking involved at all. 

Maumenee: No, there was no banking. We had a secretary who kept track 
of where the eyes came from and who got them. Then the 
eyes went to pathology and we tracked them down through 
that. We looked at the eyes in pathology. 

Hughes: Were these eyes being used strictly for transplantation? 
Maumenee: Strictly for transplantation. 
Hughes: So you weren't doing any pathology. 

Maumenee: Oh yes, we would then put them in formaldehyde and send 
them up to pathology lab. But by the time they got there, 
frequently there was a lot of autolysis in the retina and in the 
other tissues in the eye, so it made it hard to interpret. 

Hughes: Was the eye bank a new concept? 

Maumenee: The first eye bank had been started by Townley Paton in 

New York City. It was before I was a resident, because during 
my residency we got eyes through the eye bank in Baltimore 
and did corneal transplants. Townley Paton was criticized 
because some people did not think that cadaver tissues should 
be used. 



Hughes: 



61 

There may have been an eye bank at Stanford before I 
arrived. I organized it with my residents going out to get the 
eyes. It really wasn't a new concept to have an eye bank; that 
was something that was already being done. [Vladimir P.] 
Filatov was the first to use cadaver eyes to perform 
transplants. There is a large eye institute in Odessa named 
for him. 

I told potential donors that the eye is one of the few places in 
the body where you can't take a biopsy. Therefore, there 
were many diseases that we didn't understand, because we 
only saw the end stage of the disease. So when people had 
glaucoma or other serious problems, I would tell them to leave 
their eyes to the eye bank. 

Presumably, since you felt the need to write a letter to the 
American Journal of Ophthalmology, you felt eye pathology 
banks needed some encouragement.* 



Maumenee: That's right. 



Eye Pathology 



Hughes: 



Eye banks relate to another interest of yours: correlation of the 
clinical appearance with the histopathological picture. 



Maumenee: That's right. That was really my major contribution in 

ophthalmology. I correlated what I saw clinically with what 
would be seen in pathology under the microscope. I was 
asked to lecture in many places because I knew the pathology 
of the lesion, and other people hadn't had any training in 
pathology and didn't know what it was. They would look in 
with the ophthalmoscope and imagine it was this or that, but 
they really wouldn't know for sure until they'd looked at it 
under the microscope. So much research I did was because I'd 
done clinico-pathologic correlations. 

Even when I went to Stanford, I ran the pathology 
department. Frank Winter and then Horst Mueller took 
it over for a while, but I always went over and checked 
everything out. I taught pathology to each of the residents 
that went through Stanford. They did it all during the week, 
and then I'd go over on Saturday and we'd sit down and go 
over the specimens. 



Maumenee AE. Eye pathology banks. Am J Ophthalmol 1968; 65:628-29. 



62 



Hughes: 

Maumenee: 

Hughes: 

Maumenee: 

Hughes: 



A veterinarian from Oakland, Seymour Roberts, used to come 
over every Saturday to our sessions on eye pathology. He 
became the first ophthalmic veterinarian. Then he began to 
bring dog eyes with pathology that he didn't understand. So 
we got to see that animals could have some of the same 
diseases that humans have. 

And all this time you were underlining the importance of . . . 

Clinico-pathological correlations. 

So all your residents were imbued with that idea. 

That's right. 

Dr. Patz told me today that correlation was one of your major 
contributions in macular disease, that people prior to you had 
tried to classify macular disease, but not on the basis of actual 
histological changes.* 



Maumenee: That's right. I did the first classification on a pathological 
basis. 



Treating Epithelial Invasions** 



Hughes: You wrote a paper entitled "Epithelial Invasion of the Anterior 
Chamber," which was published in 1956. *** One of the points 
that you made was to differentiate among different lesions 
that resemble epithelial invasion in the anterior chamber. 
Please explain what they were and why it was important to 
differentiate among them. 

Maumenee: There are three things that can happen if your wound is not 
tightly closed after a cataract extraction or after an injury 
or corneal transplant or some other type of situation that 
causes the anterior chamber to be sliced open. The first is an 
epithelial ingrowth or downgrowth. There, the epithelium of 
the conjunctiva grows into the opening in the scleral wound 
and onto the back surface of the cornea and the anterior and 
posterior surfaces of the iris. It covers Schlemm's canal, and 
eventually, eyes with this condition are almost always totally 

* Interview with Arnall Patz, MD, May 15, 1991. 

** The discussion of epithelial invasions was recorded in Interview 3, May 16, 1991, and the 
transcript inserted here for better continuity. 

*** Maumenee AE, Shannon CR. Epithelial invasion of the anterior chamber. Am J Ophthalmol 
1956; 4 1:929-42. 



63 

lost. They go blind, they become painful, and get high 
pressures because Schlemm's canal is closed off. In the 
past, everyone had always said, "Never touch an epithelial 
ingrowth because you'll stimulate it to grow more rapidly and 
the patient's eye will be lost." 

The second type of problem is when the epithelium grows in 
through the wound and instead of forming a sheet that grows 
onto the back of the cornea, it forms a cyst. Those cysts grow 
very slowly and may take twenty-five years or so before they 
really bother the patient that is, grow so large they fill the 
anterior chamber and cover the pupil. But you never know 
whether they're going to grow very rapidly or very slowly. 
So if you see an epithelial cyst, it's much better if you take it 
out. The only difficulty is that if you don't take all of the 
epithelium out, you can convert it into an epithelial ingrowth. 
Of course, then you have a greater problem. 

The final type is an epithelial pearl. These are very, very 
rare. That is where a little piece of epithelium falls off during 
an operation, is washed into the anterior chamber, and forms 
a little clump of epithelial cells that don't cause any trouble. 

I wrote the paper primarily because I saw a patient who had 
been operated on elsewhere. About a quarter of his cornea 
was covered with epithelium that I could see under the slit 
lamp. I didn't see anything on the surface of his iris. Sol 
opened his eye again and took a curette and scraped all of the 
epithelium off. When you do that, you almost always get 
some edema of the cornea above where you scraped off the 
cells from the back of the cornea. But that can scar down and 
not bother the patient and not progress. This patient kept his 
20-20 vision, and over the period of time that I followed Him, 
he never progressed and the lesion never recurred. I reported 
the case because it was the first time anyone had ever cured 
an epithelial ingrowth. 

There had been suggestions that radiation should be given to 
kill the epithelium. Also, people put various chemicals into 
the eye to try to kill the epithelium, but they damaged the 
endothelium also, so that was no good. Patients were referred 
to me from all over the country and Europe. By the time most 
of the patients were referred to me, epithelium covered half of 
the cornea and also the iris. 

Now, when I was at Walter Reed [Hospital], it occurred to me 
that using the xenon light for photocoagulation, and later the 
laser, we could burn the surface of the iris, and if there was 
epithelium there, it turned white just like your blouse. If it 



64 

was stroma and you can have a stroma downgrowth, 
that is, fibroblasts, that looks very much like an epithelial 
downgrowth it turned brown. So this was a good diagnostic 
method. 

I wrote this up in the second paper on this subject, written in 
'64, when I described that technique as a method of diagnosis 
and gave a summary of the number of cases that I had treated 
and the results.* About 25 percent of the patients came out 
with good visual acuity. About 25 percent of them remained 
about the same. In another 25 percent, the cornea went 
totally cloudy because enough of the epithelium had been 
removed that the cornea became opaque. On some of those 
patients I did a cornea! transplant, and they could see again. 
In the latter 25 percent, the epithelium continued to advance, 
and the eye was lost. 

Hughes: Did you have a photocoagulator at Hopkins? 

Maumenee: Yes, but I didn't have any cases of epithelial downgrowth. 
Fortunately, in my years of practice I never had a single 
epithelial downgrowth in the patients on whom I had done 
the primary operation. 

Hughes: Was this more of a problem in the old days when sutures were 
less fine? 

Maumenee: Yes, and when sutures weren't used, then the incision 

frequently would open up. Georgiana Theobold wrote a long 
article about epithelial ingrowth and the percentage of 
patients who had this. Ken Swan from Oregon wrote an 
article about using a limbal-based versus a fornix-based 
conjunctival flap. A fornix-based flap means that you cut the 
conjunctiva right at the limbus and dissect it back up. Then 
when you close the wound, the epithelium is there to grow 
into the wound, because it's been cut and the wound is open 
if it's not closed tightly. They had a fairly high percentage 
of epithelial ingrowth from that. When they switched to a 
limbal-based conjunctival flap that is, making the incision 
in the conjunctiva several millimeters above the limbus and 
then covering the sutures with the conjunctival flap the 
occurrence of epithelial downgrowths practically disappeared. 

Hughes: Anything more to say on this subject? 



Maumenee AE. Treatment of epithelial downgrowth and intraocular fistula following cataract 
extraction. Trans Am Ophthalmol Soc 1964; 62:153-66. 



65 

Maumenee: I wish we had a better method of doing it. I wish that people 
would refer patients early, because the early cases are the 
ones that are really successful as far as the patients' vision is 
concerned. 

Hughes: I'm surprised that the patients didn't complain sooner. 

Maumenee: Oh, the patients complained and went back to the doctor, 
but the condition is rare enough that doctors didn't always 
recognize it. Even when they recognized it, they hoped that it 
was not an epithelial downgrowth and wouldn't do anything 
until they saw it grow. By the time it had grown down over 
half the cornea, then you had very little chance of taking all 
the epithelium off and not having the cornea become cloudy. 

Hughes: One of the techniques you tried it's mentioned in the 1964 
paper is the use of the cryoprobe. How well did it work? 

Maumenee: It worked quite well. It even worked better than curettage. 
They developed mechanical cryoprobes that could take the 
temperature down much lower than I could take the brass 
rod, which I stuck into dry ice and absolute alcohol. If you 
injected the anterior chamber with air so that the aqueous 
wouldn't carry the cold away, you could actually see the 
cornea when you were freezing it. It only took a second for 
the whole thickness of the cornea and the epithelium to 
freeze. You could see the border of the epithelium on the back 
of the cornea, where it froze. If you came around the next day, 
you could see the epithelium had fallen off into the anterior 
chamber. Freezing and refreezing it would kill the cells. 
Then at other times we would open the eye and actually 
freeze it from the inside rather than curetting it, because it 
was more accurate. Because you'd have an ice ball, or frozen 
area, on the back of the cornea, you could tell just where you'd 
frozen, and you could put the probe right next to that ice ball 
to freeze the area immediately adjacent. 

Hughes: Weren't you skeptical about the use of the cryoprobe for 
extracting the tens'? 

Maumenee: Yes. Til start by telling you about the cryoprobe. Dr. Walter 
Kornblueth came over from Israel and worked with me 
in 1947 when I was at Hopkins. When I moved to San 
Francisco, he moved out and worked with me for about three 
years. We were trying to find out what keratocytes were. 
Were they specific cells from the stroma of the cornea, or 



66 



were they just any kind of cell that in the medium of the 
mucopolysaccharide in the cornea would become keratocytes? 

I took dry ice and put it in absolute alcohol, and then would 
chill a probe that was made like a cone and was about five 
millimeters in diameter at the tip and flat. We would freeze a 
rabbit cornea all the way through, including the endothelium. 
We did a lot of studies on that. We had also frozen the nerves 
and could watch their regeneration into the cornea.* 

I tried to treat a couple of patients with glaucoma by freezing 
the ciliary body and killing it. But the cold was not great 
enough to penetrate through to kill the ciliary body, and the 
technique didn't work. [Tadeusz] Krwawicz from Poland used 
a bronze probe in the same way we did, dried off the surface of 
the lens after opening the eye, and touched the lens with the 
cold probe. The probe would stick to the lens, and you could 
pull the lens out that way. It was less likely to break the 
capsule. 

Then various types of mechanical probes were invented, 
including one by S. P. Amoils in South Africa and one that 
[Charles] Kelman invented. Several probes used freon and 
other gases that would take the temperature way down. In a 
paper at the American Ophthalmological Society, somebody 
presented work on the use of the cryoprobe for cataract 
extraction. I said, That may work all right, but I break so 
few capsules using a good pair of capsular forceps that I don't 
think that the probe is really necessary." I was wrong again. 
Since I hadn't thought of the idea and since I was doing 
all right with forceps, I didn't see any reason for taking a 
chance of having the cryoprobe touch the back of the corneal 
endothelium and damage it. After the development of smaller 
probes, I found the cryoprobe easier to use than forceps, and I 
switched over. So the cryoprobe pretty much became the 
routine method of cataract extraction. 



Maumenee AE, Kornbleuth W. Regeneration of the corneal stromal cells. I. Technique for 

destruction of corneal corpuscle by application of solidified (frozen) carbon dioxide. Am J 

Ophthalmol 1948; 31:699-702. 

Maumenee AE, Kornbleuth W. Regeneration of the corneal stromal cells. II. Review of literature 

and histologic study. Am J Ophthalmol 1949; 32:1051-64. 

Kornbleuth W, Maumenee AE, Crowell JE. Regeneration of nerves in experimental corneal grafts 

in rabbits. Clinical and histologic study. Am J Ophthalmol 1949; 32:651-59. 



67 



Fluorescein Angiography* 



Hughes: Please tell me how you got into fluorescein angiography. 

Maumenee: The fluorescein angiography came about because I had a 

patient who was a policeman from Sacramento. He was sent 
to me with a diagnosis of melanoma of the choroid. It didn't 
look like a typical melanoma, but it was an elevated lesion 
and I had to agree that it was probably a melanoma. The 
people in Sacramento enucleated his eye and sent the 
pathology to me. 

As I mentioned, I started the eye pathology laboratory at 
Stanford. I was the only person at Stanford who had an NIH 
grant for research, because the dean and the trustees thought 
it would be insulting to the Stanfords if they accepted money 
for the school from anybody except them. 

Hughes: An amazing philosophy, [laughter] 

Maumenee: Anyway, this case really upset me because the policeman then 
lost his job because he only had one eye. 

The next patient who came along was a Mr. Granger, who was 
a truck driver. He had a lesion that looked very much like the 
first patient's, whose name I've forgotten. I remembered that 
[Hans] Goldmann was using intravenous fluorescein to study 
the flow of aqueous into the eye. He would inject it into the 
vein and then watch it come into the anterior chamber. Since 
it was innocuous, I decided that I would use it. I used the slit 
lamp with a cobalt blue filter, which activated the fluorescein 
to make it fluoresce, and injected Mr. Granger with this. 
When I did, the whole tumor lit up like a sunburst. So I knew 
it was a hemangioma. He is the first person who ever had a 
pre-enucleation diagnosis of a hemangioma, and he was the 
first person ever to be treated for a hemangioma. I used 
transscleral diathermy to obliterate the tumor because we 
didn't have photocoagulation at the time, and his vision 
returned to normal. I followed him for years, and he never 
had any further difficulty with it. 

Hughes: How did you determine the dose of fluorescein? 

Maumenee: It came in an ampule of 10 percent fluorescein, and I just 
pulled it up in a syringe and injected it. 



* The discussion of fluorescein angiography was recorded in Interview 5, October 14, 1991. 



68 

Hughes: Is that what Goldmann had been doing too? 

Maumenee: That's what he had been doing. Unfortunately, it had some 
impurities in it, and the patients frequently would have 
projectile vomiting and a cold sweat and whatnot. With 
malpractice being what it was with [the lawyer Melvin] Belli 
in California, I would get into a cold sweat myself, thinking 
this patient was going to die. 

Hughes: Malpractice was a problem even in that era? 

Maumenee: This was about 1954. Belli was really terrible. 

Hughes: Did you use fluorescein on any other patients at Stanford? 

Maumenee: We did. I presented Granger, and we used it on a number of 
patients. Milton Flocks, who was a resident at the Veterans 
Hospital, which was supervised half by Stanford and half by 
the University of California, came to all of our conferences. 
Jerry Bettman, a member of the Stanford staff, was very 
interested in retinal- vascular flow. Milt worked with Jerry 
and injected fluorescein intravenously in animals and did 
fluorescein cinematography as the retinal vessels fluoresced. 
Milt published this work in 1959, two years before Novotny 
and Alvis published their paper.* 

Hughes: Who are they? 

Maumenee: [H. R.] Novotny and [D. L.] Alvis were two medical students 
at the University of Indiana who were working under John B. 
Hickman, professor of medicine. He suggested that they 
use fluorescein to look at the vessels. He was doing a lot of 
studies with various dyes. They took pictures, and their 
pictures were so beautiful they were turned in to Derrick 
Vail for the AJO [American Journal of Ophthalmology], and 
he turned the paper down, saying that this technique was 
insignificant. So they published it in Circulation. They have 
been given credit for starting fluorescein angiography because 
their picture of fluorescein in the retinal vessels was good, 
and people overlooked the papers by Flocks and me because 
we did not have the word fluorescein in the title. 



Flocks M, Miller J, Chao P. Retinal circulation time with the aid of fundus cinephotography. Am 
J Ophthalmol 1959; 48:3-6. 

Novotny HE, Alvis DL. A method of photographing fluorescence in circulating blood in the human 
retina. Circulation 1961; 24:82-86. 



69 



Hughes: 

Maumenee: 

Hughes: 



Actually, earlier, in 1959, before Novotny and Alvis published 
their paper, I gave a paper with Angus MacLean in which we 
described some five or six patients that we had diagnosed 
using fluorescein angiography.* We had studied macular 
changes extensively by injecting fluorescein and looking with 
an indirect ophthalmoscope with a cobalt blue filter, but we 
didn't have a photographer who could take good pictures. 

And you didn't publish right away either. 
I didn't publish until 1959. 

I looked at the case reports in that paper, and you mentioned 
the use of fluorescein angiography in only two patients, on 
Granger in 1955, and on a Hopkins patient in 1958. 



Maumenee: We couldn't get good fluorescein pictures at Hopkins, so we 
didn't have pictures in the paper. We described the use of 
fluorescein in the diagnosis of fundus pathology. 

Hughes: Who popularized the technique ? 

Maumenee: Well, after Novotny and Alvis published their beautiful 
pictures and the description of the filters they used 
various people developed various filters to enhance the 
fluorescence it became very popular. When Don Gass, who 
was a resident of mine, saw the results with various macular 
lesions, he became very interested, and so did Lawton Smith. 
Lawton then went to Duke where he did some work, but Don 
Gass did more work than anyone else. 

Don was one of the brightest residents I ever had. He was 
superb and meticulous in indexing everything he ever read 
and every case he had ever seen. So he did the fluorescein 
angiography and made the clinical pathologic correlations 
later. A number of these patients were elderly, and he got 
them to sign up [to donate their eyes], and he got their eyes 
and looked at them under the microscope and correlated what 
he found with the fluorescein. 

Hughes: One of the pluses of fluorescein angiography was that you 
could draw that correlation? 

Maumenee: Right. 



MacLean AL, Maumenee AE. Hemangiomaofthechoroid. Trans Am Ophthalmol Soc 1959; 
57:171-94. 



70 



Macular Degeneration 



Maumenee: At Stanford and in the Transactions of the Pacific Coast 
Oto-Ophthalmological Society, I classified macular 
degeneration for the first time.* I made some mistakes, 
but a good bit of the classification turned out to be correct. 
But it's seldom quoted anywhere because the journal has such 
a limited circulation and I never published it in the AJO or 
Archives. 

Then, at the annual meeting of the American Academy of 
Ophthalmology and Otolaryngology in about 1956, we had a 
symposium on complications of cataract surgery. I described 
the histopathology of what turned out to be cystoid macular 
edema.** As I look back at that slide now, it shows beautiful 
cystoid macular edema, but it also shows a serous detachment 
of the pigment epithelium. I was more interested in that, and 
so I called it a serous detachment of the pigment epithelium 
and did not bring attention to the cystoid changes. Don Gass 
brought attention to the cystoid changes in the retina. 

Hughes: Would you say it was a result of the fluorescein angiography 
that you became interested in macular disease? 

Maumenee: I became interested in it because nobody tried to differentiate 
different types of macular degeneration. I could see with the 
slit lamp that there was a serous detachment of sensory 
epithelium and a serous detachment of pigment epithelium. 
With the pigment epithelium detachment, you would get a 
hemorrhage, and that progressed to a disciform macular 
degeneration. *** 

Hughes: These were the subclassifications of macular degeneration? 

Maumenee: Right. 

Hughes: You were first to make those distinctions? 

Maumenee: Right. 



Maumenee AE. Serous and hemorrhagic disciform detachment of the macula. Trans Pacif Coast 
Oto-Ophthalmol Soc 1959; 40:139-60. 

** Maumenee AE. Symposium: Postoperative cataract complications, in. Epithelial invasion of the 
anterior chamber, retinal detachment, cornea] edema, anterior chamber hemorrhages, changes in 
the macula. Trans Am Acad Ophthalmol Otolaryngol 1957; 61:51-68. 

*** Maumenee AE. Clinical manifestations (macular diseases). Symposium: macular diseases. 
Trans Am. Acad Ophthalmol Otolaryngol 1965; 69:605-13. 

Maumenee AE. Pathogenesis (macular diseases). Symposium: macular diseases. Trans Am Acad 
Ophthalmol Otolaryngol 1965; 69:691-99. 



71 



Hughes: 
Maumenee: 

Hughes: 

Maumenee: 
Hughes: 



I don't know if I told you a Verhoeff story about a young boy 
whom I saw with Coats's disease. He also had a disciform 
degeneration of the macula. After many consultations, 
many people thought it was a retinoblastoma and suggested 
that his eye be removed. It was removed, and on histologic 
examination, it was a typical disciform degeneration fibrous 
tissue and whatnot from the bleeding under the macula. 
I presented this case at the Ophthalmic Pathology Club. 
Verhoeff told me that I was totally wrong and that this didn't 
have anything to do with what they called at that time senile 
disciform changes, as opposed to the hemorrhagic changes 
that they called juvenile. 

Verhoeff had actually described this condition a number of 
years earlier. The reference is in my article on macular 
degeneration.* He took the slide to his hotel that night 
and with Dave Cogan went over it. He came back to the 
Ophthalmic Pathology Club the next day and said he had 
gone over the slide thoroughly the night before, and that I 
was right and he was wrong: it was a typical disciform 
degeneration of the macular. 

/ didn't know that Verhoeff ever retracted, [laughter] 

That's the only time I ever heard him apologize and retract. 
So I was very puffed up and pleased. 

Dr. Green told me that one of the results of sharper 
differentiation of macular disease was a drop in the 
number of enucleations.** 

That's right. 

Was that because people were mixing up other conditions with 
melanoma? 



Maumenee: Yes. You see, there is a layer of pigment epithelium and 
then there is Bruch's membrane. As people get older, that 
membrane thickens and it also becomes calcified. Since the 
rods and cones are nourished by the choriocapillaris, which is 
in the choroid just outside of Bruch's membrane, blood vessels 
would try to get in to give nutrition to the rods and cones, and 
they would grow through these cracks in Bruch's membrane. 



Verhoeff FH, Grossman HP. Pathogenesis of disciform degeneration of the macula. Arch 
Ophthalmol 1937; 18:56 1-85. 

Interview with W. Richard Green, MD, May 17, 1990. 



72 



They would have very thin walls and they would hemorrhage, 
causing a black mass in the macular area. 

At that time, the thought was that you had to enucleate right 
away for any melanoma or the patient would die from it, 
because such a high percentage of patients died from true 
melanomas. So a number of eyes with hemorrhagic macular 
detachment were enucleated. That's why we have so much 
pathology on it, because of the mistaken diagnosis. 



Hughes: 



Treating Glaucoma with Goniotomy 

Dr. Bettman thought that you arrived from Wilmer with 
doubts about the value ofgoniotomy.* 



Maumenee: I did. 

Hughes: Can you tell me why? 

Maumenee: Because Fd never done any. [laughter] I didn't see how you 
could open Schlemm's canal and have it stay open. You could 
cut open a blood vessel in your arm and it would heal over; 
you wouldn't bleed to death. I couldn't see how you could 
open up a canal that had blood vessels going into it and have 
it stay patent. 

Karl Ascher had described the aqueous veins, and by 
compression around the eye, you could squeeze the eye and 
push the aqueous out, and the vessel, which had been red, 
would turn white with aqueous. You could actually push 
blood back into Schlemm's canal if you lowered the pressure 
in the eye enough. Then the pressure in the aqueous veins 
would be higher than in the aqueous, and you could see the 
blood flow into Schlemm's canal by looking at the anterior 
chamber angle through a special gonioscope contact lens. 

Hughes: Did goniotomy work ? 

Maumenee: It did work. 

Hughes: So were you eventually convinced? 

Maumenee: Oh, yes. 

Hughes: And you performed goniotomies ? 



Interview with Jerome W. Bettman Sr., MD, May 2, 1990. 



73 

Maumenee: Yes. I think I made the first movie of a goniotomy. 
Hughes: Where is it? 

Maumenee: Somebody stole it. 

I had a good friend, Cliff Bennett, whose father-in-law made a 
fortune during the war by making stepladders for the landing 
barges. I told Cliff's father-in-law that we needed a camera 
for taking movies of eye operations. So he let me buy the best 
Kodak movie camera that was available. We took all of our 
own movies during operations, because we didn't have a 
photographer. We also bought a fundus camera and took our 
own fundus pictures. Milton Flocks used the movie camera to 
record the first fluorescein angiography research. 

Hughes: Were goniotomies performed at Hopkins at that time? 

Maumenee: No. 

Hughes: When you went back, did you introduce it? 

Maumenee: Yes. 

Hughes: How were they treating glaucoma at Hopkins? 

Maumenee: They were doing just regular glaucoma filtering operations, 

trephines or iridencleisis. They didn't see very many patients 
with congenital glaucoma. These patients weren't being sent 
to Wilmer. 



Hughes: 



The Possibility of an Eye Institute on the 
Stanford Campus, Palo Alto 

Dr. Bettman thought that you had ideas about forming an eye 
institute in Palo Alto.* 



Maumenee: I did. I had a patient, Arthur Bailey, who was a multi- 
multi-millionaire. He was a very good friend of [W. Averell] 
Harriman and also a good friend of the head of the Chrysler 
Motor Company. He talked them into getting together $2 
million for me to build an eye institute when we moved to 
Palo Alto, if I'd come back to California. 

Hughes: This occurred after you had returned to Wilmer? 



Interview with Jerome W. Bettman ST., MD, May 2, 1990. 



74 

Maumenee: Yes. 

So Dean Alway came to Baltimore to my house, and we made 
arrangements for me to go back to Stanford. I was ready to go 
back because I had been making a lot more money out there. 
I figured that if they weren't going to let me do what I wanted 
to do at Wihner, I would go back and build my own institute 
in California. 

Hughes: This was shortly after you had returned to Hopkins? 

Maumenee: Yes. Then Wallace [Sterling], who was the president of 
Stanford, said that they couldn't do that because it would 
make ophthalmology better than any other department in the 
school. So the idea fell through, and I didn't get the eye 
hospital. 



Marriage (July 1949) and Children 

Hughes: The last question about the Stanford period concerns meeting 
your first wife [Anne Elizabeth Gunnis]. How did that come 
about? 

Maumenee: I went down to a meeting in Los Angeles, and I've forgotten 

how I got a date with her. We had a great time, and I enjoyed 
her very much. She had been married before, but she and her 
husband were separated. So she got a job in San Francisco 
and finally decided she'd been separated long enough. She 
went to Reno and got a divorce, and we got married. 

Hughes: What year ? 

Maumenee: July of 1949. 

Hughes: Do you have anything more to say about the Stanford period? 

Maumenee: We had two kids our daughter, Elizabeth [Libby], in April 
of 1950, and our son, Alfred Edward Maumenee III [Trip], in 
August 1951. He's married and has two children and lives in 
Mobile. 

Hughes: What about Libby ? 

Maumenee: Libby was a real liberal. She went to Bryn Mawr High 

School, and she was always a good student. She was accepted 
at Duke, and Duke is supposed to be the second most difficult 
co-ed school after Stanford to get into. 



75 

After graduating from college and working for a while, she 
was accepted at several law schools and decided to go to the 
University of Maryland. She worked for several judges while 
she was in law school, and then went to Annapolis where she 
joined the legal staff and became assistant attorney general in 
environmental protection for the state of Maryland. Finally 
she got fed up with the fact that most people in government 
didn't work hard enough, so she joined one of the leading law 
firms in Baltimore. 

My son, Trip, was also a late starter. He worked for a while 
and then went to night school at Hopkins, and competing 
with the graduate students he made a B+ average. He 
eventually went to work for my brother Rad, who was 
president of Alabama Drydocks. He's now project manager 
for the new company that bought Alabama Drydocks. 

I was working very hard in ophthalmology and did not spend 
enough time with either Trip or Libby. Also, their mother 
had multiple sclerosis during their teen years and was 
handicapped in her activities. She had two automobile 
accidents and then stopped driving, and then she couldn't 
walk, and then she was totally bedridden. Finally, I had to 
put her into a nursing home where she lived for fifteen years 
before she finally died the most miserable thing I've ever 
seen in my life. 



76 



77 



PHOTOGRAPHS 



78 





Mother 

Lulie Martha Raddiff Maumenee, 1950s 



Father 

Alfred Edward Maumenee I, ca. 1940 




Young A. Edward Maumenee 



79 




A. Edward Maumenee at about age 10, dressed as a page to the 
King of the Mardi Gras 




As a resident, performing chemical warfare studies with Jonas Friedenwald, ca. 
1942-1943 (Photo courtesy of W. Richard Green, MD) 



80 




Jonas Friedenwald, 1943 (Photo courtesy of 
W. Richard Green, MD) 



Caricature drawing of the young resident 



If ft 




Ophthalmic Pathology Club Meeting (named Verhoeff Society in 1964), early 1950s. John S. McGavic, 
John McLean, Helenor Wilder, A. Edward Maumenee, and Merrill J. Reeh. (Photo courtesy of W. Richard 
Green, MD) 



81 




A. Edward Maumenee and his residents 

Ronald E. Smith, C. P. Wilkinson, "The Prof," Michael Burg, and Walter J. Stark, 1969. 

(Photo courtesy of W. Richard Green, MD) 




Alan C. Woods, ca. late 1930s (Photo courtesy of W. Richard Green, MD) 



82 




Receiving the Research to Prevent Blindness Award from President Richard M. Nixon, 1971 
(Photo courtesy of W. Richard Green, MD) 



83 



A. Edward Maumenee fishing in Alaska, 
late 1950s 




President of the American Academy of Ophthalmology, 
1971 (Photo courtesy of W. Richard Green, MD) 



84 




Monday conferences at the Wilmer Ophthalmological Institute, 
ca. late 1960s (Photo courtesy of W. Richard Green, MD) 



SIMM 
PWMTIO Of BLINDNESS 




Speaking at the Jerusalem Seminar on the Prevention of Blindness, 1971 (Photo courtesy of W. 
Richard Green, MD) 



85 




Dedication of the Jules Stein Institute, ca. early 1960s 

Clockwise from left: Jules Stein, (front center), unidentified, Maumenee, 

and actor Hugh O'Brien (Photo courtesy of W. Richard Green, MD) 




Receiving an award for leadership in international ophthalmology from the Societas 
Ophthalmologica Mediterranean. 1987 



86 




Maumenee's children, 1993 

Front: Anne Elizabeth Maumenee Nelson 

Back: Alfred Edward Maumenee III, Niels Kim Maumenee, and Nicholas 

Radcliff Maumenee 

Portrait in background is of Maumenee's great-great-grandmother on the 

maternal side 



87 



VI. CHAIRMAN, WILMER 

OPHTHALMOLOGICAL INSTITUTE, 
1955-1979 



Return 



[Interview 3: May 16, 1990, Wilmer Ophthalmological 
Institute, Baltimore, Maryland] 

Hughes: The next step is to discuss your return to Wilmer as chairman 
of the department and director of the institute. Please sum up 
why you decided to come back. 

Maumenee: In San Francisco, I was on a geographic full-time basis in 

which Stanford University Hospital supplied me with a small 
examining room, and a small room for my administrative 
work, and another small room for my secretary, and one of the 
residents who would stay on after he finished his residency 
and work with me. Things were going well and my practice 
increased out there. I was doing quite well financially and 
also having a very interesting practice because it was strictly 
a referral practice of difficult cases. 

But I did not have the facilities for research or clinical work 
that they had back here at Hopkins. And I didn't have the 
collaboration with people like Jonas Friedenwald and Frank 
Walsh and Alan Woods and people in other parts of the 
medical school. At that time, Hopkins was small enough that 
you could go to practically anybody in the school with an idea, 
and if it was in their area, they would help you work it out. 
That just wasn't true at Stanford. I complained enough to 



88 



Hughes: 
Maumenee: 



Hughes: 
Maumenee: 



Hughes: 
Maumenee: 

Hughes: 
Maumenee: 

Hughes: 



Alan Woods and Jonas Friedenwald that when they asked me 
if I'd come back, I felt too embarrassed to turn the offer down, 
even though the salary was about a third of what I was 
making at Stanford. 

Were they considering anybody else? 

Yes, but I don't know who else was considered. Dr. Russell 
Nelson, who was the head of the hospital, told me I had been 
selected, and then I got a formal letter from Dr. [Lowell] Reed, 
who was president of the university, offering me the job. 

Do you think Friedenwald was considered? 

Friedenwald was not really interested in administration. He 
had a relatively small practice and didn't operate very much. 
So he wouldn't have stimulated a big clinical program. But I 
was excited because I thought I could stimulate the clinical 
part and he could run the research part. 

Policies Regarding Race and Sex 

Do you think the fact that Friedenwald was Jewish played any 
role? 

I'm sorry you asked that question, but it is true that at that 
time Hopkins was very prejudiced and they had never had a 
Jewish chairman of a department. 

How long did that policy hold? 

I really can't tell you who was the first Jewish professor of a 
department here. 

You were unusual at Hopkins in that you did appoint Jews 
senior resident when apparently that had not been the policy 
in the past. 



Maumenee: That's not 100 percent true, because Ben Rones under 

Wilmer, and Bernie Becker under Woods, were Jewish. I did 
not let religion come into my choice of people. I took them on 
the basis of their ability and basic scientific knowledge. I did 
find out if a person could get along with other people. If not, 
it would practically wreck the department. 



Hughes: So personality had to be a factor. 



89 



Maumenee: Personality was a factor in my decision of whom to ask to 
come on as a resident. 

Hughes: How did you feel about women? 

Maumenee: I felt that Hopkins was one place in the country that had 

basic research and the facilities to teach people how to teach 
and how to become chairmen of departments. As I mentioned 
to you, O'Brien in Iowa and Wilmer at Wilmer were the only 
full-time chairmen of eye departments. I felt Wilmer had 
an opportunity to improve ophthalmology throughout the 
country. So I chose people primarily on their ability. I felt 
that the females applying at the time were really not 
competitive scientifically or in class standing. In all 
probability, they were going to get married and have children 
like they should, and, running the family, wouldn't be able to 
spend full time as professors. So it wasn't until late in my 
chairmanship that I took on a couple of females. 

Hughes: Did they work out all right? 

Maumenee: They did, but they have never become chairpersons of 

university departments. As a matter of fact, I don't know 
even today of a female chairperson of a department of 
ophthalmology. There are some doing superb academic work, 
like Rene [Dr. Maumenee's ex-wife, Irene, an ophthalmologist 
at Wilmer], and either she or some of her fellows will probably 
become chairpersons in the near future. 

Debate over the Use of Profits from Clinical Care 

Hughes: I understand that there was a controversy over the terms of 
your acceptance of the chairmanship. 

Maumenee: When I accepted the chairmanship, I made an agreement 
with the dean, Phil Bard, and with the head of the hospital, 
Russ Nelson, that any funds that we made from taking care of 
clinical patients would remain in the Wilmer Institute for me 
to use to build up our research department and other things. 
I got my appointment sometime in the summer of 1955. 

Dr. Barry Wood, who had been an all-American football 
player at Harvard, was just a fantastic guy and was head 
of medicine at the University of Washington in St. Louis. 
He came back to Hopkins to be vice-president in charge of 
medicine, over the dean. He came back only on the basis that 
all money that came in from private practice would come to 



90 

his office and would then he distributed according to where 
he thought it ought to go. When I came back to the Wilmer 
meeting, which was in May [1955], and they told me that this 
was what was going to happen, I said to the dean and to the 
director of the hospital, "Okay, you tell me right now whether 
you are going to keep your agreement with me or with Barry 
Wood. I'm not coming back unless you keep your promise that 
the money comes to me. Fll just stay at Stanford because 
you've promised." Both Bard and Nelson said, "Our promise 
to you came first. So that's the way it's going to be." 

Then Barry told them, "Either you cave in and give me the 
money, or I won't accept the appointment." Here I was, young 
to be head of an eye department, and the great Barry Wood, 
whose appointment at Hopkins had been enthusiastically 
written about in the paper, was going to leave because I 
wouldn't agree. So Dr. Woods told me, "Get a lawyer and sue 
him! Take it to the board of trustees. They'll agree with you, 
because it was a promise on their part. They won't back 
down." I said, "Prof, if I do that, I'm going to be a failure here 
because people will blame me for making Barry Wood leave. 
And I'm just not going to do it." 

So I wrote Barry a letter saying, "Barry, this is my final say. I 
will not give you the money. I'll make the budget out so you 
won't get a penny." So I made the budget out every year so 
there wasn't a penny left over. When Tommy Turner became 
dean, he went along with what I wanted to do. He said, 
"Okay. You made the agreement, and you make the budget. 
If there's no profit, Barry Wood doesn't get anything." Every 
year we came out exactly to the penny, [laughter] So I never 
spent any of Wilmer's endowment money, because they 
couldn't make me spend it. When I turned the department 
over to Arnall Patz, I had $5 million in endowment funds. 

Hughes: That's quite a nest egg. 

Maumenee: See, I wanted to put up a new building for clinical work 

because we were so crowded by the time I was ready to retire. 
Patients came from all over the country, and they had to 
stand up in the halls; there were no seats for them. It was 
terrible. So I said, "We've just got to have more space," and 
they said, "Maybe the next professor won't want it." So I said, 
"Well, I'll take an early retirement." So at sixty-two I said, 
Til retire. You find somebody else." They didn't find anybody 
until I was sixty-five. 

Hughes: The new building was the Maumenee building? 



91 



Maumenee: I started an advisory board to help raise money. Arnall came 
in as chairman and was a fantastic money-raiser. He raised 
$12 million, I think, for the building. 



Departmental Fellowships 



Hughes: Dr. Miller spoke of your effort to attract medical students. * 

Sometimes the vehicle, and I think it applied in his case, was 
a summer fellowship in the Wilmer Institute. 

Maumenee: The Seeing Eye Foundation, which is a foundation for the 

Guide Dogs for the Blind, had a fairly large amount of money 
coming in. As a matter of fact, they had enough donations 
that they wrote to people and asked them not to give any 
more money; they had all they needed. They asked me to be 
on their scientific advisory committee, and when I accepted, 
they were looking for unique things to do. I said, "A unique 
thing to do would be to pick out medical students who have 
shown a real aptitude for research, and pay their way 
through medical school if they are willing to do research in 
ophthalmology in their spare time." I think we started out 
with $6,000 a year and cut it back to $3,000 a year. 

Hughes: It was more than just a summer fellowship. 

Maumenee: We had that program plus summer fellowships. We were a 
well-endowed department because of the money that Wihner 
had collected from his patients. There were about six 
fellowships available the Vanderbilt, the Harkness, the 
Copeland. There were many other fellowships available to 
which people had given $100,000 or something like that. The 
interest from these endowments was used to pay the fellows 
for their summer work. 

Hughes: The hope was to interest medical students to enter 
ophthalmology? 

Maumenee: That's right. It was to show them that good research work 
was going on in ophthalmology. 

I immediately began to look for people who were outstanding 
investigators. Dr. Maurice Langham was one of the key 
people on the faculty at the Institute of Ophthalmology 
[in London], so I offered him a job and he came over. 
Dr. [Arthur M.] Silverstein, who was at the Armed Forces 



Interview with Neil Miller, MD, May 16, 1990. 



92 



Hughes: 



Institute of Pathology in Bethesda, came on the faculty. 
Then I got Dr. John Bowling from Harvard to come down 
to do neuro-physiology. So we had people at Wilmer in 
immunology, physiology, glaucoma, and neurophysiology of 
the retina. The fellows and students could work under my 
direction or other members of the faculty. 

How successful were the fellowships in attracting students to 
ophthalmology ? 



Maumenee: Very. Some of our best house officers came out of that 

program, because after we had seen them work and gotten to 
know them for two years or so, we knew how good they were 
and took them. 



Rounds and Conferences 

Hughes: We haven't talked about the Thursday morning house staff 
rounds. 

Maumenee: Alan Woods made rounds of patients in the hospital on 

Monday and Thursday. Instead of making rounds on Monday, 
I started a conference. I still made rounds every Thursday on 
the patients. The saying was that if the residents had bad 
results, they hid the patients in the bathroom so I couldn't see 
them, [laughter] 

Hughes: Is there anything to say about Thursday morning rounds? 

Maumenee: Well, those were interesting because we would walk around 
and they'd show me each patient. I could tell how the chief 
resident was doing, because he was doing most of the surgery. 
If he was getting a lot of bad results, then I knew that he 
needed help. The younger residents didn't do too much of the 
surgery, but if they were getting bad results, I could tell. 
Students could also learn a lot, because I would ask questions 
of the first- and second-year house officers, so they had to be 
prepared to discuss the subject in front of their colleagues. 
They didn't want to look bad, so they studied pretty hard on 
the diseases they thought we would be presenting on rounds 
so they'd have an answer and be able to make some 
intelligent remarks. 

Hughes: Did the research staff, people like Arthur Siluerstein and 
Maurice Langham, attend rounds as well? 



93 



Maumenee: It's just like oil and water; it's very difficult to get the 

clinicians to mix with the basic scientists. I invited them, 
and they'd come and there wouldn't be anything particularly 
in their line of work, so they'd come maybe once or twice and 
never come back. So it didn't really work out, in spite of the 
fact that the Woods Building was built strictly for research 
and there were supposed to be no clinical patients there 
unless they were being studied. It didn't work; I thought 
there would be a complete mix of clinical and basic science 
people. 

As a matter of fact, we even tried to have a research residency 
where the person would take a year of clinical work and then 
take a year of research, and then he would take another year 
of clinical work and another year of research. It would take 
him a bit longer to get through. He wouldn't do surgery; he 
would just do medical ophthalmology. Only about three 
people took that curriculum, and they all felt they were 
second-rate ophthalmologists because they weren't doing 
surgery, so we stopped the program. 

Hughes: Do you know of instances where it has been possible to mix 
basic scientists and clinicians successfully? 

Maumenee: Oh, yes. Bernie Becker is an excellent example. He was a 
very excellent basic scientist and very excellent clinician. 
The residents who went on to take chairmanships were very 
familiar with research and clinical work. 

Hughes: Then there were the Saturday morning neuro-ophthalmology 
conferences, which I guess Frank Walsh started? 

Maumenee: Frank Walsh started them, and he loved them, and he never 
missed one if he was in town. They were very popular. The 
neurosurgeons and neurologists and many of the medical 
students and house officers came, and they were very, very, 
very good. 

Hughes: Did you usually attend? 

Maumenee: I attended some. I was never particularly interested in neuro- 
ophthalmology. I knew enough to do neuro-ophthalmology 
at Stanford because there was nobody else on the staff to do 
it, but I was more interested in the operative side of eye 
problems. Uveitis was something I could treat. Most of the 
neurological problems, if any treatment was done, was done 



by the neurosurgeon or the neurologist and really didn't fall 
into treatment by the ophthalmologist. 

Hughes: Dr. Green told me that at his clinical/ pathological conferences 
you frequently made controversial statements to get others to 
speak* 

Maumenee: That's right. I used to argue with Dick all the time. 
Hughes: You had your favorite targets then. 
Maumenee: Yes. 

Hughes: Somebody said that you wouldn't pick on people who you knew 
couldn't make a repartee. 

Maumenee: That's right. I never tried to embarrass anybody. If they 
knew less than I knew, I tried to make them speak out and 
give their side of the story. 

Administrative Work 

Hughes: How would you describe your administrative style ? 

Maumenee: My administrative style with house officers was to turn the 
job over to the senior house officer in the fifth year. I made 
the residency into a five-year program instead of a four-year 
program, giving one resident a year off to go somewhere else 
to get special training. Then I added another house officer, 
making a total of five, thinking that they would have more 
time for research. But they didn't; they just filled it up with 
clinical work and they were no different than they were 
before. But it did give the senior resident a chance to spend a 
year in some special research laboratory or in some clinical 
field. He was in charge of organizing all the lectures, all the 
rounds, all the care of the clinic patients, making decisions 
about who was to operate and how it was to be done. As 
I mentioned, I never interfered unless he said, "This is 
something I'm not able to get this young man to do." I 
think there were only two house officers that I fired. 

Hughes: What about administration, in the sense of the inevitable 
decisions that you as director and chairman had to make? 



Interview with W. Richard Green, MD, May 17, 1990. 



95 

Maumenee: At first I worked strictly on what I thought was best. I made 
decisions on what should be done. I went around the institute 
at least once a month and tried to go around every week. I 
walked around to the people in the basic science buildings 
and saw how they were doing, what they needed, what they 
were accomplishing. 

Hughes: Did they come to you if they had a problem? 

Maumenee: Oh, yes. They primarily came to me when they didn't have 
money or space. But they didn't come to me for basic science 
because they knew much more about their science than I did. 

Hughes: Were you pretty good at getting funding for research ? 

Maumenee: Yes. Whenever an organization or a research foundation was 
established that gave money, I seemed to be able to get on the 
advisory committee. I always saw to it that Hopkins got its 
share of funds. 

Hughes: Was the bulk of it coming from NIH? 

Maumenee: For basic research, yes. But for endowed chairs I obtained 
private funds. Each of the heads of the various specialties 
had endowed funds for salaries. I got the Odd Fellows to 
support Dr. Silverstein. We had a fund already established 
for glaucoma, and I gave that as a base for Maurice 
Langham's salary, and then he could get more funds by 
getting grants from the NIH and drawing part of his salary 
from that. For Dr. Dowling I got a patient to give lots of 
funds. So each of the basic science people who were running 
a section had an endowed chair. 



Basic Scientists 



Maurice E. Langham 

Hughes: Do you care to go into more detail about what Maurice 

Langham, Arthur Silverstein, and John Dowling were doing? 
Do I have the order right in which they arrived? 

Maumenee: Yes. 

Hughes: How was Dr. Langham brought here? 



96 

Maumenee: I went to a meeting in Knokke, Belgium. That's 

a little town outside of Brussels where [Sir Stewart] 
Duke-Elder had arranged for a conference on the cornea. 
There I met Dr. Langham, and he presented some very 
excellent work. After talking about the work he was doing 
in glaucoma, I thought he would be an excellent person to 
come here. I asked him if he would come and he agreed. 
Duke-Elder got furious, because in England that's not done; 
you first ask for a professor's permission to ask somebody to 
come. Duke-Elder wrote me a very stern letter saying he 
wouldn't speak to me again because I came to his house for 
dinner and then stole his best man. 

So I wrote to Norman Ashton, who was a pathologist and 
later became the leading person in research in the Institute 
of Ophthalmology in London, and asked him how I could 
make up to Duke-Elder, because I didn't know that I wasn't 
supposed to make an offer to one of his staff without his 
permission. Norman said Duke-Elder had given a lecture 
in Canada in which he said, "When you find somebody for 
research, you go after him any way you possibly can, and 
when you get him, you pamper him and let him have 
whatever he wants, and push him and protect him in any 
way you want to. You cheat, steal, and do anything to get the 
person you want." [laughter] So I copied that section from 
Duke-Elder's talk and sent it to him, and I said, "Sir Stewart, 
I just read your paper, and I did what you said should be 
done." He wrote back a very jovial letter and said, "You win. 
Okay." [laughter] We became very good friends after that. 

Hughes: How did Dr. Langham work out? 

Maumenee: Dr. Langham is a very smart, capable, and inventive person. 
I think he has a fault that's gotten him into trouble on several 
occasions, and that is, he's too enthusiastic about his work 
and overemphasizes its importance. He didn't get along 
very well with the people, primarily physicians, working 
in the field of glaucoma. He was not an ophthalmologist; 
he was a PhD, and he began to work on patients. The 
ophthalmologists shunned him a bit, and that hurt his 
feelings. 

Hughes: You mean because he was not an ophthalmologist? 

Maumenee: They felt unsure about his statements. So when the time 

came to decide upon his grants, they were on the committees, 
and they turned down his applications. 



97 



Hughes: Was he working on aqueous flow? 

Maumenee: Yes, he did a lot of work on that subject. As a matter of fact, 
he wrote many papers on the beta and alpha adrenergic 
blockers well before Timoptic came along, and he thought 
they were very important. Unfortunately, he didn't find the 
one that really worked well. 

Arthur M. Silverstein 

Hughes: And then there was Art Silverstein. 

Maumenee: Art is a very good immunologist and certainly the best 

immunologist in ophthalmology. He did some very good work 
with Ali Khodadoust, who later went to Shiraz, Iran, to run 
the eye department. Art also worked on producing uveitis in 
animals, and then did some other basic work, particularly on 
fetal animals, in removing the thymus and various other 
organs to see if he could prevent them from developing 
immunological competence. 

Hughes: Was that work connected with ophthalmology? 

Maumenee: Not particularly. It was basic science work in immunology. 
He removed the fetus from sheep, cut the thymus out, and 
then put the fetus back in the uterus and let it go to term. 
Or he might inoculate it while it was in utero and see if it 
developed immunity to that particular substance. 

Hughes: He talked about the immunologic privilege of the eye.* Had 
immunohgists paid any particular attention to the eye? 

Maumenee: No. When I gave the dean's lecture,** I pointed out that 

because the cornea is avascular, you can do many things with 
it that wouldn't involve the blood vessels, and you could see 
what kind of reactions you could get. You could inject an 
antigen on one side of the cornea and an antibody on the 
other, and when the two would meet they would form an 
ortolani line, a white line of precipitate.*** 



Interview with Arthur M. Silverstein, PhD, May 15, 1990. 

Maumenee AE. The Dean's Lecture. The eye as a test-tube for the study of biological 
phenomena. Presented at The Johns Hopkins University School of Medicine, Baltimore, Md., 
February 6, 1978. 

Parks JJ, Leibowitz HM, Maumenee AE. Immediate hypersensitivity reactions in the cornea of 
the guinea pig. J Immunol 1962; 89:323-25. 

See also the many papers by Maumenee, Parks, and Leibowitz on immunology, usually in 
non-ophthalmic journals. 



98 

Hughes: Which you could see microscopically? 

Maumenee: Grossly. With Howie Leibowitz and Jim Parks, we did a lot of 
work on injecting the cornea and checking out immediate 
hypersensitivity. See, there are two types of hypersensitivity. 
One is a humoral type caused by using horse serum or egg 
white or something like that, and the other type is a 
lymphocytic hypersensitivity which is called delayed 
hypersensitivity. We did a lot of work injecting the cornea 
and looking at the cells of the limbus to see what was going 
on. It was really basic immunology, and Art did a lot of work 
along those lines too. 

Hughes: Did he publish in immunological as well as in 
opht halmological journals ? 

Maumenee: Oh, yes. 

Hughes: Was he successful in getting immunologists interested in the 
eye? 

Maumenee: He was certainly asked to speak, and he started the 

immunological society here at Hopkins and attracted people 
from the basic science departments. I don't know that any 
of them really worked on the eye, but Art and Dr. Robert 
Prendergast worked on various tilings successfully. They 
tried to develop antibodies that would kill cancer cells. 

I always felt basic scientists should do what they did best, and 
never tried to guide them. I told them that they didn't have 
to work on anything directly related to clinical ophthalmology. 
They could work on anything that was basic science, that 
sooner or later it would become important in learning the 
pathogenesis of diseases of the eye. 

John E. Dowling 

Maumenee: John Dowling was doing beautiful work on the organization of 
the retina. He felt that he was not contributing to the clinical 
aspects of ophthalmology, so he felt that he didn't belong here 
at Wilmer, that he should go to a neurosciences department. I 
tried to convince him that it really didn't make any difference 
to me whether he found something that was clinically 
important or not, as long he was discovering basic facts 
about the retina, that sooner or later they would become 
very important clinically. 



99 

Hughes: He was working, to put it crudely, on the wiring of the retina? 

Maumenee: That's right. 

Hughes: Was he a pioneer in that area ? 

Maumenee: Yes. 

Hughes: He worked at the microscopic level? 

Maumenee: Electron microscopic and microscopic. 

Hughes: You had an electron microscope in the institute? 

Maumenee: Yes. 

Hughes: He was here from 1966 to 1971 as an associate professor of 
ophthalmology and biophysics. 

Maumenee: Yes. When they looked for a successor to George Wald, who 
was a Nobel Prize winner at Harvard, they chose John 
Dowling, and he took the job. He's one of the best people in 
neurophysiology in the world today. 

Hughes: Why did he have a joint appointment in biophysics? 

Maumenee: Because he was working on the wiring of the retina. The eye 
is an outpouching of the brain. It's the only place you can 
actually see what's going on in the brain. That work is the 
reason [David] Hubel and [Torsten] Wiesel won the Nobel 
Prize. Steve Kuffler would have been included, but he died 
before the prize was given. I got John Dowling after Steve 
Kuffler left. Steve was so good that Harvard offered Steve, 
Dave Hubel, and Torsten Wiesel chairmanships of 
pharmacology and physiology. 

When John Dowling left, Dave Robinson, who had a PhD in 
engineering, came on, and he began to take the brain apart. 
Using the extraocular muscles, he could show that the brain, 
if damaged, could rewire itself as long as the olive of the 
cerebellum was intact. I thought he was the first one to think 
of that. He told me just recently that someone else had 
thought of it, but he was the one who really exquisitely 
proved that this was true. 



100 



Hughes: 



The New Outpatient Department 



In either I960 or '61 the date seems to be vague a new 
outpatient department was built. Is there anything in 
particular to say about that? 



Maumenee: When I came, nothing had been done in the way of renovating 
the institute since it was built in 1927. The outpatient clinic 
had two rooms with a room in the middle. It was not a very 
good thing because you had to wait to use the slit lamp in a 
dark room on the side of each of these two rooms, and if you 
wanted to take a visual field you had to wait until somebody 
was not using the perimeter. So one of the first things I 
did when I came back from California was to remodel the 
basement clinic area into individual offices. Each office 
was fully equipped with slit lamp, perimeter, refraction 
equipment, and everything that was needed to examine the 
patient. 

Hughes: I read in the history of Wilmer that Dr. Woods was initially 

concerned that the new clinic with its separate rooms would be 
a detriment to resident teaching, that they wouldn't have the 
advantage of being able to freely consult or to look over 
somebody's shoulder.* 

Maumenee: There were a couple of things I did that Dr. Woods disagreed 
with. One was that he thought that it was wrong to put the 
resident in a room by himself and let him examine the patient 
and not have somebody sitting nearby to consult with. The 
other was that the elevators didn't match the floors. The 
buildings didn't match exactly, and that's why you have to 
walk down steps between buildings. He wanted me to take 
out those elevators and put in new elevators, and I just didn't 
think it would work. He thought the library, which was just 
at the right of the front door, should stay where it was. I 
thought the ideal place was the basement of the new Woods 
Building because we had spare room and it was quiet. 



Hughes: 



The Alan C. Woods Research Building 

The Woods Building opened in 1964. Was it the first building 
in ophthalmology totally devoted to research? 



Randolph ME, Welch RB. The WUmer Ophthalmological Institute: The First Fifty Years, 
1925-1975. Baltimore: Williams & Wilkins, 1976, p. 156. 



101 

Maumenee: It was the first building devoted solely to basic eye research, 
as far as I know. Prior to 1964, basic research had been done 
in the basement of the Wilmer Institute. It was very crowded 
down there, and it was obvious that to get good people in 
basic science we had to have something special to offer them. 
Either we had to offer them a lot higher pay which they 
usually wouldn't come to Wihner for, because more money 
didn't interest them if they couldn't do their work or we had 
to give them better space and equipment. So I decided the 
best thing we could do was to build a research building, the 
Woods Building. We estimated the costs at $800,000 when we 
started. I think we finally ended up with close to $2 minion 
for the building in '62. 

Hughes: Research to Prevent Blindness had a role in the funding. 
Maumenee: Yes. 

Hughes: You told me off tape that Milton Eisenhower, the president's 
brother, was helpful in raising funds. 

Maumenee: Yes. 

Actually, the very first money we got came from a patient of 
Dr. Alan Woods who was with Texaco Oil Company. He gave 
$50,000. Then when we went to people to get money, we said, 
"That $50,000 is a starter. What will you give?" About the 
same time, Townley Paton, who I told you started the first eye 
bank and had been a resident here, knew Jules Stein's lawyer, 
Bob McCormick. McCormick came to Townley and he said, 
"Look, I have this client who is very wealthy; I think he's 
worth $500 million." 

Jules Stein, interestingly enough, was an ophthalmologist. 
He went through medical school at Rush Medical School 
and then went into practice with Harry Gradle in Chicago. 
He made his way through school working with a band. He 
started the Music Corporation of America and went on to get 
practically every actor in Hollywood and every musician 
under contract with him. That's where he made all of his 
money. 

Hughes: Did he ever practice ophthalmology again ? 

Maumenee: No, not after he left Harry Gradle. He passed his boards, and 
he wrote a paper on low vision, but that's as far as he went in 
ophthalmology. 



102 

I talked to Townley Paton and Bob McCormick on how one 
could get Jules interested in ophthalmology. We decided I 
would get twenty-five of the best ophthalmologists from 
around the country to meet in New York. I figured the best 
thing to ask Jules to do was to give us relatively small 
amounts of free money, because when you apply for a grant 
from NTH you've got to say exactly what you're going to do 
with the money and you can't do anything else. But he could 
give $5,000 a year to a department if it showed that it was 
capable of using the money properly. 

Hughes: For research? 

Maumenee: For research. Secondly, we told him we needed buildings for 
research space to attract good basic scientists and for assured 
professorships. Assured salary is what enticed John Bowling 
to come here. I had to make every effort to get his salary for 
him, but if I couldn't get it, Research to Prevent Blindness 
would provide it for three years. As soon as we got Jules 
interested, I asked for all three categories of funding [for 
salaries, additional research space, and unrestricted grants]. 

He put up $25,000 to hire a fundraiser, and the fundraiser 
told me, "I can't raise money for you. You have to go out and 
do it yourself. When I go to people, they're not going to give 
me any money. I'm a professional. Fll tell you how to present 
things to them and how to go about it." I couldn't get along 
with the first fundraiser he sent, so I fired him The second 
person was really very nice and very cooperative and we 
got along fine, so I went to various people and began to get 
money. Certainly Milton Eisenhower, who was then president 
of Hopkins, was very helpful and encouraging. 

Then we got funds from Alcon [Eye Research Foundation]. 
Bill Connor [Alcon's founder] was a friend of mine. He gave 
a floor. We went back to Kellogg [of the W. K. Kellogg 
Foundation], who had initially given money to Hopkins to do 
research on the cause of glaucoma. His foundation gave us a 
floor. The biggest surprise came from Dr. Angus MacLean, 
who had a patient who made Filbert's margarine. I explained 
to Mr. Filbert that we were putting up this research building, 
and he gave us a floor. With that donation, we topped what 
we were supposed to raise. 

Research to Prevent Blindness helped build four or five other 
eye institutes. It then hired Mr. David Weeks, who became 
director. Jules left $20 million, and his wife, Doris, left 
$20 million, to Research to Prevent Blindness, so it's well 



103 



endowed. At one time there were three Nobel Prize 
winners on the scientific advisory board. I was the only 
ophthalmologist on the board for a while, and then Dr. David 
Cogan joined. 

Hughes: The scientific advisory board decided . . . 

Maumenee: . . . who should get the money for the grant proposals that 
were submitted. Then the recommendations from the 
scientific advisory board went to a lay executive board. 



Louise L. Sloan 

Hughes: What about Dr. Louise Sloan and physiological optics? 

Maumenee: Sloanie was in the basement. I can't remember whether 
Wilmer or Woods brought her here.* 

[Clarence] Ferree and [Gertrude] Rand were here [as 
heads of the Department of Physiological Optics], and they 
thought bacteria were going to get them, so they wouldn't 
touch anything, and they thought the whole place was 
contaminated all the time. They were very difficult. I 
don't know who finally fired them, Wilmer or Woods.** 

Then we had a machinist, Mr. [Albert] Goebel, who had all 
the modern machinery. He could build anything we wanted 
in the way of equipment. He built a lot of equipment that 
Sloanie designed for physiological optics. She became known 
as a leader in physiological optics in America, if not the world, 
and was made an honorary member of the Academy. 

Hughes: What was her background? 

Maumenee: I really don't know.*** Sloanie was very smart and she wrote 
beautifully and did a superb job of research, but she was a 
poor lecturer. So her lectures weren't very well attended, and 
we didn't get very many people interested in physiological 
optics, in spite of the fact that she was really the world leader. 



* It must have been Dr. Wilmer because Dr. Sloan's association with the Wilmer Institute began in 
1929. (Randolph and Welch, The Wilmer Ophthalmological Institute, p. 117.) 

** Ferree and Rand were fired in 1934. Without more information, it is impossible to know who 
fired them, since Wilmer stepped down from, and Woods stepped up to, the chairmanship that 
year. 

*** Her background is described in Randolph and Welch, The Wilmer Ophthalmological Institute, pp. 
117-18. 



104 

Large-Scale Clinical Trials 



Hughes: Do you have any comments to make about the introduction of 
the large-scale clinical trial into medicine? 

Maumenee: I think in a way it's been way overplayed. There were a lot of 
things that were discovered and advances that have occurred 
before the advent of the large-scale clinical trial, particularly 
in cataract extraction and lens implantation. Even after we 
were doing a million lens implants a year in the United 
States, Carl Kupfer wanted to have a massive controlled 
study where we'd do an in tracapsular cataract extraction on 
one eye and the extracapsular with a lens implant on the 
other. I think it's fine for a controlled study to be done on 
some problems, but you have to have some background in 
pathology of why your idea is right. You've got to then try 
it out on animals if that's appropriate some things are 
appropriate and some are not, and some animals will react 
and some won't. Once you do that, then you have to have a 
pilot study on a relatively few patients to see if it's going to 
work. And if it doesn't work, why go into a multi-million 
dollar, clinical trial? 

The first really big clinical trial in ophthalmology was the 
diabetic retinopathy photocoagulation study with the laser. 
But there were people who had already done the research and 
were convinced that the vessels in the retina disappeared 
when they burnt most of the retina off. So they wouldn't 
participate in the clinical trial. They said, "We're not going to 
subject our patients to this." If you know a procedure is good, 
I think it's not right to withhold it. On the other hand, there 
certainly have been mistakes in medicine where we thought a 
procedure or treatment was good, and it turned out to be not 
as good as we thought when we made a clinical trial. I think, 
particularly with drugs of questionable efficacy or toxitity, 
that the clinical trial is worthwhile. 

When Simmons was head of the FDA [Food and Drug 
Administration], I knew him fairly well. He came to Hopkins 
and asked me, "Don't you think the FDA ought to be in charge 
of surgery? You surgeons are always modifying procedures, 
and you don't get any permission from anybody, you just go 
ahead and do it." I said, "I don't think you're going to ever 
be able to do that." I don't do a cataract extraction the 
same way twice in a month. I make innovations and minor 
modifications all the time. If I find that something's working 
much better than it worked before, I'm not going to go back 



105 



and ruin some eyes [using the old technique] just to prove 
that what I'm doing now is better, m do a series of cases and 
keep good records and then report those, and if the results are 
better than surgeons are getting elsewhere, they'll take up my 
technique. So I think clinical trials are good for some things 
but certainly not good for everything. 



Informing Patients 

Hughes: Dr. Bettman mentioned that you changed the method of 

informing patients when you came to Stanford.* Apparently 
the old Viennese method was to protect the patient from 
unpleasant information. According to him, you believed in 
telling the patient what the actual situation was. 

Maumenee: That's right. I never told patients that they should have a 

cataract extraction. I would tell them what they had; I would 
tell them what the cataract extraction consisted of. I had a 
model eye, and I'd show them how the lens was removed. 
Then I would explain the complications that could occur. 
They could get an infection or hemorrhage and lose the eye. 
They could die from the local anesthetic. If they insisted on 
having general anesthesia, they could die from it, too. A lot of 
these complications were very, very rare, or we wouldn't have 
been doing as many cataracts as we were doing. These were 
complications that the surgeon couldn't help. No surgeon can 
operate and not have complications. If he doesn't, he isn't 
operating. You're going to have complications, I don't care 
how good you are. Even if you're taking out ingrown toenails, 
somebody's going to get gangrene or something. 

Hughes: Did you require some form of written consent? 

Maumenee: No. 

Hughes: When were consent forms introduced at Hopkins? 

Maumenee: I don't remember because my fellows and my residents always 
got them signed. 



Interview with Jerome W. Bettman Sr., MD, May 2, 1990. 



106 

Glaucoma 



History of Surgical Techniques 

Hughes: Could you tell me about the evolution of operative techniques 
for glaucoma 1 ? 

Maumenee: There were a number of techniques for operating on 

glaucoma, starting in the 1800s with [Albrecht] von Graefe, 
who did an iridectomy in a patient who happened to have 
angle-closure glaucoma. Otto Barkan was one of the first 
people who used the gonioscope to differentiate between 
angle-closure glaucoma and open-angle glaucoma. Of course, 
there were all sorts of people, once gonioscopy got under way, 
who used it and probably get more credit than Otto Barkan. 

Von Graefe didn't know the difference between angle- 
closure glaucoma and open-angle glaucoma when he did an 
iridectomy. With angle-closure glaucoma, you get a relative 
pupillary block. The iris slides up on the lens, and as it slides 
up, the iris presses more on the lens. People with shallow 
anterior chambers have a greater chance of getting angle- 
closure glaucoma, because the iris bulges up in the periphery 
and closes off the angle, and the intraocular pressure goes up 
very rapidly and very high. Von Graefe's iridectomy cured 
that. So that became the operation for all types of glaucoma. 

Iridectomy doesn't work in a lot of patients, because only 
about 5 percent or 10 percent of glaucoma patients have 
angle-closure glaucoma. Most are cases of open-angle 
glaucoma. An open-angle glaucoma is more like water 
running into the sink, and because of grease in the pipe, the 
water finally overflows the sink. The eye's a closed circuit so 
the aqueous can't get out, so it pushes on the optic nerve and 
causes cupping of the optic nerve and pinching of the axonal 
fibers. This blocks the axoplasmic flow which causes loss of 
ganglion cells, but nobody really knows why. They think it's 
because there's not a feedback through the retrograde flow of 
axoplasm, but that's just a guess. 

Then [Robert Henry] Elliot came along with a trephine. He 
would pull down a conjunctiva! flap and trephine a little hole 
into the eye and pull the flap back, and then the fluid would 
flow out under and through the conjunctiva. I don't know 
who invented the iridenocleisis, but the surgeon would make 
an opening in the sclera and pull out two parts of the iris 
under the conjunctiva, and the incarcerated iris would keep 
the wound open until you got a good flow of aqueous. The 



107 

iridenocleisis worked pretty well. But a sufficient number of 
people with iridenocleisis got sympathetic ophthalmia with 
that operation. It went out of style and was pretty much 
discarded. 

Hughes: Did you ever do it? 

Maumenee: Yes, I did a lot of them. It was an easy operation, and when it 
worked, it worked beautifully. But I remember one of Dr. 
Alan Woods's patients got sympathetic ophthalmia when I 
was helping him. 

Hughes: Was that because there was an external opening? 

Maumenee: Yes, there was iris sticking out. In all these years, we've 

never found out why some people get sympathetic ophthalmia 
when they get laceration of the iris and other people don't. 
We were primarily doing trephines, and then somebody 
figured out it was easier to make an opening in the sclera by 
punching out a piece of sclera. 

Hughes: Did you ever use goniopuncture ? 

Maumenee: I never thought goniopuncture really worked. I know Hank 
Scheie thought it was good, but nobody else thought so.* 
Nobody got the same good results that he did. 

Hughes: Because the hole plugged up ? 

Maumenee: Yes. It wasn't a big enough hole. See, the mistaken idea 
that people had was that the sclera healed and closed 
off the wound. I wrote a paper for the AOS [American 
Ophthalmological Society] in which I pointed out that that 
was practically never the case.** The subconjunctival Tenon's 
capsule becomes fibrotic, forming a watertight membrane. 
You could form a bleb four millimeters in height and width. 
So you had two anterior chambers, and the patients could 
have a tension of forty. You could then inject fluid between 
the two layers of Tenon's capsule and conjunctiva and, with a 
knife, slice into the posterior part, and the tension would drop 
to zero right away and nitration would occur. If you put 



For Dr. Scheie's views on goniopuncture, see Harold Glendon Scheie, MD. Ophthalmology 
Oral History Series, A Link with Our Past. Interview conducted by Sally Smith Hughes. The 
Foundation of the American Academy of Ophthalmology, San Francisco, and The Regional Oral 
History Office, University of California at Berkeley, 1988, pp. 236-39. 

Maumenee AE. External filtering operations for glaucoma: the mechanism of function and 
failure. Trans Am Ophthalmol Soc 1960; 58:319-28. 



108 

fluorescein on the outside of the eye and pressed on the eye, 
you could see the aqueous flow through the conjunctiva. 

[Peter C.] Kronfeld in Chicago, who was head of the Illinois 
Eye and Ear Infirmary, did a lot of fancy work looking at 
the ascorbic acid in the tears. Since the tears had such a high 
ascorbic acid, he could show that it was a functioning bleb 
because the aqueous had a high concentration of ascorbic 
acid. So he felt that filtration through the conjunctiva was 
the main way gonio worked. It's taken generations to get that 
idea across. People still thought until just recently that the 
major problem was the closure of the sclera. But I did enough 
reoperations to see that there was a very thin layer of 
fibroblasts over the sclera and the scleral opening. I'd 
cauterize those few cells and all the aqueous would 
immediately flow out. 

Failure in Filtration Surgery 

Hughes: Marvin Sears wrote me a letter from which I would like to 

quote: "Dr. Maumenee consistently and repeatedly pointed out 
the main cause for failure in filtration surgery in glaucoma, a 
point which . . . was not picked up for years after his initial 
studies and description of these important conditions."* 

Maumenee: That is referring to the paper I wrote for the Transactions of 
the American Ophthalmological Society which describes the 
causes of the failure of glaucoma filtering blebs.** I was 
interested in why glaucoma filtering operations failed to 
work, and I pointed out that it was due to a fibrosis of the 
subconjunctival tissue. Everybody else thought that the 
sclera healed over the opening and that was a cause of the 
failure of the operation. 

They have now found that fibrosis of the subconjunctival 
tissue is the primary cause of failure of glaucoma filtering 
operations, and this can be blocked to some extent by using 
5-FU, which inhibits the development of fibroblasts. They 
have shown when they use 5-FU they can get a much higher 
success rate of glaucoma filtering operations. They now have 
a new product that is more powerful than 5-FU. They are 
getting a fantastic number of excellent filtering blebs because 
they are blocking fibroblastic proliferation. 



Marvin L. Sears, MD, to Sally S. Hughes, PhD, October 26, 1989. 

** Maumenee AE. External filtering operations for glaucoma: the mechanism of function and 
failure. Trans Am Ophthalmol Soc 1960; 58:319-28. 



109 



Hughes: How does this work? 



Maumenee: The surgeon made a hole in the sclera, but the 

subconjunctival tissue would come down and seal it off. 
For instance, I operated one day on a young lady who had 
glaucoma. She came back that night and had a big bleb in the 
area of operation and her pressure was thirty-five. I looked at 
her under the slit lamp, and there was one anterior chamber 
under the bleb and another anterior chamber in its normal 
position. I turned her upside down because there was an air 
bubble pushing up Tenon's capsule and the conjunctiva. As 
soon as I did, the air bubble went into her anterior chamber, 
the compactness of the tissue disappeared, and the pressure 
fell to fifteen. 

I had a group of patients who had had glaucoma filtering 
operations which had failed. I had to do cataract extractions 
on them. When I went back in [surgically], I found that the 
hole in the sclera never heals. The sclera never seals, except 
in a Scheie operation which creates a slit which is so narrow 
that it closes up.* Every case I looked into, I could balloon up 
the conjunctiva, and it would be perfectly all right but there 
would be a thin membrane over the hole. As soon as I cut 
through that membrane the aqueous would flow out. 

Harold G. Scheie 

Hughes: Speaking of Scheie, since he did so much glaucoma work, was 
there communication between you two? 

Maumenee: We had a lot of arguments. Hank was a superb surgeon and a 
very smart guy, very, very positive, very domineering, and he 
really ran everything. He built the Scheie Eye Institute in 
Philadelphia. 

I will never forget. I was arguing with Hank about congenital 
glaucoma, and I said, "Hank, how do you know that's true?" 
His answer was, "I know it's true because I say it's true." 
[laughter] 

Hughes: I know you operated a lot on congenital glaucoma, which was 
also one of his specialties. Did you differ on how to treat it? 

Maumenee: Yes. Completely. 



For a discussion of the Scheie procedure, see the oral history in this series with Dr. Scheie, pp. 
240-43. 



110 

He claimed that he could make [gonio]punctures which cured 
all his patients. I would make the same kind of punctures 
and have every one of them seal over. They just didn't work. 
He claimed he was getting great results. I don't know what 
else he was doing. Maybe he was doing a goniotomy and 
cutting the longitudinal muscle away from the trabecular 
meshwork which allowed the longitudinal muscle to go back 
and work. I still don't know how a goniotomy works and 
nobody else does either. 

That was one thing we disagreed on. There were several 
other things. I really had great respect for Hank, and his 
wife was delightful. He was a superb surgeon. There is no 
question about it. He did a tremendous amount of surgery. 
But he didn't know anything about pathology, and that was 
probably my greatest asset. 

Recessed- Angle Glaucoma 

Hughes: Dr. Sears also wrote that "he," meaning you, "was the true 
discoverer of recessed angle glaucoma, a condition which he 
diagnosed on ward rounds and told what he believed the 
cause was[,] and allowed his colleagues and students to get 
the credit." * 

Maumenee: That's right. The iris in an infant comes right off the scleral 
spur. As you get older, and particularly in a nearsighted 
person, the iris recedes so that there's a good area of sclera 
between the iris and the scleral spur, and the trabecular 
meshwork goes from the scleral spur to Schwalbe's line. 

We had a young black boy who had been hit in the eye and 
developed an angle recession. The angle was receded well 
back, so I thought that was the cause of his glaucoma. I made 
a comment on rounds about this case and said that I thought 
that the longitudinal muscle had been stripped off the scleral 
spur so that it wouldn't pull the iris open, and that that was 
probably the cause of the glaucoma. I don't know 100 percent 
whether that's right or wrong. Very frequently, people get 
angle recession and won't get glaucoma for twenty years. 
But we did discover that condition in this patient. Then 
Stewart Wolff, who was a resident at the time, looked at some 
slides of the eyes of glaucoma patients who had undergone 
trauma to the eye, and saw that the angle had been recessed, 
and wrote the paper on it.** Marvin's got a good memory. 



Marvin L. Sears, MD, to Sally S. Hughes, PhD, October 26, 1989. 

Wolff SM, Zimmerman LE. Chronic secondary glaucoma. Am J Ophthalmol 1962; 54:547-63. 



Ill 



Hughes: 
Maumenee: 



Hughes: 



Maumenee: 

Hughes: 

Maumenee: 

Hughes: 

Maumenee: 

Hughes: 
Maumenee: 



Tonography 

What about tonography, which I understand was Bernie 
Becker's special interest? 

Right. I didn't have much to do with tonography. I think 
Morton Grant at the Massachusetts Eye and Ear was the first 
person to describe this technique.* It consisted of putting a 
weight on the eye, leaving it there for a certain period of time, 
taking the weight off, and seeing how much fluid had been 
pushed out of the eye. If the patient had glaucoma, a graph of 
fluid outflow would remain flat; there wouldn't be any change 
in the pressure. The increased pressure didn't cause an 
outflow. But tonography has so many problems that I don't 
think anybody uses it anymore. 

That was certainly Dr. Scheie's opinion when I talked with 
him.** He was an early opponent of tonography because, for 
one thing, he couldn't get reproducible results. He said it was 
difficult to get a paper on glaucoma published during a 
certain period without tonographic . . . 

. . . proofs. 

Was that your experience? 

I didn't really think much of it, so I seldom did it. 



Why? 

I couldn't get a consistent finding, 
and a different one on the next. 

That's what Dr. Scheie said. 



Fd get one reading one day 



It required a complicated mathematical formula. The 
patients who had low outflow sometimes wouldn't have any 
other evidence of glaucoma, and those patients that would 
have good outflow would have evidence of glaucoma. 



* For more on tonography, see the oral history in this series with Dr. David Cogan, pp. 50, 63. 
** Scheie oral history, pp. 247-49. 



112 



Hughes: 



Hypotony 

I'd like to discuss a paper on hypotony which you published in 
1961 with Paul Chandler* 



Maumenee: It's an interesting story. I had noticed that if you did a 
cyclodialysis that is, if you broke the adhesion between 
the scleral spur and the muscle fluid would get in under 
the ciliary body, and the patients would develop hypotony. 
Surgeons felt for some reason that they had to do basal 
iridectomies in cataract extractions. When they did, they 
would tear the iris off the ciliary body and they would produce 
a small cyclodialysis. 

While I was drinking a pitcher of martinis with Paul 
Chandler in Madrid one night and we were talking about 
glaucoma, I told him about this problem. He said, "Ed, you're 
right. I've seen that too." So then I went back and looked at 
the pathology of the patients who had hypotony, very low 
pressure, people who had had their eyes removed for some 
reason. They all had a serous detachment of the ciliary body. 

I made a hole 180 degrees away from the area of the 
cyclodialysis hole and drained all the fluid from the ciliary 
body. I put fluorescein in the anterior chamber and showed 
that fluorescein was flowing out through the hole between the 
ciliary body and sclera. When I made the hole 180 degrees 
away, fluorescein came out. When I sealed off the space 
between the ciliary body and sclera where the cyclodialysis 
hole was, the pressure would go up that night to sixty or 
seventy. It cured the hypotony, so I got patients referred to 
me from all over the country who had developed hypotony 
after cataract extractions. 

My idea came about through Jack Guyton, who is very 
interested hi cyclodialysis for the treatment of glaucoma. He 
operated on both eyes of one of the key people in the Ford 
Motor Company. Every time he let the pupil contract, one eye 
would go into hypotony and the patient couldn't see. Jack 
dilated the pupil with atropine to close off the opening, and 
the pressure went up. That's why I got the idea that the 
cyclodialysis cleft was causing the hypotony. I still have no 
idea why a fluid over the ciliary body keeps it from secreting. 
But it is a very delicate mechanism. 



Chandler PA, Maumenee AE. A major cause of hypotony. Trans Am Acad Ophthalmol 
Otolaryngol 1961; 65:563-75. 



113 

Paul Chandler and I wrote the paper, and since Paid was my 
senior, I let him put his name first, but he never looked at any 
pathology. 

Otto Barkan and Congenital Glaucoma 

Hughes: Dr. Maumenee, when I talked with Dr. Harry Quigley, he told 
me that the belief in ophthalmology used to be that glaucoma 
was a disease of poor blood vessels, that the elevated pressure 
hurt the blood supply to the optic nerve.* You apparently did 
not agree with that theory. 

Maumenee: Let me go back a little further. When I first went to Stanford, 
Otto Barkan was the world authority on congenital glaucoma. 
He was very nice to me. We played golf together. He operated 
in secrecy and wouldn't let anyone see him, but he let me 
come in and watch him operate. 

Hughes: Why was he secretive? 

Maumenee: He was a peculiar person. He and his brother Hans Barkan 
got into some kind of argument, and for some twenty years 
they wouldn't speak to each other. Otto Barkan was a 
brilliant guy. He was one of the first people who did 
gonioscopy and described shallow-chamber glaucoma. He 
looked at children with glaucoma, and he thought he saw a 
membrane over the trabecular meshwork. He never looked at 
any children with strabismus or normal children that were 
being examined for other reasons. All children have a 
shagreen over the trabecular meshwork. 

So I went back and got the pathology on some twenty-four 
eyes of children who had congenital glaucoma. It was during 
the time of the rubella epidemic, where the mother had 
rubella and the children had glaucoma. It was probably 
related. The children had died on the operating table because 
they had heart troubles. When I looked at these eyes, there 
was no membrane there, so I told Otto he was wrong. He 
totally prohibited me from ever coming to his operating room 
again. We had a symposium on congenital glaucoma that Al 
Reese asked me to organize. Otto Barkan refused to be on the 
program with me because I had disagreed with him So I got 
Bob Shaffer to give my paper for me. Bob gave me credit for it 
because I had all the pathology. 



Interview with Hairy A. Quigley, MD, May 14, 1990. 



114 

I found that in doing an iridectomy, blood got into the anterior 
chamber. Red blood cells got through the trabecular 
meshwork, so there couldn't be any membrane there. 

Hughes: Had Barkan actually looked at the pathology? 

Maumenee: He never looked at any glaucoma pathology. He only looked 
clinically with a gonioscope. He could see this membrane and 
I could see it too. The shagreen was present in all children. 

I always took December off to do the written work I had to do. 
To prepare my AOS thesis,* I went back and looked at slides 
of congenital glaucoma cases. Much to my surprise, the 
longitudinal muscle of the ciliary body had bypassed the 
scleral spur. In the angle of the anterior chamber, you have 
the scleral spur, which is a piece of sclera. The trabecular 
meshwork hooks anteriorly onto Schwalbe's line and 
posteriorly to the scleral spur. When this spur is pulled back 
by contraction of the longitudinal muscle of the ciliary body, 
it opens all the pores of the transscleral meshwork so that 
the aqueous can flow out. In the same way, when you give 
pilocarpine, you open up the angle so that the fluid can get 
out. What I found in congenital glaucoma was a longitudinal 
muscle which in embryonic life was normally ahead of the 
scleral spur but which did not recede as it should. It stayed 
forward. 

Hughes: So it was a mechanical blockage. 

Maumenee: Yes. 

I had written my AOS thesis on the basis of this work [but not 
yet turned it in]. Just before Christmas [1957], I looked at 
the tissue sections again, and I noticed that the longitudinal 
muscle bypassed the scleral spur, and I had to rewrite the 
whole paper and turn it in. That has become the generally 
accepted concept of the pathogenesis of congenital glaucoma. 

Theories on Loss of Visual Field 

Maumenee: You asked about the theory that elevated pressure in 
glaucoma decreases the blood supply to the optic nerve. 
[S.S.] Hayreh, who worked with Norman Ashton in England, 
wrote a ton of articles, and so did Duke-Elder, saying that the 
loss of visual field was due to an ischemia of the optic nerve. I 
thought the vascular theory of the loss of visual field was 

* Maumenee AE. The pathogenesis of congenital glaucoma: a new theory. Trans Am Ophthalmol 
Soc 1958; 56:507-70. Also in: Am J Ophthalmol 1959; 47:827-58. 



115 

wrong, because my patients who had shock or whatnot did 
not get loss of visual field. There were many other things 
that pointed to the fact that it was not due to a vascular 
abnormality. No one had really studied the lamina cribrosa. 
That's the outlet where the optic nerve goes through the 
sclera and then on to the brain. F. Vrabek did silver stains of 
the nerve and showed that the blockage of the axonal fibers 
occurred right at the lamina cribrosa.* A resident, Mark 
Lieberman, and I got a number of eye bank eyes, and we 
serially sectioned them and showed that the lamina cribrosa 
was fed by vessels that went straight from the short posterior 
ciliary arteries into the lamina cribrosa. 

Hayreh, using [Paul] Henkind's studies of the choroid, felt 
that the vasculature to the lamina cribrosa came from the 
choroid. When we studied it, there were only a few tiny 
vessels coming from the choroid; 99 percent of them came 
from outside of the choroid. 

So all this made me think that the vascular theory was totally 
false. I sent Harry Quigley down to Doug Anderson, whom I 
considered one of the leading experimental pathologists in the 
country. Doug somehow or other was totally convinced the 
loss of visual field in glaucoma was vascular. So Harry came 
back with the idea that it was vascular. I said, "Harry, you 
have got to look into this. It's not vascular." Strictly on the 
basis of what Fd observed clinically and what I'd read in 
Steven Drance's and others' papers, the relationship between 
loss of blood and loss of visual field is very vague. 

Harry did some absolutely gorgeous work and showed that 
the lamina cribrosa was made up of eleven layers of collagen 
fibers. I had observed that there were pits that occurred in 
the lamina cribrosa.** These pits exactly corresponded to the 
areas of visual field loss. So something was happening to the 
lamina cribrosa which made it give way in these areas. 

Harry did superb studies counting the axonal fibers in 
patients with glaucoma. He showed that there was a diffuse 
loss of ganglion cells, but there was a loss primarily along the 
arcuate scotomas. He then used substances that had the 
same permeability as oxygen and showed that there was no 



Vrabek F. Glaucomatous capping of the optic disk; a ncurohisto logic study. Arch Ophthalmol 
1976; 198:223-34. 

Radius RL, Maumenee AE, Green WR. Pit-like changes of the optic nerve head in open-angle 
glaucoma. Br J Ophthalmol 1978; 62:389-93. 



116 



loss of oxygen to the lamina cribrosa. [Donald S.] Minckler 
had done some very good work on axoplasmic flow.* 

In about 1970, 1 went to all the physiologists that I knew 
and asked how I could prove the loss of visual field to be 
mechanical. Keffer Hartline referred me to a fellow named 
Paul Weiss who was at the Rockefeller Institute. Weiss had 
found that during World War II, when people had their 
peripheral nerves cut, if he put a vascular cuff over the ends 
of them so that fibroblasts couldn't grow in, the nerves would 
regenerate and be perfectly all right. But if the vascular cuff 
was too tight, it would cause a bulge between the ganglion cell 
and the point where the blockage occurred.** This showed, in 
contrast to what people believed before, that the nerve fibers 
acted only like electric wires, that there was an active, living, 
axoplasmic flow. 

So I wrote to Weiss and he wrote back and said, "From what 
you're telling me, I think you are probably entirely right that 
this is a mechanical blockage and not a vascular blockage. A 
vascular blockage will occur and will stop the axoplasmic flow 
if the blood vessels are knocked out." 

I looked at the pathology, and even in the most advanced 
cupping [of the optic disc] I could find good blood vessels all 
through the lamina cribrosa. Harry has convinced the rest 
of the world, in a series of excellent studies in animals and 
cadaver eyes of patients who had glaucoma, that it is not 
ischemia that causes glaucoma's field loss. 

Hughes: What is it? 

Maumenee: It's like putting your fingers into a Chinese puzzle. If you pull 
hard enough, the puzzle gets tighter and tighter and you can't 
get your fingers out. Well, these fibers are arranged in ten 
layers, one on top of another. They have holes which the 
axonal fibers go down through. When the pressure goes up, 
depending on the strength of your connective tissue, these 
layers give, and when they slide, they pinch the axons and cut 
off the flow of axoplasm. Harry confirmed that there was an 
orthograde flow from the ganglion cells back to the optic nerve 
head, and the blockage occurred right at the lamina cribrosa. 
He also showed that there was a retrograde flow coming from 
the end organ that flowed back in the other direction and was 
blocked right at the lamina cribrosa. 



* Minckler DS. Optic nerve in glaucoma. Obstruction to axoplasmic flow. Surv Ophthalmol 1981; 
26:128-36. 

** Weiss PA. T>anta Rhei' and so flow our nerves. Proc Philosoph Soc 1969; 113:140. 



117 



Hughes: So the evidence was convincing, wasn't it? 



Maumenee: Yes, it was convincing. The blockage had to be at the 

lamina cribrosa. Since the blood vessels didn't change in 
the lamina cribrosa in eyes with glaucoma, then the blockage 
had to be mechanical. I think we now have convinced many 
ophthalmologists around the world that the mechanical 
theory is a factor in visual field loss in glaucoma. 

Hughes: There is a tendency in science to hang onto an old theory well 
after it should be discarded. Do you think there was a certain 
amount of that going on? 

Maumenee: Yes. Some of the older pathologists had pointed out that it 
was probably the change in the structure of the lamina 
cribrosa that caused visual field loss. But this hypothesis 
was forgotten because Duke-Elder said that glaucoma was a 
systemic disease of the smaller blood vessels. 

I presented the mechanical theory in the Shaffer lecture and 
summarized all the clinical evidence that I had, but it was 
Harry Quigley who did the pathology.* People believed Harry, 
and Harry became the world's greatest authority on the loss 
of visual field in glaucoma. 

Low-Tension Glaucoma 

Hughes: Does that information have clinical implications? 

Maumenee: Oh yes. We have people with low-tension glaucoma whose 

intraocular pressure never seems to go up. When I put them 
on home tonometry, I said, "Your blood pressure is not the 
same all day long and neither is your eye pressure. A doctor 
takes your pressure for about two seconds. The rest of the 
day, the rest of the month, the rest of the three months before 
you come in again, you don't know what it is." So I sent 
people home with a Schiotz tonometer, which became 
discredited because it had to do with scleral rigidity, ocular 
rigidity, and the reading would be quite false. [Hans] 
Goldmann developed an applanation tonometer which became 
the standard because it pressed on the cornea and flattened it 
out to a certain degree, giving you a much better gauge of 
what the pressure was in the eye. It still has defects, but it is 
much better than the Schiotz. 



Maumenee AE. The Robert N. Shaffer Lecture. Causesof optic nerve damage in glaucoma. 
Ophthalmology 1983; 90:741-52. 



118 



If I took a Schiotz tonometer reading of the pressure in the 
eye and then checked it again with an applanation tonometer, 
I would get a constant difference in reading. So I sent the 
patient home with a Schiotz tonometer. Using this constant 
difference, I could calculate what the pressure was.* They 
would bring in beautiful daily charts and say, "Two cups of 
coffee, and the pressure went up like this. I had four 
martinis, and my pressure fell like this." For a week the 
pressure would be perfectly normal. Then all of a sudden 
the pressure would spike to thirty or thirty-five millimeters 
of mercury. The lamina cribrosa in those people was weak. 

I happened to have one patient who had been diagnosed at 
Duke, at Columbia, and at other places. They all told her 
that she had ischemia of the optic nerve. Her sister was also 
told she had the same ischemia of the optic nerve because the 
ophthalmologists never found the pressure up. Well, I gave 
her two pints of water to drink, and dilated her pupils, and 
did everything to push her pressure up, and it went up to 
thirty-five. Then I took her pressure from time to time, and 
on rare occasions and on home tonometry, her pressure would 
go up. The lamina cribrosa, just like all your other tissues, 
has different strengths in different people. You have people 
with weak lamina cribrosas who can't even stand a pressure 
of nineteen. 

I had another patient who was about five four and weighed 
two hundred and fifty pounds and had high blood pressure. I 
followed her for twenty-five years. I operated on her I don't 
know how many times, to bring her pressure down. I could 
never get it down. But she never went blind. She wouldn't 
let me take a good visual field, so I didn't know how it was 
doing. She saw until she died. Because I had been so close to 
her, she left her eyes to be examined, and we put them in 
glutaraldehyde right away. She had a big, thick, trabecular 
meshwork. It was very strong. Two weeks later another 
woman, whose soft glaucoma I had been following, died and 
left me her eyes. Her lamina cribrosa was composed of very 
thin connective tissue fibers. It didn't have any strength. 

Acceptance of the mechanical theory is one of the things I 
enjoy so much because almost everybody believed in the 
vascular theory as a cause of loss of visual field in glaucoma. 
I finally got my way, through Harry Quigley's brilliance and 
excellent basic research. 



Jensen AD, Maumenee AE. Home tonometry. Am J Ophthalmol 1973; 76:929-32. 



119 

Hughes: I've noticed that you like the challenge of trying to convince the 
world that you are right. 

Maumenee: I was fortunate to be a general ophthalmologist. I did 
everything. My main fun in life was to give residents a 
project and get them to do all the work, and then I would get 
credit for it. [laughter] But it made them realize that they 
could do something. 

As Mort Goldberg said, "In my residency, you always pushed 
me beyond anything I thought I could do. You were so 
positive that it really made me achieve. I didn't think I could 
do all these things. You were always on me, making me do 

them." 

Hughes: So the residents were trying their darnedest to live up to your 
expectations. 

Maumenee: That's right. That's the way I had fun. Doing all the 

administrative work and everything else, I got to the point 
where I just didn't have time to go to the laboratory myself. 

Hughes: When it came to publication, where did you put your name? 
Maumenee: On most of my papers, my name is last or well down the line. 
Hughes: That isn't the way it used to be done, particularly in Europe. 
Maumenee: Yes. 



The Resident Training Program 



Encouraging Residents to Enter Academic 
Medicine 

[Interview 4: May 18, 1990, Wilmer Ophthalmological 
Institute, Baltimore, Maryland] 

Hughes: Do you like to teach? 

Maumenee: I enjoy it. I think one of the greatest pleasures I've had in 

ophthalmology is to teach some very bright young people and 
then see them go to the top of ophthalmology. It's like having 
your own children succeed. So many of the residents say, 
"You've been like a father to me. You've taught me more than 



120 

anybody's ever taught me." It's just great. It's just such a 
pleasure to hear that. 

Hughes: Were you conscious of being a role model? 

Maumenee: Several of the ex-residents who became chairmen have said 
that they tried to run their departments the way I ran mine. 

Hughes: How would you describe your teaching style ? 

Maumenee: I told them what to do, and I showed them where they made 
mistakes and where they did well. I tried to compliment them 
and give them confidence in themselves. I made suggestions 
about the type of research or writing they could be doing. If 
they were particularly good, then I tried to convince them 
that the best place in the world for them was in academic 
ophthalmology where they'd have the freedom and time to 
carry out their ideas. If they were not good, I told them to go 
into private practice. 

Hughes: Have you been successful in convincing people to go into 
academic ophthalmology? 

Maumenee: As I mentioned to you before, I think at one time I had 

seventeen chairmen of departments in other medical schools, 
which is a record; no one else in the history of ophthalmology 
has ever trained as many. Then there have been equally that 
many or more who have become full-time faculty members, 
but who don't want the responsibility of being chairman. Don 
Gass, Lawton Smith, and some of the other very capable 
people Fve had like to do their own thing. 

Hughes: Dr. Miller told me that in the seventies there was an amazing 
group of residents, he being one of them. He named people 
such as Al Sommer and Harry Quigley.* 

Maumenee: David Guyton. Walter Stark. RonMichels. 

Hughes: He said that you encouraged them to stay at Wilmer, which 

seems to me a slightly different pattern. As you said, you had 
previously been encouraging your best residents to become 
department chairmen. Why at that particular time were you 
trying to keep people at Hopkins? 



Interview with Neil R. Miller, MD, May 16, 1990. 



121 

Maumenee: I think a couple of things happened. Ken Kenyon helped 
recruit a lot of those people from medical school. He knew 
them and got them to come to Wilmer. 

The other thing was, before, when I tried to keep people here, 
they would get offers from other medical schools at three 
times the salary Hopkins was allowing me to offer. It was 
such a marked difference, they wouldn't stay. This group 
came along, and we had places for them, and they all had 
subspecialties which fit right into the program. So I coaxed 
them to stay on here. We were making enough money that I 
could pay them salaries equal to what they could get 
anywhere else, and more than many places. Most of them 
have stayed on, even though every one of them has been 
offered chairmanships in other places. I think Ron Michels is 
one of the few that left. 

Selecting Residents 

Hughes: Please comment on selecting residents. 

Maumenee: I think the most important thing in the resident training 

program is the selection of the resident. That's very difficult 
to do when you have a half-hour interview with someone 
who's spent most of his life becoming a doctor. First of all, I 
look for people from the better medical schools because the 
better medical schools get the better students. 

Hughes: Would you consider somebody from a lesser medical school? 

Maumenee: Yes. Some of the best residents I've trained have come from 
smaller medical schools. After all, I came from the University 
of Alabama. 

Hughes: [laughs] That's true. 

Maumenee: The first thing I did was look at residents' standing in medical 
school. If they were in the top of the class in medical school, 
then I was very interested in them, particularly if they had 
done research applicable to problems in the eye but outside 
the field of ophthalmology, or even if the research was not 
applicable to problems in the eye. It showed that they knew 
how to do laboratory research. So if I had two applicants from 
equal medical schools with equal grades, and one had done 
some good research and the other had just been a book-study 
person, I would take the person who had done research. 



122 

Hughes: And the reason you did that? 

Maumenee: I wanted my residents to go into academic medicine. I 
thought that Wihner was one place where we had the 
facilities to train residents to be chairmen of departments 
or very good academic medicine persons. 

Hughes: So you felt that if a person wanted to be a general practicing 
ophthalmologist, there were other institutions that could 
provide that training? 

Maumenee: That's right. I frequently told some of the really top students, 
when I asked them what they wanted to do and they said they 
thought they would like to do a little academic teaching and 
go into practice with their father, that there were a number 
of places where they could learn good ophthalmology, and I 
thought those departments were better for them than Wilmer. 
I was much more interested in people who wanted to go into 
academic ophthalmology. 

Hughes: Were you disappointed when your residents chose practice as 
opposed to academia? 

Maumenee: Well, a little. A few of the people that I thought would have 
been good academicians didn't go into academia. I convinced 
almost all of those that I really felt would make good 
academics to go into academic medicine, and they're delighted 
with it. They wouldn't give it up for anything. They are 
people who have imagination, who really enjoy doing new 
things. 

The second thing I looked for in choosing residents was the 
ability to think independently, to come up with new ideas, 
new concepts, new ways of doing things. 

Hughes: You determined that through conversation? 

Maumenee: Yes. 

I remember when I was a second-year resident, one of 
the leading ophthalmologists from Birmingham, Alabama, 
Dr. Brownley, came up to the Wihner residents' meeting. 
Vitamins were the big thing at that time, and they were 
supposed to do all kinds of great things for the patient. I gave 
a talk on vitamins, and he came up afterwards and spent half 
an hour or so asking me all about vitamins. He didn't even 
know what the new vitamins were, and I thought, my gosh, if 
one of the leading ophthalmologists in Birmingham doesn't 



123 

know any more than that, I don't want to go into practice and 
become that far behind the leading things in medicine. I had 
the nerve to tell somebody when I was a second- or third-year 
resident that I wanted to be the best ophthalmologist in the 
world. So I just couldn't see myself going into private practice. 

As the residents came along, if they seemed to have some 
ability to do something new, either clinically or in the 
laboratory, then I tried very hard to get them to go into 
academic medicine and to find them a position. We would 
pick five residents for the residency training program. There 
were four when I first came back to Hopkins in 1955, and 
then we went to five so we could give them more time to do 
research. It didn't turn out that way; they filled up the year 
with other things and didn't do any more research work than 
they did before. 

Program Structure 

Maumenee: The first year was strictly a learning period. They worked 
primarily in the clinic, seeing all the clinic patients. They 
did all the night work, they did all the inpatient workups, 
and they did all the scut work, so to speak the things that 
weren't particularly exciting. Practically every resident said 
they learned more in that first year than they'd ever learned 
in their whole training in school. 

Most medical schools do a very poor job of teaching 
ophthalmology because they assign the ophthalmology 
faculty such a short period of time to be with medical 
students. It's primarily lectures. The terminology in 
ophthalmology is foreign to them. Unless we get them to 
work in the lab and spend their free time with us, they really 
don't get to know ophthalmology until their first year of 
residency. 

We have a great referral practice at Wilmer, so we see a lot 
of pathology. We emphasize that we are a referral center, a 
tertiary center, not a refraction center. We do refractions, of 
course that keeps the place going. The doctors in private 
practice didn't want to waste their time, so they would send 
all their difficult cases to us. It was great because we had just 
the best pathology in the world in the clinic. It's gotten worse 
now because these patients can either get their eye care paid 
through the government or they have insurance. The clinic is 
not a nice place, so they go to a private doctor instead. 

First-year residents assist in the operating room. They fix 
lacerations and other injuries at night in the accident room. 



124 



If it's an intraocular operation, the assistant resident is 
called at night, and he does the operation and the first-year 
residents help. 

In the second year, they begin to operate. They rotate 
through pathology, they rotate through neuro-ophthalmology, 
they rotate through strabismus, they rotate through all of 
the various subspetialties. During that time they have a 
period in which they call themselves "the resident." It's a 
three-month period in which they do most of the surgery. 
There's some done by other residents, but they get the 
majority of the surgery that's not done by the senior resident. 

In the third year, they go to Baltimore City Hospital, now 
called the Francis Scott Key Hospital, and also they go to the 
old marine hospital, now called Wyman Park Hospital, which 
is a government-run hospital. Wyman Park gets a fair 
number of patients who are veterans and merchant marines. 
We have a senior resident or one of the staff members go over 
in a supervisory position. 

Hughes: Are the types of cases different from Wilmer's? 

Maumenee: A little. They don't get as many referrals of tough cases, but 
they've got enough cataracts and glaucoma and other routine 
cases that the residents get good experience. 

Hughes: Do your residents do a lot of operating? 

Maumenee: I'd say that the average resident will end up doing 150 to 200 
operations. 

Hughes: How does that compare to other programs? 

Maumenee: About medium, Fd say. There are hospitals that concentrate 
primarily on clinical work and not research, like Wills Eye 
Hospital.* I think they take something like thirty residents a 
year. They have a vast volume of patients coming in. The 
former Wills residents refer all their cases to Wills, so it's a 
much bigger volume of clinic patients than we have. Fd say 
we're in the middle group in regard to the number of patients 
we see. In percentage of pathology, we're very, very high. But 
the number of patients is relatively low, and we don't want a 
great volume of patients. We don't want to do a lot of 



For information on Wills Eye Hospital, see Thomas David Duane, MD. Ophthalmology Oral 
History Series, A Link with Our Past. Interview conducted by Sally Smith Hughes. The 
Foundation of the American Academy of Ophthalmology, San Francisco, and The Regional Oral 
History Office, University of California at Berkeley, 1989, pp. 85-93. 



125 

refractions. We have to do some, because we've got to learn 
how to refract. The joke is that the Wilmer residents never 
learn how to refract; they only know how to use a pinhole. 
[laughter] 

Then the third-year residents come back to Wilmer, and they 
supervise the first- and second-year house officers. The 
fourth-year residents go away for a year and take a special 
fellowship in lab research in a clinical specialty. There are 
some residency programs that let the fellows that come from 
outside do most of the operations. The house officers there 
don't like it because it takes operations away from them. 

Hughes: Do you leave the decision about where to go up to the resident? 

Maumenee: Absolutely. 

Hughes: Does it require a recommendation on your part? 

Maumenee: Yes. Usually in their three years of training, they've gone 
through all the subspecialties, and they pick out one that 
they particularly like. I recommend a subspecialty to each 
resident: one may be a very skilled surgeon; another may be 
a good clinician and handle patients very well; another may 
be an outstanding research person. One resident, who has 
just finished his residency of three years, has written twelve 
books on computers. Two were on the New York Times 
nonfiction best-seller list. 

Hughes: Maybe he won't have to practice ophthalmology, [laughs] 

Maumenee: That's what I said. 

The senior resident is really like a chairman of a small 
department, because he runs the residency. He sets up the 
lecture schedules and the teaching periods, assigns who's 
going to do what, and supervises them. Some senior residents 
do a better job than others, because it requires them to do a 
lot of teaching. 

One of the things that makes the Wilmer Institute 
outstanding is that the residents are on their own. They 
have to make up their minds, and they have to read and study 
to understand the cases they're seeing. Comparisons are 
odious, but at Harvard, there are two or three attending men 
in the clinic, and they tell the residents everything to do and 
diagnose every case. In a way, it's good teaching, but on the 
other hand, the residents just don't get an independent 



126 

experience. They operate with the attending men from the 
clinic, and the attending man may decide that he wants to do 
a case himself, and the resident has to help him, even though 
it's a clinic patient. 

Hughes: Is there any other institution that gives residents the 
independence that the Wilmer does? 

Maumenee: I think there are a number of them. The residents that Fve 
trained who have become departmental chairmen have 
modeled their program after the Wilmer Institute. 

Guiding Residents 

Hughes: Other than hoping that your residents went into research, into 
the academic life, what else did you expect of them? 

Maumenee: That's the major thing. Also that they were honest and 
capable of getting along well with their fellow residents. 

Hughes: Did you hope that they would be interested in surgery as 
opposed to medical ophthalmology? 

Maumenee: No. Whatever they were interested in, if they did it well, that 
was fine. I didn't push a surgeon more than a basic science 
person or a neuro-ophthalmologist or any other subspecialist. 

Hughes: You said that you didn't particularly like neuro-ophthalmology 
and hadn't published in that field. Some of the reason that 
you weren't particularly attracted was because it consists of 
more diagnosis than treatment. Do you think it was also 
because it isn't a particularly surgically oriented subspecialty? 

Maumenee: It was primarily a specialty in which diagnosis was the most 
important aspect. There was little medical or surgical 
treatment for many of the neurological diseases that affected 
the eye, and I was more interested in treatment than 
diagnosis. 

When I was in medical school, as I told you, I went down 
every Saturday and worked with Foster Kennedy, who was a 
great neurologist a number of syndromes were named for 
him and Samuel Wortis, who was also a very outstanding 
neurologist. It was wonderful. It's a mental challenge, it's 
more like playing chess, to diagnose what these patients have. 
Once you've played chess, there's no treatment. 



Hughes: 



127 

At Hopkins, they've combined neurology, neurosurgery, 
psychiatry, neuropathology, and neuropharmacology into the 
Mind-Brain Institute. All these disciplines work together, and 
they're coming up with drugs that treat schizophrenia and 
Huntington's chorea, and other conditions. So it is getting to 
the point where treatment is available for some of these 
neurological problems. 

Ron Smith talked about your love of debate or friendly 
argument over a medical or surgical topic.* Do you think 
you use debate as a means of instruction? 



Maumenee: Yes, absolutely. If someone had given a lecture and I thought 
he was wrong, it was wonderful fun to debate with him I 
always said that anything that you know now, ten years from 
now it'll be wrong, because medicine is about 90 percent 
witchcraft, [laughter] 

Hughes: Are you sure you want to have that published, Dr. Maumenee? 
[laughs] 

Maumenee: I've said it enough times in public. Go right ahead and use it. 

Hughes: Dr. Goldberg said this morning that he felt that you always 
had higher goals for an individual resident than he had for 
himself, so then he felt compelled to meet your expectations.** 
Were you conscious of that? 

Maumenee: Well, I certainly pushed residents as hard as I could. 

Hughes: Were you conscious of being tougher on some residents than on 
others because you knew that they could take it? 

Maumenee: I would say more that I would try to use them as examples of 
what a resident ought to be. 

We'd have as many as eight or nine hundred people come to 
the Winner residents' meeting, and the residents would have 
to get up in front of the crowd and talk. The comments from 
the visiting doctors were, "My goodness, your residents are 
certainly the most articulate speakers that we've ever heard. 
They're so alert." 

Hughes: Did you make an effort to instill ethics in your residents? 



* Interview with Ronald E. Smith, MD, November 1, 1989. 

** Interview (not tape-recorded) with Morton F. Goldberg, MD, May 18, 1990. 



128 

Maumenee: I always told them that the patient had to come first. If the 

patient had a complaint, I didn't want them to tell him to wait 
until tomorrow morning. I wanted them to tell him to come in 
that night and they would go over to see him. The patient 
came first. If the resident put off seeing a patient, he really 
caught hell. 

Hughes: So you could get angry? 

Maumenee: Well, the residents said I did. They were scared to death of 
me. When I would help them operate, they would have such 
a tremor, and I didn't mean to frighten them. I found that 
giving them Enderol blocked their tremor, so I would make 
them take it before they operated. They said, "Look, that's 
going to slow down our mental processes. We won't be able to 
think." I said, "It's not going to slow you down." 

Hughes: How would you characterize your relationship with your 
residents? 

Maumenee: Oh, I played golf with them. I played tennis with them. I told 
you about the summer house that we called Focal Point. We 
would go down for weekends. They would bring their wives 
and children and swim and sail and have a good time together. 

Louise Friedenwald said, "I hear some of the residents call 
you the Prof. That's terrible. They ought to call you Professor 
Maumenee." I said, "Louise, it doesn't make any difference to 
me what they call me as long as they work." 

Hughes: What was the most important concept you were trying to get 
across to your residents? 

Maumenee: I thought they ought to keep up with the literature, meaning 
they ought to read the basic books, like Duke-Elder's. They 
ought to have a good knowledge of ophthalmology. We 
quizzed them constantly on what they knew. Whenever I 
could, I would try to get them to come up with different ways 
of doing things, different operating procedures, something 
innovative, because that to me was the heart and soul of 
somebody who was going to accomplish something. 



129 

Subspecialization in Ophthalmology 

Hughes: What is your feeling about subspecialization in ophthalmology? 

Maumenee: I think it's fantastic. The beauty of an academic center is 
that you can work in neuro-ophthalmology where you can't 
charge patients very much because there is often no available 
treatment. Neil Miller, a neuro-ophthalmologist at Wilmer, 
does a little surgery, but there's no way he can make any 
great amount of money. The rest of the staff realize that, so 
we supplement his salary through the high earners, who 
make many times his salary. 

Hughes: Do the high earners resent supporting the low earners? 

Maumenee: I don't think so. It's always been explained that they're in a 
privileged academic position, that they get referrals, that if 
they'd gone out into practice, it would have been very difficult 
for them to build up a reputation. They have time off to write 
books and to do research and other things that bring them to 
the top of the ladder in their field. Somebody in private 
practice may have to do refractions and waste time doing 
minor things that really aren't important in order to earn 
enough to keep his office going. He just can't afford to 
specialize very much. You get good by doing the same 
operations over and over. You modify and keep improving 
them. 

Hughes: Yet you have never looked at yourself as a specialist, have you ? 
Maumenee: No, but Fve always operated quite a lot. 

Hughes: But not in any one field; you've done a lot of different types of 
operations. 

Maumenee: Yes. Well, I don't think I would have ever been the world's 
greatest retinal surgeon. I didn't like that field particularly. 
And I don't like plastic surgery. People always want to look 
like some Hollywood beauty queen, and they never look that 
way. I did a fair amount of plastic surgery at Stanford. At 
that time, people didn't specialize; they did everything. As 
people came along who could do procedures better than I, I 
sent all my cases to them. So they finally narrowed me down 
to cataract and cornea! transplants. I did a lot of glaucoma 
operations until Harry Quigley came along, and then I began 
to refer the patients to him. 



130 

Hughes: So you thought of yourself as a glaucoma and cataract and 
transplant surgeon? 

Maumenee: I developed instruments for glaucoma, cataract, and corneal 
transplant surgery. 



Retinal Surgery 



Hughes: Why didn't you particularly like retinal surgery? 

Maumenee: It was very time consuming. The visual results were rather 
poor. If the retinal surgeon could get someone to see 5/200, 
he considered that a success because the retina was back in 
place. But frequently the retina had been detached long 
enough that the macula had degenerated and the patient 
didn't have good visual acuity. It was very tedious and 
difficult surgery. In the indirect ophthalmoscope, everything 
you see is upside down. 

When I came back to Baltimore in 1955, 1 probably did as 
many retinal cases as anybody on the staff here. Harold 
Pierce was just getting started, and he did nothing but retina. 
He soon did more cases than I did. But at first I was doing as 
many as he did, and certainly at Stanford I did as many as 
anybody but Pischel. 

Hughes: Did you pay attention to what Dr. Schepens was doing in the 
field of retinal surgery? 

Maumenee: Yes, I knew. I didn't always agree with Charlie. I thought he 
did some good things. The operation for shortening the sclera 
or in-buckling the choroid and retina was done well before 
Charlie Schepens came along, although he improved the 
technique a lot. We would take out a full-thickness piece of 
sclera and thereby shorten the eye instead of putting a buckle 
around it and pushing everything in. [Ernst] Custodis 
buckled the sclera with a piece of plastic of some kind and 
did not remove sclera. 

Hughes: Did Schepens get his idea for the buckling operation from 
Custodis? 

Maumenee: Well, how do I know? Schepens may have had the idea at the 
same time. Schepens used tubes that wrapped all the way 
around the eye. [Hermenegildo] Amiga used a piece of very 
heavy suture material. I tried that on a couple of patients, 



131 

and in two or three years the suture would cut through the 
sclera and the retina would be hanging out on the suture like 
clothes on a clothesline, [laughter] 

Hughes: Did you ever watch Dr. Pischel operate? 
Maumenee: Oh, yes. He was very meticulous and very good. 
Hughes: I would expect him to be meticulous. 

Maumenee: Dave Cogan picked various people to write review articles 
once a year on what had happened during the year in their 
field. 

Hughes: For the Archives of Ophthalmology? 

Maumenee: For the Archives. For four or five years I wrote the review on 
the retina. I took all of December off and spent the time in 
the library looking at every journal medical, surgical, and 
everything else that mentioned retina or vascular diseases 
of the eye. 

Schepens began to write about how much more you could 
see with the indirect ophthalmoscope. Well, Pischel was 
so good with the direct ophthalmoscope that he could pick 
up holes that were out in the periphery. I wrote that I didn't 
think that the indirect ophthalmoscope was that much of an 
advance, because Pischel could see everything with the direct 
ophthalmoscope and get just about as good results as with the 
indirect ophthalmoscope. Well, that changed, because as time 
went on ophthalmic surgeons did more and more difficult 
cases that Pischel would say were hopeless. They would 
cure them, because they could see better and farther in 
the periphery with scleral depression and the indirect 
ophthalmoscope. With the indirect ophthalmoscope you 
can see all the way to the ora serrata. 



Photocoagulation 

[Interview 5: October 14, 1991, annual meeting, 
American Academy of Ophthalmology, Anaheim, 
California] 

Hughes: When did you begin to use the xenon arc photocoagulator, 
Meyer-Schwickerath's invention? 



132 

Maumenee: Dr. Alan Woods, the former director of the Wilmer, went to 
Europe for some meeting and saw Meyer-Schwickerath's 
xenon photocoagulator. This was a big, bulky machine that 
weighed about two tons and was very difficult to handle. But 
he came back and said that it was a fantastic new piece of 
equipment. So I bought one immediately for the Wilmer 
Institute, and we began using it to obliterate vessels in the 
back of the eye that were bleeding, and in diabetes and Von 
Hippel's and Coats's disease. We used his light to obliterate 
various vascular abnormalities in the fundus. 

Hughes: Dr. [DuPontJ Guerry was one of the first to try photo- 
coagulation in this country, because he received one of 
the first Zeiss machines.* 

Maumenee: Actually, Verhoeff, who wrote a book in 1917 or 1918, 

mentioned using a carbon arc light to burn the retina.** 

Hughes: Was photocoagulation an easy technique to pick up? 

Maumenee: Yes. You looked in through an ophthalmoscope, and you had a 
button you punched. You see, light is heat, and the xenon 
light gave off enough heat to obliterate the vascular 
abnormalities. 

Hughes: You could target it pretty reliably? 

Maumenee: You obliterate very small areas of newly formed blood vessels 
or aneurysms. 

Hughes: Would you consider the xenon light a real advance over 
diathermy? 

Maumenee: Yes, because you didn't have to operate on the eye; you went 
right through the pupil. It didn't damage the lens or the 
cornea or anything else because you focused it on the retina. 

Hughes: Dr. Pischel said there were initially only three photo- 

coagulators in this country, one with DuPont Guerry in 
Virginia, one with Graham Clark in New York, and Dr. Pischel 
had one as well.*** He didn't mention the instrument at the 
Wilmer. How long did it take for photocoagulation to catch on? 



See the oral history in this series with Dr. Gueny, pp. 131-37. 

Verhoeff FH, Bell L. The Pathological Effects of Radiant Energy on the Eye: An Experimental 
Investigation. Boston: American Academy of Arts and Sciences, 1916. 

See the oral history in this series with Dr. Pischel, p. 79. 



133 

Maumenee: Within a few years, it became a standard piece of equipment 
for most of the larger ophthalmic institutes in this country 
and in Europe. The argon laser was developed by Fran 
UEsperance in New York. Arnall Patz had the Johns Hopkins 
Applied Physics Laboratory make one for him. But then 
some commercial companies made much less cumbersome 
ones. You could hold the ophthalmoscope with an argon 
photocoagulator, whereas with the xenon ophthalmoscope, it 
was on a long bar. You had to move the bar around to focus on 
the retinal lesion. It was very awkward to use, but it was 
very effective. 

Hughes: These instruments were progressive improvements in 
technique, moving from diathermy to the laser. 

Maumenee: That's right. 

Hughes: And techniques that were readily accepted into ophthalmology? 

Maumenee: Yes. 

Meyer-Schwickerath said that obliterating the vessels in the 
periphery of the fundus in diabetes would stop the progress of 
the retinopathy. He claimed that his machine was more like a 
shotgun. It created a much bigger area of burn than the laser 
beam, which was like a rifle just one little hit. So people 
had to use a thousand or two thousand blasts of the laser 
beam to knock out the vessels, whereas he could obliterate 
them with many fewer shots with his xenon light. So, until 
quite recently, he continued to use the xenon light rather than 
the laser. 

Hughes: But not other people. 

Maumenee: Not other people. Hunter Little, who went to Palo Alto 

[California, the location of Stanford University], did extensive 
work with diabetic retinopathy, along with Chris Zweng. 
They refused to enter the double-mask study of the laser 
obliteration of the peripheral retinas in patients with diabetic 
retinopathy that the National Eye Institute started, because 
they said they knew obliteration of the diseased retina 
stopped the progress of the retinopathy. They weren't going 
to give their patients a placebo when they knew laser 
treatment worked. 

Hughes: Have you said enough about macular disease? 



134 

Maumenee: We did an extensive classification of macular disease.* 

Once you began to break down macular disease into definite 
integers, then you could look for a specific etiology for them. 
When you lumped everything under "macular disease" and 
treated everything, you could not get a clear answer as to the 
value of laser therapy. But when you defined the problem as 
histoplasmosis or vascular lesions outside of an avascular 
circle of the macular area, you could treat those conditions 
with photocoagulation and stop the bleeding. 

I understand from Brad Straatsma's discussion last night 
that they are now picking up the retina and exposing the 
small vessels that come through Bruch's membrane and 
coagulating them to prevent hemorrhage. It's unbelievable 
that they can do that and get the macula to go back in place. 
They aspirate the blood that's there, because the hemorrhage 
keeps nutrition from getting to the rods and cones and fibrous 
tissue forms. 



Research on the Cornea** 



Research on Rejection 

Hughes: Please go back to the work that had been done on skin 

rejection and how that led to your research on the cornea. 

Maumenee: I had read a paper by Peter Medawar, who later won the 

Nobel Prize for his work on tissue rejection.*** Medawar had 
not been able to explain why the cornea doesn't reject. I felt 
that this problem would be a wonderful thing to work on. 

What was different about the cornea! cells from other cells in 
the body? I had the machine shop make me a copper cone on 
a stick to use as a cryoprobe. I would put it in dry ice and 
absolute alcohol which was at a temperature of minus 78 
degrees Fahrenheit. I could put the cryoprobe on the cornea 
and freeze the cornea and kill all the cells in the cornea.f 



Maumenee AE, Emery JM. An anatomic classification of diseases of the macula. Am J 
Ophtkalmd 1972; 74:594-99. 

** Parts of a discussion of research on the cornea from Interview 1, May 14, 1990, are incorporated 
here. 

*** Medawar PB. Immunity to homologous grafted skin. Br J Exp Pathol 1946; 27:9-14. 

t Maumenee AE, Kornbleuth W. Regeneration of the corneal stromal cells. I. Technique for 
destruction of corneal corpuscle by application of solidified (frozen) carbon dioxide. Am J 
Ophthalmd 1948; 31:699-702. 



135 

Then we would give the animals methylene blue and 
other dyes intravenously so that the macrophages in the 
bloodstream would pick them up. When the animals' corneas 
regenerated, we would kill the animals and enucleate them 
and see that the cells contained methylene blue. 

We knew that the cells that made the cornea regenerate were 
macrophages.* There was very little mitosis of the corneal 
stromal cells. Everybody thought that they were specific 
cells, but they were actually macrophages in the environment 
of the mucopolysaccharide, which is called keratosulfate, in 
the cornea. The keratosulfate made these cells turn into 
keratocytes. 

Hughes: None of this was known before you did this research? 

Maumenee: No. This was the first time it was done. 

Dr. Walter Kornblueth came over from Israel to work with 
Jonas Friedenwald. Jonas asked if I would let Walter work 
with me, and Walter and I did work together for three or four 
years. When I moved to Stanford after the war, Walter went 
with me and we continued to work on the cornea. 

Hughes: How did people explain corneal rejection before you came 
along with this macrophage idea? 

Maumenee: [Ramon] Castroviejo was the leading corneal expert. He 
claimed that it was uveitis due to sinus infection because 
there were inflammatory cells in the eye that were caused by 
the antigens of the endothelial cells which were different than 
those in the recipient. The killer lymphocytes would come in 
and destroy those cells and set up an inflammatory rejection. 
They all considered this inflammatory reaction the cause of 
the loss of corneal transparency. 

There is a monograph written by Paufique, Sourdille, and 
Ofiret called La Maladie du Greffon, which was published in 
1948.** They said that the immune reaction killed the graft 
in the first week. After that it was the nutrition to the graft 
that caused it to go bad. Failure was due to an invasion of 
the defective host tissue. They are credited as the first to 
describe that the immune reaction killed the graft. But they 
were all wrong because it takes at least two weeks for skin 



Maumenee AJE, Kornbleuth W. Regeneration of the corneal stromal cells. II. Review of the 
literature and histologic study. Am J Ophthalmol 1949; 32:1051-1064. 

Paufique L, Sourdille G-P, Offret G. Les Greffes de la Corn&e (Kiratoplastles). Paris: Masson & 
Cie, 1948. 



136 

or a kidney or any other tissue to sensitize an animal. Yet 
people write that they were the first to discover cornea! graft 
rejection due to an immune reaction. Once the graft is 
sensitized, the secondary reaction occurs quite rapidly. 

We did a study to try to find whether the nerve supply to the 
cornea was the reason why the graft went bad.* We cut 
out all the cornea tissue in a circle around the limbus, thus 
cutting off all of the cornea! nerves coming in. We found that 
Descemet's membrane and the cornea stayed perfectly clear. 
When the cornea and nerves regenerated, the cornea would be 
perfectly clear because the cornea! lamellae weren't disturbed. 

Hughes: Was that work that had been done before Art Silverstein came 
to Wilmer? 

Maumenee: Way before. Actually my paper in the AJO in 1951 described 
everything Art Silverstein and Ah Khodadoust talked about 
except that I didn't do as detailed a study as they did.** They 
perfected the description of the sequence of events that I 
described. I described the pathology and the fact that 
cortisone would stop the reaction. My idea was that the 
cornea was avascular, and therefore the white cells couldn't 
normally get to the cornea unless it was vascularized. The 
white cells couldn't get to the cornea to find that it was a 
foreign body. The body tries to reject any foreign body. 

I transplanted skin from rabbit A to rabbit B, and when 
rabbit B rejected the skin transplant, then I transplanted 
the cornea from rabbit A to rabbit B, and the cornea would 
reject because the animal was already sensitized. The 
inflammatory reaction from the operation would cull out the 
lymphocytes and cause rejection. The cornea would become 
cloudy just as it does in the human. 

Immunologic Privilege 

Hughes: Dr. Silverstein talked to me about the immunologic privilege of 
the cornea.*** Could you expand on that concept? 



* Kombleuth W, Maumenee AE, CrowellJE. Regeneration of nerves in experimental corneal grafts 
in rabbits. Clinical and histologic study. Am J Ophthalmol 1949; 32:651-59. 

** Maumenee AE. The influence of donor-recipient sensitization on comeal grafts. Am J 
Ophthalmol 1951; 34:142-52. 

*** Interview with Arthur M. Silverstein, PhD, March 15, 1990. 



137 



Maumenee: It is only that the cornea doesn't have any blood vessels in it, 
and that's why it is privileged. Everybody thought that the 
cornea! cells, the keratocytes, were privileged, and they 
wouldn't react immunologically. [M. F. A.] Woodruff from 
England was one of the main people who said the cornea was 
a privileged tissue.* It didn't carry any of the antigens. 

Hughes: Therefore, it was an exception to Medawar's hypothesis? 

Maumenee: Yes. Nobody could make it turn cloudy. Actually, Medawar 
and Billingham took the corneal epithelium and put it on the 
skin and showed that it would reject, but they didn't include 
the stroma. The stroma has so few cells in it. Walter 
Kornblueth and I took off all the epithelium and endothelium 
and put the cornea under the skin of an animal and showed 
that it would reject. The fact that we could freeze the cornea 
and show that it didn't have specific cells showed that the 
only privilege was that it didn't have any blood vessels. 

Hughes: Otherwise it followed the theory. 
Maumenee: Otherwise it acted like every other tissue. 
Hughes: Is there more to say about corneal opacification? 

Maumenee: The other thing we became interested in was why the cornea 
became edematous. There were lots of basic scientists 
working on the endothelium. They figured out that there 
was a pump mechanism that pumped fluid out of the cornea 
because the cornea gets all of its nutrition from the aqueous 
of the eye. Nobody could figure, if nutrition went in, why the 
cornea didn't swell from the aqueous going in. 

We cut a piece of a paper clip about one millimeter long and 
made a small incision into the anterior chamber at the limbus 
and put the piece of metal into the anterior chamber of the 
eye. After it had healed, we would pull a magnet across the 
back of the cornea and destroy the endothelial cells without 
making another incision. We showed that the cornea swelled 
as soon as the endothelial cells were rubbed off. This had 
been done before by David Cogan. We had the idea that if the 
endothelial cells kept the aqueous out of the cornea, the best 
thing to do when the cornea was edematous was to put Saran 



Woodruff MFA. The Transplantation of Tissue and Organs. Springfield, HI.: Charles C. Thomas, 
1960. 



138 

Wrap over Descemet's membrane, which, made it impermeable 
and then the aqueous couldn't come in.* We thought we 
could cure endothelial dystrophy that way. We did do that 
in rabbits, and sure enough the cornea stayed absolutely 
clear. But, unfortunately, within two or three weeks the 
cornea would begin to melt over the Saran Wrap because all 
the nutrition to the cornea came from the aqueous. Since the 
nutrition couldn't get through, the technique didn't work. 

Ali Khodadoust 
Hughes: Please tell me about Ali Khodadoust's work. 

Maumenee: Ah' is from Shiraz, Iran, and he was top of his class at the 
university there. He applied to me for a fellowship, but I 
never took any foreign fellows because I had so many good 
people applying from American schools. Stewart Wolff had 
met him and told me that he was a very smart guy. 

Finally, after he had persisted so long, I brought him over 
for a one-year fellowship. He worked so hard and was so 
brilliant, I took him as a resident. Somebody on the house 
staff dropped out for some reason, so I had Ali take his place. 
Ali then went through the residency. He worked night and 
day with Art Silverstein on really exquisite research. 

When I was working with Horst Mueller from Germany, we 
bled animals to death and put their serum in the anterior 
chamber and could never make them reject. We were really 
not the first who showed that the white blood cells were 
the reason you got rejections. Ali repeated that research 
and made beautiful pictures of flat preparations of the 
endothelium with a single lymphocyte attacking and eating 
the endothelial cells. He did a number of good experiments 
along that line. He also showed quite exquisitely that all 
three layers of the cornea could reject. 

Cortisone Treatment 



Hughes: 

Maumenee: That's right. 



In a paper that you published in 1951, you suggested cortisone 
treatment.** 



Bock RH, Maumenee AE. Corneal fluid metabolism. Experiments and observations. Arch 
Ophthalmol 1953; 50:282-85. 

Maumenee AE. The influence of donor-recipient sensitization on corneal grafts. AmJ 
Ophthalmol 1951; 34:142-52. 



139 

Hughes: Wasn't cortisone very new? 

Maumenee: It was brand new. 

Hughes: Was it being used in ophthalmology at that point? 

Maumenee: No. 

Hughes: How did you come to suggest it? 

Maumenee: I heard there was somebody from Canada who had shown 
that cortisone worked on allergic reactions and arthritis. In 
general medicine, cortisone was well known. It might have 
been used topically in the eye for iritis, but it had never been 
used to block an immune reaction to the cornea! graft. 

Hughes: Was it immediately successful? 
Maumenee: Yes. It blocked the immune reaction. 

Hughes: I know from talking to Dr. Thygeson that there were some 
problems later with the use of cortisone in ophthalmology.* 

Maumenee: There was tremendous prejudice, as there is with everything 
new. For fifteen years, people claimed that the cornea did not 
reject and that uveitis was causing the problem. I remember 
going to a meeting where I was so fed up that I said, "The 
longer you keep fighting cornea! rejection, the better it's going 
to make me look in the end. [laughter] You bigwigs just don't 
know what you're talking about." 

Alan Woods hated cortisone. He blamed cortisone for all the 
bad reactions that occurred in uveitis and said it was the most 
horrible drug that ever had been introduced into medicine. 
There was some evidence that cortisone made people more 
susceptible to infections. 

Thygeson and Alan Woods were terrible critics of it. Daniel 
Gordon said, "I treat all my uveitis patients with cortisone 
and they do better." Alan Woods called him a liar, but Gordon 
was right. Cortisone did cut down the inflammatory action. 
But if given enough time, it suppresses the adrenals. You get 
a moon face and osteoporosis. If used topically on the eye, it 
causes a marked elevation of pressure, just as in glaucoma. It 
also causes cataracts to develop. There are complications to 
any drug, particularly if it is overused. 



See the oral history in this series with Phillips Thygeson, pp. 172-73, 241-42. 



140 



Hughes: 



Corneal Hypersensitivity 

Fred Germuth was also working on corneal immunology at 
Wilmer. 



Maumenee: Arnold Rich, chairman of the Department of Pathology, was a 
brilliant guy. He did a lot of work on tuberculosis. There 
were two types of sensitivity, delayed hypersensitivity and 
immediate hypersensitivity. Those were the two terms used 
at the time. It turns out that one is humoral hypersensitivity 
which is related to serum reactions. For example, if you 
give an animal egg white or horse serum, you would get a 
reaction. If you use tissue, you get a delayed hypersensitivity. 
Humoral hypersensitivity comes on much more rapidly 
than delayed hypersensitivity. 

Hughes: Had that all been worked out? 

Maumenee: That had been worked out by Arnold Rich. So we decided to 
look at the cornea and see if this was really true. 

Germuth was Arnold Rich's right-hand man. He was 
assistant or associate professor. So I went over to talk to 
Fred, and I said, "Let's use the cornea to see if Rich is right. I 
don't think he is. I think it is something else." We injected 
antibody on one side of the cornea and antigen on the other. 
That is, we would sensitize an animal to horse serum and get 
its antibody out of the plasma. We would inject that on one 
side, and we would inject horse serum on the other side. 
When they came together, it was just like an Ochterlony 
plate. Ochterlony showed that you could put antibody on one 
side of an agar preparation and antigen on the other, and they 
would come together and make a precipitate. 

We did that in the cornea to see if we could produce a delayed 
hypersensitivity reaction and necrosis. I think Fred wrote a 
paper saying that there was some evidence that it did cause 
necrosis.* But it was so minimal, I never agreed with it. 
Delayed hypersensitivity didn't turn out to be a factor. 



Germuth FG, Maumenee AE, Pratt-Johnson J, Senterfit LB, et al. Observations on the site and 
mechanisms of antigen-antibody interaction in anaphylactic hypersensitivity. Am J Ophtholmol 
1958; 46:282-86. 



141 



Hughes: 



I got Jim Parks, who had a PhD in immunology, a $6,000-a- 
year scholarship to go through medical school if he would do 
research work in ophthalmology. So with Howie Leibowitz 
we did a lot of studies on transferring delayed and humoral 
hypersensitivity. We wrote a series of papers, showing that 
we could produce delayed hypersensitivity by injecting white 
blood cells as opposed to injecting serum.* This was basic 
science. It really had no clinical application. 

Was there research going on at Wilmer that was having a 
direct impact on corneal transplantation? 



Maumenee: I pointed out that if the cornea was vascularized from a 

disease or ulcer or chemical burn, we would get 70 percent 
rejection. If it was a keratoconus, or a macular or granular 
dystrophy, or some avascular clouding of the cornea, we could 
get almost a 90 percent take of the cornea graft without 
having a reaction if we could educate the local doctor to put 
the patient on steroids the first time he saw any evidence 
of cells in the anterior chamber. Frank Polack from 
Tallahassee, Florida, showed that steroids would kill the 
white blood cells on the back of the cornea. We could save a 
lot of corneas if we treated them right away with intensive 
topical steroids. In the Ciba Symposium publication that 
came out much later, there is a very good review of this 
work.** 

Hughes: Were immunologists interested in the work that was going on 
on the eye? 

Maumenee: They were interested enough to invite me to all their 

meetings. For instance, I went to the Harriman House in 
New York. I went to meetings in England. I lectured to the 
immunologists when I was visiting professor at Guy's 
Hospital in 1958. 



Parks JJ, Leibowitz HM, Maumenee AE. The effect of route of inoculation upon development of 

antibody in rabbits. J Immunol 1961; 87:199-204. 

Leibowitz HM, Parks JJ, Maumenee AE. Manifestations of localized hypersensitivity in a 

previously sensitized tissue. Arch Ophthalmol 1962; 68:66-71. 

Parks JJ, Leibowitz HM, Maumenee AE. A transient stage of suspected delayed sensitivity 

during the early induction phase of immediate corneal sensitivity. J Exp Med 1962; 115:867-80. 

Parks JJ, Leibowitz HM, Maumenee AE. Immediate hypersensitivity reactions in the cornea of 

the guinea pig. J Immunol 1962; 89:323-25. 

Maumenee AE. The role of steroids in the prevention of corneal graft failure. In Symposium on 
Corneal Graft Failure, London, 1972. Ciba Foundation Symposium 15 (new series), 
Amsterdam/New York: Elsevier, 1973, pp. 241-55. 



142 



Hughes: 



Dr. Silverstein told me about a combination of workshops 
and conferences on ocular immunology that you organized, 
beginning in 1957.* Were those conferences an outgrowth of 
the work that you were doing on the cornea? 



Maumenee: It was partially an outgrowth of my work on graft rejection, 
but really primarily the work of Jim Parks and Howie 
Leibowitz and what we had done on the cornea. Then Art 
did a whole lot of work along those lines too. He started the 
immunology group at Hopkins, which people from, the basic 
sciences attended. I never participated; they were over my 
head. 

Hughes: Was that a weekly conference? 

Maumenee: No, they met periodically. Art was not only a good 

immunologist, he had a very sound philosophy. Whenever 
I had problems in running the department, I would go to Art 
and get his advice. 

Contesting the Theory of the Corneal 
Endothelium Pump 

Hughes: I want to quote again from the letter that Marvin Sears wrote 
to me: "In the field ofcorneal transplantation and corneal 
physiology, [Dr. Maumenee's] demonstrations were the 
first physiologic demonstrations of how fluid truly moved 
through the cornea and what the importance of the corneal 
endothelium was. He did this with plastic membranes in 
some very memorable and important studies that have long 
since been written out of the literature by those entrepreneurs 
who are not scholars. He was the first one to emphasize 
repeatedly and consistently the importance of delayed reaction 
to the graft or an immunogenic reaction of the corneal graft. 
He also indicated ways of avoiding this reaction and 
contributed immeasurably to the field ofcorneal 
transplantation in this manner. "** 

What does he mean by "written out of the literature by those 
entrepreneurs who are not scholars"? 

Maumenee: My work was crude compared to the work of Dave Maurice 
and Keith Green and Dave Spector. They showed that some 
salts would be held back and other products would be allowed 
to go through the cornea. They worked out the pump 

* Interview with Arthur M. Silverstein, PhD, May 15, 1990. 

** Marvin L. Sears, MD, to Sally S. Hughes, PhD, October 26, 1989. 



143 

mechanism of the endothelium, whereas my worry was to 
show that putting Saran Wrap over Descemet's membrane 
blocked exchange, that there was a pump. Other people said, 
"Well, all the exchange comes from the limbus." This was 
very early on. 

I had lots of arguments of why it couldn't be a pump. 
For instance, if you have an epithelial ingrowth, if the 
conjunctival epithelium grows down into the eye and onto 
the back of the cornea after an intraocular operation, the 
cornea doesn't become edematous. Why would the cornea be 
crystal clear over an epithelial ingrowth, if the endothelium 
with its pump was absent? I argued that very heavily, which 
turned out to be wrong. Dave Maurice and the others showed 
that the epithelium was enough to block the fluid from 
coming through and that the rest of the endothelium was 
enough of a pump to keep the cornea clear. They all showed 
that the tears were pumped in the cornea from the outside 
through the surface of the cornea. 

I would object: "Why wouldn't fluid be pumped into the 
cornea from the back?" In the Cogan lecture [never 
published], about 1960, 1 tried to defeat the idea that there 
was an actual pump mechanism in the endothelium. But 
other people who did very sophisticated work on isolated 
corneal material, particularly Dave Maurice, showed without 
any question there was a pump. 

Developing Media, Sutures, and Instruments for 
Corneal Transplantation 

Hughes: David Paton wrote in the festschrift in the AJO: "[Dr. 
Maumenee] has been one of the early champions of the 
continuous 10-0 nylon suture for securing penetrating grafts, 
an ardent exponent of the Flieringa ring for scleral support in 
aphakic keratoplasty, and has devised numerous instruments 
for tying, grasping and suturing many of which bear his 
name." * Please explain some of those terms and their 
significance. 

Maumenee: When a person died, we would get the family to give us the 
eyes. The cornea doesn't last more than twenty-four or 
forty-eight hours at the most because the aqueous doesn't 
have enough nutrition in it to maintain the endothelial cells, 
and the endothelial cells die. 



* Paton D. The surgery of A. Edward Maumenee. Am J Ophthalmol 1979; 88:297. 



144 

Then B. E. McCarey in Michigan invented a tissue culture 
medium that would keep the endothelium alive. Herb 
Kaufman [then at the University of Florida at Gainesville] 
took him on as a staff member. Herb placed corneas removed 
from animal eyes in the medium and showed the endothelium 
survived for three or four days. In 1962, when I was a visiting 
lecturer at the University of California, Herb Kaufman was 
there, and he described the McCarey medium. I immediately 
brought it back to the eye hank in Baltimore. We used it right 
away to keep corneas going. I think we were the first eye 
bank in the country to use the medium to preserve human 
corneas for transplantation. 

In the early 1960s Joaquin Barraquer began to use 9-0 virgin 
silk suture which caused much less inflammatory reaction 
than the larger 5-0 to 6-0 silk suture. I switched to these. At 
about the same time, [H.] Harms and [Guenter] Mackensen 
began to use 10-0 single filament sutures. I argued on 
television at the AAOO [American Academy of Ophthalmology 
and Otolaryngology] meeting that the nylon was too stiff and 
hard to use and was no better than Barraquer's virgin silk. 
Again I was wrong, for once I learned to use the 10-0 nylon, it 
was much better and caused less inflammatory reaction. The 
knots were so small you could bury them in the tissue, and 
then the epithelium would grow over the suture and there 
wouldn't be any way for infection to get into the tissue. 

I devised some suturing techniques and instruments to 
handle very fine suture because the crude instruments we 
had couldn't catch a 10-0 suture. It would just slip right 
through the tying forceps. 

Hughes: Fine sutures were not available before World War II. 

Maumenee: That's right. They were developed in Germany. I became 
good friends with Paul Haffee at Johnson and Johnson. We 
pointed out to him the real value of fine sutures, and he got 
Johnson and Johnson to make nylon sutures. They made 
them better and better so that they were strong enough to 
hold. You just had to put in more sutures and not permit 
patients to bump their eyes. Fine sutures were a real 
advance, and everybody uses 10-0 nylon sutures now to 
close cataract wounds and other types of incisions. 

Hughes: The sutures are not ever removed 1 ? 

Maumenee: Well, there were some people who said that they shouldn't 

ever be removed, so I went through a phase of leaving them in 



Hughes: 



145 



for two or three years. But then they hiodegraded. The body 
would finally dissolve them and they would break. When 
they broke they were still stiff, and so they would stick out of 
the epithelium. Where the epithelium was broken, bacteria 
could get in and cause an abscess. They were impossible to 
take out because they were so friable and brittle they just 
broke apart. So I went back to taking them out at the end of a 
year. Even at the end of a year, sometimes the wound would 
open when I took them out. 

Did you have a relationship with a specific surgical 
instrument maker? 



Maumenee: John McLean, Jack Guy ton, and I gave a course on cataract 
surgery at the annual meeting of the Academy. For fifteen 
years, our course was the first one sold out. We had a lot of 
ideas about instruments of one sort or another that would 
help do things a little better. Eric Storz of Storz Instruments 
was always great. He would make them for us right away, 
whereas Mueller and Grishaber were more staid and they 
wouldn't listen to us. After all, we were quite young, and they 
didn't think we had the stature to sell their instruments with 
our names because nobody knew us. 

I talked to Eric Storz in the exhibit hall about getting rid of 
astigmatism in corneal grafts. I got Storz to make a trephine 
with a handle on it and put a cross line at 12:00, 9:00, 6:00, 
and 3:00. Then I dyed those little cross lines, and I would get 
four exact places for sutures in the graft. I could do the same 
thing with the whole eye, and I would get four exact places in 
the whole eye. If you draw a circle with an ordinary compass 
and you move the point of the circle over a half a milometer, 
you will find that one side comes way out and the other side 
will be too short. That will cause thirteen diopters of 
astigmatism. 

Hughes: So it is not a small point. 

Maumenee: That's right. Besides allograft rejection, astigmatism is still 
one of the major problems in corneal grafting, because nobody 
has figured out a way to align the graft to avoid astigmatism. 
I have made the marks on the recipient, but I haven't been 
able to figure out any way to make the mark on the donor 
corneal button because we use the cornea and turn it upside 
down. If you damage the endothelial cells, then the graft 
doesn't work very well. 



146 

I designed a pair of forceps that had two sets of teeth which 
held the needle. There were two teeth on one blade of the 
forceps and two teeth on the opposite blade. If you have just 
one set of teeth to hold things together, the needle twists and 
the suture won't go in straight and it skews the graft. But if 
you have two sets, and you grab the corneal tissue so that 
now you can put your suture between these two, you've got 
two stable points. You can put the suture exactly vertically 
through. 

Hughes: Dr. Paton mentioned the Flieringa ring for scleral support. * 

Maumenee: If the lens is in the eye and you make a hole in the cornea, it 
stays pretty much a round hole. If you have had a cataract 
extraction and most of the grafts we do are secondary to 
damage done at the time of cataract extraction there is no 
lens in the eye, so you have a suture above and below, and 
when you cut a circle, it immediately becomes an oval. 
Putting the ring which H. J. Flieringa designed to go around 
the cornea helped stabilize it so that the hole would stay more 
like a circle than an oval. 

Hughes: Were you one of the first to introduce the ring into this country"? 

Maumenee: No. I did a lot of talking about corneal grafts and I mentioned 
it a lot. [Girolamo] Bonaccolto, from New York, claimed that 
he invented the ring, but Flieringa had described it before he 
did. Other people invented rings. Dermont Pierce from 
England invented a flat ring that is even more stable. They 
come in various sizes, from 11 millimeters to 15 millimeters in 
diameter. 



Vitreous Surgery 



Hughes: I would like to move on to vitreous surgery and to quote David 
Paton, who stated definitively: "In 1957, Maumenee initiated 
present-day vitreous surgery." ** Please explain what you did. 

Maumenee: When a patient had malignant glaucoma, very high-pressure 
glaucoma, which at that time everybody went blind from, 
physicians couldn't do anything. No operation worked. 
I showed that there was a pocket of fluid vitreous in the eye. 
I had seen this pocket histologically many times in specimens 



* Paton D. The surgeiy of A. Edward Maumenee. Am J Ophthalmol 1979; 88:297. 
** Paton D. The surgery of A. Edward Maumenee. Am J Ophthalmol 1979; 88:297. 



147 

when I was working with Friedenwald. I put a needle in 
the eye, and I would suck out the fluid vitreous. Then the 
iris and the lens would fall back, and I would do an 
iridectomy, and the patient would be cured. 

Most ophthalmologists thought at that time if you took the 
vitreous out of the eye it would be lost. I did not take out 
formed vitreous. [David] Kasner did that. He would make 
his residents push vitreous out of the eye, cut it off, and show 
that it didn't make any difference. 

I was the first person to take fluid vitreous out of the eye. It 
was a dangerous thing to do because it was hard to find the 
pocket. A couple of times I hit the retina. 

Hughes: How could you find the pocket? 

Maumenee: Blindly. 

Hughes: Is fluid vitreous an abnormality? 

Maumenee: Everybody as you get older develops fluid vitreous. If you 

have uveitis or you have had trauma to the eye, you get fluid 
vitreous earlier. 

Hughes: Dr. Paton referred to "open-sky aspiration of fluid vitreous."* 
What does that term mean? 

Maumenee: That's when you have opened the eye [surgically] and the 

vitreous looks like it's coming forward. I would stick a needle 
right back through the vitreous to the fluid pocket and suck 
out the fluid, and the vitreous would fall back in the eye. 

Bob Machemer developed the method of taking out formed 
vitreous with a vitreous cutter. Nick [Douvas] and others also 
invented rotary vitreous cutters. Some of them are punches 
that cut the vitreous strands and you can then suck the 
vitreous out of the eye. I was not involved with any of those 
developments. 

Hughes: Was it taboo to tamper with the vitreous? 

Maumenee: It was. I don't think my taking out fluid vitreous really 
stimulated anyone to try the method. 

Hughes: Why, do you suppose? 



Paton D. The surgery of A. Edward Maumenee. Am J Ophthalmol 1979; 88:297. 



148 

Maumenee: It just didn't catch on. It was believed for a very long time 

that the eye would collapse if the vitreous was removed. But 
when Kasner pushed out formed vitreous and cut it off and 
showed that it didn't hurt the eye, and that the eye would 
heal and be perfectly all right, that caught people's attention. 

Hughes: Was that technique safer than yours? 

Maumenee: No. He was wrong. You get more retinal detachment. 

Hughes: Was that what surgeons were afraid of if they removed 
vitreous? 

Maumenee: Yes. The vitreous is attached to the peripheral retina, and if 
you put it on stretch it will pull a hole in the retina. 

Hughes: And that was a real danger. 
Maumenee: That was a real danger. 

Hughes: Did Machemer have to be careful about how much formed 
vitreous he took out? 

Maumenee: No, he would cut it out so neatly that there wouldn't be any 
pull in the periphery. 



Cataract Extraction 



Extracapsular Extraction 

Hughes: My understanding is that in the past it was the extracapsular 
that was pretty universally performed. Am I right? 

Maumenee: The operation goes back a long way. Couching consisted of 
putting a needle into the side of the eye and depressing the 
lens out onto the vitreous, and then the patient could see. 
This happens spontaneously in a number of elderly people 
with mature cataracts because the zonular capsular ligament 
gets very fragile and falls down into the bottom of the eye. 

In 1745, Jacques Daviel, a Frenchman, did a couching 
operation from below, for some reason. The lens must not 
have been mature enough because he couldn't push it back 
down into the vitreous. So he enlarged the incision to get a 
better leverage on the lens, and when he did, he broke the 
capsule and the nucleus popped out. That was the first 



149 

extracapsular cataract extraction ever done. That totally 
revolutionized eye surgery. In the couching operation, when 
the lenses fall back into the vitreous, they don't seem to cause 
much reaction for about three or four years, and then most of 
the patients get detachments and go blind. 

The extracapsular operation consisted of removing the lens. 
But the difficulty was, you had to wait until the lens became 
completely mature. Its cortex would get totally white and 
fluid. In an immature lens with, say, 20/100 or 20/200 vision, 
the cortex was sticky enough that we didn't have any way of 
getting it all out of the eye. The cortex that remained in the 
eye caused phacoanaphylaxis that is, autohypersensitivity 
to a patient's own tissue. Verhoeff was the one who first 
described the problem of autohypersensitivity after cataract 
extraction. Other people had shown that they could produce 
anaphylaxis in animals by sensitizing them to lens material 
and then injecting it, but it was a different thing from the 
chronic inflammation. 

You tried your best to wash out the cortex, but you just 
couldn't do it. So the extracapsular was not a very good 
procedure in a lot of patients. Because there were no sutures 
to close the wound, you got iris prolapses and infections. 

I ntracapsular Extraction 

Maumenee: Colonel Henry Smith was one of the first to advocate 

intracapsular cataract extraction that is, taking the whole 
lens out. He would make an incision in the superior part of 
the eye and then push on the inferior part with his finger and 
push the lens out. He lost vitreous in about 50 percent of the 
cases, and a very high percentage got detachments. But he 
started the intracapsular cataract extraction. 

Hughes: But at quite a price. 
Maumenee: I know. 

Hughes: I read that you learned intracapsular cataract extraction 
under John McLean.* Were you a resident then? 

Maumenee: I was a second-year resident. 

Hughes: Was intracapsular extraction the established technique at that 
time? 



Paton D. The surgeiy of A. Edward Maumenee. Am J Ophthalmol 1979; 88:299. 



150 

Maumenee: Extracapsular was the procedure of choice until about 1927. 
Ignacio Barraquer, Joaquin's father, invented the erysiphake, 
which was a little suction cup you put onto the lens and 
removed the whole lens in one piece. Barraquer didn't push 
on the vitreous, so he only had about a 10 percent vitreous 
loss, so his method was much better than Smith's. From 
that time on, intracapsular cataract extraction was so much 
better than leaving all the cortex in the eye and getting 
inflammation that it became the procedure of choice. 

As I mentioned to you, John McLean, Jack Guyton, and I gave 
a course at the Academy probably beginning the forties. We 
talked about instruments and techniques that made it a lot 
easier to do intracapsular extraction. There wasn't any major 
breakthrough: [Marcel] Kalt invented forceps for grabbing 
the capsule and taking the lens out in one piece. Barraquer 
invented the erysiphake. We made better and smoother 
forceps [in the laboratory]. I took out the cornea and the iris, 
leaving just the zonules to hold the lens in place. I showed 
that it was not a breaking of the zonules but a breaking of the 
zonular capsular ligament that allowed the lens to be 
removed in the capsule. Our technique of removing the lens 
and the capsule was much simpler than the other techniques 
that were used, but it was not a major breakthrough. It was 
just a modification and improvement of the techniques used 
at that time. 

Hughes: By the late 1930s, was the intracapsular method the method of 
choice across the country? 

Maumenee: I think the extracapsular was still the method of choice. 

Elliott Randolph, who was the senior resident in 1937 before 
John McLean, said that you had to learn to crawl before you 
could walk, so you had to learn how to do extracapsulars 
before you did intracapsulars. I was one of the first residents 
who on the first case did an intracapsular instead of an 
extracapsular. 

Cataract Extraction under the Microscope 

Hughes: Another thing Dr. Paton said in the festschrift is that by the 
mid-1960s you were using the microscope for all phases of 
cataract operations while most of your contemporaries were 
still using loupes.* 



Paton D. The surgery of A. Edward Maumenee. Am J Ophthalmol 1979; 88:299. 



151 

Maumenee: That's right. Again, I didn't realize the importance of it; 
I never wrote it up. In the 1950s, the otolaryngologists 
at Stanford were using the microscope to operate on the 
inner ear. So I borrowed their microscope and started doing 
goniotomies through the microscope because I could see the 
angle so much better. 

Hughes: Didn't that take a lot of adjustment? 

Maumenee: I had to turn the microscope upside down to focus it on the 
trabecular meshwork. But it was possible to do. The thing 
that made me stop using the microscope was the Zeiss 
oculars. You have objectives [lenses] at the lower end of a 
microscope, and you have oculars [lenses] at the upper end. 
With Zeiss oculars you had to get your eye right next to the 
ocular to see a full field. I was beginning to get presbyopic. If 
I took my glasses off, I could see the whole field through the 
oculars. But if I put them on, my eyes are so deep set, I would 
see only about half the field. I had such a small field, I didn't 
use the microscope very much. 

Hughes: I read that between 1956 and 1971, you performed something 
like 1,500 cataract extractions, apparently with very good 
results.* 

Maumenee: No one had written up a large series of cataract extractions 
before we published our cases.** [Travis A.] Meredith, my 
co-author, was a resident. I said, "Why don't you go over my 
cases and see what kind of results there are?" It took him 
about two years to get all of the history and summarize my 
results. People use those figures as the standard for results of 
cataract extraction. 

Hughes: Why were your results so good ? 

Maumenee: They weren't better than many other good ophthalmic 
surgeons. Nobody else bothered to write up that many 
patients. 

Did you know that the first aspiration of a cataract was done 
in about 1000 A.D. in Mesopotamia by Ammar? 

Hughes: What did he use? 



Paton D. The surgery of A. Edward Maumenee. Am J Ophthalmol 1979; 88:299. 

Maumenee AE, Meredith TA. A survey of 500 cases of cataract extraction (at the Wilmer 
Institute). In: Emery JM, Paton D, eds. Current Concepts in Cataract Surgery. Selected 
Proceedings of the Third Biennial Cataract Surgical Congress. St. Louis: C. V. Mosby Co., 1974; 
pp. 423-26. 



152 

Maumenee: He had a needle knife with a hole in it which he would stick 
into the lens of the mature cataract, and he would get his 
assistant to suck on the tube and suck the lens out. 

Hughes: Isn't that remarkable. 

Maumenee: Yes. I have a beautiful slide that I use to give the history of 
cataract extraction. The technique fell out of use, and Hank 
Scheie repopularized it in the 1960s for congenital cataracts. 

Hughes: Knowing nothing about Ammar, presumably. 
Maumenee: He didn't quote him. [laughter] 

Surgical Techniques in Cataract Extraction 

Hughes: I talked by phone with Dr. Frank Winter.* He told me that you 
developed a less traumatic method for removing the lens. Do 
you know what he was referring to? Presumably it was at 
Stanford because that's where Dr. Winter was a resident. 

Maumenee: Yes, that's right. I trained him. The only thing I can think of 
is that we were more gentle with the tissue. 

Hughes: He went on to say that you emphasized careful closure of the 
cataract wound and gentle handling of the tissue. 

Maumenee: As soon as I took the cataract out, I put a big air bubble in the 
anterior chamber so that the endothelium of the cornea 
wouldn't touch the vitreous. The bubble protected the 
endothelium and I got much less cornea! edema. It was not a 
major contribution. 



The Intraocular Lens 



Hughes: 



Harold Ridley's Posterior Chamber Lens 

When did you take up the intraocular lens? 



Maumenee: I took it up in 1956, and I did about six cases using the 
Dannheim lens. I had a German fellow, [Wolfgang A.] 
Geeraets, and he convinced me to use the lens. The first 
intraocular lens was inserted by an Englishman, Harold 
Ridley, in 1949. 



May 9 and 11, 1990. 



153 

I learned in Barcelona that in 1750 Tadini described putting 
artificial lenses in rabbit eyes after taking out the natural 
lenses. Casaamata in 1795 put one in an aphakic human eye, 
but the lens was made of glass and fell back into the vitreous. 
So Ridley was not the first person to put a lens in an eye. He 
was the first to put one in a human eye, as far as we know. 
He put it in the posterior chamber. 

I used the Dannheim lens in the anterior chamber. It was 
kind of a Maltese Cross. You put two arms in front of the iris 
and two arms in back of the iris. The results in six cases were 
so bad that I stopped. I only put them in children who had 
monoclonar traumatic cataract and could or would not wear 
contact lenses. 

Hughes: Ridley apparently had a hard time convincing 

ophthalmologists to adopt the intraocular lens. I 
understand that one of the reasons is that surgically 
he was very dexterous, so his results were better than 
anybody else's and people couldn't duplicate his results. 

Maumenee: Ridley chose lucite polymethyl methacrylate for his lens 
because he saw a lot of military pilots and their navigators 
who were hit in the eyes with lucite after the blister dome of 
the plane had been hit by flak. These eyes tolerated the lucite 
so well that a medical school student watching him operate 
said, "Dr. Ridley, you've just taken the lens out of that person. 
When are you going to put one back in so the patient can 
see?" So Ridley had an optician grind lucite into a round lens 
which he put in the posterior chamber after an extracapsular 
cataract extraction. It was very heavy and it had lots of 
impurities in it. After a while, many of these heavy lenses fell 
back into the vitreous and the patients went bund. 

When I was in South Africa I got a scanning electron 
microscope picture of a lens that had been in the eye of a 
patient for twenty-six years. There was no biodegrading of 
the PMA, polymethyl methacrylate. It is still the product 
that is used in the majority of lenses. 

Then I saw another patient when I went to Hyderabad, India. 
Ridley had put in a lens twenty-two years before, and she still 
saw 20/20. The iris was totally bound down at the lens from 
the inflammatory reaction to the lens, which held it in place. 
She had a completely bound down pupil, but she was still 
seeing 20/20. 



154 



Anterior Chamber Lenses 

Maumenee: When the Ridley lens turned out to be bad, everyone jumped 
on the bandwagon and made a lens. There were hundreds of 
different styles of anterior chamber lenses. Nobody went back 
to the posterior chamber lens. 

Hughes: I understand that Ridley's initial results were good. 

Maumenee: They were great, but three or four months later all these 

problems occurred. Then they tried to figure out some way to 
get better support for the lens, so it wouldn't fall back into the 
vitreous. So they went to anterior chamber lenses. There 
were hundreds. 

The Transactions ofBarraquer the Institute of 1956 contain 
pictures of modifications of lenses for the anterior chamber 
which were presented at a symposium on intraocular lenses. 
But the anterior chamber lenses rubbed off the back of the 
cornea. Patients got corneal or cystoid macular edema and 
didn't do very well. 

Joaquin Barraquer made the anterior chamber lens that 
Steve Shearing put in the posterior chamber. Shearing gives 
credit to Barraquer and the pictures of Barraquer's lens. 
By that time [in the mid to late 1950s], the polymethyl 
methacrylate had been purified and they had better haptics 
and lighter lenses, and so the lens worked. 

Hughes: You stopped inserting intraocular lenses and then, when they 
were improved, you got back in again? 

Maumenee: That's right. 
Hughes: When? 

Maumenee: Well, I was visiting professor at the University of Miami 

[1966], and Norman Jaffe showed me all these elderly people 
in whom he had inserted Copeland anterior chamber lenses. 
They were seeing and doing great. He said, "Most of these 
patients are only going to live five years or so, so let them 
have good vision for five years." He was using the lens only 
in people seventy years old or older. 

Hughes: That made sense to you ? 

Maumenee: Well, no, it didn't. Some of them would live longer than 

seventy-odd years. I talked to Don Gass and Lawton Smith 



155 

and my other ex-residents who were at the University of 
Miami with Ed Norton. They said, "Ed, these people are just 
ecstatic about these lenses. You should start using them." 
When I went back, Norman let me look at the patients under 
the slit lamp. They were great. But as I have mentioned, 
many patients got late complications, especially when 
ophthalmologists began to use lenses in younger patients 
who lived longer. 

Cornelius Binkhorst from Holland had developed a lens that 
would clip onto the iris, an iris-fixation lens. He claimed 
fantastic results with no complications. Because of his 
reports, I started using the Binkhorst lenses. But they were 
very difficult to use. 

Hughes: You mean they were difficult to put in? 

Maumenee: Yes, it was a technically difficult operation. I had to sew them 
to the iris to keep them in place, and the sutures were used 
while working over bare vitreous after an intracapsular 
cataract extraction. Because of all that, we didn't like them 
very much. 

In 1978 I went to the Welch World Congress of 
Ophthalmology in Houston, Texas, and Shearing talked 
about his posterior chamber lens. With Kelman's irrigation/ 
aspiration apparatus, you could get all the cortex out of the 
eye. The trouble with extracapsulars had been that you just 
couldn't get the cortex out. So with the irrigation/aspiration 
apparatus, you could get it all out and you could get great 
results. 

So I mentioned in one of the Monday conferences that I 
would never do another intracapsular cataract extraction. 
Everybody laughed at me. They said, "This is the most 
absurd thing I've ever heard." But by the time Shearing came 
along with his lens, I was doing nothing but extracapsular 
cataract extractions. So we went right into the extracapsular 
extraction with the lens in the posterior chamber. They 
worked very well, we got such good results, and very few late 
complications with patients whom Walter Stark and I had 
operated on ten years before. 

Hughes: Apparently in the 1970s, the FDA [Food and Drug 

Administration] declared that the lens implant was a drug 
rather than a device. What was behind that decision? 



156 



Maumenee: The FDA had a committee on devices and one on drugs. I 
think the drug committee was the czar for ophthalmology. 
Walter Stark was asked to be chairman. The committee 
called the lens implant a drug instead of a device just to get 
control of it. 

Complications with the Intraocular Lens 

Hughes: In 1975, about ten years after the intraocular lens was first 
used in the United States, you and several associates began a 
trial of intraocular lens implants. Why did you decide to do 
that, and what was the result? 

Maumenee: It was because I saw all Norman Jaffe's implant cases and 

because Binkhorst claimed so few complications from his lens, 
which turned out to be totally wrong. His lens was awful. 
But it took about five years for it to rub on the iris and 
produce problems. 

Hughes: Did you pick up the problems in the study? 

Maumenee: Binkhorst never reported problems. We found them when we 
used his lens. 

And Norman Jaffe never published his complications. I went 
to Norman who said, "You can go through my books and listen 
to my patients. None of them have any complications." I 
said, "Well, Norman, why are you changing from one lens to 
another if you don't have any complications?" He said, "Well, 
I thought that this was a better lens." 

As I have mentioned, Walter Stark and I had kept a complete 
record of all of the patients in whom we had placed lenses. 
We tried to follow all of these patients at least once a year. 
We found a high percentage of both early and especially late 
complications, such as cornea! edema and cystoid macular 
edema.* 

Peter Choyce in England put solid lenses in the anterior 
chamber which always gave a lot of pain because they pushed 
on the iris in the chamber angle. Few people use his lens now. 

We swore off anterior chamber lenses after we had bad 
results. Joaquin Barraquer had such terrible results from his 
lenses. He put them in young girls to correct their myopia. 



Stark WJ, Maumenee AE, Datiles M, et al. Intraocular lenses: complications and visual results. 
Thins Am Ophthalmol Soc 1983; 81:280-309. 

See also Smith PW, Wong SK, Stark WJ, et al. Complications of semi-flexible closed loop anterior 
chamber intraocular lenses. Arch Ophthalmol 1987; 105:52-57. 



157 

They got cataracts and corneal edema, and he had to take out 
most of the lenses. He swore he would never use lenses. 

When I went over to Spain to receive the Barraquer Medal in 
1987, 1 gave a lecture on posterior chamber lenses and tried to 
get him to use them, but he said, "No, I'll never do that again. 
I've blinded so many people by putting in those lenses." His 
lens was a good lens, but there is no good lens for the anterior 
chamber. 

Hughes: Why is that? 

Maumenee: Because it rubs on the iris and the back of the cornea. The 

irritation of the anterior chamber causes cystoid edema of the 
macula to develop. We don't know why. 

I challenged Barraquer through his daughter Elena, who had 
trained in Boston. She came back to Spain and put lenses in 
and showed him how good they were, so now he is back in the 
lens business. 



Uveitis 



Hughes: 



Uveitis and Tuberculosis 

[Interview 6: October 15, 1991, annual meeting, 
American Academy of Ophthalmology, Anaheim, 
California] 

Your first paper on uveitis was published in I960.* Why were 
you interested in uveitis? 



Maumenee: Well, my interest in uveitis really was primarily because of 
Dr. Alan Woods. It was his claim to fame. Almost his entire 
practice was uveitis. As I mentioned, he called everything 
[causing uveitis] tuberculosis. 

At a much later date, Norman Ashton was chairman of the 
centenary meeting in the United Kingdom of the British 
Ophthalmological Society. For that meeting, he assigned 
various people to look at where the subspecialties stood one 
hundred years ago. A lot of people had miliary tuberculosis 
with little nodules in the back of the eye, but they didn't get 



Welch RB, Maumenee AE, Wahlen HE. Peripheral posterior segment inflammation, vitreous 
opacities, and edema of the posterior pole. (Pars planitis). Arch Ophthalmol 1960; 64:54049. 



158 

any chronic inflammation. But because tuberculosis was so 
prevalent and so many people had positive tuberculins [tests], 
Dr. Woods called everything tuberculosis. 

Did you read my Jackson lecture?* 
Hughes: I did. 

Maumenee: It was picked by Dan Albert, who is very good on the history 
of medicine, as one of the classic articles in ophthalmology.** 

Alan Woods and even Jonas Friedenwald said, "The eye 
can only react in a few given ways, so clinically you can't 
distinguish one type of uveitis from another." I disagreed, so 
I tried to break uveitis down into entities which I described in 
my Jackson lecture. 

Hughes: Why did you disagree? 

Maumenee: Primarily because I couldn't find the tubercle bacillus 

reported anywhere in the literature on uveitis. I couldn't 
find it in any of the hundreds of specimens I looked at from 
the AFIP [Armed Forces Institute of Pathology] and from our 
pathology lab. So it didn't make any sense to me that they 
were all tuberculosis. 

Pars planitis is bastard or irregular Latin. It should be 
plans parsitis. We made the noun be the adjective because 
it sounded better. I didn't want to call it anterior uveitis 
the way [Michael] Hogan did. Schepens called it peripheral 
uveitis. It took years for ophthalmologists to change 
terminology and now, throughout the world, they all call it 
pars planitis. 

Hughes: Why did you object to the other terms? 

Maumenee: Because I didn't like to use a name that indicated that I knew 
where the inflammation was or what caused it. 

I was criticized as "that stupid American who can't even get 
his Latin right." But if they had read the 1960 paper, I said 
on my first page in a footnote, "I am calling this pars planitis 
because I do not want to indicate that it is an inflammation of 



Maumenee AE. The 26th Edward Jackson Memorial Lecture. Clinical entities in "uveitis 1 : an 
approach to the study of intraocular inflammation. Am J Ophthalmol 1970; 69:1-27. 

Albert DM. Analysis of the Archives' most frequently cited articles. JAmMedAssoc 1988; 
106:465-70. 



159 

the uveal tract, because it is not. Until we find the etiological 
factor and the pathogenesis, I would rather make it a distinct 
entity so that people can begin to look at what it is."* 

Histologically, it is an inflammatory reaction around the blood 
vessels in the retina, and the inflammatory reaction is in the 
vitreous over the peripheral part of the retina, not even over 
the pars plana. It was a very distinct entity. You could see 
the "snowbank" by depressing the sclera in the area and 
looking into the eye with an indirect ophthalmoscope. 

Mike Hogan claimed pars planitis was due to a worm, a 
nematode. A nematode and a number of other things produce 
a snowbank in the periphery of the fundus. But they are 
totally different from pars planitis. The worm looks like a 
white nodule in the periphery, but it doesn't spread all the 
way around the retina. Pars planitis is a very distinct entity 
and has been accepted as a distinct entity. 

Hughes: In the lecture you objected to the term uveitis itself and used 
"uveitis" in quotes all the way through the paper. 

Maumenee: That's right. Because 90 percent of the inflammatory reaction 
is not in the uveal tissue. For instance, pars planitis was not 
in the uveal tissue. Chris Zweng saw a patient who had pars 
planitis. They put her on massive doses of steroid, and she 
developed a fungal abscess of the brain and died, and we got 
her eyes for study. Histologically, the inflammation was in 
the vitreous overlying the peripheral retina, not even in the 
pars plana. Calling it pars planitis indicated that it was in 
the pars plana area. That's the area of the uvea anterior to 
the retina. 

I inherited Dr. Woods's uveitis practice when I became 
chairman. I found an internist, Tom Van Metre, who I 
thought was very careful and good. I said, "Dr. Woods surveys 
patients and either they have positive tuberculin [tests], they 
have syphilis, they have arthritis, they have everything 
wrong with them, or they have nothing wrong with them. 
A survey on one patient doesn't mean a thing because a 
disease may affect the eye or it may not affect the eye; we 
have no way of knowing." The correct way to do a survey is 
to review a thousand patients. If one specific type of uveitis 
[inflammatory reaction] correlates in a higher percentage of 
systemic disease, then it is a very likely probability that the 



The actual footnote reads: "The term 'pars planitis' is used because it is a good descriptive term 
although its usage is not grammatically accurate." 



160 



systemic disease is the cause of that type of intraocular 
inflammation. 

I sent all of my patients to Van Metre and told him he was not 
to look at the eye. He was merely to do all the tests and then 
come up with a diagnosis. Well, he got good enough at looking 
in with the ophthalmoscope and the slit lamp that he could 
make the diagnosis by the ocular findings, which loused up 
our double-masked study. But at least we were able to 
characterize histoplasmosis, which was what Dr. Alan Woods 
and H. E. Wahlen had first described clinically.* 

When I was a resident, we had a big dining room where all 
the doctors ate. We were talking about uveitis. I said, "Why 
don't you find out how many people who have athlete's foot, 
dermatophytosis, also have uveitis. You'll find the highest 
correlation with uveitis of anything you can possibly think of 
because there are so many people who have fungal infections 
on the feet." [laughter] 

Katy Borkovich, who was an internist, said, "Well, Ed, that's 
not too foolish. They now know that histoplasmosis has been 
mistakenly diagnosed as tuberculosis. It produces a lesion 
in the lung which looks just like tuberculosis. So I bet you 
that Histoplasma capsulatum [fungus] will produce an 
inflammatory reaction in the eye." I told one of my residents, 
Bob Day, about it, and Bob injected the Histoplasma 
organism into animals' eyes. Sure enough, it produced an 
inflammatory reaction in the eye. It looked just Eke the 
tuberculosis reaction. 

Then Ron Smith took it up, and the whole staff went up to 
his hometown, WalkersviUe, Maryland, where they had a lot 
of histoplasmosis, and examined the entire population.** 

We had an epidemiologist from the school of hygiene go with 
us, and he pointed out that there was a definite correlation 
between histoplasmosis and the specific little lesions that 
occurred in the uveal track. It hit the macular area and 
caused macular hemorrhage. 



Woods AC, Wahlen HE. The probable role of benign histoplasmosis in the etiology of 
granulomatous uveitis. Am J Ophthalmol 1960; 49:205-20. 

Meredith TA, Green WR, Key SN HI, Dolin GS, Maumenee AE. Ocular histoplasmosis: 
clinicopathologic correlation of 3 cases. Surv Ophthalmol 1977; 22:189-205. 

Dr. Smith described this episode in an interview recorded on November 1, 1989. 



161 



Classification of Uveitis 

Maumenee: Gradually, I was able to categorize uveitis as I did in that 
1970 article. As I said, I don't mean to be critical of people 
like Woods and Hogan. We can see further into the distance 
because we stand on the shoulders of the giants of the past. 
That was a quotation Derrick Vail used and I gave him credit 
for it. I found out later that the quote was as old as Julius 
Caesar. 

Hughes: I have heard it attributed to Isaac Newton, but maybe it goes 
back further than that. 

How did your colleagues react to this more precise 
classification? 

Maumenee: Well, I think a lot of them began to look at it. What I wanted 
people to do was to take fundus pictures of these various 
specific entities from around the world and do tests to show 
whether you had toxoplasmosis or not. But I could never get 
it done. 

The International Council of Ophthalmology had a 
committee on uveitis. Terry Perkins, from the Institute 
of Ophthalmology in London, was on the committee. He was 
very interested in uveitis. He worked for a year with us at 
the Wilmer Institute. The committee broke down uveitis into 
anterior and posterior uveitis, and acute and chronic uveitis. 
This classification means nothing. It doesn't help you get 
anywhere when you could be basing the classification on 
these typical histologic pictures. I could look in the eye and 
say this is toxoplasmosis, and I would be right 99 percent of 
the time. 

Hughes: Does precise diagnosis lead you to a specific treatment? 

Maumenee: Yes. You have to recognize the entity. Then you have to break 
down uveitis into clinical entities because, just like macular 
degeneration, it may be caused by a lot of different things. 
Then you take each entity and see if you can't find some 
common systemic denominator. Your next step is to obtain 
histopathologic material which ophthalmologists were more 
backward in obtaining than any other specialty in the world. 

Hughes: Why? 

Maumenee: Because you can take a biopsy of the breast, you can take a 

biopsy of the colon, you can take a biopsy of the brain, you can 



162 



take a biopsy of practically anything except the eye. There 
was no way to take a biopsy of the eye during the acute stage 
of the disease. You could tap the anterior chamber, but the 
spillover of inflammatory reaction from the back of the eye 
would come in through the anterior chamber and would be 
either nongranulomatous or granulomatous. Most of the 
inflammatory reactions start out as nongranulomatous. 
When they become chronic, they become granulomatous 
that is, they contain a lot of macrophages and lymphocytes 
and other cells. 

I wouldn't accept the report on uveitis for the International 
Council of Ophthalmology, and I said, "This puts us back 
twenty-five years. There are plenty of diseases classified 
under uveitis that you should be looking at worldwide." 

Hughes: Did they modify the report? 

Maumenee: I think the whole world has swung to that. We already 
knew there were specific clinical types of ocular 
inflammations that were well described and classified, like 
sympathetic ophthalmia, Vogt-Koyanagi's disease, acute 
nongranulomatous iritis that occurs with arthritis, and 
Behcet's syndrome, which occurs in the Middle East and in 
the Japanese. But people called general uveitis simply 
anterior or posterior. 

Hughes: Why did you decide to give the Jackson lecture on uveitis? 

Maumenee: It was a subject I was working on at the time. The lectures 
that I gave throughout the years were on subjects that I was 
currently working on. If I couldn't make a real contribution, I 
didn't want to give the lecture. 

The last entity that I described as a form of uveitis took five 
years to get into the ophthalmic literature. Steve Ryan and I 
called it birdshot choroidopathy.* Patients had little spots 
peppered all over the back of the fundus, and cells in the 
vitreous and whatnot. Since Fm a hunter, I thought the 
fundus looked like a bedsheet with holes from number nine 
shot. 

At the National Eye Institute, there was a whole group of 
people who worked on autoimmunity. I sent some patients 
with the clinical picture of birdshot retinochoroidopathy down 



Ryan SJ, Maumenee AE. Birdshot retinochoroidopathy. Am J Ophthalmol 1980; 89:31-45. 
Nussenblatt RB, Mittal KK, Ryan SJ, Green WR, Maumenee AE. Birdshot retinochoroidopathy 
associated with HLA-A29 antigen and immune responsiveness to retinal S-antigen. Am J 
Ophthalmol 1982; 94:147-58. 



163 



Hughes: 



to them because I was then out of uveitis. They found that a 
high percentage of the patients had antibodies to antigen S, 
which is a retinal antigen. Histologically, this was a disease 
that attacked the outer segments of the retina, producing a 
diffuse inflammatory reaction. They also did HLA [human 
leukocyte antigen] studies on it. The birdshot patients had 
HLA-A29 antigens as frequently as did those with 
Marie-Strumpell disease. 

Immunologists' Interest in Uveitis 

Were the immunologists taking any interest in uveitis? It 
seems to me you were showing that the eye is a wonderful way 
of visualizing inflammatory responses. 



Maumenee: Right. There were so many physicians that made mistakes 
by looking in the eye with the ophthalmoscope and thinking 
they knew what the basic pathology was, but they weren't 
pathologists and they never looked at any pathology. So they 
described what they thought the pathology was, which turned 
out to be wrong 90 percent of the time. Once you had looked 
at the clinical picture and then looked at the histopathology 
under the microscope, you could put the two together and do a 
good job. 

Immunologists have shown some interest in some of the eye 
diseases. But eye diseases are so difficult to diagnose. Even 
Art Silverstein made some errors in nongranulomatous 
anterior uveitis. He showed that if he injected horse serum 
into the eye, after fourteen days the animal would get an 
inflammatory reaction. If a year later he injected horse 
serum into the eye, the eye would flare up immediately. 
Apparently, there were cells that remembered that they were 
allergic to horse serum and would flare up. So he claimed 
that this was the problem in anterior uveitis. 

That didn't make any sense to me because every time we 
operated on a patient for cataract we produced inflammatory 
cells that participate in the healing process. If these people 
had allergies to anything, those cells would be there. For 
instance, if somebody was allergic to seafood, every time he 
ate seafood, he ought to get a flareup of his eye. 

Hughes: Did you argue with Dr. Silverstein ? 
Maumenee: Yes I did, but I never wrote it up. 



164 



Histoplasmosis 



Maumenee: Alan Woods, in his textbook written about a year before 
he died, had a beautiful picture of histoplasmosis with 
hemorrhage in the macula and scars around the optic nerve 
and in the periphery. He called it tuberculosis! This was a 
classic picture of histoplasmosis. 

I sent Don Gass over to the AFIP [Armed Forces Institute of 
Pathology] to work with [Lorenz] Zimmerman, and he got 
interested in pathology. I said, "While you are over there, look 
up all the cases of hemorrhagic macular disease and see if you 
can't find the Histoplasma organism." He came up with one 
specimen with a granulomatous lesion in the macula area, but 
he couldn't find any organism in it. 

Later on, I sent Steve Ryan to spend a year with Zimmerman. 
They stained the specimen Don Gass had found with a special 
stain. They found one organism that looked like Histoplasma. 
The doctor in Memphis had taken the eye out, thinking it was 
a melanoma. He was afraid he would be sued, so he wouldn't 
tell Steve where the patient was. The patient's name was 
Smith. Steve went through the Memphis telephone directory 
and called every Smith in the directory and asked if they had 
a son who'd had an eye removed for a tumor. He finally found 
the mother of this boy. The kid was in law school. Steve went 
down to Memphis, looked him up, looked in his other eye, and 
he had the typical punched-out lesions of histoplasmosis. The 
persistence to call every Smith in the Memphis telephone 
directory is typical of Steve Ryan. This patient has been one 
of the most frequently reported cases of histoplasmosis. 
There have been other cases that have been found since that 
time. 



Eye Donation 



Hughes: At the end of your Jackson lecture, you urged ophthalmologists 
to ask their patients to will their eyes for research. Was that a 
crusade of yours? 

Maumenee: Yes. 

Hughes: Again, it was the theme of correlating the clinical and the 
histological picture. 

Maumenee: The theme of my research life was clinical-pathologic 
correlations. 



165 



Hughes: Had others preceded you in that emphasis? 

Maumenee: I'm sure they did. [Ernst] Fuchs certainly made some very 

astute observations on various types of histopathology, and so 
did Verhoeff and Friedenwald. But I don't think any of them 
really went at it with the idea that they were going to look at 
the clinical aspects of a disease and then try to correlate them 
with the pathology. Once you got the pathology, you tried to 
get the etiology; and once you got the etiology, you tried to 
find the pathogenesis. 

Hughes: How successful were you in persuading your patients to donate 
their eyes? 

Maumenee: I would say we did fairly well. Certainly, Harry Quigley has 
done a much better job than I have. In his work on glaucoma 
and the pathogenesis of visual field loss, he would take visual 
fields and pictures of the fundus shortly before his patients 
died so that there was a really good clinical-pathologic 
correlation. He found that you could lose as much as 40 
percent of your axons without losing any visual field in 
glaucoma, which was a very important finding. 

One of the major problems he and others are working on now 
is how to determine the first manifestation of damage to the 
eye from glaucoma. Nobody knows today. Visual field testing 
is just not sensitive enough. Apparently there is a general 
loss of the large ganglion cells as the first damage to the axon 
from the retina. They decrease in one localized area more 
than in others, and that is why patients get a characteristic 
arcuate scatoma extending from the upper and lower poles of 
the eye. Those are the areas where I found the pits, as we 
published in the British Journal of Ophthalmology.* 

Hughes: What arguments did you find were successful in convincing 
patients to donate their eyes? 

Maumenee: I would say, "In medicine, we are not gods. We are just plain 
human beings. We don't know everything. In 20 percent of 
medicine we know what we are doing, and 80 percent is 
witchcraft. We just think we know what we are doing. The 
only way we will ever find out what the answers are in 
ophthalmology is to get fresh specimens of various lesions in 
the eye and to look at them under the microscope. We can't 
take a biopsy of your eye or we would ruin it. If you want to 



Radius RL, Maumenee AE, Green WR. Pit-like changes of the optic nerve head in open-angle 
glaucoma. Br J Ophthalmol 1978; 62:389-93. 



166 

do anything for humanity, will your eyes to the eye bank and 
say, Tor pathologic studies only. Not for cornea! transplants.' " 

It was amazing how many patients would comply. Some 
people would shudder and say, "You're not interested in me. 
You're just interested in me dying and getting the eyes." They 
would get all upset. But the majority were patients whom I 
had really worked with, and who realized that I had been 
interested in their disease. 

I always believed in explaining to the patients for at least 
fifteen minutes what their problem was and whether or 
not we really knew anything about it. I said, "Even if we 
don't have any cure for your disease, if I can tell you what to 
expect in life, then you can plan your life better. If I know 
what's going to happen to you, even though I don't know why 
it's going to happen, it's going to be of value to you." 

Hughes: And patients responded to that line? 

Maumenee: They did. They said, "You're the first doctor who has ever sat 
down and really told me anything. Other doctors told me that 
they didn't know what the problem was and they didn't know 
how to treat it, and out the office I would go. Or they would 
give me some medicine." It's much easier to give a patient 
medicine than it is to explain their diagnosis to them. 

Hughes: How successful were you in persuading your colleagues of the 
necessity to make these correlations and to obtain specimens to 
examine? 

Maumenee: I think it spread. It is certainly not wholesale, even today. 
But there are certain people who have gotten some good 
specimens. 



Bleeding Episodes in the Eye 

Hughes: Dr. Sears wrote that you emphasized, and I am quoting, 
"the sources and causes of a variety of conditions that led 
to bleeding, both inside the posterior segment and interior 
segment of the eye, and emphasized certain conditions 
underlying these bleeding episodes^] such as xanthomas 
in childhood."* 



Marvin L. Sears, MD, to Sally S. Hughes, PhD, October 26, 1989. 



167 



Maumenee: Actually, the first time a nevoxanthoendothelioma in the eye 
was described was by a dermatologist named Harvey Black. 
I saw this baby in Seattle. It had an anterior chamber 
hemorrhage from unknown cause and had a gray spot. 
I didn't know what it was. Then, at a Verhoeff Society 
meeting, Ted Sanders presented a case of an eye that had 
been removed because of a mistaken diagnosis of a tumor 
when it was a nevoxanthoendothelioma. 

So I called up Carl Jensen, who was a good friend of mine, 
and asked him to take a biopsy, and he did, and it turned out 
to be a nevoxanthoendothelioma. I published that case, and 
after that I saw several other cases which I treated with 
radiation because the cells looked sensitive to radiation.* It 
cured them. Then Don Gass found out that you could get rid 
of the cells by putting cortisone in the eye, which is a much 
safer way of doing it. 

Hughes: Why would those cells be sensitive to cortisone? 

Maumenee: They were abnormal fibroblasts which were sensitive to 
cortisone. 

I published that I thought that expulsive hemorrhages began 
as a serous exudate and that as the vessels were stretched 
and became brittle they would break and cause an expulsive 
hemorrhage.** If you sewed the eye up very rapidly when 
you saw things begin to come forward in an operation, and if 
you let the pressure go up, it would act as a tourniquet that 
would then stop the bleeding. You could proceed with the 
operation and come out with a perfect eye. 

As I told you, I treated Coats's disease, which consists of 
dilated vessels in the retina. Exudate forms under them. I 
treated hemangiomas of the choroid. There is a condition 
called circinate retinopathy. It wasn't actually a bleeding 
disease, but it was written in the textbooks that macrophages 
phagocytized the dead cells and then they formed a white 
ring. That's why it was called circinate retinopathy. Using 



Maumenee AE. Ocular lesions of nevoxanthoendothelioma (infantile xanthoma disseminatum). 
Trans Am Acad Ophthalmol Otolaryngol 1956; 60:401-405. 

Maumenee AE, Longfellow DW. Treatment of intraocular endothelioma (juvenile xantho- 
granuloma). Am J Ophthalmol 1960; 49:1-7. 

Maumenee AE. Shearing lens implantation techniques and complications. In: Francois J, 
Maumenee AE, Esente I, eds. Cataract Surgery and Visual Rehabilitation. Proceedings of the 
Second International Congress on Cataract Surgery and Visual Rehabilitation. Milano, Italy: 
Libreria Scientifica gia Ghedini, 1982; pp. 433-38. 



168 



Hughes: 



fluorescein, I showed that diseased blood vessels in the center 
of the area were leaking serum, which was absorbed, and 
leaving the lipid behind.* If you photocoagulated the diseased 
vessels, the lipid would disappear. 

The analogy to that is arcus senilis, in which a lipid layer 
occurs around the periphery of the cornea. In a lot of people, 
particularly if they have high cholesterol and if vessels grow 
into that area, the lipid layer extends around those vessels 
and then comes back around the limbus. 

I treated some cases of von Hippel-Lindau's disease which 
were actual hemangiomas of the retina out in the periphery 
that produced changes in the macula area for some reason. 
I have told you about the hemorrhagic detachments in the 
macula. 

Were you treating these bleeding conditions with the 
photocoagulator? 



Maumenee: The xenon photocoagulator. 

Hughes: And then you moved to the laser when it came out? 

Maumenee: Yes. 



Differentiating Ne vi and Melanomas 

Hughes: Tell me about diagnosing melanoma. 

Maumenee: I argued with Zimm [Lorenz Zimmerman] that in making a 

diagnosis of melanoma it was the height of the melanoma, not 
the spread or the extent of it, that was important. I think 
that most people agree now that if a lesion is not more than 
two millimeters thick, it's probably not a melanoma; it's a 
nevus. We used to take out a lot of eyes with nevi rather than 
melanomas. Fm sure Meyer-Schwickerath and his group 
photocoagulated [so-called] melanomas with the xenon arc. 
Many of the pictures he showed were nevi as far as I was 
concerned; they weren't melanomas. He still got a death rate 
about the same as that after enucleation. The dermatologists 
used to burn off moles, and those people used to die like flies 
because the treatment stimulated a totally benign lesion to 
turn into a malignant one. 



Maumenee AE. Doyne Memorial Lecture. Fluorescein angiography in the diagnosis and 
treatment of lesions of the ocular fundus. Thins Ophthalmol Soc UK 1968; 88:529-56. 



169 



Hughes: When you saw something that wasn't big enough to diagnose 
as a melanoma . . . 

Maumenee: We just took pictures of it. 

I had something like ninety patients with large and small 
pigmented, flat lesions. Ed Tamler, a resident of mine, and I 
followed them for five years, and none of the lesions turned 
into melanomas. Then Ed got as many patients back as he 
could ten years later and still none of them had melanomas. 
But that didn't mean anything. I did not have enough 
patients to pick up nevi that turned into melanomas. As a 
matter of fact, David Rnox followed a doctor at Hopkins for 
about eight to ten years with a typical nevus in the choroid. 
The patient was very apprehensive, so Dave took fundus 
pictures every three to four months. Finally the lesion grew 
rapidly. The eye was removed, and it was a malignant 
melanoma. 

J. V. Thomas from Massachusetts Eye and Ear Infirmary 
in Boston went through our specimens at the Wilmer 
Institute and showed that the survival rate of patients who 
had small melanomas was much, much better than those 
with big melanomas.* 



Keratinization and Vitamin A 



Hughes: I will quote again from Marvin Sears's letter about you: "He 
was the first one to demonstrate the importance of the gray 
line, that is the line between the skin of the outer lid and 
the conjunctiva . . . , showing that when the gray line was 
compromised a squamiftcation or thickening of the cornea 
would result." ** Do you remember the so-called gray line? 

Maumenee: "Gray line" is not the correct term. I don't know what the 

thing is called. On the lid margin, just behind the ducts of the 
meibomian glands, the tissue is usually mucous membrane. 
Under certain conditions it undergoes transdifferentiation 
to stratified squamous keratinized skin. That keratinized 
tissue is very rough, very irritating. After radiation or 
Stevens-Johnson syndrome or a number of different 
conditions, for some reason or another the conjunctiva, 
which contains goblet cells and flat cuboidal cells, turns 



* Thomas JV, Green WR, Maumenee AE. Small choroidal melanomas. Arch Ophthalmol 1979; 
97:861-64. 

** Marvin L. Sears, MD, to Sally S. Hughes, PhD, October 26, 1989. 



170 



into stratified squamous epithelium. This acts then like 
sandpaper. Every time you close your eye, it rubs on the 
cornea. Eventually, the cornea becomes vascularized and 
frequently becomes cloudy. 

I wrote a paper describing some of the causes of 
keratinization* and a later one in which I described 
cutting out this stratified squamous epithelium and 
replacing it with a mucous membrane graft from the 
mouth.** Then about 1956 or so, there was a beautiful article 
written by Fell and Mellanby in the Journal of Physiology.*** 
They were working at the Strangeways Laboratories in 
England and found that if they took mucous membrane from 
the nose of chick embryos and put this in tissue culture that 
contained no vitamin A, the tissue would grow feathers and 
have stratified squamous epithelium. If they put vitamin A in 
the culture medium, the tissue would turn back into mucous 
membrane with goblet cells. If they took skin off the back of a 
chicken and put it in high vitamin A, it would become mucous 
membrane. When they put it into low vitamin A, it would 
become keratinized. 

I have just written a history of vitamin A which goes back to 
2000 B.C. The Egyptians would take the liver of oxen and 
squeeze the juice of the ox liver into the eyes of people who 
were night blind. It would cure their night blindness because 
they had had vitamin A deficiency. The liver contains large 
amounts of retinol. 

There are 1,500 analogues known of vitamin A. Two of them 
have been worked out quite well. One is retinol, which is a 
breakdown of beta carotene. Carrots and green vegetables 
contain a lot of beta carotene. This breaks down into retinol 
which then forms the pigment epithelium of the retina. 
Retinol is the only vitamin A analogue that has been worked 
out in great detail. George Wald won the Nobel Prize for 
figuring out the exact chemistry of the breakdown.! 

Then the other type of analogue is all-trans retinoic acid. 
All-trans retinoic acid is very unstable. It only lasts for a 
week or so. It is responsible for the development of epithelial 



Maumenee AE. Keratitis secondary to keratinization of the tarsal conjunctiva. Am J Ophthalmol 
1956; 41:477-87. 

** Maumenee AE. Keratinization of the conjunctiva. Trans Am Ophthalmol Soc 1979; 77:133-42. 

*** Fell HB, Mellanby E. Metaplasia produced in cultures of chick ectoderm by high vitamin A. 
JPhysid 1953; 119:470-88. 

t Wald G. The photoreceptor process in vision. Am J Ophthalmol 1955; 40:1841. 



171 

cells. So if you feed animals a diet that is deficient in 
all-trans retinoic acid, they come out with all kinds of defects. 

Accutane (13-cis retinoic acid) for the treatment of acne in 
young people is an isomer of trans retinoic acid. An isomer is 
a mirror image of the normal product. It has exactly the same 
configuration. The body cannot metabolize the isomer. There 
were a number of young girls who were pregnant who didn't 
know it and they were taking Accutane. They had as many 
deformed babies as thalidomide caused. 

Hughes: But it didn't get quite the press, did it? 

Maumenee: It got a good bit. They then put a warning on the packages 
against taking Accutane during pregnancy. Trans retinoic 
acid is effective in stopping the excessive keratinization that 
plugs the sebaceous glands and causes acne. 



Spectra Pharmaceutical Services, Inc.* 

Maumenee: Scheffer Tseng, a Wilmer resident from Taiwan who had done 
a lot of tissue culture work with [Denis J.] Gospodarowicz 
in 1980 and 1981 at the University of California in San 
Francisco, repeated the work. He took the epithelium off the 
cornea of both eyes of rabbits and monkeys. In one eye he put 
vitamin A all-irons retinoic acid, and in the other eye he put a 
placebo. The eye with the all-irons retinoic acid retained 
conjunctiva! epithelium for two or three months afterwards, 
whereas the placebo eye underwent transdifferentiation into 
normal stratified squamous epithelium. 

I had a young boy from Guatemala in whom I'd been grafting 
mucous membrane, but the grafts were thick and unsightly. 
I described his keratinization and named the different causes 
for it.** So I decided to treat this young boy with vitamin A 
on a compassionate basis. I told his mother that it was 
strictly experimental. Within two weeks his keratinization 
had cleared. He hadn't been able to open his eyes in the 
sunlight; he hadn't been able to read; he hadn't been able 
to get along. The keratinization disappeared. So I said, 
"Scheffer, let's run a compassionate study, a pilot study, on 
this." 



* Spectra Pharmaceutical Services was also discussed in Interview 7, on October 16, 1991. 
Segments from the transcript of that later interview are incorporated here. 

** Maumenee AE. Keratinization of the conjunctiva. Trans Am Ophthalmol Soc 1979; 77:133-42. 



172 



You now have to contact the JCCI, the Joint Commission on 
Clinical Investigation, to get permission to run any kind of 
new study or new treatment of a patient. I had Scheffer 
submit to the JCCI for permission to do a trial, a pilot study. 
Tom Hendricks wrote back and said, "You'll have to get an 
IND, investigational new drug, first." That takes a lot of 
toxicology testing, a lot of other testing. It would have taken 
Scheffer at least six months to get the testing done, and he 
was leaving for Boston for a fellowship at the Massachusetts 
Eye and Ear Infirmary in July of 1984. 

Enclosed with the JCCFs request for an IND were two copies 
of statements from the FDA that said if a drug had been used 
for one purpose and been successful and was not toxic or 
harmful, and it would not be toxic or harmful for another 
purpose, a physician could use it on a limited basis, on a 
compassionate basis.* I said, "Scheffer, we can't get the IND 
in time. Let's go ahead and treat a few patients." To my 
knowledge, we treated only about six patients. He treated a 
number more that he didn't tell me about. So it ended up that 
we published some twenty patients that we had treated as a 
pilot study.** 

I started a company to make generic drugs for the eye 
because I thought trade name drugs or drugs that had 
patents on them were too expensive. 

One of the things we put in our brochure when we went 
public was this remarkable thing of using all-trans retinoic 
acid. It cleared the keratinization up completely on the 
twenty patients in our pilot study. I got into massive troubles, 
all kinds of bad publicity. It was the worst thing I've ever had 
happen to me in my life. Because of not getting permission 
from the JCCI, Hopkins had a study on misconduct. They 
claimed that I, as principal investigator, had not supervised 
Scheffer as I was supposed to. I had not gotten an IND, and 
although there was no evidence of fraud or deceit or financial 
conflict of interest, that I had not followed the rules of the 
hospital, and therefore I was to be censured.*** I said, 
"'Censured' is too strong a word. Fd appreciate it if you'd 
say 'admonished.' " They did that. 



"Use of approved drugs for unlabeled indications," FDA Drug Bulletin 12: 1, April 1982. Copy on 
deposit at the Foundation of the American Academy of Ophthalmology. 

** Tseng SCG, Maumcnec AE, Stark WJ, et al. Topical retinoid treatment for various dry-eye 
disorders. Ophthalmology 1985; 92:7 17-27. 

*** Richard S. Ross, MD, Dean of the Medical Faculty, Johns Hopkins, to A. E. Maumenee, MD, 

February 21, 1989 and March 7, 1989. Copies of correspondence on deposit at the Foundation of 
the American Academy of Ophthalmology. 



173 

As a result of some adverse articles in the lay press we 
were investigated by the Subcommittee on Oversight and 
Investigations of the House Committee on Energy and 
Commerce, the Maryland Medical Society Committee on 
Ethics, the U.S. Securities and Exchange Commission, the 
Massachusetts Securities Exchange, the National Institutes 
of Health, the Harvard committee on ethics, and the Johns 
Hopkins Medical School Committee on Misconduct. I can 
say that none of these investigations resulted in reported 
evidence of fraud, deceit, or financial conflict of interest on 
my part as far as I was concerned. In addition the American 
Academy of Ophthalmology committee on ethics, after 
examining the facts in this matter, took no action. 

Spectra's I-Scrub 

Maumenee: We made some unique products. We had one product, 

I-Scrub, that is just fabulous. We made it for the hygienic 
care of blepharitis, that is, clearing up inflammation of the 
lid margins. Although it has never been approved for other 
problems by the FDA, patients have used it successfully for 
a number of conditions. In culture, it kills all aerobic and 
anaerobic bacteria. It takes all the plaque off your teeth. I 
sent it to the University of Maryland Dental School and John 
Hassler, the assistant dean, had a bacteriologist check it 
against all the bacteria that cause gingivitis. It kills them all. 

They wanted to do surgery on my teeth because I had so much 
plaque. I started brushing them with the I-Scrub, and it took 
all the plaque off completely. One of our technicians had to 
go every month to have her plaque scraped off. She started 
brushing her teeth with this once or twice a week, and she 
has no plaque anymore. Your teeth feel like you had just 
come out from the dental hygienist, they are so slick. There 
is no plaque whatsoever. 

Hughes: How did you get from blepharitis to plaque ? 

Maumenee: Dick Giovanonni, our experimental pharmacist, was a really 
brilliant guy. We were using Johnson's Baby Shampoo to 
clean off the lid margins. So I asked him to look at Johnson's 
Baby Shampoo. He came back and said, "Ed, that's not a 
soap. That's a detergent." 

So he made up a detergent of about ten ionic and anionic 
detergents which had a pH of 7.2 and was isotonic so it didn't 
irritate the eye at all. It cleaned silicone contact lenses that 
we were throwing away because they would get deposits 



174 

on them and turn white. We could just soak them in the 
detergent and it would take the deposits off. It has cured 
Candida infections under the toenails; it's cured Candida 
vaginitis. It kills the trachoma agent. It kills the AIDS virus, 
which is easily killed, but the detergent is too toxic to take 
systemically. It kills the herpes virus. The herpes virus stays 
in the Gasserian ganglion and periodically comes out to the 
skin. If you feel the tingling sensation that you are going to 
get a breakout of herpes, you just put it on your skin three or 
four times a day, and the virus, when the virus comes to the 
skin, is killed. 

Hughes: Does anybody know how it works? 

Maumenee: They know how detergents work and they have been used to 
sterilize instruments and other things. But we have never 
taken that product through the FDA. We only took it through 
for blepharitis. But since a physician can use any therapy if 
it is safe, they have tried it on patients. We tried it in the 
laboratory first to see if it would kill viruses in epithelial 
tissue culture that wouldn't grow on anything else. It would 
kill the virus without killing the epithelial tissue culture. 



Scientific Research and Financial Enterprise 

Maumenee: Mort Goldberg, editor of the Archive of Ophthalmology, has 
accepted my history of vitamin A and is going to publish it in 
the Archives of Ophthalmology.* 

Hughes: Does the history include your work on the subject? 

Maumenee: Yes. He has asked me to tell my side of the story of all 

the bad publicity I got regarding Spectra Pharmaceutical 
Services, Inc. and ah 1 the challenges. 

There have been many, many articles in Science and other 
journals about the conflict of interest between basic scientists 
and the financial gain they can get out of the products that 
they make. This might influence the interpretation of their 
results. It might make them biased as to whether the 
products are good or not. This is not good. 



Maumenee AE. The history of Vitamin A and its ophthalmic implications. A personal viewpoint. 
Arch Ophthalmol 1993; 111:547-50. 



175 



Dr. Maumenee's Approach to Research 

Hughes: I've heard you called an idea man. * Please comment. 

Maumenee: Having an interest in pathology and some interest in virology 
and microbiology gave me a chance, when I would see 
something that nobody knew anything about, to fall back on 
those interests and make some suggestions as to what might 
be done. I've always said that anything that is written is 
believed. That's because only the monks knew how to write. 
Since the monks got the word from God, if they wrote it, it 
must be correct. 

I never believed that whatever is written is true, so I 
questioned anything that didn't fit in with what I saw 
clinically. On the basis of that, I would have an idea of how 
to do some research. 

Hughes: So instead of accepting, you questioned. Then the next step 
was to test. 

Maumenee: That's right. 

Hughes: How open was your mind when you started a research 
problem? 

Maumenee: I always went at a problem by giving it the biggest overdose 
of whatever the drug was, the biggest chance to work. If that 
didn't work, then I thought probably the drug wasn't going 
to be any good. If that worked, then I would cut down [the 
dosage] to where there was less toxicity or less chance of 
getting side effects. If the drug still worked at a lower dose, 
it could be used. I used this technique in the allograft project. 
I transplanted big pieces of skin so the animal would be sure 
and get sensitized before I did the cornea! transplant. 

I always told every resident, "Look for something that 
nobody knows anything about. Your chances of making a 
breakthrough are much better than if you go for something 
that a thousand basic biochemists are working on." 

Hughes: It seems to me that you've done that on a number of occasions. 
You worked out fluorescein angiography in a relatively crude 
form, but then you didn't seem to be terribly interested in 
future refinements. Would you say that the joy comes from 
proving the initial idea? 



Interview with W. Richard Green, MD, May 17, 1991. 



176 

Maumenee: Yes. I enjoy changing the concept that is generally held by 
ophthalmologists about a given disease or disorder. I used 
fluorescein angiography to learn more things about the 
pathology of the circulation. We couldn't take good pictures 
until we got a better photographer. I rigged up an indirect 
ophthalmoscope in which I knocked out the ground glass filter 
and inserted a cobalt blue filter. The light penetrating the 
cobalt blue filter would make visible the fluorescein flowing in 
the blood vessels of the retina and choroid. I could follow the 
fluorescein flares and see what was going on in the retinal 
vessels. 

Hughes: So you did refine the technique. 

Maumenee: Yes. 

Hughes: But not to the extent ultimately reached. 

Maumenee: That's right. 

I think that different people have different minds. There are 
some people who really are students and learn a lot from 
books, and there are other people who have imagination and 
come up with new ideas. I think I am lucky to be one of the 
people who does a lot of things. I do things differently from 
other people because it doesn't seem to me logical to do them 
the way everybody else is doing them. 

Hughes: Do a lot of your ideas not pan out? 

Maumenee: Some of them. As Jonas Friedenwald told me, "If you can 

make one of your ideas out of twenty work, you are hitting a 
high mark. You get all kinds of ideas, but most of them are 
not going to work for you." I found that to be true. 

Hughes: Is it easy for you to release ideas when they don't seem to pan 
out? 

Maumenee: Yes. I don't feel comfortable publishing articles or continuing 
research about ideas that haven't panned out. I've done 
everything I could think of to make a perfect cut in the 
anterior capsule of the lens. I have used cautery. I had 
a resident who dropped out and is now working in 
electromagnetic fields. He said he could make a cutting 
electrode that I could use in the eye. It wouldn't heat up the 
aqueous. Gosh, we ruined more eye bank eyes and more 
rabbit eyes than you can think of, but we never got one to 
work. 



177 



Hughes: The laser won't do that? 

Maumenee: The laser might well do it, but it would mean doing it the day 
before the operation or doing it downstairs and then having to 
take the patient back up to the operating room. We have a 
hand-held laser now, and maybe the thing to do is to take 
the hand-held laser up to the operating room and make the 
punctures. 

Hughes: Nobody has tried that? 

Maumenee: Nobody has tried that. The trouble is that when you make a 
puncture, the capsule sometimes spreads, and you can get a 
big opening. Other times you get just a little dot opening. 
So it's not controlled. It would be much better to have an 
electrode or a sharp knife or some other instrument which 
wouldn't make any traction but would cut the capsule. 

We used the laser to open the posterior capsule, but it is 
on stretch because you've got the lens implant in. But 
sometimes you hit it and, bingo, you get a tremendously big 
hole. The next time you hit, you get a little hole. Maybe 
you can tune down the laser. It may be a good idea. 

Hughes: You might get something out of this oral history after all. 
Maumenee: Right. 

Hughes: Please comment on techniques and technologies as applied to 
research and surgical or clinical practice that have made a 
difference in your career. 

Maumenee: I have to say that I have made a lot of mistakes. If I didn't 
think of the idea myself, I always figured it was not good. I 
said to myself, "I can't do everything." So I just wouldn't 
adopt a new technique until somebody else had worked it out 
and I found it was safe and effective. Then I would jump on 
the bandwagon and we would try to do it better, do more 
cases, publish it more, and talk more about it. 



What do you consider to be the major clinical and scientific 
problems in ophthalmology? 

I think the major problems in ophthalmology are conditions 
for which we have no therapy or that we can't prevent. 



Hughes: 

Maumenee: 

Hughes: What are you thinking of? 



178 



Maumenee: Senile macular degeneration, retinitis pigmentosa, glaucoma 
that we can't control, any number of congenital abnormalities. 



The National Eye Institute 

The National Institute of Neurological Diseases 
and Blindness (NINDB) 

Hughes: Do you know the origins of the NINDB? 

Maumenee: Yes. Mary Lasker was the wife of a big publisher and 

was extremely wealthy. Her husband died and she gave 
practically every politician that amounted to anything 
$5,000 a year for his campaign, so she was very popular in 
Washington. She lived in New York. She had a good deal of 
influence on starting some of the institutes in the National 
Institutes of Health. She was very interested in neurological 
diseases, so she started the Institute of Neurological Diseases. 
Then Mildred Weisenfeld, and Mary also, decided to add 
blindness to the title. 

Hughes: Was that their decision, with no pressure from the 
ophthalmologists ? 

Maumenee: Yes. It was through Mary's political connections that this got 
done. I was on the council for the Institute of Neurological 
Diseases and Blindness, and I also testified before Congress 
from 1955 or 1956 for twenty-five years, primarily with 
the aid of Senator Lister Hill who was from Birmingham, a 
friend of my family. He took me around and introduced me to 
[Stuart] Symington and other powerful senators. I had taken 
care of Mark Hatfield's wife, who had recurrent erosion of the 
cornea! epithelium. So I knew a fair number of senators. I 
didn't know as many people in the House. 

Every year, when I testified, the chairman of the finance 
committee was usually the only committee member present. 
He was usually on the telephone talking to somebody all the 
time you were talking. He never listened to you. The staff 
made decisions. The staff runs Washington; senators and 
congressmen don't make the final decisions. Usually you 
have to go through a staff member, who is the guy behind the 
throne, to get to a senator. 

Every year, Congress would raise the budget of NINDB. It 
would specifically say, "We are raising the budget so that 



179 



Hughes: 



more money can go into research to prevent blindness." It 
would be turned over to the head of the National Institute 
of Neurological Diseases and Blindness. The neurologists 
would give the ophthalmologists 20 percent of the budget 
every year. That was it. So I said to the neurologists, "What 
is the justification for that? When I'm down there testifying 
to Congress for ophthalmology, I'm the only person they 
are listening to. They are not listening to the obscure, 
neurological problems you're talking about. They don't 
even know what you are talking about." 

You were the only ophthalmologist to testify to the finance 
committee 1 ? 



Maumenee: Yes. 

Founding the National Eye Institute (NEI) 

Maumenee: The advisory board of NINDB is made up of heads of clinical 
and basic science departments. There were about twenty of 
us on the board. I went to a meeting and the professor of 
medicine said, "Well, you know the American Association of 
Professors of Medicine thinks this is the way it should be 
done." The chairman from surgery said, "The Association of 
the Professors of Surgery thinks this is the way it ought to be 
done." And it went down the line. 

I thought, we ought to have an AUPO, an Association of 
University Professors of Ophthalmology. What's the best 
way to get it started? So I picked Dave Cogan, Mike Hogan, 
Bernie Becker, John McLean, Frank Newell, and myself to be 
the council of the organization. We met in Chicago and got 
caught in a snowstorm and no plane could get out. So that 
night we all sat around and talked about how AUPO could 
improve ophthalmology in the United States. 

The question then came up: Shouldn't we see if we could get 
out from under the Institute of Neurological Diseases and 
Blindness and get a national eye institute started? So I went 
to Jules Stein because he had started Research to Prevent 
Blindness. Stein said he had made a major contribution to 
Nixon's campaign and thought he could use some influence to 
get an eye institute funded. He did a good job. 

I went to Lister Hill and asked him what he thought. He 
said, "Well, Ed, it's going to be tough because [James] 
Shannon, the head of the National Institutes of Health, does 
not want to see NIH divided up into more institutes. It would 



180 



Hughes: 



be impossible to run. So he is going to really fight you hard to 
keep a new institute from, being founded. I don't know if we 
can do it or not. Let's see about it." Lister Hill did some very 
good work and got the bill passed in the Senate. 

But the Senate cannot initiate. Bills have to be initiated in 
the House and then they go to the Senate. We got somebody 
to introduce the bill in the House. 

[Fred BJ Rooney, who was a representative from Tom Dunne's 
district in Pennsylvania* 



Maumenee: You're right; Rooney introduced it. Then we had to testify 
before the appropriations committee. 

So Jules Stein went in and lied like a trouper. He said, Tin a 
businessman. I've made half a bilhon dollars. I own Music 
Corporation of America. I've had everybody in Hollywood and 
every band in the country under contract. If you start this 
institute, I guarantee it will cost you less money, because we 
will be more efficient than if we stay under Neurological 
Diseases and Blindness." I thought, "God, that guy can he 
his head off." 

We [the National Eye Institute] now get $250 million a year 
instead of $20 million. Every year Congress upped us. 
Percentage-wise, we got a larger raise every year than any 
other institute of the National Institutes of Health, except 
cancer. 

Hughes: What do you attribute that to? 

Maumenee: Because with the help of Research to Prevent Blindness, Jules 
Stein's foundation, I testified before Congress. I had contact 
with a key person, Harley Staggers of West Virginia, who was 
head of the committee that brought bills like this to the floor. 

Anyway, as soon as the bill came out of committee, it went 
right through the House. Then Lister Hill got it through the 
Senate. Shannon said, "Those dirty bums, they didn't say a 
word to me and they did all this behind my back. They had 
all the senators and congressmen in their pocket before I 
could get to them. Before I could get prepared, they had 
gotten an eye institute." 

We had to have a head of the eye institute. Irv Leopold had 
agreed that if we got an institute, he would be the head of it. 



For more on NINDB and the foundation of the National Eye Institute, see the oral histories in 
this series with Dr. Duane, pp. 103-108, and Dr. Cogan, pp. 126-128. 



181 

Hughes: That was arranged beforehand? 

Maumenee: That was arranged when we went down to the [annual 
meeting of the] Association for Research in Vision and 
Ophthalmology [ARVO]. 

The strange thing was that there were a number of 
ophthalmologists who were very much opposed to creating 
an eye institute. 

Hughes: Why? 

Maumenee: They said, "We've got a good, secure thing [NINDB]. The 

neurologists are taking care of us very well. You don't know 
if you are going to get any money. You don't have a director. 
You don't have any way to run it." As a matter of fact, I tried 
to get ARVO to vote to have an eye institute and they 
wouldn't do it. 

Hughes: Why? 

Maumenee: They said they wanted to stay with neurology. Maybe it was 
the neurophysiologists who wanted to stay with neurology. I 
don't know. But anyway they wouldn't do it. 

Hughes: What about the Academy? 

Maumenee: I don't think the Academy backed it either. We had very 
little backing from the various associations. The AUPO 
[Association of University Professors of Ophthalmology] 
backed it completely. 

Hughes: The AUPO had been created in part to endorse an eye institute. 

Maumenee: That was one of the first things AUPO wanted to do. It was 
before the Academy broke away from otolaryngology. 

Hughes: Oh yes. The Academy didn't become independent until 1979, 
and NEI was formed in 1970. 

Maumenee: Then maybe the Academy wasn't very strongly behind NEI 
because the otolaryngologists didn't want us to have an 
institute if they did not have an institute. As I recall, we got 
very little support from the Academy, and the AOS [American 
Ophthalmological Society] wouldn't have anything to do with 
it at all. 



182 

Hughes: The Academy in those days maintained that it was not 
a political organization, that it was an educational 
organization. They may have stood on that point. 

Maumenee: Yes. 

Then we went through several people who declined the 
directorship. Carl Kupfer, who was chairman at the 
University of Washington in Seattle, applied for the job. Carl 
did a great job. He is now the deputy director of the National 
Institutes of Health. He was named the best director of any 
institute in the National Institutes of Health after his second 
or third year there. 

Hughes: About the time the institute was formed in 1970, the 
government began to cut back on its grants. Do you 
remember funding being a problem ? 

Maumenee: It really wasn't. Congress gave us $20 million right off the 
bat. 

The National Advisory Eye Council 

Hughes: You were on the National Advisory Eye Council, serving from 
1969 to 1970 and then again from 1974 to 1978. Is there 
anything that you would like to say about those terms? 

Maumenee: No. The staff runs the advisory council. We would vote for 

something and then the staff would do what they thought was 
right. 

Hughes: Oh really? [laughter] 

Maumenee: We really didn't have much say. We would make suggestions, 
but by and large the staff took the council's advice and ran 
it the way they thought the council's ideas could be best 
accomplished. 

Hughes : The staff being Kupfer et al. ? 

Maumenee: Kupfer. And Carl picked out the best people EdMcManus 
and then another guy who became the deputy director of the 
National Institutes of Health. They did a great job. 

Hughes: What was the attraction to a government job? 



183 

Maumenee: Permanent pay. You're a civil servant. You can't be fired. 

None of these people were physicians [except for Carl Kupfer]. 
They were administrators. 

Hughes: What is the National Advisory Eye Council supposed to do? 

Maumenee: It is supposed to look over the budget and plan how the 
money is spent and distributed. 

We kept harping that there was not enough money going into 
clinical research. It was all for basic research because when 
a problem concerning clinical research would come up, 
everybody would be critical of it they could do it better. 
They would give a high rating to basic research that they 
didn't know much about. But anything that was clinical that 
they knew about, they always had some correction on it. So 
we just couldn't get any money through for clinical research. 

Hughes: Do you have anything more to say about NEI? 

Maumenee: Mary Lasker was very complimentary to me. She said, 

"You're the best politician I know in Washington. You know 
everybody there. You can do anything you want to. You've got 
money now for research, but you don't have any buildings or 
facilities. You should get money for buildings." 

Senator Fritz Rollings from South Carolina is a delightful 
guy. He has been to my house with his wife, Peaches, a 
number of times for dinner. Whenever I had an important 
foreign visitor at Wilmer, I would invite him to dinner with 
him. I told Fritz that Mary Lasker said we ought to have 
money for a building. He said, "Okay, Til get it." 

I got a lot of flak from the people doing research in the basic 
sciences. They said, "They will take the money away from 
basic science research and put it in buildings." I said, "No, 
this will be additional money I will get for you." But they 
didn't believe it, so they fought it like everything. The finance 
committee added money to our [NEI's] budget specially for a 
research building. This was done primarily by Fritz Rollings. 
Now they think it's the best thing in the world. Everyone is 
applying for it. [laughter] 



184 



185 



VII. ACTIVITIES IN 

OPHTHALMOLOGICAL 
ORGANIZATIONS 



International Congress of Ophthalmology 

History 

[Interview 7: October 16, 1991, annual meeting, 
American Academy of Ophthalmology, Anaheim, 
California] 

Maumenee: This is a good time to record what I can remember of the 

history of the International Congress of Ophthalmology. The 
first congress met in 1857 in Brussels. It was an outgrowth 
of the German Ophthahnological Society and met irregularly 
and without any particular organization. During World 
War I, they had no meetings. The membership was almost 
100 percent European because it was difficult to travel from 
the United States to Europe. 

The congress was so poorly organized that in 1927 they 
developed an international council [International Council of 
Ophthalmology] to be the governing body for the congresses 
and for the federated societies. The federated societies have 
representatives from, I think, seventy countries around the 
world now. Then they began to have international congresses 
on a regular basis every four years. 

The international congress was a good social meeting, but the 
papers usually didn't get printed until after the publication of 
the proceedings. A lot of people didn't turn papers in on time, 



186 



and then it was usually a year or two years before the book 
came out, so that nothing in it was really red hot and new. So 
nobody really gave their best papers at the meeting. 

They then established several committees and wrote up a 
constitution and bylaws which have been changed two or 
three times. There were ten regular members, plus the 
president, the vice-president, the secretary, and the treasurer. 

Hughes: Who were elected? 

Maumenee: Who were elected via the council. Then they were approved 
by the federated societies. 

Hughes: How was the council appointed? 

Maumenee: The council members were the most powerful and best-known 
people in ophthalmology. They established committees on 
various topics, such as the fight against trachoma, visual 
driving safety, and ophthalmological education. Then they 
had the International Agency for Prevention of Blindness. 
None of these committees were very active. They would meet 
once a year and give a report to the federated societies every 
four years at the international congress. 

To be on the council was the highest honor you could get 
in European ophthalmology. In the United States, most 
ophthalmologists had never heard of the International 
Council. They did have one person from the States, 
[George E.] de Schweinitz from Philadelphia, on the first 
council in 1927. 

There was a meeting in New York in 1876 and another in 
Washington, D.C., in 1922, which they didn't call a regular 
congress. They called it something else; I don't know why. 
Those were the only congresses held in the United States 
until 1954, when they had a joint meeting with Canada and 
the United States because the United States, on account of 
the Cold War, wouldn't let the Russian delegates come to the 
United States. But they could come into Canada, so hah the 
meeting was in Montreal and half in New York City. 

Hughes: Is it still a very European-dominated group? 

Maumenee: Well, it began to expand. Sir Stewart Duke-Elder was really 
the dominating figure for a number of years. He wrote a 
charming booklet for the hundredth anniversary of the 



187 

council which gives the story of how the council was formed, 
who was on it, and all of the presidents and the secretaries.* 

Sir Stewart Duke-Elder 

Maumenee: Duke-Elder, as I say, ran the council. He was ophthalmologist 
to the queen. He absolutely ran ophthalmology after World 
War I with an iron hand. He totally dominated. He wrote 
A System of Ophthalmology, which consisted of about 
eight volumes of one thousand pages per volume. It was 
unbelievable. He claimed that he only slept two or three 
hours one night and worked all night the next night. His 
wife was an ophthalmologist and she helped him. He did a 
remarkable job, particularly in his younger years. He was a 
dynamic, beautiful speaker, world-renowned. 



Hughes: 
Maumenee: 



But you didn't always agree with him, as you said a couple of 
days ago. 

No, I didn't. If there were two sides, he always seemed to 
take the wrong side. We were good friends. He and Alan 
Woods were very good Mends. He immediately became very 
nice to me. He was president of the International Council for 
three terms. 



Hughes: 
Maumenee: 



Each term being four years. 

Yes, it was quite a long time, 
life president. 

Jules Francois 



They finally made him honorary 



Maumenee: Then Jules Francois came along. Jules ran it the same way; 
he made all the decisions. He would say, "Okay, this is what 
the council says. Everybody in favor? Okay, that passes." 
They hadn't voted. Whatever he said went. Everybody loved 
him, and he went all over the place to every meeting. 

I think Francois wrote something like 1,500 scientific papers 
and I don't know how many books. He had all these fellows 
working for him. They would write a paper and he would 
put his name on it. That was a European custom. The 
chairman's name went on any paper that came out of his 
clinic. 



Duke-Elder S. A Century of International Ophthalmology, 1857-1957. London: Henry Kimpton, 
1958. 



188 



Hughes: Did his name come first? 

Maumenee: His name came first, and sometimes the name of the person 
who did the work wasn't even on the paper. 

Hughes: It was good science ? 

Maumenee: It was very good science. He was without question the 
leading ophthalmologist in Europe. 

Dr. Maumenee's Offices 

Hughes: According to my notes, you joined the International Council of 
Ophthalmology in 1972. 

Maumenee: Yes. Duke-Elder said, "Ed, you are the president of 
everything in the United States, but you are not 
international. You should be international." Derrick 
Vail said the same thing. I think Derrick Vail became 
president of the council in 1966. He was a very close friend 
of Duke-Elder's. So they prevailed upon me to take the 
first vice-presidency of the International Association for 
Prevention of Blindness and promised me that I wouldn't 
have any work to do. 

[Adolph] Franceschetti died two or three months after I took 
that job, so I automatically became the interim president 
[in 1968]. I then went on the council because I became 
president of the Pan- American Association. Then I was 
elected a regular member of the council. I was president of 
the International Congress of Ophthalmology in 1982, so that 
put me on the council for another four years. Then I became 
president of the council in 1982 which gave me another eight 
years. So I've been on the council for a long, long time. 

Hughes: Was the council an effective body when you joined it? 

Maumenee: They were not doing as much as they should. We had 

been the representative body for the WHO [World Health 
Organization]. WHO said, "Look, you're not doing anything 
to prevent blindness. So unless you start doing something on 
prevention of blindness in the developing countries, we will 
choose some other body to represent the ophthalmologists." 

In the meantime, the International Association for Prevention 
of Blindness that I took over didn't do anything. They met 
periodically, and they had a journal published on the cheapest 



189 



paper you ever saw in your life and papers so out of date that 
it was awful. 

I went over to Amsterdam as the successor to Franceschetti 
in 1968. They didn't let me in as an ex-officio member but 
as an interim president because I was first vice-president 
when Franceschetti died. I told them that I thought the 
organization should be disbanded. It didn't do anything. It 
hadn't done anything. Unless they put some money into it 
and did something viable, they ought to get rid of it. 

Hughes: What was the reaction? 

Maumenee: In the European tradition, if the chairman of the department 
said something, you never disagreed with it. They were 
absolutely floored that a squirt my age would tell them what 
to do. Queen Juliana had invited them to dinner at the 
palace. They wouldn't invite me because I was not a 
full-fledged president of the association. 

Hughes: Were you offended? 

Maumenee: I got on the plane and flew back to the States. I think I flew 
over in the morning and came back in the afternoon. 

I held several meetings of the association and then they let 
me come on the council as an ex-officio member. We had a 
meeting in Paris in 1971, and John Wilson, who was blinded 
at thirteen, was there. He went through law school and 
graduated with double honors, which is the top honor you 
can get at Oxford. He became a very successful barrister in 
London. During the war he heard of many blinded soldiers 
and started the Commonwealth Society for the Blind. He did 
such a good job that it was made the Royal Commonwealth 
Society for the Blind. He collected about 5 million, and the 
pound was worth five dollars at that time, so it was quite a 
large sum of money. 

John suggested we combine the International Association for 
Prevention of Blindness and the World Council for the Blind 
and call the organization the International Agency for the 
Prevention of Blindness (IAPB). I insisted that John should 
be the president since he led the Royal Commonwealth 
Society for the Blind and had the money to make this an 
active organization. Besides, he was the best person in the 
world to run the agency. 



190 



Changing the International Council of 
Ophthalmology 

Maumenee: We had a meeting of the council in Kyoto in 1978. My 

secretary did not realize the dateline between the United 
States and Japan, and I was a day late because of the change 
of time. They were very upset because they had planned to 
nominate me for the presidency but I wasn't at the meeting. 
They nominated Jules again, so he was president for twelve 
years. 

Hughes: Why had they chosen you ? 

Maumenee: I had been very vocal and active in making suggestions and 
was vice-president. Jules consulted with me on the people we 
should put on the council. I, of course, appointed my friends, 
who I knew were good. 

Hughes: Did you appoint Americans ? 

Maumenee: Yes, Americans and Pan- Americans. 

Hughes: So you were changing the complexion of the council? 

Maumenee: That's right. Since I had been so involved in political 

activities in ophthalmology in Latin America and the United 
States, I had a lot of experience. By that time, I had gone 
to Europe quite frequently to give lectures in one place or 
another, so I knew a lot of the European ophthalmologists. 
Having been on the council, they elected me president. 

Hughes: Was there any resentment that the organization was becoming 
a more truly international group rather than mainly a 
European society? 

Maumenee: Well, they never expressed it to me, Sally. 

The council became more of an international organization, 
but it still wasn't recognized very widely and it still didn't 
have any plan of action. So when I became president, I tried 
to change it by rewriting the bylaws and attracting young 
people. I was going to call it the Young Advisory Committee, 
but it turned out that most of them were in their forties and 
they didn't think they were young anymore. They came up 
with some really good ideas about how we should do things. 

We made every effort to bring the Chinese and the Russians 
in. The Russians wouldn't join. The Chinese joined, but they 



191 

wouldn't allow us to fly the flag of Taiwan, so they [the 
Chinese] said they wouldn't come to the congress. So we 
didn't put any flags up at all. We got people from Hong Kong 
to give money to transport the Chinese delegation. It was in 
1982 that the Chinese first came. We provided them with free 
hotels and spending money. 

Hughes: Why wouldn't the Russians come? 

Maumenee: Russia was very secretive and claimed it couldn't afford to get 
the currency. Rubles weren't allowed to go outside the country. 

After the breakup of the Soviet Union, I got a letter signed by 
Y. F. Maichuk, N. M. Logia, Michael Krasnov, E. S. Avtisov, 
and N. Puchkovskaya asking if they could become members of 
the federated societies. I had a talk last night with Maichuk. 
He said, "You have been the rock that has held us together 
and brought us into the federated societies. We want to be 
part of the world now that the Soviet Union is no more." So 
they're going to join. 

Honorary Life President 

Maumenee: After eight years as president of the council, I said that no 
one should be president for longer than that. People become 
stagnant and don't get things done, so you ought to change 
officers. 

Hughes: You were made honorary life president of the international 
council in 1990. Only two other people had received that 
honor, Stewart Duke-Elder and Jules Franqois. How was 
the decision made? 

Maumenee: They [the members of the council] came to me and said, "You 
don't have any prejudice. You are for everybody and you have 
the personality to convince people to do things. We want you 
to stay on as president. The council will drift back into doing 
nothing if you don't stay on and keep pushing it." So I said, "I 
really don't think it's right. My age is advancing, and who 
knows when I am going to become senile. I think I should 
resign while I'm still active and turn the presidency over to 
somebody who can continue this program." They said, "Well, 
we want you to stay on the council, so well make you an 
honorary life member so you can attend the meetings." In 
1994, about six of the ten people who are on the council are 
going to retire. I am going to try and put some really good 



192 

people on, especially younger members who will do more 
things. 

Hughes: Do you think you have the pull to do that? 

Maumenee: I think the friends I've appointed will do what I ask 
them to do. 

Prevention of Blindness Programs 

Hughes: You were president of the council from 1982 to 1990. Did you 
assume the presidency with specific goals in mind? 

Maumenee: Yes, at every congress we had a major session on prevention of 
blindness, which was a major theme of the congress. We also 
put up signs for people to volunteer to go to foreign countries 
to help them do cataracts and teach. 

Hughes: Did they? 

Maumenee: Yes, they did. 

The international council has a booth here in Anaheim at 
this annual meeting, and it has presented a major paper on 
prevention of blindness. The council became quite a bit more 
active in promoting and supporting restoration of vision and 
prevention of blindness. 

We started a program in Accra, Ghana, to teach people both 
extracapsular and posterior chamber lens implantation. You 
had to hog-tie the Africans to bring them in to do cataract 
extractions on them because the surgeons did intracapsulars 
and patients lost their glasses so they couldn't see any better 
after they were operated on than they could before. They 
would get retinal detachments and other problems and they 
would become totally blind, whereas they had light perception 
or hand-motion vision before the extraction. But once we 
started putting lenses in, there was a long line to get into the 
clinic to be operated on. 

We wanted to teach. I went to Frank Winter, who was a 
former resident of mine, who had done superb work in 
Botswana and had moved to Upper Volta [now called Burkina 
Faso], where he had trained ancillary help to the extent where 
they could make a living taking care of patients. They were 
self-sufficient and they could teach. They could help the 
ophthalmologist. 



193 



Frank did a great job in these countries. He went over for six 
months with his family to these places as a representative of 
the Christian Eye Ministry. By that time, I had become 
friendly with Akef El Maghraby of Saudi Arabia and HRH 
Prince Abdul Aziz Ben Ahmed Ben Abdul Aziz Saudi. 
Through the Saudi Eye Foundation they agreed to give us 
$2 million to build an eye hospital in Accra. The minister 
of health, the president of the university, and all fifteen 
ophthalmologists in the country were 100 percent behind 
this program. 

Then Frank's secretary made the mistake of sending a letter 
from Frank with the Christian Eye Ministry logo on it. They 
said, This is just a sham to convert Muslims to Christianity.'' 
So they turned us down completely. We have not been able to 
get the money from anybody else. 

Three hundred ophthalmologists signed up in Singapore to 
work abroad, even though the booth for registration was 
hidden. A lot of young people are interested in serving, 
some of them for the experience of doing a lot of surgery. 
We don't want them, we want experienced people. We 
screen everybody before we send them over. 



Hughes: 



Jerusalem Seminar on the Prevention of 
Blindness, 1971 

Sir John Wilson wrote a wonderful letter to me in which 
he mentioned meeting you in Jerusalem. Was that the 
Jerusalem Seminar on the Prevention of Blindness in 1971 ? 



Maumenee: That's right. 

Hughes: He said that you and he conceived of a global strategy for the 
prevention of blindness. 

Maumenee: He is very generous. Isaac Michaelson was an English 

ophthalmologist. After England and the United States took 
land from the Palestinians for the Jewish homeland, Isaac 
joined the Israeli army and did a great job. He was very 
capable and a very wonderful man, so he was made professor 
of ophthalmology at the Hadassah Eye Hospital. 

Michaelson held a congress on prevention of blindness in 
1971. He had been sending his residents to Africa to operate. 
It was a very good congress and [there were] a lot of good 
papers. Sir John and I were staying in the same hotel. After 



194 

a dinner party he said, "Will you help me home tonight?" So I 
took him to his room. He said, "Don't bother to turn on the 
lights. I can't tell whether they are on or not." 

The next morning I went by to pick him up to take him to the 
meeting, and he said, "You know, Ed, I had a few too many 
drinks last night and I couldn't sleep very well, so I wrote a 
draft on prevention of blindness. It's in Braille, but let me 
give it to you to see what you think of it." Gosh, it was 
exquisite. So he presented that draft the next day. 

Hughes: What was the gist? 

Maumenee: That we should organize and get more ophthalmologists 
involved in combatting blindness, that there were a great 
number of blind people who could be helped. At the time, he 
was arranging cataract camps which were responsible for 
100,000 cataract extractions a year in these developing 
countries. He said it was a joint report that the two of us 
had written, but I didn't do anything. 

Hughes: Was it implemented as he conceived it? 

Maumenee: None of these proposals get completely implemented. There 
are very few people like John who are willing to buy trucks 
and to go out into the woods and find people with cataracts. 
They won't come in independently; you have to go get them 
to operate on them. John was and still is the best. He was 
knighted by the queen for his great work and now is Sir John 
Wilson. As wonderful as Sir John is, he could not have 
accomplished all he has without the help of his wife, Jean. 

Hughes: I heard that there was, or perhaps still is, a controversy over 
whether to do intracapsular or extracapsular cataract 
extractions in developing countries. 

Maumenee: That's true. I felt very strongly that the patients should have 
extracapsular cataract surgery with posterior chamber lens 
implants because then they could see right away. Instead of 
having to drag people in for operations, they line up early in 
the morning and beg to be operated on. You have to operate 
on just one prominent person and have Him walk around 
seeing again, and the word spreads like a drum roll. 

I feel very strongly that local ophthalmologists can be taught 
how to do extracapsular cataract surgery in a month or so. 
Insertion of the lens is the simplest thing in the world to do. 
If you train ancillary help to put the sutures in, patients 



195 

might have a fair amount of astigmatism because the sutures 
aren't tied quite right, but it wouldn't really make that much 
difference. They'll see much better, and they won't have to 
wear glasses. All they need to see is the rear end of an ox to 
plow the field. 

The prediction is that by the year 2000 most of manufacturing 
will be done in the developing world because they have so 
much cheaper labor and we can put factories over there and 
automate them. They are going to have to have better vision 
to be able to do that. 



International Agency for Prevention of Blindness 

Hughes: Do you want to comment on the International Agency for 
Prevention of Blindness? 

Maumenee: That's really gone over tremendously well. John Wilson was 
president for eight years. It's a much more active body than 
the council. They have established camps and organized 
prevention of blindness societies and whatnot. 

Carl Kupfer was president next. He also did a very good 
job, and he had the financial backing of the National Eye 
Institute. So he could travel and put money into research in 
various places. 

Hughes: 1 read that you and Sir John composed the first resolution on 
blindness that was put before the World Health Organization.* 

Maumenee: Yes. After we put the two organizations together [the 

International Agency for Prevention of Blindness and the 
World Council for the Blind], John said, "We ought to get a 
resolution from the World Health Organization that blindness 
is a really important problem." John wrote out the resolution 
and got the representative from Malawi to agree to make 
this proposal at a meeting of the World Health Organization 
[WHO] in Boston. John then suggested that I go to Boston 
and help to get the resolution passed. 

It turned out that the presiding officer for the meeting was a 
friend. He ran for the Tulane track team when I ran the mile 
for Alabama. So I went to him and said, "Look, would you 
allow this to come to the floor?" I sat through three days of 
the assembly members arguing about whether drugs should 



Alfred Sommer. Contributions of A. Edward Maumenee to international ophthalmology and the 
prevention of blindness. Am J Ophthalmol 1979; 88:293-95. 



196 



be labeled such and such a way and whether Italian drugs 
were fit to use and all kinds of other things that went on in 
the WHO. Finally, he recognized the representative from 
Malawi, who presented a resolution that blindness was one 
of the important problems in developing countries. 

It became one of the four or five major goals of the World 
Health Organization. They started with an ad hoc committee 
on the prevention of blindness. I was on the committee and I 
went down to Ouagadougou, Upper Volta. When I was there, 
I said that I had been active in trying to get the World Health 
Organization to recognize blindness as an important problem, 
but I had really never done any field work. So I felt that I 
should resign from the committee and that they should 
bring somebody else on. The other people who were on the 
committee, who weren't really doing field work, ought to get 
off and bring in the people who were serving camps and doing 
surveys and studying onchocerciasis and whatnot. 



Controlling Onchocerciasis 

I had met Bob McNamara, the secretary of defense, through 
Agnes Meyer, who owned the Washington Post and Atlas 
Chemical. I got a call one day saying, "Ed, this is Bob." I 
said, "Bob who?" "Bob McNamara." "Yes, sir. What do you 
want?" I wasn't a close friend, but I had seen him several 
times. He played squash with a urologist who had been a 
very good friend of mine while I was a resident at Hopkins, 
so we had something to talk about. 

He said, "If you can cure onchocerciasis, Fll pay for it [with 
funds from the World Bank, which McNamara then headed]. 
I don't give a damn about medicine, but the Upper Volta is the 
most fertile land in the world and it could feed half of Africa. 
But they all go blind from onchocerciasis that is carried by the 
Simulium fly." So I said, "Okay, Fll try to do something." 

So I went to the meeting in Geneva [the Ad Hoc Committee on 
the Prevention of Blindness] and talked to Mahler, who was 
head of WHO, and said, "Look, I don't know whether it is 
really true or not, but Bob McNamara called me and said that 
if you could get rid of onchocerciasis, he would pay for it." 
Sure enough, they started spraying with nontoxic materials to 
get rid of the fly. They reduced onchocerciasis quite a bit. 

Then the drug Ivermectin, which veterinarians had used in 
animals for a long time for worms, was tried on humans. The 



197 

veterinarians did everything they could to block use of the 
drug in humans because they were afraid of adverse reactions 
causing its removal from the market, because it was so good 
for their animals 

Now they are really on the way to wiping out onchocerciasis, 
which was one of the three major causes of blindness in 
the world. It's not only in Africa but in South America and 
some other parts of the world. The drug is made by Merck 
Sharpe & Dohme which gives it free for the treatment of 
onchocerciasis. The IAPB plans to give Merck a plaque in 
recognition of its contribution. 

Hughes: Trachoma, I assume, is one of the three. What is the third one? 

Maumenee: It was trachoma, onchocerciasis, and keratomalacia. The 
latter is due to a vitamin A deficiency. Really, when you get 
down to it, cataracts are now the most frequent cause of 
blindness, because the other conditions are all curable. 



Hughes: 



Pan-American Association of Ophthalmology 

/ read that you attended the first meeting of the Pan-American 
Association of Ophthalmology in Cleveland in 1940* 



Maumenee: The AMA was having a meeting in Cleveland. A group of 
people from the section for ophthalmology, primarily Harry 
Gradle from Chicago, Connie [Conrad] Berens from New York, 
and Moacyr Alvaro from Brazil, decided that there should be a 
Pan-American meeting so that people from the United States 
would become more friendly with the Latin Americans. I 
signed up and became a charter member of the Pan-American 
in 1940. I didn't go to any meetings. The congresses were 
primarily social. They weren't very educational. 

In the 1950s, there was a secretary for affairs in the United 
States from Chicago by the name of Allan. He called me one 
night and said, "You have been elected assistant secretary 
treasurer for America for the Pan-American." I said, "Look, 
I'm not even a member." I had forgotten I had signed up in 
Cleveland. He said, "We realized that the only way we could 
make you active was to make you an officer." 



Boyd BF. A. Edward Maumenee and Pan-American Ophthalmology. Am J Ophthalmol 1979; 
88:293. 



198 



Moacyr Alvaro Fund 



Maumenee: I went to the meeting in Santiago, Chile, which I think must 
have been 1954 or 1955, and that's where I met Ben Boyd 
from Panama. We then went with Brittain Payne from 
New York, who was active in the Pan-American, to visit 
Moacyr Alvaro, who lived in Sao Paulo. We visited the coffee 
plantations. The organization was very loosely run and they 
didn't have any money. Moacyr had a stroke shortly after 
that. I decided we should start the Moacyr Alvaro Fund so 
people from Latin America could come to the United States 
on a fellowship. 

I wrote a letter every year to every ophthalmologist in the 
United States who was a member of the Pan-American, 
asking him or her to make contributions. We built up a 
couple of hundred thousand dollars. 

When I retired in 1986, Bill Connor took over the presidency, 
and now the Pan-American charges ten dollars to every 
person who signs up for a congress. The money goes to the 
Pan-American Foundation for fellowships and to promote 
teaching. 

Then I got the idea of having visiting professors go from the 
United States to Latin America and vice versa for a month or 
more. Two or three would give a series of lectures and show 
movies about new techniques. The visiting professor program 
became quite popular from an educational point of view. 

Benjamin F. Boyd 

Maumenee: In 1958, Alvaro died, and I thought, "Who would be the best 
person to run the Pan-American?" We picked Ben Boyd 
because he was from Panama, which made him centrally 
located, and he was totally bilingual. Ben really worked at 
this. He started writing the Highlights of Ophthalmology, 
which turned out to have the largest circulation of any 
ophthalmic journal in the world. It's translated into Spanish, 
German, French, and Chinese. 

He would go to a meeting, take the biggest hotel suite, stay in 
his pajamas all day, and interview people who were leaders in 
glaucoma and cataract and uveitis and whatnot. He really 
became superbly efficient at his interviews. He got excellent 
material. The reader got this material in Highlights before it 
was ever published elsewhere. 

Working very closely with Ben, I became his advisor on many 
things. A lot of the changes that we made in running the 



199 



Pan-American were things that I thought of. Being head of 
organizations in this country, I knew how they were rim, and 
I put that knowledge into effect in the Pan-American. I have 
been on the council for I don't know how many years [since 
1967]. 

The Pan-American certainly honored me. I got the Gradle 
Medal for Teaching [1979] and was president from 1972 to 
1975. Ben and I have been close friends since the 1950s 
and have worked closely together for the betterment of the 
Pan-American. 

Ben was a wonderful executive. He alone brought all of the 
Latin American countries into the Pan-American, a task 
which was not easy when one considers the diverse attitudes 
of these countries. Ben really made the Pan-American what 
it is today. They honored him by establishing the Benjamin 
Boyd humanitarian award to be given to the person who has 
done the most to promote education and fellowship amongst 
the ophthalmologists in the Americas. Ben received the first 
award. 



Hughes: 



American Academy of Ophthalmology 

Palmer House Days 

What are your memories of your first annual meeting of the 
Academy? 



Maumenee: I really can't remember my first meeting. I know it was while 
I was a resident because it was when I got infected with 
streptococcus, when I was working on chemical warfare. 
Except during the war, I attended every annual meeting each 
year. The first activity I really had with the Academy was a 
course on cataract surgery that John McLean, Jack Guyton, 
and I gave, which I told you about. It was the first course sold 
out for fifteen years. I told you the story about the movie? 

Hughes: No. 

Maumenee: Every year, about fifty people gathered in a little room in the 
Palmer House. It was hot and stuffy and there was no air 
conditioning. We showed movie after movie after movie after 
movie. People would get sleepy and dull. So I decided I 
was going to wake them up. I got a movie of a girl doing a 
striptease on the side of a pool [laughter]. She stripped and 
just as she had turned her back and was taking off her last 



200 



Hughes: 



clothes, I cut off the movie and spliced that part onto the end 
of my cataract movie. 

/ understand from Frank Newell that one of the attractions of 
that course was that you would debate back and forth with 
Jack Guy ton and John McLean.* 



Maumenee: We argued like mad. 
Hughes: And the audience loved it. 

Maumenee: That's right. In fact, Dr. Alan Woods encouraged you always 
to question everything he said and to argue with him. We 
were all three trained under Alan Woods. So we carried this 
arguing on back and forth. 

Hughes: Did the audience enter in at all? 

Maumenee: Oh yes. 

But to carry that story on further, Connie Bricker, who was a 
good Catholic at Stanford, said, "I have to lecture to the nuns 
at my hospital. May I borrow one of your movies?" I said, 
"Yes, you sure can. But I don't have time to pick it out. 
The stack of movies that I have taken is over there." He 
unknowingly picked out this movie with the striptease on it 
and showed it to the nuns. He came back on Monday and 
said, "Ed, you son-of-a-gun. You almost got me kicked out of 
that hospital. I was showing that movie and here came the 
striptease. The nuns were absolutely shocked beyond words." 
[laughter] 

Bill Benedict was a good friend of Alan Woods. Bill Benedict 
was the Academy. When he first started, probably 200 people 
came to the annual meeting. He organized a staff to run 
the Academy and built it up to where there were several 
thousand people who came to the annual meeting. We always 
met in the Palmer House. The Palmer House got so crowded 
that we couldn't all stay there. People had to stay in other 
hotels. The elevators were so full that you couldn't get up and 
down. Five hundred people couldn't get in to hear the main 
sessions because the auditorium wasn't big enough. So the 
Academy moved out of the Palmer House. 

After a number of years, I was asked to become a councillor on 
the administrative board of the Academy. 



Interview with Frank W. Newell, MD, October 29, 1989. 



201 



Hughes: Your first office was in 1962, when you became a vice- 
president. In 1963, you became a member of the council. 

Maumenee: I went to Bill and I said, "Bill, I don't want this vice- 
presidency. That's the kiss of death. That means you've 
paid me off." He said, "No, that's just a stepping stone to the 
council. See how it goes." So I did, and then we had two 
ophthalmologists and two otolaryngologists, and the council 
made all the nominations for everything and passed them on 
to the president and to the executive secretary. The executive 
secretary ran everything. 

Separation into Two Academies, 1979 

Maumenee: The ophthalmologists got fed up working with 

otolaryngologists. There were only about thirty or forty 
members who were practicing both specialties, so we really 
had no reason to be affiliated with the otolaryngologists 
except that the eye is close to the nose and that was all there 
was to it. The otolaryngologists had developed a whole 
group of other societies, so they were very split up. The 
ophthalmologists had one main society, the Academy. The 
otolaryngologists spent about 60 or 70 percent of the money 
for otolaryngology, and ophthalmology put in about 80 percent 
of the amount of money. The Academy was primarily an 
academic teaching organization. 

Hughes: That was Bill Benedict's goal. 
Maumenee: Yes. 

Hughes: I understand that he was opposed to the Academy getting into 
politics. 

Maumenee: That's right. He wanted it to be a teaching organization. 
Hughes: How did you feel about that? 

Maumenee: I thought it was a good policy. Practically all of the people 
who were on the Academy board were from medical schools. 

Bill appointed a committee and asked me to be chairman 
of it. It consisted of Derrick Vail and I don't know who 
the other ophthalmologist was. There were three of us 
ophthalmologists and then there was Leajune, who was an 
otolaryngologist, and Howard House, and somebody else, 
maybe Mike Kos. The six of us went to see Bill when he was 
not feeling well. He said, "It will just kill me if you split the 



202 



Academy. I've worked all my life to put it together. It is now 
a powerful political body, and you just can't split it." 

There were never more than fifty to seventy-five people 
who came to the business meeting out of the thousands of 
ophthalmologists and otolaryngologists who came to the 
annual meeting. So it was kind of a farce. Nothing really 
happened. But Lawton Smith and J. V. Cassady proposed 
that we split. I convinced them that the Academy should 
not split until Bill Benedict passed away. He had made the 
Academy what it was, this was his life's work, and it would 
just destroy him to divide it. 

So I came back from seeing Dr. Benedict and convinced the 
membership at the next meeting that they should not split. 

Hughes: Now was this in the sixties? 

Maumenee: Yes, it must have been. It was about two or three years later 
that Bill Benedict died [1969]. When he did, I went to Lawton 
and said, "Lawton, now is the time for the Academy to split. 
I'll tell all my friends to come to the business meeting, but 
they have to be sworn to secrecy." We rigged the votes. He 
and Cassady and several of the people rounded up as many 
ophthalmologists as they could to go to the meeting. 

At that time Jules Stein was giving $25,000 as the Stein 
Award to the ophthalmologist who had made the most 
contributions to ophthalmology. He gave a reception 
afterwards. I was at the reception when I got word that 
Rene [Dr. Maumenee's wife] had just been taken to the 
operating room to have Niels. Dave Noonan got me a police 
escort and a plane ticket. I left immediately and got into 
Baltimore about one o'clock in the morning. Rene had had a 
caesarean by that time, and the baby was all right. But I 
wasn't there. I was there for the birth of our second child, 
Nickie. 

Lawton brought up the motion at the business meeting, and 
they voted overwhelmingly to split. 

Hughes: Had you arranged with Dr. Smith to make the motion? 

Maumenee: Yes. I said, "Now is the time to make the motion to split." 

They made the motion and they voted. The ophthalmologists 
had packed the business meeting. The otolaryngologists were 
absolutely furious. They said that was the dirtiest low-down 
trick they had ever seen. They said, "You stuffed the meeting 
with ophthalmologists and didn't tell us anything about it." 



Hughes: 



203 

Then they tried to get the vote rescinded, arguing that there 
were not enough members present for a valid vote. So we had 
to send out a mail ballot to see whether members wanted 
the Academy to split. Of course, the ophthalmologists all 
wanted to split. It was confirmed by the mail ballot that 
we wanted to split. The otolaryngologists used every political 
maneuver they could think of to reverse the vote, particularly 
Howard House, whom I respected greatly. He is a superb 
otolaryngologist. He used the rules of order to try to keep the 
organization together. 

Why were the otolaryngologists so intent on preventing the 
split? 



Maumenee: Because they were getting money to keep them going. They 
had sixteen organizations and the Academy organization that 
was so well organized that it worked fine. Mike Kos did a 
good job as executive secretary during the split. 

We went through some very rough, hectic times. It took two 
or three years before we finally got the lawyers to draw up a 
contract. There was a big monetary fund in Rochester with 
stipulations that Bill Benedict had made that it could never 
be split between ophthalmology and otolaryngology. So 
we had to break that law. There were all kinds of details 
that had to be worked out before we split. 

When we got Bruce Spivey in as executive secretary, the 
Academy really took off. He did a superb job and really built 
it up. 

American Association of Ophthalmology 

Maumenee: Then there was the American Association of Ophthalmology 
that was strictly interested in the political activities of 
ophthalmologists. 

Hughes: Fighting optometry. 

Maumenee: Fighting optometry and all that. I went off the council and 
the Association wanted to merge with the Academy. I was 
opposed to it because I wanted the Academy to be strictly an 
educational affair. But times were changing, and the doctors 
in practice kept coming to me and saying, "Why doesn't the 
Academy protect us ophthalmologists?" 

It was Brad Straatsma who worked out the union of the 
Association and the Academy. 



204 



Hughes: One of the hurdles, I understand, was the fact that not 

everybody in the Association was board certified, so a new 
type of membership had to be created for the uncertified. 

Maumenee: You're right. One of the rules of the Academy was that you 
had to be board-certified before you could get in. 

Hughes: Once that merger occurred it was calm and happy? 

Maumenee: Yes. The Academy has a lobbyist. With the government 

coming into medicine now, it has worked out quite well [for 
the Academy to have a political stance]. 

Hughes: You were on the council in 1963, for a four-year term in 1964, 
and for another four years in 1970. 

Maumenee: The council nominates the president, vice-president, and 

other officers. The president and vice-presidents are really 
figureheads. The executive secretary and the secretaries of 
the various teaching courses really ran the Academy. Dave 
Noonan, Bruce Spivey's assistant, really does a tremendous 
job of running things. 

Hughes: How do you feel about the Academy's move into the political 
arena? 

Maumenee: I think it really has turned out to be necessary. As I 

mentioned to you, if I didn't think of something myself, I 
always thought it was bad. I didn't think of this. I was so 
determined that the Academy should be a teaching body and 
not get involved in politics. As things have developed, it's 
very lucky that we have this. I think it has given the average 
ophthalmologist what he wants. I don't think the Academy 
would be anywhere near the size or importance it is if it 
hadn't gone into politics. So I think it turns out to be a very 
important step. But I must say, I couldn't see it at the time. 



205 

President of the American Academy of 
Ophthalmology, 1971 

Hughes: In 1971 you became president. Do you have anything to say 
about that year? 

Maumenee: It was just another function of being on the council. You could 
invite one guest of honor, so I had Norman Ashton. Then I 
had five or six other people as honored guests. I got around 
the stipulation of only one guest of honor hy railing the others 
honored guests. I invited Joaquin Barraquer, [Lorenz] 
Zimmerman, Mike Hogan, and David Cogan, Irving Leopold, 
and Frank Newell. But you can look in the Transactions of 
that time and see their names. They each presented papers 
which were so good, Mosby wanted to publish them, and I 
think they did publish them as a book.* From that time on, 
the presidents have had more guests of honor. 

The convention center in Dallas was built with the Academy's 
consultation. The architects said, "Look, who knows more 
about vision than the ophthalmologists? Who knows 
more about hearing than otolaryngologists?" So they 
built a convention center according to our stipulations. 

I started having the instruction courses given in Spanish for 
the Latin Americans. The council was reluctant to accept 
foreigners as members of the Academy because they hadn't 
passed the American Board of Ophthalmology exams. There 
were some very important Europeans who wanted to join. I 
insisted that they allow them to come into the Academy. 

Hughes: Did they? 

Maumenee: Yes. Now the annual meeting is really international, 
particularly this time.** 



Maumenee AE, ed. Contemporary Ophthalmology. St. Louis: C. V. Mosby, 1972. 

The 1991 annual meeting was co-sponsored by the Academy and the Pan-American Association of 
Ophthalmology. 



206 



Hughes: 



The American Board of Ophthalmology 

Reorganization 

Dr. [Robert N.J Shaffer wrote that the two of you tried to 
reorganize the American Board of Ophthalmology.* What 
exactly were you trying to do? 



Maumenee: Bob has written the history of the American Board.** The 
American Board of Ophthalmology was the first specialty 
board in medicine. It started in 1916. At first, they gave a 
written essay examination to candidates. Then it became a 
multiple-choice exam that could be put in the computer. 

I was chairman of the written committee for four or five 
years. The oral part of the exam was given in a hospital, 
where candidates examined patients who were brought in 
and then the examiners quizzed them about what they found. 
That really was a terrible thing because, in the first place, 
they frequently were using slit lamps that were different from 
the ones that they had used before and that didn't work very 
well. The ophthalmoscopes also didn't work very well. The 
patients, after being examined by ten different people, would 
get fidgety and obnoxious about having the bright lights 
shone into their eyes. It was terrible. So what Bob and I 
initiated was to stop having actual physical examinations and 
instead to use pictures of different diseases. We would show 
them good pictures and then quiz the resident. 

The oral has always been a difficult thing because no two 
ophthalmologists know the same things. There is a lot of 
disagreement about what is the best thing to do. Some 
examiners are very good and some are very poor. The poor 
candidate could get a tough examiner and a bad grade. 

Hughes: The exam wasn't standardized? 

Maumenee: It just wasn't standardized. We [Bob Shaffer and I] wrote out 
what we expected a candidate to know, and we gave that to 
the examiner. If he had a candidate who was doing poorly, he 



Robert N. Shaffer, MD, to A. Edward Maumenee, MD, January 15, 1991, in "A Collection of 
Letters from a Selection of Friends on the Occasion of the 50th Meeting of the Wilmer Residents 
Association, April 25, 1991," prepared by Morton F. Goldberg, MD, Baltimore, and David Paton, 
MD, New York (bound photocopy). The collection is available at the Wilmer Ophthalmological 
Institute and at the American Academy of Ophthalmology. 

Shaffer, Robert N. The History of the American Board of Ophthalmology 1916-1991. Rochester, 
Minn.: Johnson Printing Co., 1991. 



207 

would have to ask the question written out on that page. The 
answer would also be given to the examiner. 

This system of pictures and answers certainly improved the 
board exam a lot. I understand that they have now improved 
it still further in that the assistant examiners and the main 
examiner that is a member of the board quiz the person at one 
time and then they make up a grade. 

Examiner for the Board 

Hughes: Were you a tough examiner? 

Maumenee: The candidates thought I was the toughest person on the 

board. They were all deathly afraid of me. It was my fault, 
because if I had a good candidate, I would keep questioning 
him. I would finally ask hi a question to which I knew 
nobody knew the answer. He would think that that was what 
I was grading him on. But it wasn't. I was just trying to see 
whether I should give him an A+ or an A. I never asked the 
poorer candidates difficult questions. My average grade was 
right smack in the middle of the range. I graded quite easily, 
certainly in the middle level, but I did ask fundamental 
questions. I asked a lot of pathology and basic physiology. 
I wanted to see how candidates thought. Because of that, 
they thought that I was tough. 

Hughes: Did you like examining? 
Maumenee: I enjoyed it. 

Hughes: You weren't reluctant to flunk somebody if you felt he deserved 
it? 

Maumenee: That's right. 



American Ophthal mologieal Society 

Hughes: Please comment on the American Ophthalmological Society. 

Maumenee: The AOS is one of the oldest ophthalmic organizations in the 
country. It was started in New York by a group of people 
who were doing some work on the eyes. Many of them were 
general surgeons, not trained ophthalmologists. There is a 



208 



very good book written by Maynard Wheeler on the first 
hundred years of the AOS.* 

In preparing my presidential address, which I never 
published, I found out that the New York Academy of 
Medicine has the original handwritten minutes of the first 
meetings of the AOS. It is very interesting to read them. 
People would meet at various homes and present an 
interesting case. Gradually, they weeded out the general 
surgeons and kept just the ophthalmologists. It gradually 
grew to 225 members and has been at that level for at least 
the last twenty-five years. 

It has turned out to be more of a social meeting. They 
certainly try to pick the best ophthalmologists and the most 
congenial people in the country. They don't always pick out 
the smartest people. If a person is very smart and he is 
unethical, or advertises, or he is in any way difficult, he can't 
get into the AOS. You have to write a thesis which has to be 
reviewed and accepted before you can become a member. 
Many people who have written theses never write another 
paper after they become members of the AOS. I thought 
it was founded to be the intellectual organization of 
ophthalmology. It wasn't until I read the minutes that I 
realized that it really is primarily a social gathering. It is 
a delightful organization. You can't find nicer people. The 
papers are pretty good. 

All the papers are published in the Transactions of the 
American Ophthalmological Society, which has only about 
100 subscribers outside of members and libraries. Therefore, 
when you give a paper there, it gets buried and never gets 
quoted. 

Hughes: So people hesitate to give their best papers at the AOS ? 

Maumenee: That's right. They give something they have given the 

essence of at another meeting and expand on it for the AOS. 

Hughes: How do you feel about the emphasis on the social rather than 
the academic? 

Maumenee: I guess I was critical of it. It took a long time for them to 
make me president [19851986]. That was the last 
presidency I've had, except for the International Council of 
Ophthalmology [1982-1990]. 



Wheeler M. The American Ophthalmological Society: The First Hundred Years. Toronto: 
University of Toronto Press, 1964. 



209 



Hughes: Do you think because you had spoken out? 
Maumenee: Yes. 

Hughes: I gather from what you have told me about these social 
overtones that a good thesis isn't enough to ensure 
membership; a candidate also has to have certain social 
attributes. 

Maumenee: I don't think they actually take you on your social 

attributes; they keep you out if you are obnoxious. You get 
in because you are a leader in your area in ophthalmology, 
not necessarily an academic leader who has published 
outstanding papers, but that you have been an outstanding 
person. The AOS has tennis tournaments and golf 
tournaments and fishing tournaments and skeet 
shooting tournaments and bridge tournaments and 
gives cups and silver awards to the winners. 



210 



211 



VIII. REFLECTIONS 



Motivation 



Hughes: What has motivated you in your long and diverse professional 
career? Why have you done all of the things that you have 
done? 

Maumenee: Sally, I don't know. I really and truly do not know. 

I was determined to be equal to the best ophthalmologist in 
the world. It wasn't with the idea of getting any acclaim. I 
never politicked for any position, but I worked hard. When 
an opportunity came for me to do something, I did it. I also 
hoped to prove some of the old concepts wrong. The same was 
true with organizations I joined. 

In California, I saw that I could change all of ophthalmology 
out there. It gave me a great sense of confidence and made 
me known nationally. As one of my friends said, "I never 
heard you give a paper that you didn't say something original. 
You never just rehashed the way other people do. You either 
didn't give a paper or you gave something new." 

When I came back to Baltimore in 1955, Dr. Woods said, 
"Well, you'll be president of these organizations." I said, "But 
Prof, Fm not interested in politics. All I want to do is work 
with Jonas Friedenwald, teach, do research, and make the 
Wilmer Institute the best place I can make it." I guess I was 
insensitive about failure because it never occurred to me 
that I could fail. I didn't really aspire to any position. I just 
wanted to do the best I could. That was all. 



212 

Hughes: You did end up doing much more than just making the Wilmer 
a great place. Did your goals change ? 

Maumenee: Every single presidency I went into, I changed the 

organization. I looked at the flaws, and I got people to 
agree with me. I cultivated friends who were, I thought, 
smart and capable and ethical. I would work with them to 
change the organizations. So we changed them, and I got 
the reputation for being a great leader. Just one thing piled 
up after another. 

Hughes: Your wife described you as a "power broker. " * 

Maumenee: I would think of a power broker as somebody who definitely 
goes out to use people to put himself ahead. I never did that. 
I never purposely cultivated anybody to get a job or to get 
something done. I was really much more interested in, and 
the thing that really excited me was, teaching residents and 
doing something in the laboratory or in the operating room 
that was new and innovative. I hated writing. I did so many 
things that I never wrote up. 

I really enjoyed doing innovative things. As someone said, 
"I came to watch you operate last year, and now you're doing 
something entirely different." I said, T never do the same 
operation twice. I'm always trying to think of some way to do 
it differently." 

Hughes: I have a quote from Dr. Norton about your advice to him about 
controlling a board meeting: "You must be the first to speak, to 
present your solution to the problem at hand. From then on, 
the discussion revolves around your view of the problem and 
your solution." ** Do you think that is accurate? 

Maumenee: When I began to hold offices in many different organizations, 
I knew what was going on in a vast field. Other people were 
only interested in the one organization where they held office. 
So I had the great advantage of having inside information 
on multiple organizations at one time. It gave me a great 
advantage over my colleagues on the councils who really were 
primarily in practice. 

Hughes: Do you think there was ever resentment? 



Interview with Irene H. Maumenee, MD, November 1, 1989. 

Edward W. D. Norton, MD, to A. Edward Maumenee, MD, January 1, 1991. "A Collection of 
Letters from a Selection of Friends on the Occasion of the 50th Meeting of the Wilmer Residents 
Association, April 25, 1991." 



213 



Maumenee: I'm sure there was. There always is when you accomplish 
something others don't agree with. I'm sure that I didn't 
hesitate to argue with people and to tell them I thought they 
were wrong. So I'm sure I hurt their feelings and that they 
didn't like it. 

Hughes: What have you enjoyed most in your medical career? 

Maumenee: I guess two things. One is teaching and seeing my residents 
really learn and accomplish things. If s very gratifying. 
It's like having another family and having very successful 
children and having them be very appreciative. The other 
thing is Fve always really enjoyed doing research and having 
a new idea and arguing with people and finding out I was 
right and they were wrong. 

I guess the final thing is the care of patients. When the 
patients come in and say, "You're a god. It's unbelievable. I 
was bund and now I can see perfectly. I have no problems. 
You're just the greatest thing that ever lived." It can't help 
but go to your head a little, [laughter] 



Qualities of a Good Physician 



Hughes: What do you think makes a good physician ? 

Maumenee: I think he really has to treat the patient as a human being 
and do the best he possibly can to make that patient a real 
individual. If he does the best he possibly can for the patient, 
then he is going to be a good physician. Of course, he's got to 
have ability. There are some people who would rather go 
camping or on a cruise instead of studying and working. They 
can be big socialites, and their patients get terrible treatment 
because they don't really know what they are doing, and they 
are not good physicians. I think good physicians have got to 
be intelligent. I think they have got to work hard. They have 
got to devote their lives to the patient. 

As Duke-Elder used to say, "Your first love is ophthalmology." 
You've got to love it and love working with it. You are married 
to ophthalmology if you are a good ophthalmologist. 



214 



Leisure Activities 



Hughes: What do you do for relaxation and leisure? 

Maumenee: I've always liked golf and tennis and fishing and hunting 
physical activities. I am not an avid reader, outside of 
ophthalmology. Actually, I think it goes back to my younger 
years. I figured that if I had any time to read, I should read 
ophthalmology, so that I would know more about it. Reading 
novels was a waste of time when I could have been reading 
ophthalmology. So I am very narrow, from a cultural point of 
view. There are some people who know all about history, art, 
music, and things of that sort. I would much rather read a 
book about ophthalmology. 

Hughes: You wanted to talk about the Trans-Pacific Yacht Race. 

Maumenee: I've had a lot of good times and unusual times. The race was 
one of them. Carl Jensen, who is an ophthalmologist, asked 
me if I wanted to be in the Trans-Pac Race with Him on his 
boat. 

It was a very exciting thing to sail past Catalina [Island on 
the Southern California Coast] and never see another boat or 
another thing except the stars and an occasional airplane 
flying over, which we had radio contact with. We came in 
fifth, or something like that, out of thirty-five boats. 

Hughes: Had you had any previous experience with racing 1 ? 

Maumenee: I had done a lot of sailing on Mobile Bay [Alabama] but in 
small boats. Carl had a crew of eleven. I had the twelve to 
four watch with Boo Pascal and Carl's cousin, who was a 
urologist. 

It was really fun. We were going full sail in a storm with the 
spinnaker up, and the boom came up, hit the spinnaker, and 
tore a big hole in it. We thought that was going to ruin us for 
the race. But I had a thousand yards of dental floss, and I 
sewed up the spinnaker with dental floss with a lock stitch, 
[laughter] It held full wind, and we went across the finish 
line with the spinnaker wide open. I used to carry a picture of 
us crossing the finish line. 



215 



Regrets 

Hughes: Do you have any regrets? 
Maumenee: I'm getting old. 
Hughes: So are we all. [laughter] 
Maumenee: I regretted coining back to Baltimore. 
Hughes: Why? 

Maumenee: Because I was having a great time in California. I had 
everything going my way. 

Hughes: Can you think of anything that you would have done 
differently if you had it to do all over again? 

Maumenee: Sally, I never planned anything. You should do the best you 
can and make every day count and do your hardest work and 
drive in the right direction. 

I guess the one thing that really disappointed me was 
Spectra. I really got what I thought was very unfair criticism. 
I think there are people who still consider Spectra a black 
mark on my career. But to me it wasn't. I thought this was a 
great opportunity to have something to do when I retired, to 
help out patients, and to develop innovative products. I got 
involved in something that's caused me more of a headache 
than anything I've ever done. 



Greatest Contribution 



Hughes: What do you consider to be your greatest contribution ? 

Maumenee: I guess my greatest contribution is general leadership in 

ophthalmology. I have been told by people all over the world, 
"You're the leading ophthalmologist in the world. You're the 
most outstanding." I was told last night by the Russians that 
I've been the rock that has held them interested in joining up 
with the West. People from all countries on the International 
Council said, "You're the only person who has the personality 
and the drive and the ideas to make things go. We want you 
to stay on as honorary life president." Patients come in all 
the time and tell me that they saw such and such a doctor and 



216 



he said, "Dr. Maumenee? You've seen him? He's tops in 
ophthalmology. He really leads us all." 

I think that has made me feel quite good. Certainly 
contributing to that feeling has been the fact that my 
residents have done so well. I have had the good luck of 
choosing good people and having them work out right. 

Being the leading ophthalmologist, there is hardly a place 
that I've ever been that people didn't know me or what I had 
written. They have always given me the best position in 
anything that comes along. I've always been treated as kind 
of a king wherever I've gone, which is very nice. 




A. Edward Maumenee and 
Sue Ballard Maumenee, 1993 



217 



APPENDICES 



218 



CURRICULUM VITAE 

Name Alfred Edward Maumenee, MD 

Date of Birth September 19, 1913 

Place of Birth Mobile, Alabama 

Married, Anne Elizabeth Gunnis, July 1949 

Children: Anne Elizabeth, born 1950 

Alfred Edward III, born 1951 

Married, Irene Hussels, October 1972 

Children: Niels Kim, born 1973 

Nicholas Radcliff, born 1975 

Married, Sue Ballard, August 1993 

Education Degree Year 

University of Alabama, AB 1934 

University of Alabama, Medical School 1936 

Cornell University School of Medicine MD 1938 

Wilmer Ophthalmological Institute, The Johns Hopkins Hospital: 

Assistant Resident in Ophthalmology 193942; 

Chief Resident in Ophthalmology 1942-43 
Honorary Degrees 

F.R.C.S.ED., Honorary Fellow of the Royal College of Surgeons of 
Edinburgh, 1971. 

Sc.D., Honorary Doctor of Sciences, University of Illinois, 1974. 
Sc.D., Honorary Doctor of Sciences, University of Alabama, 1982. 
M.D., Honorary Doctor of Medicine, Technischen Universitat Munchen, 
1986. 



219 

Academic Appointments 

Director Emeritus, Department of Ophthalmology, Wihner 
Ophthalmological Institute, The Johns Hopkins University School of 
Medicine, July 1979-. 

Director, Department of Ophthalmology, Wilmer Ophthalmological 
Institute, The Johns Hopkins University School of Medicine, July 
1955-June 1979. 

William Holland Wilmer Professor Emeritus of Ophthalmology, The Johns 
Hopkins University School of Medicine, July 1979. 

William Holland Wilmer Professor of Ophthalmology, The Johns Hopkins 
University School of Medicine, July 1955-June 1979. 

Chairman, Division of Ophthalmology, Stanford University Hospital, 
1948-55. 

Professor of Surgery in Ophthalmology, Stanford University, 1948-55. 

Associate Professor of Ophthalmology, The Johns Hopkins University 
School of Medicine, 1946-48. 

Assistant Professor of Ophthalmology, The Johns Hopkins University 
School of Medicine, 1943-46. (On military leave, 1944-^46.) 

Instructor in Ophthalmology, The Johns Hopkins University School of 
Medicine, 1942-43. 

Military Service 

Lieutenant, U.S. Navy (Marine Corps), 194446. 
Hospital Appointments 

Ophthalmologist-in-Chief Emeritus, The Johns Hopkins Hospital, July 
1979-. 

Ophthalmologist-in-Chief, The Johns Hopkins Hospital, July 1955-June 
1979. 

Trustee, The Johns Hopkins Hospital. 

Chairman, Medical Board, The Johns Hopkins Hospital. 

Chairman, Division of Ophthalmology, Stanford University Hospital, 

1948-55. 

Consultant in Ophthalmology, San Francisco Hospital, 1948-55. 
Consultant in Ophthalmology, Laguna Honda Hospital, 1948-55. 
Civilian Consultant, Letterman Army Hospital, 1948-55. 
Civilian Consultant, U.S. Naval Hospital, Oakland, Calif., 1948-55. 
Civilian Consultant, Walter Reed Army Hospital, 195578. 
Civilian Consultant, U.S. Naval Hospital, Bethesda, Md., 1955-78. 
Civilian Consultant, Clinical Center, National Institutes of Health, 1955-. 



220 

Civilian Consultant to Surgeon-General, U.S. Navy, Special Consultant on 
Matters of Education in the Field of Ophthalmology, 1963- 

Consultant, Baltimore City Hospitals, 1959-. 

Consultant, U.S. Public Health Service Hospital, Wyman Park, 1965-. 

Consultant, National Academy of Sciences, 1974. 

Associate Ophthalmologist, The Johns Hopkins Hospital, 1946-48. 

Clinical Staff, Mt. Zion Hospital, San Francisco, Calif, 1949-55. 

Clinical Staff, Children's Hospital, San Francisco, Calif, 1949-55. 

Positions Held 

Director 

Director Emeritus, Department of Ophthalmology, Wilmer 
Ophthalmological Institute, The Johns Hopkins University School of 
Medicine, July 1979- 

Director, Department of Ophthalmology, Wilmer Ophthalmological 
Institute, The Johns Hopkins University School of Medicine, July 
1955-June 1979. 

Director, Ophthalmic Publishing Co., 1968-. 

Honorary Director, Institute de Ciencias de la Visi6n del Comit6 National 
Prociegos y Sordomudos, Guatemala, 1982. 

Ophthalmologist-in-Chief 

Ophthalmologist-in-Chief Emeritus, The Johns Hopkins Hospital, July 

1979-. 
Ophthalmologist-in-Chief, The Johns Hopkins Hospital, July 1955-June 

1979. 

Chair in Ophthalmology 

The William Holland Wilmer Chair in Ophthalmology, The Johns Hopkins 
University School of Medicine, July 1955 June 1979. 
July 1979- (Emeritus). 

Trustee 

Trustee, The Johns Hopkins Hospital. 

Trustee, Association for Research in Ophthalmology, Inc., 1963-68. 
Trustee, Association of University Professors of Ophthalmology, 1963-68. 
Trustee, The Ophthalmic Publishing Company, 1967. 

President 

Honorary Life President, Concilium Ophthalmologicum Universale 
(International Council of Ophthalmology), 1990. This honor has only 
been bestowed on two other persons: Sir Stewart Duke-Elder and 
Professor Jules Francois. President, 198290. 



221 

President, American Ophthalmological Society, 1985. 

First President, Association of University Professors of Ophthalmology, 
1965-66. 

President, American Academy of Ophthalmology and Otolaryngology, 1971. 
Acting President, International Agency for Prevention of Blindness 

(formerly International Association for Prevention of Blindness), 

1968-70. 

President, Pan-American Association of Ophthalmology and 
Otolaryngology, 1972-75. 

President, Board of Directors, American Journal of Ophthalmology, 
1975-1989. 

President, International Congress on Cataract Surgery, First, 1978; 
Second, 1981; Third, 1984; Florence, Italy. 

President, 24th International Congress of Ophthalmology, San Francisco, 
1982. 

President, Science Advisory Committee, International Eye Bank, 
Baltimore, Md. 

President, The Ophthalmic Publishing Company, 1982-89. 

Chairman 

Chairman, Medical Board, The Johns Hopkins Hospital. 

Chairman, Division of Ophthalmology, Stanford University, 1948-55. 

Chairman, of Trustees, Association for Research in Ophthalmology, Inc., 
1968. 

Chairman, National Committee, 24th International Congress of 
Ophthalmology, 1982. 

Chairman, American Board of Ophthalmology, 1967. Vice-Chairman, 1966. 
Chairman, AMA Section on Ophthalmology, 1965. 

Chairman, Association of University Professors of Ophthalmology, 1965-66. 
Chairman, Planning Subcommittee, National Institutes of Health, 1977. 

Chairman, Advisory Committee of International Relations, National 
Society for the Prevention of Blindness. 

Chairman, Advisory Committee, Ophthalmic Drugs Council, U.S. Public 
Health Service, Food and Drug Administration, 1970-73. 

Chairman, Board of Directors, Pan-American Ophthalmological 
Foundation, 1974-. 

Chairman, Symposium on Connective Tissue Diseases, Cambridge, 
England, September 13-14, 1974. 

Chairman, Advisory Committee, Variety Club Blind Babies Foundation, 
1949-55. 



222 

Chairman, Scientific and Technical Advisory Committee, Mentor O & O, 

Inc., 1985-. 
Chairman of the Board, Chief Executive Officer, and Director, Spectra 

Pharmaceutical Services, Inc., 1985. 

Honorary Chairman, Board of Trustees, Pakistan Eye Foundation, 
RockviUe, Md., 1990-. 

Vice-President 

Vice-President, Concilium Ophthalmologicum Universale (International 

Council of Ophthalmology), 1977. 
Vice-President, American Ophthalmological Society, 1985-85. 

Vice-President, American Academy of Ophthalmology and Otolaryngology, 
1962. 

First Vice-President, International Association for Prevention of Blindness, 
1966-68. 

Vice-President, International Agency for Prevention of Blindness, 1970-74. 
Vice-President, Pan-American Ophthalmological Foundation, 1966-67. 
Vice-President, The Ophthalmia Publishing Company, 1973. 

Associate Officer 

Order of St. John, 1972. 

Board of Directors 

American Journal of Ophthalmology, President, Board of Directors, 1975. 

National Society for the Prevention of Blindness, Member, Board of 
Directors, 1978. 

Pan-American Ophthalmological Foundation, Board of Directors: 
Chairman, 1974-; Member, 1967- 

The Ophthalmic Publishing Company, Member, Board of Directors, 

1968-89. 
Mentor O & O, Inc., Member, Board of Directors, 1985- 

Advisory Board 

The Johns Hopkins Hospital, Member, Advisory Board, 1955-. 
Society of Eye Surgeons, Member, Advisory Board, 1970. 
International Eye Bank, Member, Advisory Board, 1965-. 
Audio Digest Ophthalmology, Member, Editorial Advisory Board, 1963. 
Institute for Sensory and Brain Research, Member, Advisory Board, 1970-. 
Saudi Eye Foundation for Research & Prevention of Blindness, Member, 
Advisory Board, 1989-. 

California Bureau of Vocational Rehabilitation, Member, Medical Advisory 
Board, 1949-55. 



223 

Advisory Committee 

American Foundation for Overseas Blind, Member, Advisory Committee, 
1972-74. 

Asia-Pacific Academy of Ophthalmology, Member, Advisory Committee, 
1976. 

California Department of Public Health, Member, Advisory Committee of 
Ophthalmologists, 1949-55. 

California Department of Social Welfare, Member, Advisory Committee of 
Ophthalmologists, 1950-55. 

International Eye Bank, President, Scientific Advisory Committee. 
Knights Templar Eye Foundation, Ophthalmologist-Advisor, 1956. 
National Academy of Sciences, Member, Advisory Committee 
(Ophthalmology), 1955-58. 

National Council to Combat Blindness, Member, Scientific Committee, 
1950-. 

National Society for the Prevention of Blindness, Member, Advisory 
Committee, 1955. 

National Society for the Prevention of Blindness, California Chapter, 
Member, Professional Advisory Committee, 1948-55. 

New York Eye and Ear Infirmary, Member, Advisory Committee, 1956-58. 
Ophthalmic Foundation, Member, Advisory Committee, 1956-62. 
The Seeing Eye, Inc., Member, Advisory Committee, 1967-70. 

Mentor O & O, Inc., Chairman, Scientific & Technical Advisory 
Committee, 1985-. 

Advisory Council 

American Academy of Ophthalmology & Otolaryngology: Member of 
Council, 1963, 1964-68, 1970-; Councillor, 1964-68. 

American Ophthalmological Society, Member of Council, 1975-. 

National Eye Institute, Member, National Advisory Eye Council, 196971; 
1975-. 

National Institutes of Health, NIH National Advisory Eye Council, 
Chairman, Planning Subcommittee, 1977. 

Neurological Diseases and Blindness, Member, Advisory Council, 
Subcommittee on Impaired Vision and Blindness, 1967-69. 

The Alfred P. Sloan Foundation, Member, Advisory Council for Research in 

Glaucoma and Allied Diseases, 1956-68. 
American Federation for Aging Research (AFAR), Inc., Member, National 

Scientific Advisory Council, 1985-. 



224 

Advisory Panel 

Research to Prevent Blindness, Member, Scientific Advisory Panel, 1962. 

World Health Organization: Member, WHO Expert Advisory Panel on 
Trachoma and Prevention of Blindness, 1979-84, 1984-; Member, 
Programme Advisory Group for the Prevention of Blindness in the WHO 
Program, 1978-; Member, WHO Scientific Advisory Panel, 
Onchocerciasis Control Program, 1974. 

Consultant 

International Agency for Prevention of Blindness, (formerly International 
Association for Prevention of Blindness), Honorary Consultant to Annals, 
1979-. 

John F. Kennedy Institute, Consultant, Medical Staff, 1973-74. 

National Institute of Neurological Diseases and Stroke, U.S. Public Health 
Service. Consultant, National Institute of Health Graduate Training 
Committee, 1953-55. 

Vanderbilt University, Department of Ophthalmology, Consultant to the 
Vice-Chancellor, 1975. 

World Health Organization, Consultant, Onchocerciasis Project, 1974. 

Visiting Professor 

George Washington University, 1968. 
Guys Hospital, London, 1958. 

Harvard College, Paul A. Chandler Visiting Professor of Ophthalmology, 
July 15-31, 1971. 

Henry Ford Hospital, Detroit, 1964. 

Massachusetts Eye & Ear Infirmary, Harvard Medical School, 1971. 

San Diego Academy of Ophthalmology, February 4, 1980. 

Stanford University, Allergan Visiting Professor of Ophthalmology, 
September 21-22, 1987. 

Tulane University of Louisiana, 1973. 

La Universidad de Cartagena, Cartagena, Colombia, April 26, 1982. 

University of Arizona, 1974. 

University of California, San Francisco, 1962. 

University of Cincinnati, 1963; 1977. 

University of Gainesville, Gainesville, Fla., January 10-12, 1980. 

University of Honolulu, 1966. 

University of Illinois, Chicago, 1971; 1974. 

University of Kentucky, March 1-2, 1976. 

University of Miami, Miami, Fla., 1966. 



225 

University of Miami, Bascom Palmer Eye Institute, 1974. 
University of Pittsburgh, January 13, 1977. 
University of Puerto Rico, San Juan, Puerto Rico, 1971. 
Washington University, St. Louis, Mo., 1968. 
Yale University, 1971. 

Awards 

Society of Military Ophthalmologists Award, 1959. 

Beverly Myers Achievement Award, 1967. Educational Foundation on 
Ophthalmic Optics. 

The Howe Medal, 1969. American Ophthalmological Society. 
The Lucian Howe Gold Medal, 1970. A.M.A. Section on Ophthalmology. 
The Howe Medal, 1970. Buffalo Ophthalmological Society. 
The Francis I. Proctor Research Medal, 1972. The Association for 
Research in Vision and Ophthalmology. 

The Jorge Malbran Gold Medal, 1974, Argentina. 

Physician's Recognition Award. American Medical Association, 1973-1976. 

First John M. McLean Gold Medal Award, 1976. The International Eye 
Foundation Society of Eye Surgeons. 

The $25,000 Research to Prevent Blindness Trustees' Award, 1976. 

The 1977 Alumnae Award of Distinction. Cornell University Medical 
School. 

Distinguished Public Service Award, 1977. Department of the Navy, 
Washington, D.C. 

The Knights Templar Eye Foundation Award of Appreciation, 1977. 

Gradle Medal for Teaching, 1979. Pan-American Association of 
Ophthalmology. 

Krieger Prize on Ophthalmology, 1979. Sinai Hospital of Baltimore, 
Division of Ophthalmology. 

Castroviejo Medal for 1980. 

Award of Merit. City of Baltimore Mayor's Citation to Edward Maumenee, 

1980. 
Distinguished Service Award, 1981. Asia-Pacific Academy of 

Ophthalmology. 
The Most Distinguished Alumnus Award, 1981. The University of 

Alabama in Birmingham. 
The First Maumenee Gold Award, 1981. 
The Leslie Dana Gold Medal Award, 1981. The St. Louis Society for the 

Blind. 



226 

Frank Claffy Memorial Medal, 1982. University of Sydney, Australia. 
The Gonin Medal (Medaille Gonin), 1982. University de Lausanne, Societe 

Suisse d'Ophtalmologie. 

First Knights Templar National Public Service Award, 1982. 
Schlaegel-O'Connor Medal for Uveitis, 1984. 
La Orden Rodolfo Robles (The Rodolfo Robles Order), 1984. Ministerio de 

Salud Publica y Asistencia Social, Guatemala. 
Ophthalmic Award of Excellence, 1984. Vanderbilt Medical Center & 

Hospital Corporation of America. 
The 1985 Pisart Vision Award. The Lighthouse, the New York Association 

for the Blind. 
The International Duke-Elder Medal, 1986. International Council of 

Ophthalmology. 

Medalla de Oro y Premio Institute Barraquer (Gold Medal and Award, 
Barraquer Institute), 1987. Barcelona, Spain. 

The Paul Harris Fellowship Award, 1987. The Rotary Club, Baltimore. 

The First Bennedetto Strampelli Medal, 1988. The International 
Mediterranean Ophthalmological Society, Rome, Italy. 

Saudi Arabian Ophthalmological Society Medal, 1988. 

George L. Tabor, MD Award, 1988. San Diego Eye Bank. 

L. Harrell Pierce, MD, Wilmer Resident Teaching Award, 1989. 

The Dr. P. Siva Reddy International Gold Medal, 1989. Hyderabad 
Academy of Ophthalmology, India. 

First Gold Medal of the Society Oftalmologica Internazionale del 
Mediterraneo, 1989, Palermo, Italy. 

The Jose Rizal Gold Medal, 1990. Asia-Pacific Academy of Ophthalmology. 

Award recognition for establishment of the National Eye Institute, 
Alliance for Eye and Vision Research, 1993. 

Other Honors 

Plaque, Society of Military Ophthalmologists, 1959. 
Certificate, Sociedad Argentina de Oftalmologia, Buenos Aires, 1968. 
Plaque, Association of University Professors of Ophthalmology, 1965-69. 
Plaque, Association for Research in Ophthalmology, Inc., 1969. 
Diploma, VII Congreso Panamericano de Oftalmologia, Bogota, 1971. 

First Silver Membership Plaque, for launching Fund-Raising Campaign, 
March 8, 1971. Presented at the White House by President Richard M. 
Nixon on behalf of Research to Prevent Blindness. 

Certificate, American Academy of Ophthalmology and Otolaryngology, 
1971. 



227 

Diploma, Sociedad Venezolana de Oftalmologia, Caracas, 1973. 
Commissioned a Kentucky Colonel by Julian M. Carroll, Governor, 
Commonwealth of Kentucky, 1976. 

Honored at Banquet of the Centennial Congress on Retinal and Choroidal 

Diseases, Johns Hopkins Medical Institutions, 1976. 
Certificate, The American Board of Ophthalmology, 1976. 

Certificate of Acceptance. lolab Corporation. Investigative Device 
Exemption Investigator for lolab Corporation, 1978. 

Certificate, American Academy of Ophthalmology and Otolaryngology, 
1977. 

Festschrift issue of the American Journal of Ophthalmology to honor A. E. 
Maumenee, MD. (AJO 1979 Sept;88 [3 Pt 1].) 

Plaque, Patient's Recognition, Associated Jewish Charities and Welfare 
Fund, Baltimore, 1980. 

Honored Speaker, Eighth Annual Program, San Diego Eye Bank, 1988. 

Honorary Fellow, The Australian College of Ophthalmologists, Sydney, 
1988. 

Plaque, for support of development and education programs of Division of 
Ophthalmology, Howard University College of Medicine, Washington, 
D.C., 1965-1990. 

The Thirty-Ninth Science Meeting in Honor of A. E. Maumenee, MD. The 
Residents Association of the Wilmer Ophthalmological Institute, 1980. 

Volume Dedicated to A. Edward Maumenee, MD. Current Concepts in 
Cataract Surgery. Selected Proceedings of the Sixth Biennial Cataract 
Surgical Congress. Edited by Jared M. Emery, Adrienne C. Jacobson. 
St. Louis: Mosby, 1980. 

Plaque. Honorary director, Institute de Ciencias de la Vision, Guatemala, 
1982. 

Plaque. Patient's recognition from Florence May Eichberg, 1982. 
Plaque. Research to Prevent Blindness, 1983. 

The A. Edward Maumenee Building. Third building of The Wilmer 
Ophthalmological Institute. Dedication, November 8, 1982; 
inauguration, April 19, 1983. 

Diploma. XTV Congreso Panamericano de Oftalmologia. Lima, Peru, 1983. 

Certificate of charter membership. International Glaucoma Congress. 

Diploma and Recordatory Medal. Accademia Medica di Roma, Italy, 1987. 



228 

Memberships 



Academia Ophthalmologica Internationalis. Charter Member No. XL. Bal 
Harbour, Florida, 1975. 

Accademia Medica di Roma, Foreign Honorary Member, 1987. 
Accademia Ophthalmologica Italica, Honorary Member, Florence, Italy, 
1981. 

Alpha Omega Alpha, National Medical Honor Society, Johns Hopkins 
Chapter. Honorary Member, 1976. 

American Academy of Ophthalmology and Otolaryngology: President 1971; 

Vice-President, 1962; Councillor, 1964-68; Member of Council, 1963, 

1964-68, and 1970-. 
American Association of Ophthalmology, 1972. 

American Board Ophthalmology: Chairman, 1967; Vice-Chairman, 1966; 
Member 1959-67. 

American Foundation for Overseas Blind, Member Advisory Committee, 
1972-74. 

American Medical Association. 

A.M.A. Section on Ophthalmology, Chairman, 1965. 

American Ophthalmological Society: President, 1985-; Vice-President, 
1984-85; Member of Council, 1975-; Member 1958-. 

Argentine Ophthalmological Society, Honorary Member, 1968. 
Arizona Ophthalmological Society, Honorary Member, 1974. 

Association for Research in Vision and Ophthalmology (formerly 
Association for Research in Ophthalmology, Inc.): Chairman of Trustees, 
1968-; Trustee, 1963-68. 

Association of University Professors of Ophthalmology: Founding Member, 
First President, Chairman, 1965-66; Trustee, 1965-69. 

Asia-Pacific Academy of Ophthalmology, Member Advisory Committee, 
1976-. 

California Academy of Sciences and Medicine, Member, 1949-55. 

California Bureau of Vocational Rehabilitation, Member Medical Advisory 
Board, 1949-55. 

California Department of Public Health, Member Advisory Committee of 
Ophthalmologists, 1949-55. 

California Department of Social Welfare, Member Advisory Committee of 
Ophthalmologists, 1950-55. 

California Medical Association, 1948-55. 

Canadian Implant Association, Member, 1984. 

The Castroviejo Society, Member of the Castroviejo Cornea! Society, 1982. 



229 

Fundaci6n Oflalmologia Argentina Jorge Malbran, Member (Comisi6n 
Asesora en lo Cientifico), 1979. 

Hellenic Ophthalmologies! Society, Honorary Member, 1969; Advisory 

Committee of Ophthalmologists, 1949-55. 

Institute for Sensory and Brain Research, Member, Advisory Board, 1970-. 
Institute de Cientias de la Visi6n del Comite National Prociegos y 

Sordomudos, Honorary Director, 1982. 

International Agency for Prevention of Blindness (formerly International 
Association for Prevention of Blindness): Acting President, 1968-70; 
First Vice-President, 1966-68; Vice-President, 1970-74; Honorary 
Consultant to Annals, 1979-; Member, at large, 1974-. 

International Council of Ophthalmology (Concilium Ophthalmologicum 
Universale): Honorary Life President, 1990; President, 1982-90; 
Vice-President, 1977; Ex-Officio Member, Gonin Commission 1983; 
Member, International Study Committee on Teaching and Continuing 
Education in Ophthalmology, 1974. 

International Eye Bank, Member, Advisory Board, 1965- 
International Eye Foundation, Member, 1961-. 

International Glaucoma Committee (formerly International Glaucoma 
Club), Honorary Member. 

International Glaucoma Congress, Charter Member. 

International Ophthalmic Microsurgery Study Group, Member Emeritus, 
1979-. 

Japanese Ophthalmological Society, Honorary Member, 1978. 

John F. Kennedy Institute, Member Consultant Medical Staff, 1973-74. 

Jules Gonin Club, Honorary Member, 1982. 

Knights Templar Eye Foundation, Ophthalmologist-Advisor, 1956. 

Louisiana-Mississippi Ophthalmological and Otolaryngological Society, 
Honorary Member, 1965. 

Maryland Ophthalmological Society, Member. 

Medical and Chirurgical Faculty of the State of Maryland, Member. 

Mentor O & O, Inc.: Chairman, Scientific & Technical Advisory 

Committee, 1985-; Member, Board of Directors, 1985-. 
National Academy of Sciences, Member, Advisory Committee 

(Ophthalmology), 1955-58. 
National Council to Combat Blindness, Member, Scientific Committee, 

1950-. 
National Eye Institute, Member, National Advisory Eye Council, 1969-71; 

1975-. 



230 

National Institute of Neurological Diseases and Stroke, U.S. Public Health 
Service. Consultant, National Institute of Health Graduate Training 
Committee, 1953-55. 

National Institutes of Health: Member, Vision Research Training 
Committee, 1964-67; N.I.H. National Advisory Eye Council, Chairman, 
Planning Subcommittee, 1977. 

National Society for the Prevention of Blindness: Chairman, Advisory 
Committee on International Relations; Member, Board of Directors; 
Voting Member, 1978-79; Member, Advisory Committee, 1955-86. 

National Society for the Prevention of Blindness: California Chapter, 
Member, Professional Advisory Committee, 1948-55. 

Neurological Diseases and Blindness, Member, Advisory Council, 
Subcommittee on Impaired Vision and Blindness, 1967-69. 

New York Eye and Ear Infirmary, Member, Advisory Committee, 1956-58. 

Ophthalmic Drugs Council, Chairman, Advisory Committee, 1970-73, U.S. 
Public Health Service, Food and Drug Administration. 

Ophthalmic Foundation, Member, Advisory Committee, 1956-62. 

Ophthalmic Pathology Club (Verhoeff Society) Member. 

Ophthalmic Publishing Company: Vice-President, 1973-; Trustee, 1967-; 

Member, Board of Directors, 1968-. 
Order of St. John, Associate Officer, 1972. 

Pacific Coast Oto-Ophthalmological Society, Honorary Member, 1958; 
Round Table, 1948-55. 

Pan-American Association of Ophthalmology, President, 197275. 

Pan-American Ophthalmological Foundation; Chairman, Board of 
Directors, 1974-; Vice-President, 1966-67; Member, Board of Directors, 
1967-. 

Phi Beta Kappa, Member, by action of the Alpha of Maryland at Johns 
Hopkins University, 1971. 

Puget Sound Academy of Ophthalmology and Otolaryngology, University 
of Tacoma, Washington, Honorary Fellow, 1952. 

Research to Prevent Blindness, Member, Scientific Advisory Panel, 1962. 
The Royal Australian College of Ophthalmologists, Honorary Fellow, 1988. 
San Francisco County Medical Society, Member, 1948-55. 
The Seeing Eye, Inc., Member, Advisory Committee, 1967-70. 

The Alfred P. Sloan Foundation, Member, Advisory Council for Research in 

Glaucoma and Allied Diseases, 1956-68. 
Societa Oftalmologica Internazionale del Mediterraneo, honorary president 

to the first meeting of the society, Palermo, Italy, 1989. 
Societe Francaise d'Ophtalmologie, Member. 



231 



Society of Eye Surgeons, Member, Advisory Board, 1970-. 
South African Ophthalmological Society, Member, 1972. 

Spectra Pharmaceutical Services, Inc., Chairman of the Board, Chief 
Executive Officer, and Director, 1985. 

University of Illinois Alumni Association, Life Member, 1974. 

Variety Club Blind Babies Foundation, Chairman, Advisory Committee, 
1949-55. 

Wilmer Residents Association, Wilmer Ophthalmological Institute, Johns 
Hopkins Hospital, Member, 1939. 

World Health Organization, Member, Programme Advisory Group for the 

Prevention of Blindness in the WHO Program, 1978-. 
World Health Organization, Member, WHO Expert Advisory Panel on 

Trachoma and Prevention of Blindness, 1979-84, 1984-87. 
World Health Organization, Member, WHO Scientific Advisory Panel, 

Onchocerciasis Control Program, 1974-; Consultant, Onchocerciasis 

Project, 1974-. 

World Health Organization, Member, WHO Study Group on the 
Prevention of Blindness in the WHO Technical Report Series No. 518, 
Geneva, Nov. 6-10, 1972. 

Name Lectures: Published 

Reprint No. 



94. Maumenee AE. Jules Stein Lecture: Further advances in the study of the 
macula. Arch Ophthalmol 1967; 78:151-65. 

99. Maumenee AE. Doyne Memorial Lecture: Fluorescein angiography in the 
diagnosis and treatment of lesions of the ocular fundus. Trans 
Ophthalmol Soc UK 1968; 88:529-56. 

114. Maumenee AE. The 26th Edward Jackson Memorial Lecture: Clinical 
entities in "uveitis": An approach to the study of intraocular 
inflammation. Am J Ophthalmol 1970; 69:1-27; also in: Trans Am Acad 
Ophthalmol Otolaryngol 1970; 74:473-504. 

129. Maumenee AE. The Horacio Ferrer Lecture: Fluorescein in the diagnosis 
and treatment of macular lesions. Mod Probl Ophthalmol 1971; 
9:188-207. 

185. Maumenee AE. The Pocklington Lecture: Recent advances in cornea! 
transplantation. Trans Ophthalmol Soc UK 1976; 96:462-70. 

272. Maumenee AE. The Robert N. Shaffer Lecture: Causes of optic nerve 
damage in glaucoma. Ophthalmology 1983; 90:741-52. 



232 

Name Lectures: Unpublished 



The Charles H. May Memorial Lecture, 1957. 

The XXII de Schweinitz Memorial Lecture, 1959. 

The Wright Memorial Lecture, 1962. 

The Albert C. Snell Memorial Lecture, 1965. 

The Sanford R. Gilford Memorial Lecture, 1965. 

The Arthur J. Bedell Lecture, 1966. 

The E. B. Dunphy Lecture, 1966. 

The XXII Annual Austin M. Curtis Memorial Lecture, 1967. 

The Gradle Lecture: Complications of Cataract Surgery. Presented 
by A. E. Maumenee during the VIII Pan-American Congress of 
Ophthalmology in Mar del Plata, Argentina, March 1968. Unpublished 
by the author, but reported by: Boyd BF, ed. Complications of cataract 
surgery. Highlights Ophthalmol 11:120-32, 1969. 

The Francis I. Proctor Lecture, University of California, San Francisco, 
1969. 

The John McLean Memorial Lecture, 1971. 

The Jules Stein Lecture, 1972. 

The Proctor Lecture, Association for Research in Vision and 
Ophthalmology, 1972. 

The First Annual Claude W. Wood Lecture, 1972. 

The Cecil O'Brien Lecture, Tulane University, 1973. 

The Everett L. Goar Lecture, Houston, 1973. 

The Jorge Malbran Lecture, Buenos Aires, 1974. 

The Ralph Lloyd Lecture, State University of New York, Downstate 

Medical Center, 1975. 
The John McLean Memorial Lecture. Second World Congress on the 

Cornea, The International Eye Foundation, Washington, D.C., 1976. 

The Seymour R. Roberts Memorial Lecture, 1976. 

The First Jack S. Guyton Lecture. Henry Ford Hospital, Detroit, June 24, 

1977. 
The Sir Benjamin Rycroft Lecture: Corneal graft rejection. Queen Victoria 

Hospital, Sussex, England, June 29, 1977. 

The First Asbury Lecture: Pathogenesis of glaucoma field defects late in 
the afternoon. University of Cincinnati Medical Center, November 29, 
1977. 

The Mark Schoenberg Memorial Lecture: Visual field loss in glaucoma. 
New York Society for Clinical Ophthalmology, December 5, 1977. 



233 

The Dean's Lecture: The eye as a test-tube for the study of biological 
phenomena. The Johns Hopkins University School of Medicine. Lecture 
series no. Ill, February 6, 1978. 

The Estelle Doheny Lecture: Vasculature of optic disc and its importance 
in visual field loss in glaucoma. Estelle Doheny Eye Foundation. Los 
Angeles, February 24, 1977. 

The First Claude L. Cowan Memorial Lecture: The pathogenesis of visual 
field loss and glaucoma. University of Maryland School of Medicine, 
Department of Ophthalmology, Baltimore, July 30, 1978. 

The Krieger Memorial Lecture: Future trends of ophthalmology, Sinai 
Hospital of Baltimore, Division of Ophthalmology, April 24, 1979. 

The Castroviejo Lecture. Given at the Annual Meeting of the Castroviejo 
Society. American Academy of Ophthalmology Meeting, Chicago, 
November 7, 1980. 

The First Jules Fra^ois Lecture. Given at San Vincent's Hospital and 
Medical Center of New York, October 18, 1980. 

The First Annual Harvey E. Thorpe Lecture. Pittsburgh Ophthalmology 
Society, March 27, 1981. 

The Gonin Lecture: Visual field loss in glaucoma. University de Lausanne, 
March 13, 1982. 

The John Milton McLean Memorial Lecture: Current status of penetrating 
keratoplasty. Cornell University Medical College, Department of 
Ophthalmology, June 11, 1982. 

The Eleventh Annual Bruce Fralick Lecture. The University of Michigan, 
The W. K KeUogg Eye Center, April 25, 1983. 

The Edmund B. Spaeth Lecture. The Edmund B. Spaeth Clinical Research 
Foundation. The Union League of Philadelphia, March 21, 1983. 

The Fourth Annual Tullos O. Coston Lecture. Dean A. McGee Eye 
Institute, University of Oklahoma, Oklahoma City, April 9, 1983. 

The First Lester Quinn Lecture. The University of Texas, Dallas, 1985. 

The First Bennedetto StrampelH Lecture. The International 
Mediterranean Ophthalmological Society Meeting, Rome, Italy, April 
1988. 

The Dr. P. Siva Reddy International Gold Medal Oration. Hyderabad 
Academy of Ophthalmology, India, August 4, 1989. 

Addresses 

Chairman's Address, A.M.A. Section of Ophthalmology, 115th Annual 

Convention, Chicago, June 1966. 
Centennial Address, University of Sydney, April 1982. 



234 

Commencement Address, University of Alabama at Birmingham, June 6, 
1982. 

Presidential Welcoming Address, 24th International Congress of 
Ophthalmology, San Francisco, October 31-November 5, 1982. 

Opening Address, Third International Congress on Cataract Surgery and 
Visual Rehabilitation, Florence, Italy, May 9-12, 1984. 

Keynote Address: The tear film and its pathology. Eighth Annual 
Program, Current Concepts in Ophthalmology, San Diego Eye Bank, 
June 25, 1988. 

Editorial Positions 

American Journal of Ophthalmology: President, Board of Directors, 
1975-39; Member, Editorial Staff, 1955-89; Consulting Editor, 1989-. 

A.M.A. Archives of Ophthalmology: Associate Editor, 1952-53. 
Audio Digest Ophthalmology: Member, Editorial Board, 1980. 
Contemporary Ophthalmology: Member, Editorial Board, 1980. 
EYESAT: Member, Editorial Board, 1981-. 
Highlights of Ophthalmology: Associate Editor, 1954-65. 
Investigative Ophthalmology: Member, Editorial Board, 1964-68. 

Pakistan Journal of Ophthalmology: Member, Editorial Advisory Board, 
1984-. 

Transplantation Bulletin: Corresponding Editor, 1953-57. 



235 



BIBLIOGRAPHY (Provided by Dr. Maumenee) 

1. Maumenee AE. Retinal lesions in lupus eyrthematosus. Am J Ophthalmol 
23:971-81, 1940. 

2. Maumenee AE, Hellman LM, Shettles LB. Factors influencing plasma prothrombin 
in the newborn infant. IV. The effect of antenatal administration of vitamin K on the 
incidence of retinal hemorrhage in the newborn. Bull Johns Hopkins Hasp 68:158-68 
1941. 

3. Maumenee AE, Hayes GS, Hartman TL. Isolation and identification of the causative 
agent in epidemic keratoconjunctivitis (superficial punctate keratitis) and herpetic 
keratoconjunctivitis. Am J Ophthalmol 28:823-39, 1945. 

4. Downs CM, Coriell LL, Pinchot GB, Maumenee AE, Klauber A, Chapman SS, Owen 
B. Studies on tularemia. I. The comparative susceptibility of various laboratory 
animals. J Immunol 56:217-28, 1947. 

5. Maumenee AE, Scholz RO. III. The histopathology of the ocular lesions produced by 
the sulfur and nitrogen mustards. Bull Johns Hopkins Hosp 82:121-47, 1948. 

6. Maumenee AE, Kornblueth W. Regeneration of the cornea! stromal cells. I. 
Technique for destruction of cornea! corpuscle by application of solidified (frozen) 
carbon dioxide. Am J Ophthalmol 31:699-702, 1948. 

7. Maumenee AE, Kornblueth W. Symposium: Cornea! transplantation. IV. 
Physiopathology. Trans Am Acad Ophthalmol Otolaryngol 52:331-40, 1948; also in 
Am J Ophthalmol 31:1384-93, 1949. 

8. Kornblueth W, Maumenee AE, CrowellJE. Regeneration of nerves in experimental 
cornea! grafts in rabbits. Clinical and histologic study. Am J Ophthalmol 32:651-59, 
1949. 

9. Maumenee AE, Kornblueth W. Regeneration of the cornea! stromal cells. II. Review 
of literature and histologic study. Am J Ophthalmol 32:1051-64, 1949. 

10. Maumenee AE. Retrobulbar alcohol injections. Relief of ocular pain in eyes with and 
without vision. Am J Ophthalmol 32:1502-08, 1949. 

11. Maumenee AE. The influence of donor-recipient sensitization on cornea! grafts. Am J 
Ophthalmol 34:142-52, 1951. 

12. Winter FC, Maumenee AE. An unusual pigmented tumor of the iris. Arch 
Ophthalmol 46:438-40, 1951. 

13. Maumenee AE, Michler RC. Sterility of the operative field after ocular surgery. 
Trans Pacific Coast Oto-Ophthalmol Soc 32:172-79, 1951. 

14. Friedenwald JS, Maumenee AE. Peculiar macular lesions with unaccountably good 
vision. Arch Ophthalmol 45:567-70, 1951. 

15. Miiller H, Maumenee AE. Consideration sur la maladie du greffon. Arch Ophthalmol 
(Paris) 11:146-54, 1951. 



236 

16. Muller H, Maumenee AE. Eintriibung klarer Hornhauttransplantate durch 
individualspezifische Sensibilisierung des Empfangers. Graefes Arch Ophthalmol 
152:1-15, 1951. 

17. Maumenee AE. Diseases of the retina. Arch Ophthalmol 45:572-604, 1951. 

18. Muller H, Maumenee AE. Tierexperimentelle Transplantation von Sklera in die 
Hornhaut. Graefes Arch Ophthalmol 152:521-26, 1952. 

19. Priedenwald JS, Wilder HC, Maumenee AE, et al. Ophthalmic Pathology. An Atlas 
and Textbook. Published under joint sponsorship of the American Academy of 
Ophthalmology and Otolaryngology and the Armed Forces Institute of Pathology. 
Philadelphia: Saunders, 1952. 

20. Wiener M. Maumenee AE, Ireland PE, Sullivan JA, eds. Progress in Ophthalmology 
and Otolaryngology. A Quadrennial Review. Vol 1. New York: Grune & Stratton, 1952. 

21. Maumenee AE. Diseases of the retina. Arch Ophthalmol 47:643-90, 1952. 

22. Bock RH, Maumenee AE. Corneal fluid metabolism. Experiments and observations. 
Arch Ophthalmol 50:282-85, 1953. 

23. Maumenee AE. Diseases of the retina. Arch Ophthalmol 49:553-86, 675-710, 1953. 

24. Maumenee AE. Cornea. Transplantation Bull 1:7, 1953. 

25. Maumenee AE. Bibliography on comeal transplantation. Transplantation Bull 
1:107-22, 1954. 

26. Maumenee AE. The immune concept: its relation to corneal homotransplantation. 
Ann NYAcad Sci 59:453-61, 1955. 

27. Maumenee AE. Bibliography on corneal transplantation. Transplantation Bull 2:73, 
1955. 

28. Maumenee AE. The biological problem. In: Rycroft BW. Corneal Grafts. London: 
Butterworth; 208-15; 1955. 

29. Tamler E, Maumenee AE. Lens extraction in the treatment of glaucoma. Arch 
Ophthalmol 54:816-30, 1955. 

30. Maumenee AE, Shannon CR. Epithelial invasion of the anterior chamber. Am J 
Ophthalmol 41:929-^2, 1956; also in Trans Pacific Coast Oto-Ophthalmol Soc 
36:107-35, 1956. 

31. Maumenee AE. Jonas Stein Priedenwald. Diabetes 58:155-56, 1956. 

32. Maumenee AE. Keratitis secondary to keratinization of the tarsal conjunctiva. Am J 
Ophthalmol 41:477-87, 1956. 

33. Maumenee AE. Ocular lesions of nevoxanthoendothelioma (Infantile Xanthoma 
disseminatum). Trans Am Acad Ophthalmol Otolaryngol 60:401-405, 1956. 

34. Maumenee AE. Ocular manifestations of collagen diseases. Arch Ophthalmol 
56:557-62, 1956. 

35. Maumenee AE. Symposium: Postoperative cataract complications. III. Epithelial 
invasion of the anterior chamber, retinal detachment, corneal edema, anterior 
chamber hemorrhages, changes in the macula. Trans Am Acad Ophthalmol 
Otolaryngol 61:51-68, 1957. 

36. Maumenee AE, Davis L. Bibliography of corneal transplantation and lens 
transplantation. Transplantation Bull 4:115-27, 1957. 



237 



37. Germuth FG, Maumenee AE, Pratt-Johnson J, Senterfit LB, van Arnam CE, Pollack 
AD. Observations on the site and mechanisms of antigen-antibody interaction in 
anaphylactic hypersensitivity. Am J Ophthalmol 46:282-86, 1958. 

38. Maumenee AE. The pathogenesis of congenital glaucoma: A new theory. (AOS 
Thesis.) Trans Am Ophthalmol Soc 56:507-70, 1958; also in Am J Ophthalmol 
47:827-58, 1959. 

39. Maumenee AE, ed. Uveitis. Symposium (First on Uveitis) by the Council for 
Research in Glaucoma and Allied Diseases, May 18-20, 1958. Sponsored by the 
Alfred P. Sloan Foundation, Inc. Surv Ophthalmol 4:211-423, 1959. 

40. Duke JR, Maumenee AE. An unusual tumor of the retinal pigment epithelium in an 
eye with early open-angle glaucoma. Am J Ophthalmol 47:311-17, 1959. 

41. Maumenee AE, Davis L. Bibliography of comeal and lens transplantation, and 
vitreous replacement. Transplantation Bull 6:120-26, 1959. 

42. Maumenee AE. Penetrating autokeratoplasty of entire cornea. Am J Ophthalmol 
47:125-33, 1959. 

43. Tamler E, Maumenee AE. A clinical study of choroidal nevi. Arch Ophthalmol 
62:196-202, 1959. 

44. Maumenee AE. Serous and hemorrhagic disciform detachment of the macula. Trans 
Pacific Coast Oto-Ophthalmol Soc 40:139-60, 1959. 

45. Maumenee AE. Classification of glaucoma. In: Clark WB, ed. Symposium on 
Glaucoma. St. Louis: Mosby; 98-107; 1959. 

46. Maumenee AE. What is good medical control? In: Clark WB, ed. Symposium on 
Glaucoma. St. Louis: Mosby; 142-54; 1959. 

47. Maumenee AE. Surgery for congenital glaucoma. In: Clark WB, ed. Symposium on 
Glaucoma. St. Louis: Mosby; 206-26; 1959. 

48. Maumenee AE, Longfellow DW. Treatment of intraocular endothelioma ( Juvenile 
xanthogranuloma). Am J Ophthalmol 49:1-7 , 1960. 

49. Davis L, Maumenee AE. Bibliography of comeal transplantation, lens 
transplantation and vitreous replacement. Transplantation Bull 7:43034, 1960. 

50. MacLean AL, Maumenee AE. Hemangioma of the choroid. Am J Ophthalmol 
50:3-11, 1960; also in Trans Am Ophthalmol Soc 57:171-94, 1959. (Note: First time 
fluorescein angiography was ever described.) 

51. Maumenee AE. Effect of Alpha-chymotrypsin on the retina. Trans Am Acad 
Ophthalmol Otolaryngol 64:33-36, 1960. 

52. Boyd BF, Maumenee AE, McLean JM. Advances in cataract surgery. Highlights 
Ophthalmol 3:239-77, 1960. 

53. Maumenee AE. Symposium. Corneal Surgery. II. Biological responses to cornea! 
homografts. Trans Am Acad Ophthalmol Otolaryngol 64:765-74, 1960. 

54. Welch RB, Maumenee AE, Wahlen HE. Peripheral posterior segment inflammation, 
vitreous opacities, and edema of the posterior pole. (Pars planitis.) Arch Ophthalmol 
64:540-49, 1960. 

55. Maumenee AE. Congenital hereditary cornea! dystrophy. Am J Ophthalmol 
50:1114-24, 1960. 

56. Maumenee AE. External filtering operations for glaucoma: The mechanism of 
function and failure. Trans Am Ophthalmol Soc 58:319-28, 1960. 



238 

57. Maumence AE. The immune reaction to cornea! homografts. In: Duke-Elder WS, 
Perkins ES, eds. The Transparency of the Cornea. A symposium organized by the 
Council for International Organizations of Medical Sciences. Springfield, HI.: CC 
Thomas; 193-207; 1960. 

58. Maumenee AE, ed. Toxoplasmosis. Symposium (Second on Uveitis) by the Council 
for Research in Glaucoma and Allied Diseases (November 20-22, 1960). Sponsored by 
the Alfred P. Sloan Foundation, Inc. Surv Ophthalmol 6 (6/Pt 2), 1961. 

59. Chandler PA, Maumenee AE. A major cause of hypotony. Trans Am Acad 
Ophthalmol Otolaryngol 65:563-75, 1961; also in Am J Ophthalmol 52:609-18, 1961. 

60. Parks JJ, Leibowitz HM, Maumenee AE. The effect of route of inoculation upon 
development of antibody in rabbits. J Immunol 87:199-204, 1961. 

61. Zimmerman LE, Maumenee AE. Ocular aspects of sarcoidosis. Am RevRespirDis 84 
(5 Supl): 38-44, 1961. 

62. Maumenee AE. Clinical aspects of the corneal homograft reaction. Invest 
Ophthalmol 1:244-52, 1962. 

63. Maumenee AE. Further observations on the pathogenesis of congenital glaucoma. 
Trans Am Ophthalmol Soc 60:140-62, 1962; also in Am J Ophthalmol 55:1163-76, 
1968. 

64. Maumenee AE. New Research Building at the Wilmer Institute. Editorial. Am J 
Ophthalmol 53:389-91, 1962. 

65. Davis L, Maumenee AE. Bibliography of corneal transplantation, lens 
transplantation, vitreous replacement. Transplantation Bull 29:11016, 1962. 

66. Parks JJ, Leibowitz HM, Maumenee AE. A transient stage of suspected delayed 
sensitivity during the early induction phase of immediate corneal sensitivity. JExp 
Med 115:867-80, 1962. 

67. Germuth FG Jr, Maumenee AE, Senterfit LB, Pollack AD. Immunohistologic studies 
on antigen-antibody reactions in the avascular cornea. I. Reactions in rabbits actively 
sensitized to foreign protein. JExp Med 115:919-28, 1962. 

68. Leibowitz HM, Parks JJ, Maumenee AE. Manifestations of localized hypersensitivity 
in a previously sensitized tissue. Arch Ophthalmol 68:66-71, 1962. 

69. Parks JJ, Leibowitz HM, Maumenee AE. Immediate hypersensitivity reactions in the 
cornea of the guinea pig. J Immunol 89:323-25, 1962. 

70. Eisenlohr JE, Langham ME, Maumenee AE. Manometric studies of the 
pressure-volume relationship in living and enucleated eyes of individual human 
subjects. Br J Ophthalmol 46:536-48, 1962. 

71. Patz A, Maumenee AE. Studies on diabetic retinopathy: I. Retinopathy in a dog with 
spontaneous diabetes mellitus. Am J Ophthalmol 54:53241, 1962. 

72. Maumenee AE. Histopathology of corneal degenerations and dystrophies. In: Pandit 
YKC, ed. XIX Concilium Ophthalmologicum. Scientific papers and reports read at 
the XDC International Congress of Ophthalmology held at Delhi, India, December 2-7, 
1962. Bombay: YKC Pandit; 1:509-22; 1962. 

73. Davis L, Maumenee AE. Bibliography of comeal transplantation and plastic corneal 
discs, lens implantation, and vitreous replacement. Transplantation 1:406-13, 1963. 

74. Maumenee AE. Obituary. Alan Churchill Woods, M.D., 1889-1963. Am J 
Ophthalmol 55:842-45, 1963; also in Arch Ophthalmol 69:534-37, 1963. 



239 

75. Maumenee AE, Silverstein AM, eds. Immunopat hology ofUveitis. A symposium 
sponsored by the Council for Research in Glaucoma and Allied Diseases. Alfred P. 
Sloan Foundation, Inc., September 3-5, 1963. Baltimore: Williams & Wilkins, 1964. 

76. Langham ME, Maumenee AE. The diagnosis and treatment of glaucoma based on a 
new procedure for the measurement of intraocular dynamics. Trans Am Acad 
Ophthalmol Otolaryngol 68:277-300, 1964. 

77. Maumenee AE. Repair in the cornea. In: Montagna W, Billingham RE, eds. 
Advances in Biology of Skin. Vol 5: Wound Healing. New York: Macmillan, 1964. 

78. Van Metre TE Jr, Maumenee AE. Specific ocular uveal lesions in patients with 
evidence of histoplasmosis. Arch Ophthalmol 71:314-24, 1964. 

79. Maumenee AE. Treatment of epithelial downgrowth and intraocular fistula following 
cataract extraction. Trans Am Ophthalmol Soc 62:153-66, 1964. 

80. Maumenee AE. The contributions of immunology to clinical ophthalmology. Am J 
Ophthalmol 58:230-38, 1964. 

81. Van Metre TE Jr, Knox DL, Maumenee AE. The relation between toxoplasmosis and 
focal exudative retinochoroiditis. Am J Ophthalmol 58:6-21, 1964; also in Trans Am 
Acad Ophthalmol Otolaryngol 68:810-29, 1964. 

82. Davis L, Maumenee AE. Bibliography of corneal transplantation and plastic cornea! 
discs; lens implantation and vitreous replacement. Transplantation 3:262-69, 1965. 

83. Van Metre TE Jr., Brown WH, Knox DL, Maumenee AE. The relation between 
nongranulamatous uveitis and arthritis. J Allergy 36:158-74, 1965. 

84. Maumenee AE. The histopathology of corneal grafts. In: King JHJr, McTigueJW, 
eds. The Cornea World Congress. First World Congress on the Cornea, Washington, 
D.C., October 1964. Washington: Butterworths, 1965. 

85. Van Metre TE Jr, Knox DL, Maumenee AE. Specific ocular uveal lesions in patients 
with evidence of histoplasmosis and toxoplasmosis. Southern Med J 58:479-86, 1965. 

86. Maumenee AE, panelist. Blindness and the perspective of ophthalmic research. In: 
Duane TD. Ophthalmic Research: U.S-A. A Comprehensive National Survey of Eye 
Research, A National Survey Report initiated and sponsored by Research to Prevent 
Blindness, Inc. New York: Research to Prevent Blindness, Inc., 1965. 

87. Patz A, Berkow JW, Maumenee AE, Cox J. Studies on diabetic retinopathy. II. 
Retinopathy and nephropathy in spontaneous canine diabetes. Diabetes 14:700-708, 
1965. 

88. Berkow JW, Shugarman RG, Maumenee AE, Patz A. A retrospective study of blind 
diabetic patients. J Am MedAssoc 193:867-70, 1965. 

89. McKusick VA, Kaplan D, Wise D, Hanley WB, Suddarth SB, Sevick ME, Maumenee 
AE. The genetic mucopolysaccharidoses. Medicine 44:44583, 1965. 

90. Maumenee AE. Endogenous uveitis. In: Samter M, ed. Immunological Diseases. 
Boston: Little, Brown and Company; 811-20; 1965. 

91. Maumenee AE. Clinical manifestations (macular diseases). Symposium: Macular 
Diseases. Sixty-Ninth Annual Session of the American Academy of Ophthalmology 
and Otolaryngology, Chicago, October 18-23, 1964. Trans Am Acad Ophthalmol 
Otolaryngol 69:605-13, 1965. 



240 

92. Maumenee AE. Pathogenesis (macular diseases). Symposium: Macular Diseases. 
Sixty-Ninth Annual Session of the American Academy of Ophthalmology and 
Otolaryngology, Chicago, October 18-23, 1964. Trans Am Acad Ophthalmol 
Otolaryngol 69:691-99, 1965. 

93. Maumenee AE, Goldberg MF. Push-pull cataract aspiration and Franceschetti 
corepraxy. Arch Ophthalmol 74:72-73, 1965. 

94. Goldberg MF, Maumenee AE, McKusick VA. Corneal dystrophies associated with 
abnormalities of mucopolysaccharide metabolism. Arch Ophthalmol 74:516-20, 1965. 

95. Maumenee AE. Serous and hemorrhagic chorioretinopathy. Clinical description, 
pathology and management. In: Kimura SJ, Caygill WM, eds. Retinal Diseases. 
Symposium on differential diagnostic problems of posterior uveitis, University of 
California, San Francisco, 1965. Philadelphia: Lea & Febiger; 244-56; 1966. 

96. Maumenee AE. Toxoplasmosis. Clinical description and course. In: Kimura SJ, 
Caygill WM, eds. Retinal Diseases. Philadelphia: Lea & Febiger; 281-82; 1966. 

97. Maumenee AE. Histoplasmosis. Clinical course and description. In: Kimura SJ, 
Caygill WM, eds. Retinal Diseases. Philadelphia: Lea & Febiger: 315-16; 1966. 

98. Maumenee AE. Malignant melanoma. General description and pathology. In: 
Kimura SJ, Caygill WM, eds. Retinal Diseases. Philadelphia: Lea & Febiger; 360-61; 
1966. 

99. Maumenee AE. Hemangiomaof thechoroid. Clinical description and course. In: 
Kimura SJ, Caygill WM, eds. Retinal Diseases. Philadelphia: Lea & Febiger; 1966; 
382-83. 

100. Von Noorden GK, Maumenee AE. Atlas of Strabismus. St. Louis: Mosby, 1967. 

101. Maumenee AE. The history of the Wilmer Ophthalmological Institute. Am J 
Ophthalmol 60:770-88, 1965. 

102. Burch PG, Maumenee AE. Iridocyclectomy for benign tumors of the ciliary body. Am 
J Ophthalmol 63:447-52, 1967. 

103. Maumenee AE. The educational and political structure of ophthalmology in America. 
Chairman's address read before the Section on Ophthalmology at the 115th Annual 
Convention of the American Medical Association, Chicago, June 26-30, 1966. Arch 
Ophthalmoin:295-304, 1967. 

104. Maumenee AE. Further advances in the study of the macula. Inaugural Scientific 
Program of the Jules Stein Eye Institute. Arch Ophthalmol 78:151-65, 1967. 

105. Von Noorden GK, Maumenee AE. Clinical observations of stimulus-deprivation 
amblyopia (amblyopia ex anopsia). Trans Am Ophthalmol Soc 65:244-55, 1967; also 
in Am J Ophthalmol 65:220-24, 1968. 

106. Maumenee AE. Editorial on eye pathology banks. Am J Ophthalmol 65:628-29, 1968. 

107. Maumenee AE. An approach in the study of uveitis. In: Aronson SB, et al, eds. 
Clinical Methods of Uveitis. Fourth Sloan Symposium on Uveitis, Baltimore, 1967. 
St. Louis: Mosby; 21-40; 1968. 

108. Maumenee AE. Obituaries. John Milton McLean. Am J Ophthalmol 66:130-32, 
1968. 

109. Maumenee AE. Fluorescein angiography in the diagnosis and treatment of lesions of 
the ocular fundus. (Doyne Memorial Lecture.) Trans Ophthalmol Soc UK 88:529-56, 
1968. 



241 

110. Kenyon KR, Maumenee AE. The historical and ultrastructural pathology congenital 
hereditary corneal dystrophy: A case report. Invest Ophtkalmol 7:475-500, 1968. 

111. Maumenee AE. Ophthalmology Residency Appointments. Am J Ophthalmol 
66:1181-82, 1968. 

112. Maumenee AE. Foreword. In: Welsh RC, Welsh J, eds. The New Report on Cataract 
Surgery. Proceedings of the First Biennial Cataract Surgical Congress. Miami Beach, 
Fla: Miami Educational Press, 1969. 

113. Maumenee AE. Vitreous surgery for macular edema. In: Welsh RC, Welsh J, eds. 
The New Report on Cataract Surgery. Miami Beach, Fla: Miami Educational Press- 
89-90; 1969. 

114. Maumenee AE. Persistent post-cataract hypotony. In: Welsh RC, Welsh J, eds. The 
New Report on Cataract Surgery. Miami Beach, Fla: Miami Educational Press- 
160-61; 1969. 

115. Maumenee AE. Management of epithelial downgrowths. In: Welsh RC, Welsh J, eds. 
The New Report on Cataract Surgery. Miami Beach, Fla: Miami Educational Press- 
175-77; 1969. 

116. Maumenee AE. Cryoextraction. In: Welsh RC, Welsh J, eds. The New Report on 
Cataract Surgery. Miami Beach, Fla: Miami Educational Press; 228-30; 1969. 

117. Maumenee AE. Combined glaucoma and cataract operation. In: Welsh RC, Welsh J, 
eds. The New Report on Cataract Surgery. Miami Beach, Fla: Miami Educational 
Press; 293-95; 1969. 

118. Maumenee AE. The mechanism of filtering blebs for glaucoma why they fail after 
cataract surgery. In: Welsh RC, Welsh J, eds. The New Report on Cataract Surgery. 
Miami Beach, Fla: Miami Educational Press; 326-28; 1969. 

119. Maumenee AE. Aspiration techniques for congenital cataracts. In: Welsh Re, Welsh 
J, eds. The New Report on Cataract Surgery. Miami Beach, Fla: Miami Educational 
Press; 1969; 419-23. 

120. Maumenee AE, Ryan SJ Jr. Aspiration technique in the management of the 
dislocated lens. Am J Ophthalmol 68:808-11, 1969. 

121. Maumenee AE. Cataract extraction with the cryoprobe. Trans Am Acad Ophthalmol 
Otolaryngol 73:1044-46, 1969. 

122. Maumenee AE, Wilkinson CP. A combined operation for glaucoma and cataract. 
Trans Am Ophthalmol Soc 1969; also in Am J Ophthalmol 69:360-67, 1970. 

123. Hyvarinen L, Maumenee AE, George T, Weinstein GW. Fluorescein angiography of 
the choriocapillaris. Am J Ophthalmol 67:653-66, 1969. 

124. Clinical entities in TJveitis.' An approach to the study of intraocular inflammation. 
(The 26th Edward Jackson Memorial Lecture.) Am J Ophthalmol 69:1-27, 1969; also 
in Trans Am Acad Ophthalmol Otolaryngol 74:473-504, 1970. 

125. Von Noorden GK, Ryan SJ Jr, Maumenee AE. Management of congenital cataracts. 
Trans Am Acad Ophthalmol Otolaryngol 74:352-59, 1970. 

126. Maumenee AE, Paton D, Morse PH, Butner R. Review of 40 histologically proven 
cases of epithelial downgrowth following cataract extraction and suggested surgical 
management. Am J Ophthalmol 69:598-603, 1970. 

127. Maumenee AE. Medical therapy of corneal disease. Int Ophthalmol Clin 10:187-96, 
1970. 



242 

128. MaumeneeAE. On the presentation of the Friedenwald Award in Ophthalmology to 
Dr. John E. Bowling. Invest Ophthalmol 9:650-52, 1970. 

129. Randolph ME, Maumenee AE, Diff CE. Cataract extraction in glaucomatous eyes. 
Am J Ophthalmol 71:328-30, 1971. 

130. Maumenee AE, Stark WJ. Management of persistent hypotony after planned or 
inadvertent cyclodialysis. Am J Ophthalmol 71:320-27, 1971. 

131. Hyvarinen L, Maumenee AE, Kelley J, Cantolino S. Fluorescein angiographic 
findings in retinitis pigmentosa. Am J Ophthalmol 71:17-26, 1971. 

132. Cross HE, Maumenee AE, Cantolino SJ. Inheritance of Fuchs' endothelial dystrophy. 
Arch Ophthalmol 85:268-72, 1971. 

133. MaumeneeAE. An introduction to cornea! dystrophies. Birth Defects 7:3-12, 1971. 

134. Ryan SJ Jr, Maumenee AE. The running interlocking suture in cataract surgery. 
Arch Ophthalmol 85:302-03, 1971. 

135. Patz A, Maumenee AE, Ryan SJ Jr. Argon laser photocoagulation. Advantages and 
limitations. Trans Am Acad Ophthalmol Otolaryngol 75:569-79, 1971. 

136. Topping TM, Kenyon KR, Goldberg MF, Maumenee AE. Ultrastructural ocular 
pathology of Hunter's syndrome. Systemic mucopolysaccharidosis type II. Arch 
Ophthalmol 86:164-77, 1971. 

137. Michels RG, Green WR, Maumenee AE. Cystoid macular edema following cataract 
extraction (the Irvine-Gass syndrome). A case studied clinically and 
histopathologically. Ophthalmic Surg 2:217-21, 1971. 

138. Aronson SB, Maumenee AE. Uveitis and other intraocular inflammation. In: Samter 
M, ed. Immunological Diseases. 2nd edition. Boston: Little, Brown; 2:1300-13; 1971. 

139. Maumenee AE. Fluorescein in the diagnosis and treatment of macular lesions. (The 
Horacio Ferrer Eye Institute Lecture.) Mod Probl Ophthalmol 9:188-207, 1971. 

140. Patz A, Maumenee AE, Ryan SJ Jr. Argon laser photocoagulation in macular 
diseases. Trans Am Ophthalmol Soc 69:71-83, 1971. 

141. Barlow MH, Maumenee AE. Aspiration of cataracts in adults. Am J Ophthalmol 
73:321-25, 1972; also in Trans Am Ophthalmol Soc 69:268-78, 1971. 

142. Weinstein GW, Maumenee AE, Hyvarinen L. On the pathogenesis of retinitis 
pigmentosa. Ophthalmologica 162:82-97, 1971. 

143. Maumenee AE. A classification of macular lesions based on morphologic findings. In: 
Solanes MP, ed. Proceedings of the XXI International Congress of Ophthalmology. 
Amsterdam: Excerpta Madica; 1:472-78; 1971. 

144. Hyvarinen L, Maumenee AE. Interpretation of choroidal fluorescence. In:AmalricP, 
ed. International Symposium of Fluorescein Angiography, Albi, France, 1969. 
Basel/New York: Karger, 1971. 

145. MaumeneeAE. A memoir of John M. McLean. On behalf of the Pan-American 
Association of Ophthalmology Congress, Bogota, Colombia, January 31, 1971. 
Highlights Ophthalmol 13:182-84, 1970-1971. 

146. Stark WJ, Paton D, Maumenee AE, Michelson PE. The results of 102 penetrating 
keratoplasties using 10-0 monofilament nylon suture. Ophthalmic Surg 3:1125, 
1972. 



243 

147. MaumeneeAE. Opening remarks by the President. Seventy-sixth Annual Meeting of 
the American Academy of Ophthalmology and Otolaryngology. Las Vegas, Nevada, 
September 20-24, 1971. Trans Am Acad Ophthalmol Otolaryngol 76:16A-16F, 1972. 

148. Pfaffenbach DD, Green WR, Maumenee AE. Balloon cell nevus of the conjunctiva. 
Arch Ophthalmol 87:192-95, 1972. 

149. Kenyon KR, Topping TM, Green WR, Maumenee AE. Ocular pathology of the 
Maroteaux-Lamy syndrome (systemic mucopolysaccharidosis type VT). Histologic and 
ultrastructural report of two cases. Am J Ophthalmol 73:718-41, 1972. 

150. Green WR, Maumenee AE, Sanders TE, Smith ME. Sympathetic uveitis following 
evisceration. Trans Am Acad Ophthalmol Otolaryngol 76:625-44, 1972. 

151. Maumenee AE, Emery JM. An anatomic classification of diseases of the macula. Am 
J Ophthalmol 74:594-99, 1972. 

152. Michels RG, Kenyon KR, Maumenee AE. Retro-corneal fibrous membrane. Invest 
Ophthalmol 11:822-31, 1972. 

153. Ryan SJ Jr, Maumenee AE. Acute posterior multifocal placoid pigment 
epitheliopathy. Am J Ophthalmol 7:1066-74, 1972. 

154. Maumenee AE. Chairman's opening remarks. Jerusalem Seminar on the Prevention 
of Blindness, August 25-27, 1971. Under the auspices of the Israel Academy of 
Sciences and Humanities. Israel J Med Sci 8:1028-29, 1972. 

155. Maumenee AE, Ryan SJ Jr, Photocoagulation of disciform macular lesions in the 
ocular histoplasmosis syndrome. Am J Ophthalmol 75:13-16, 1973. 

156. Michels RG, Maumenee AE. Retrobulbar alcohol injection in seeing eyes. Trans Am 
Acad Ophthalmol Otolaryngol 77:164-67, 1973. 

157. Stark WJ, Maumenee AE. Cataract extraction after successfully penetrating 
keratoplasty. Am J Ophthalmol 75:751-54, 1973. 

158. Schatz H, George T, Liu JH, Maumenee AE, Patz A. Color fluorescein angiography: 
Its clinical role. Trans Am Acad Ophthalmol 77:254-59, 1973. 

159. Maumenee AE. Clinical patterns of cornea! graft failure. In: Symposium on Corneal 
Graft Failure, London, 1972. Ciba Foundation Symposium 15 (new series). 
Amsterdam/New York: Elsevier; 5-23; 1973. 

160. MaumeneeAE. The role of steroids in the prevention of cornea! graft failure. In: 
Symposium on Corneal Graft Failure, London, 1972. Ciba Foundation Symposium 15 
(new series). Amsterdam/New York: Elsevier; 241-55; 1973. 

161. Cross HE, Maumenee AE. Progressive spontaneous dissolution of the iris. Surv 
Ophthalmol 18:186-99, 1973. 

162. Jensen AD, Maumenee AE. Home tonometry. Am J Ophthalmol 76:929-32, 1973. 

163. Von Noorden GK, Maumenee AE. Atlas of Strabismus. 2nd edition. St. Louis: 
Mosby, 1973. 

164. Maumenee AE. The immune response to cornea! allografts. Jpn J Ophthalmol 
17:255-76, 1973; also in Acta Soc OphthalmolJpn 77:1760-75 (Engl abstr), 1973. 

165. Cross HE, Maumenee AE. Ocular trauma during amniocentesis. Arch Ophthalmol 
90:303-04, 1973; also in New Engl J Med 287:993-94, 1972. 

166. Kenyon KR, Maumenee AE. Further studies of the congenital hereditary endothelial 
dystrophy of the cornea. Am J Ophthalmol 76:419-39, 1973. 



244 

167. Ryan SJ Jr, Maumenee AE. Running shoestring suture in cataract surgery. 
Ophthalmic Surg 4:12-14, 1973 

168. Harbin TS Jr, Maumenee AE. Epithelial downgrowth after surgery for epithelial cyst. 
Am J Ophthalmol 78:1-4, 1974. 

169. Maumenee AE. Fiscal fumbling and budgetary bumbling. Editorial. Arch 
Ophthalmol 92:1, 1974. 

170. Jacobs DS, Green WR, Maumenee AE. Acquired keratoglobus. Am J Ophthalmol 
77:393-99, 1974. 

171. Maumenee AE. Foreword. In: Ryan SJ Jr, Smith RE, eds. Selected Topics on the 
Eye in Systemic Disease. New York: Grune & Stratton, 1974. 

172. Maumenee AE. Introduction to ocular inflammatory disease. In: Ryan SJ Jr, Smith 
RE, eds. Selected Topics on the Eye in Systemic Disease. New York: Grune & 
Stratton; 235-i9; 1974. 

173. Ryan SJ Jr, Maumenee AE. Ocular sarcoidosis. In: Ryan SJ Jr, Smith RE, eds. 
Selected Topics on the Eye in Systemic Disease. New York: Grune & Stratton; 23549; 
1974. 

174. Smith RE, Maumenee AE. Persistent hyperplastic primary vitreous: Results of 
surgery. Trans Am Acad Ophthalmol Otolaryngol 78:911-25, 1974. 

175. Maumenee AE. National Eye Institute appropriations. Letter. Am J. Ophthalmol 
77:769-70, 1974. 

176. Schatz H, Maumenee AE, Patz A. Geographic helicoid peripapillary choroidopathy: 
Clinical presentation and fluorescein angiographic findings. Trans Am Acad 
Ophthalmol Otolaryngol 78:747-61, 1974. 

177. Jensen AD, Maumenee AE. Refractive errors following keratoplasty. Trans Am 
Ophthalmol Soc 72:123-31, 1974. 

178. Maumenee AE. Uveitis in relation to connective tissue disease. Trans Ophthalmol 
Soc UK 94:807-16, 1974. 

179. Ryan SJ Jr, Maumenee AE. Degeneracao disciforme da macula: Observacoes clinicas 
e experimentais. Rev Bras Ophthalmol 33:7-22, 1974. 

180. Maumenee AE. Pathogenesis of visual field defects. Ganka Rinsho Iho (Jpn) 
67:967-74, 1973. 

181. Maumenee AE. The shoestring suture for cataract surgery. In: Emery JM, Paton D, 
eds. Current Concepts in Cataract Surgery. Selected Proceedings of the Third 
Biennial Cataract Surgical Congress. St. Louis: Mosby; 118-19; 1974. 

182. Maumenee AE. Cataract surgery following comeal transplants. In: Emery JM, Paton 
D, eds. Current Concepts in Cataract Surgery. St. Louis: Mosby; 159-61; 1974. 

183. Maumenee AE. A further follow-up on aspiration of cataracts. In: Emery JM, Paton 
D, eds. Current Concepts in Cataract Surgery. St. Louis: Mosby; 188-89; 1974. 

184. Maumenee AE, Meredith TA. A survey of 500 cases of cataract extraction (at the 
Wilmer Institute). In: Emery JM, Paton D, eds. Current Concepts in Cataract 
Surgery. St. Louis: Mosby; 423-26; 1974. 

185. Maumenee AE. Appreciation. Francis Heed Adler, M.D. Am J Ophthalmol 79:12, 
1975. 

186. Maumenee AE. Introduction. Symposium: International Problems of Blindness. 
Trans Am Acad Ophthalmol Otolaryngol 79:445-46, 1975. 



245 

187. MaumenecAE. Presentation to Mildred Weisenfeld. The First Annual Award of the 
American Academy of Ophthalmology and Otolaryngology to a Lay Person. Trans Am 
Acad Ophthalmol Otolaryngol 79:443, 1975 

188. Quigley HA, Maumenee AE, Stark WJ. Acute glaucoma in systemic 
mucopolysaccharidosis I-S. Am J Ophthalmol 80:70-72, 1975. 

189. Wood WJ, Maumenee AE. Cornea! thickness after cataract surgery. Trans Am Acad 
Ophthalmol Otolaryngol 79:631-34, 1975. 

190. Stark WJ, Maumenee AE, Kenyon KR. Intermediate-term corneal storage for 
penetrating keratoplasty. Am J Ophthalmol 79:795-802, 1975. 

191. Michels RG, Maumenee AE. Cystoid macular edema associated with topically applied 
epinephrine in aphakic eyes. Am J Ophthalmol 80:379-88, 1975. 

192. Kenyon KR, Pederson JE, Green WR, Maumenee AE. Pibroglial proliferation in pars 
planitis. Trans Ophthalmol Soc /# 95:391-97, 1975. 

193. Maumenee AE. Outstanding achievement award for the alumni and alumnae of the 
University of Minnesota Medical School. Editorial. Am J Ophthalmol 80:304, 1975. 

194. Arentsen JJ, Christiansen JM, Maumenee AE. Marginal ulceration after 
intracapsular cataract extraction. Am J Ophthalmol 81:194-97, 1976. 

195. Maumenee AE, Hogan MJ, Newell FW, Norton EW, Shoch D, Straatsma BR. Jules 
Stein, M.D. Am J Ophthalmol 81:379-82, 1976. 

196. Lieberman MF, Maumenee AE, Green WR. Histologic studies of the vasculature of 
the anterior optic nerve. Am J Ophthalmol 82:405-23, 1976. 

197. Stark WJ, Kenyon KR, Fogle JA, Maumenee AE. Recurrent corneal erosive disorders. 
Contact Intraocular Lens Med J 2:22-30, 1976. 

198. Maumenee AE. Recent advances in cornea] transplantation. (The Pocklington 
Lecture.) Trans Ophthalmol Soc UK 96:462-70, 1976. 

199. Radius RL, Maumenee AE. Visual field changes following acute elevation of 
intraocular pressure. Trans Am Acad Ophthalmol Otolaryngol 83:61-68, 1977. 

200. Luebbers JA, Goldberg MF, Herbst R, Hattenhauer J, Maumenee AE. Iris 
transillumination and variable expression in ectopia lentis et pupillae. Am J 
Ophthalmol 83:647-56, 1977. 

201. Ryan SJ Jr, Maumenee AE. Unilateral congenital cataracts and their management. 
Ophthalmic Surg 8:35-39, 1977. 

202. Meredith TA, Green WR, Key SN III, Dolin GS, Maumenee AE. Ocular 
histoplasmosis. Clinicopathologic correlation of 3 cases. Surv Ophthalmol 
22:189-205, 1977. 

203. Maumenee AE. The pathogenesis of visual field loss in glaucoma. In: Brockhurst RJ, 
Boruchoff SA, Hutchinson BT, Lessell S, eds. Controversy in Ophthalmology. 
Philadelphia: Saunders; 301-11; 1977. 

204. Key SN III, Green WR, Maumenee AE. Pathology of macular lesion and ocular 
histoplasmosis: Its pathogenetic and therapeutic implications. In: Brockhurst RJ, 
Boruchoff SA, Hutchinson BT, Lessell S, eds. Controversy in Ophthalmology. 
Philadelphia: Saunders; 301-11; 1977. 

205. Maumenee AE. Conventional uveitis workups are obsolete. In: Brockhurst RJ, 
Boruchoff SA, Hutchinson BT, Lessell S, eds. Controversy in Ophthalmology. 
Philadelphia: Saunders; 301-11; 1977. 



246 

206. Maumenee AE. Obituary. Michael J. Hogan, M.D. Am J Ophthalmol 83:135, 1977. 

207. Maumenee AE. Open-sky vitreous surgery. Management of vitreous loss in cataract 
surgery. In: Mackenzie Freeman H, Hirose T, Schepens CL, eds. Vitreous Surgery 
and Advances in Fundus Diagnosis and Treatment. New York: 
Appleton-Century-Crofts; 445-49; 1977. 

208. Hirst LW, Snip RC, Stark WJ, Maumenee AE. Quantitative cornea! endothelial 
evaluation in intraocular lens implantation and cataract surgery. Am J Ophthalmol 
84:775-80, 1977. 

209. Stark WJ, Hirst LW, Snip RC, Maumenee AE. A two-year trial of intraocular lenses 
at the Wilmer Institute. Am J Ophthalmol 84:769-74, 1977. 

210. Sommer A, Miller NR, Pollack I, Maumenee AE, George T. The nerve fiber layer in 
the diagnosis of glaucoma. Arch Ophthalmol 95:2149-56, 1977. 

211. Radius RL, Maumenee AE. Optic atrophy and glaucomatous cupping. Am J 
Ophthalmol 85:145-53, 1978. 

212. Jampol LM, Board RJ, Maumenee AE. Systemic hypotension and glaucomatous 
changes. Am J Ophthalmol 85:154-59, 1978. 

213. Maumenee AE. Current techniques of complete cataract removal. In: Emery JM, 
PatonD, eds. Current Concepts in Cataract Surgery. Selected proceedings of the 
Fourth Biennial Cataract Surgical Congress. St. Louis: Mosby; 39; 1976. 

214. Maumenee AE. Update on aspiration of congenital and juvenile cataracts. In: Emery 
JM, Paton D, eds. Current Concepts in Cataract Surgery. Selected proceedings of the 
Fourth Biennial Cataract Surgical Congress. St. Louis: Mosby; 39; 1976. 

215. Maumenee AE. The use of Tc 199 and dextran solution in preserving cornea! graft 
buttons. In: Emery JM, Paton D, eds. Current Concepts in Cataract Surgery. St. 
Louis: Mosby; 163; 1976. 

216. Maumenee AE. Vitrectomy. In: Emery JM, Paton D, eds. Current Concepts in 
Cataract Surgery. St. Louis: Mosby; 247; 1976. 

217. Maumenee AE. Cyclocryothermy in aphakic glaucoma. In: Emery JM, Paton D, eds. 
Current Concepts in Cataract Surgery. St. Louis: Mosby; 378; 1976. 

218. Stark WJ, Michels RG, Maumenee AE, Cupples H. Surgical management of 
epithelial ingrowth. Am J Ophthalmol 85:772-80, 1978. 

219. Radius RL, Maumenee AE, Green WR. Pit-like changes of the optic nerve head in 
open-angle glaucoma. Br J Ophthalmol 62:389-93, 1978. 

220. Radius RL, Maumenee AE. Dilated episcleral vessels and open-angle glaucoma. Am 
J Ophthalmol 86:31-35, 1978. 

221. Maumenee IH, Maumenee AE. Fundus flavinaculatus clinical, genetic, and 
pathologic observations. In: Francois J, ed. The Fifth Congress of the European 
Society of Ophthalmology, Hamburg, 5-9 April, 1976. Stuttgart: Ferdinand Enke 
Verlag, 1978. 

222. Maumenee AE. A visit to the People's Republic of China. Editorial. Am J 
Ophthalmol 86:436-39, 1978. 

223. Stark WJ, Taylor HR, Bias WB, Maumenee AE. Histocompatibility (HLA) antigens 
and keratoplasty. Am J Ophthalmol 86:595-604, 1978. 

224. Pederson JE, Kenyon KR, Green WR, Maumenee AE. Pathology of Pars Planitis. Am 
J Ophthalmol 86:762-74, 1978. 



247 

225. Maumenee AE. Classification (macular diseases). In: I/Esperance FA Jr, ed. 
Current Diagnosis and Management ofChorioretinal Diseases. International 
Photocoagulation Congress, New York, 1975. St. Louis: Mosby; 287-94; 1977. 

226. Maumenee AE. Current techniques of intracapsular cataract surgery. In: Emery JM, 
ed. Current Concepts in Cataract Surgery. Selected proceedings of the Fifth Biennial 
Cataract Surgical Congress. St. Louis: Mosby; 53-4; 1978. 

227. Maumenee AE. Simple aspiration of congenital and juvenile cataracts. In: Emery 
JM, ed. Current Concepts in Cataract Surgery. St. Louis: Mosby; 97-98; 1978. 

228. Maumenee AE. Closing filtering blebs. In: Emery JM, ed. Current Concepts in 
Cataract Surgery. St. Louis: Mosby; 450; 1978. 

229. Maumenee AE. Experience with 4-loop Binkhorst iris-clip lenses. In: Emery JM, ed. 
Current Concepts in Cataract Surgery. St. Louis: Mosby; 520-21; 1978. 

230. Maumenee AE. Obituary. Frank B. Walsh, M.D., 1895-1978. Am J Ophthalmol 
87:249-51, 1979. 

231. Quigley HA, Maumenee AE. Long-term follow-up of treated open-angle glaucoma. 
Am J Ophthalmol 87:519-25, 1979. 

232. Maumenee AE. Studies on the adrenergic systems of the eye at the Wilmer Institute. 
Surv Ophthalmol 32:371-75, 1979. 

233. Thomas JV, Green WR, Maumenee AE. Small choroidal melanomas. Arch 
Ophthalmol 97:861-64, 1979. 

234. Maumenee AE. An evaluation of enucleation in the management of uveal 
melanomas. Editorial. Am J Ophthalmol 87:846-47, 1979. 

235. Maumenee AE. Teaching of pedagogics in ophthalmology. In: Shimizu K, Oosterhuis 
J, eds. XXIII Concilium Ophthalmologicum, Kyoto, 1978. International Congress 
Series No. 450. Amsterdam-Oxford: Excerpta Medica; 1:561-62; 1979. 

236. Stark WJ, Kracher GP, Cowan CL, Taylor HR, Hirst LW, Oyakawa RT, Maumenee 
AE. Extended-wear contact leases and intraocular lenses for aphakic correction. Am 
J Ophthalmol 88:535-12, 1979. 

237. Robin AL, Quigley HA, Pollack IP, Maumenee AE, Maumenee IH. An analysis of 
visual acuity, visual fields, and disk cupping in childhood glaucoma. Am J 
Ophthalmol 88:847-58, 1979. 

238. Diamond GR, Werblin TP, Richter R, Radius R, Pollack IP, Maumenee AE. Extended 
clinical studies using Timolol in patients with ocular hypertension and chronic 
open-angle glaucoma. Glaucoma 1:63-68, 1979. 

239. Meredith TA, Maumenee AE. A review of one thousand cases of intracapsular 
cataract extractions. I. Complications. Ophthalmic Surg 10:32-41, 1979. 

240. Meredith TA, Maumenee AE. A review of one thousand cases of intracapsular 
cataract extractions. II. Visual results and astigmatic analysis. Ophthalmic Surg 
10:42-45, 1979. 

241. Maumenee AE. Keratinizati on of the conjunctiva. Trans Am Ophthalmol Soc 
77:133-42, 1979. 

242. Sommer A, Pollack I, Maumenee AE. Optic disc parameters and onset of 
glaucomatous field loss. I. Methods and progressive changes in disc morphology. 
Arch Ophthalmol 97:1444-48, 1979. 



248 

243. Sommer A, Pollack I, Maumenee AE. Optic disc parameters and onset of 
glaucomatous field loss. II. Static screening criteria. Arch Ophthalmol 97:1449-54, 
1979. 

244. Frangois J, Maumenee AE, Esente I, eds. First International Congress on Cataract 
Surgery, Florence, 1978. Documenta Ophthahnologica Proceedings Series, vol. 21. 
The Hague: Junk, 1979. 

245. Stark WJ, Taylor HR, Michels RG, Maumenee AE. Management of congenital 
cataracts. Ophthalmology 86:1571-78, 1979. 

246. Maumenee AE. Discussion: Symposium on congenital cataracts. Ophthalmology 
86:1605-08, 1979. 

247. Maumenee AE. Epithelial downgrowth (epithelial ingrowth). In: Fraunfelder FT, 
Roy FH. Current Ocular Therapy. Philadelphia: Saunders; 324-25; 1980. 

248. ODonnell JE Jr, Maumenee AE. "Unexplained' visual loss in axial myopia: Cases 
caused by mild nuclear sclerotic cataract. Ophthalmic Surg 11:99101, 1980. 

249. Stark WJ, Rosenblum P, Maumenee AE, Cowan CL. Post-operative inflammatory 
reactions to intraocular lenses sterilized with ethylene-oxide. Ophthalmology. 
87:385-89, 1980. 

250. Maumenee AE. Hypotony. (Excessive cyclodialysis clefts, ocular hypotension.) In: 
Fraunfelder FT, Roy FH. Current Ocular Therapy. Philadelphia: Saunders; 44S--49; 
1980. 

251. Rosenblum P, Stark WJ, Maumenee IH, Hirst LW, Maumenee AE. Hereditary Fuchs' 
dystrophy. Am J Ophthalmol 90:455-62, 1980. 

252. Armaly MF, Krueger DE, Maunder L, Becker B, Hetherington J Jr, Kolker AE, 
Levene RZ, Maumenee AE, Pollack IP, Shaffer RN. Biostatistical analysis of the 
collaborative glaucoma study. I. Summary report of the risk factors for glaucomatous 
visual-field defects. Arch Ophthalmol 98:2163-71, 1980. 

253. Ryan SJ, Maumenee AE. Birdshot retinochoroidopathy. Am J Ophthalmol 89:3145, 
1980. 

254. Ryan SJ, Mittl RN, Maumenee AE. The distiform response: A historical perspective. 
GraefesArch Ophthalmol 215:1-20, 1980. 

255. Ryan SJ, Mittl RN, Maumenee AE. Enzymatic and mechanically induced subretinal 
neovascularization. GraefesArch Ophthalmol 215:21-27, 1980. 

256. Maumenee AE. My favorite cataract operation. In: Emery JM, Jacobson AD, eds. 
Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: Mosby; 45; 1980. 

257. Maumenee AE. Combined cataract-glaucoma filtering procedures. In: Emery JM, 
Jacobson AD, eds. Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: 
Mosby; 156-57; 1980. 

258. Maumenee AE. Aphakic cornea! transplants. In: Emery JM, Jacobson AD, eds. 
Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: Mosby; 187-88; 
1980. 

259. Maumenee AE. Management of cystoid macular edema. In: Emery JM, Jacobson AD, 
eds. Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: Mosby; 315; 
1980 

260. Maumenee AE. Prevention of blindness in the Americas. Editorial. Am J 
Ophthalmol 90:113-14, 1980. 



249 

261. MaumeneeAE. Complications associated with intraocular lenses. In: Emery JM, 
Jacobson AD, eds. Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: 
Mosby; 348-49; 1980. 

262. MaumeneeAE. Treatment of epithelial downgrowth. In: Emery JM, Jacobson AD, 
eds. Sixth Cataract Surgical Congress, Houston, Texas, 1978. St. Louis: Mosby; 
384-85; 1980. 

263. Maumenee AE. Symposium Then and Now. Uveitis. Trans Ophthalmol Soc UK 
100: 9-16, 1980. 

264. Quigley HA, Addicks EM, Green WR, Maumenee AE. Optic nerve damage in human 
glaucoma. II. The site of injury and susceptibility to damage. Arch Ophthalmol 
99:635-49, 1981. 

265. Bruner WE, Michels RG, Stark WJ, Maumenee AE. Management of epithelial cysts 
of the anterior chamber. Ophthalmic Surg 12:279-85, 1981. 

266. Bruner WE, Maumenee AE, Stark WJ. A simple method of repairing inadvertent 
filtering blebs after cataract surgery. Am J Ophthalmol 91:794-96, 1981. 

267. Stark WJ, Taylor HR, Maumenee AE, Bias WB. Keratoplasty: The role of 
histocompatibility (HLA) antigens. In: Steinberg GM, Gery I, Nussenblatt RB, eds. 
Proceeding I Immunology of the Eye; Workshop I: Immunogenetics and transplantation 
immunity. Immunology Abstracts (special supplement) 1980. 

268. Maumenee AE. Visual field loss in glaucoma. In: Transactions of the New Orleans 
Academy of Ophthalmology. Symposium on Glaucoma, 1980, New Orleans. St. Louis: 
Mosby; 160-71; 1981. 

269. MaumeneeAE. Mechanism of filtration of fistuli zing glaucoma procedures. In: 
Transactions of the New Orleans Academy of Ophthalmology. St. Louis: Mosby; 
280-88; 1981. 

270. Maumenee AE, Oyakawa RT. Combined cataract extraction and glaucoma filtering 
operation. In: Transactions of the New Orleans Academy of Ophthalmology. St. 
Louis: Mosby; 289-94; 1981. 

271. Bruner WE, Stark WJ, Maumenee AE. Combined keratoplasty, cataract extraction 
and intraocular lens implantation: Experience at the Wilmer Institute. Ophthalmic 
Surg 12:657-60, 1981. 

272. Bernuy A, Contreras F, Maumenee AE, ODonnell FE Jr. Bilateral, congenital, 
dermis-like choristomas overlying cornea! staphylomas. Arch Ophthalmol 
99:1995-97, 1981. 

273. Green WR, Kincaid MC, Michels RG, Pederson JE, Kenyon KR, Maumenee AE. Pars 
planitis. Trans Ophthalmol Soc UK 101:361-67, 1981. 

274. MaumeneeAE. Cataract controversy. In: Proceedings of the National Conference of 
the National Society to Prevent Blindness, New York, September 22-23, 1980. New 
York: National Society to Prevent Blindness; 95-96; 1981. 

275. Oyakawa RT, Maumenee AE. Clear-cornea cataract extraction in eyes with 
functioning filtering blebs. Am J Ophthalmol 93:294-98, 1982. 

276. Stark WJ, Maumenee AE, Dangel ME, Martin NF, Hirst LW. Intraocular lenses. 
Experience at the Wilmer Institute. Ophthalmology 89:104-08, 1982. 

277. Martin NF, Stark WJ, Maumenee AE, Bruner WE, Rosenblum P. Use of the Honan 
intraocular pressure reducer at the Wilmer Institute. Ophthalmic Surg 13:101-03, 
1982. 



250 

278. Flower RW, Maumenee AE, Michelson EA. Long-term continuous monitoring of 
intraocular pressure in conscious primates. Ophthalmic Res 14:98-106, 1982. 

279. Topping TM, Stark WJ, Maumenee AE, Kenyon KR. Traumatic wound dehiscence 
following penetrating keratoplasty. Br J Ophthalmol 66:174-78, 1982. 

280. Maumenee AE. Combined posterior keratectomy and cataract extraction. In: Emery 
JM, Jacobson AC, eds. Current Concepts in Cataract Surgery. Selected Proceedings 
of the Seventh Biennial Cataract Surgical Congress. New York: Appleton-Century 
Crofts; 157-58; 1982. 

281. Nussenblatt RB, Mittal KK, Ryan S, Green WR, Maumenee AE. Birdshot 
retinochoroidopathy associated with HLA-A29 antigen and immune responsiveness to 
retinal S-antigen. Am J Ophthalmol 94:147-58, 1982. 

282. Dangel ME, Kracher GP, Stark WJ, Maumenee AE, Martin NF. Aphakic 
extended-wear contact lenses after penetrating keratoplasty. Am J Ophthalmol 
95:156-60, 1983. 

283. Martin NF, Kracher GP, Stark WJ, Maumenee AE. Extended-wear soft contact 
lenses for aphakic correction. Arch Ophthalmol 101:39-41, 1983. 

284. Maumenee AE. The medical news gets a checkup. Dr. A. Edward Maumenee is 
interviewed by Alton Blakeslee. Sightsaving 5:8-11, 1982. 

285. Francois J, Maumenee AE, Esente I, eds. Cataract Surgery and Visual 
Rehabilitation. Proceedings of the Second International Congress on Cataract 
Surgery and Visual Rehabilitation of the Aphakic Eye, Florence, 1981. Milano, Italy: 
Libreria Scientifica gia Ghedini s.r.l., 1982. 

286. McDonnell PJ, Green WR, Maumenee AE, Ih'ff WJ. Pathology of intraocular lenses in 
33 eyes examined postmortem. Ophthalmology 90:386-403, 1983. 

287. Stark WJ, Maumenee AE, Fagadau WR, Hirst LW, Datiles MB. Intraocular lenses: 
Experience at the Wilmer Institute. Aust J Ophthalmol 11:95-102, 1983. 

288. Maumenee AE. Causes of optic nerve damage in glaucoma. (Robert N. Shaffer 
Lecture.) Ophthalmology 90:741-52, 1983. 

289. Maumenee AE. The qualities for a successful life: Selecting and training individuals 
in medicine. Ala J Med Sci 20:334-35, 1983. 

290. Stark WJ, Maumenee AE. Update of the intraocular lens. Experience at the Wilmer 
Institute. Ophthalmolagica 187:65-73, 1983. 

291. Stark WJ, Martin NF, Maumenee AE. Radial keratotomy. II. A risky procedure of 
unproven long-term success. Surv Ophthalmol 28:101, 10611, 1983. 

292. Maumenee AE. Welcoming address and closing comments by Dr. A. Edward 
Maumenee, President of the 24th International Congress of Ophthalmology. Opening 
Ceremony/Joint Meeting, 24th International Congress of Ophthalmology and the 
American Academy of Ophthalmology, October 31, 1982. In: Henkind P, Shimizu K, 
eds. International Congress of Ophthalmology (24th), 1982, San Francisco, California. 
Philadelphia/London: Lippincott, 1983. 

293. Terry AC, Stark WJ, Maumenee AE, Fagadau W. Neodymium-YAG laser for 
posterior capsulotomy. Am J Ophthalmol 96:716-20, 1983. 

294. Stark WJ, Maumenee AE, Datiles M, Fagadau W, Baker CC, Worthen D, Auer C, 
Klein P, McGhee E, Jacobs ME, Murray G. Intraocular lenses: Complications and 
visual results. Trans Am Ophthalmol Soc 81:280-309, 1983. 



251 

295. Fagadau WR, Maumenee AE, Stark WJ, Datiles M. Posterior chamber intraocular 
lenses at the Wilmer Institute: a comparative analysis of complications and visual 
results. Br J Ophthalmol 68:13-18, 1984. 

296. Fagadau WR, Maumenee AE, Dobies RJ, Stark WJ. A simple wick for fluid drainage 
during anterior segment surgery. Ophthalmic Surg 15:206-07, 1984. 

297. Maumenee AE. A late follow-up on Binkhorst iris-clip lenses. In: Emery JM, 
Jacobson AC, eds. Current Concepts in Cataract Surgery. Selected Proceedings of the 
Eighth Biennial Cataract Surgical Congress. Norwalk, Connecticut: 
Appleton-Century-Crofts; 112-13; 1984. 

298. Yeo JH, Maumenee AE. Using eye signs to detect systemic disease. Contemp Obstset 
Gynecol 23:191-200 (special issue), 1984. 

299. Thompson JT, Maumenee AE, Baker CC. A new posterior chamber intraocular lens 
formula for axial myopes. Ophthalmology 91:484-88, 1984. 

300. Stark WJ Jr, Maumenee AE, Fagadau W, Datiles M, Baker CC, Worthen D, Klein P, 
Auer C. Cystoid macular edema in pseudophakia. Surv Ophthalmol 28 
(Suppl):442-51, 1984. 

301. Selsky EF, Knox DL, Maumenee AE, Green WR. Ocular involvement in Whipple's 
disease. Retina 4:103-106, 1984. 

302. Tseng SCO, Hirst LW, Maumenee AE, Kenyon KR, Sun TT, Green WR. Possible 
mechanisms for the loss of goblet cells in mutin-deficient disorders. Ophthalmology 
91:545-52, 1984. 

303. Maumenee AE, Terry AC. Letter. Grooved tying forceps. Am J Ophthalmol 
98:638-39, 1984. 

304. Stark WJ, Bruner WE, Maumenee AE. Surgery of the cornea. In: Rice TA, Michels 
RG, Stark WJ, eds. Rob & Smith's Operative Surgery. Ophthalmic Surgery. 4th ed. 
St. Louis: Mosby; 115-37; 1984. 

305. Bruner WE, Stark WJ, Maumenee AE. Surgery of the lens. In: Rice TA, Michels RG, 
Stark WJ, eds. Rob & Smith's Operative Surgery. Ophthalmic Surgery. St. Louis: 
Mosby; 139-75; 1984. 

306. Maumenee AE. Tribute to the memory of the late Baron Jules Francois. AmJ 
Ophthalmol 98:665, 1984. 

307. McDonnell PJ, Quigley HA, Maumenee AE, Stark WJ, Hutchins GM. The Honan 
intraocular pressure reducer. An experimental study. Arch Ophthalmol 103:42225, 
1985. 

308. Terry AC, Stark WJ, Newsome DA, Maumenee AE, Pina E. Tissue toxicity of 
laser-damaged intraocular lens implants. Ophthalmology 92:41418, 1985. 

309. Maumenee AE, Stark WJ, Esente I, eds. Cataract Surgery and Visual Rehabilitation. 
Proceedings of the Third International Congress, Florence, Italy, May 912, 1984. 
Amsterdam/Berkeley: Kugler, 1985. 

310. Tseng SCG, Maumenee AE, Stark WJ, Maumenee IH, Jensen AD, Green WR, Kenyon 
KR. Topical retinoid treatment for various dry-eye disorders. Ophthalmology 
92:717-27, 1985. 

311. Lang GK, Surer JL, Green WR, Finkelstein D, Michels RG, Maumenee AE. Ocular 
reticulum cell sarcoma. Clinicopathologic correlation of a case with multifocal lesions. 
Retina 5:79-86, 1985. 



252 

312. Kenyon KR, Maumenee AE, Ryan SJ, Whitmore PV, Green WR. Diffuse Drusen and 
associated complications. Am J Ophthalmol 100:119-28, 1985. 

313. Maumenee AE, Schwartz MF. Acute intraoperative choroidal effusion. Am J 
Ophthalmol 100:147-54, 1985. 

314. Talamo JH, Topping TM, Maumenee AE, Green WR. Ultrastructural studies of 
cornea, iris and lens in a case of siderosis bulbi. Ophthalmology 92:167580, 1985. 

315. Lang GK, Green WR, Maumenee AE. Clinicopathologic studies of keratoplasty eyes 
obtained post mortem. Am J Ophthalmol 101:28-40, 1986. 

316. Smiddy WE, Radulovic D, Yeo JH, Stark WJ, Maumenee AE. Potential acuity meter 
for predicting visual acuity after Nd: YAG posterior capsulotomy. Ophthalmology 
93:397-400, 1986. 

317. Maumenee AE. Hypotony. In: Praunfelder FT, Roy FH, eds. Current Ocular 
Therapy 2. Philadelphia: Saunders; 392-93; 1985. 

318. Stark WJ, Denlinger DE, Terry AC, Maumenee AE. Pseudophakia: Incidence of 
cystoid macular edema. In: Blankenship GW, Stirpe M, Convers M, Binder S, eds. 
Basic and Advanced Vitreous Surgery. Fidia Research Series, vol 2. Padova: Ldviana 
Press (Springer Verlag); 153-55; 1986. 

319. Smiddy WE, Stark WJ, Young E, Klein P, Bias W, Maumenee AE. Clinical and 
immunological results of comeal allograft rejection. Ophthalmic Surg 17:64449, 
1986. 

320. McGuigan LJB, Gottsch J, Stark WJ, Maumenee AE, Quigley HA. Extracapsular 
cataract extraction and posterior chamber lens implantation in eyes with preexisting 
glaucoma. Arch Ophthalmol 104:1301-1308, 1986. 

321. Stark WJ, Terry AC, Maumenee AE, eds. Anterior Segment Surgery. lOLs, Lasers, 
and Refractive Keratoplasty. Baltimore: Williams & Wilkins, 1987. 

322. Lang GK, Green WR, Maumenee AE. Klinish-pathologische Korrelationen in 
Keratoplastik-Augen (Autopsie-Augen). Fortschr Ophthalmol 83:650-54, 1986. 

323. Tseng CG, Maumenee IH, Maumenee AE. Vitamin- A-Therapie des Pemphigoids der 
Konjunktive. Fortschr Ophthalmol 83:637-40, 1986. 

324. BrunerWE, Stark WJ, Maumenee AE, eds. Manual of Corneal Surgery. New York: 
Churchill Livingstone, 1987. 

325. Stark WJ, Maumenee AE. Intraocular lens implantation at the Wilmer Institute: 
Results. An Inst Barraquer 16:344-55, 1982-83. 

326. Smiddy WE, Stark WJ, Michels RG, Maumenee AE, Terry AC, Glaser BM. Cataract 
extraction after vitrectomy. Ophthalmology 94:483-87, 1987. 

327. Bernitsky DA, Stark WJ, McCartney DL, Wong SK, Maumenee AE. Current concepts 
in intraocular lens implantation. Dev Ophthalmol 14:146-51, 1987. 

328. Smith PW, Stark WJ, Maumenee AE, Enger CL, Michels RG, Glaser BM, Bonham 
RD. Retinal detachment after extracapsular cataract extraction with posterior 
chamber intraocular lens. Ophthalmology 94:495-502, 1987. 

329. Smiddy WE, Horowitz TH, Stark WJ, Klein P, Kracher GP, Maumenee AE. Potential 
acuity meter for predicting postoperative visual acuity in penetrating keratoplasty. 
Ophthalmology 94:12-16, 1987. 

330. Maumenee AE. DRG-39. Ophthalmology 94:1189-90, 1987. 



253 

331. Martin NF, Stark WJ, Maumenee AE. Treatment of Mooren's and Mooren's-like ulcer 
by lamellar keratectomy: Report of six eyes and literature review. Ophthalmic Surg 
18:564-69, 1987. 

332. Gottsch JD, Chen CH, Stark WJ, Maumenee AE. Cornea! metabolism monitored with 
NMR spectroscopy. Trans Am Ophthalmol Soc 84:183-91, 1986. 

333. Smiddy WE, Michels RG, Stark WJ, Maumenee AE. Cataract extraction after retinal 
detachment surgery. Ophthalmology 95:3-7, 1988. 

334. Bernitsky DA, Stark WJ, McCartney DL, Wong SK, Maumenee AE, Gottsch JD, 
Pratzer K, Fenton J, Webster N. Changing indications for intraocular lenses: 
Guidelines (legal and ethical) for cataract surgery. In: Caldwell DR, ed. New Orleans 
Academy of Ophthalmology Transactions: Cataracts. New York: Raven Press; 1-8; 
1988. 

335. McCartney DL, Stark WJ, Memmen JE, Quigley HA, Maumenee AE, Gottsch JD, 
Fenton J, Pratzer K. Current management of cataracts in patients with glaucoma. 
In: Caldwell DR, ed. New Orleans Academy of Ophthalmology Transactions: 
Cataracts. New York: Raven Press; 111-26; 1988. 

336. McCartney DL, Start WJ, Maumenee, Gottsch JD, Bernitsky DA, Wong SK, Pratzer 
K, Fenton J. Current surgical management of aphakia. In: Caldwell DR, ed. New 
Orleans Academy of Ophthalmology Transactions: Cataracts. New York: Raven Press; 
205-24; 1988. 

337. McCartney DL, Memmen JE, Stark WJ, Quigley HA, Maumenee AE, Gottsch JD, 
Bernitsky DA, Wong SK. The efficacy and safety of combined trabeculectomy cataract 
extraction, intraocular lens implantation. Ophthalmology 95:754-63, 1988. 

338. Stevens RE, Datiles MB, Srivastava SK, Ansari NH, Maumenee AE, Stark WJ. 
Idiopathic pre-senile cataract formation and galactosaemia. Br J Ophthalmol 
73:48-51, 1989. 

339. Maumenee AE. In Memoriam. Jack S. Guyton. Trans Am Ophthalmol Soc 86:34, 
1988. 

340. Smith P, Stark WJ, Maumenee AE, Green WR. Epithelial fibrous and endothelial 
proliferation. In: Ritch R, Shields MB, Krupin T, eds. The Glaucomas. St. Louis: 
Mosby; 2:1299-1335; 1989. 

341. Maumenee AE. The history of vitamin A and its ophthalmic implications. Arch 
Ophthalmol 111:547-550, 1993. 



254 



255 



INTERVIEWER BIOGRAPHY 

Sally Smith Hughes 

She graduated from the University of California, Berkeley, in 1963 with an 
AB degree in zoology, and from the University of California, San Francisco, 
in 1966 with an MA degree in anatomy. After completing a dissertation 
on the history of the concept of the virus, she received a PhD degree in 
the history of medicine from the Royal Postgraduate Medical School, 
University of London, in 1972. 

Her previous positions have been postgraduate research histologist, 
the Cardiovascular Research Institute, University of California, 
San Francisco, 1966-1968, and medical historian conducting the 
NEH-supported History of Medical Physics Project for The Bancroft 
Library, 1978-1980. 

She is presently an interviewer on medical and scientific topics for the 
Regional Oral History Office at the University of California, Berkeley, and 
for the Department of the History of Health Sciences at the University of 
California, San Francisco. She is author of The Virus: A History of the 
Concept. 



256 



257 



INDEX 



Alabama Drydocks and Shipping Co., 4, 75 

Albert, Daniel M., 158 

Alcon Eye Research Foundation, 102 

all-trans retinoic acid, 170-171 

Alvaro, Moacyr, 197-198 

Alvis, D. L., 68-69 

Alway, Robert, 74 

American Academy of Ophthalmology 
annual meetings, 59, 199-200, 205 

separation of ophthalmologists and otolaryngologists, 181, 201-202 
union with American Association of Ophthalmology, 203-204 

American Association of Ophthalmology, 203-204 

American Board of Ophthalmology examination, 41-42, 206-207 

American Ophthalmological Society, 59, 207-209 

Ammar, 151 

Amoils, S. P., 66 

Anderson, Doug, 115 

Arruga Liro, Hermenegildo, 130 

Ascher, Karl, 72 

Ashton, Norman, 27, 50, 96, 114, 157, 205 

Association for Research in Vision and Ophthalmology (ARVO), 181 

Association of University Professors of Ophthalmology (AUPO), 179, 181 

Avtisov, E. S., 191 



bacterial warfare research, 44-46 

Bagley, Cecil H., 35 

Bailey, Arthur, 73 

Bard, Philip, 89, 90 

Barkan, Hans, 33, 52, 57, 58, 113 

Barkan, Otto, 57-58, 106, 113-114 

Barraquer, Elena, 157 

Barraquer, Joaqufn, 144, 150, 154, 157, 205 

Barraquer, Jos6 Ignacio, 150 

Becker, Bernard, 37, 88, 93, 111, 179 

Bellevue Hospital (New York City), 13-14 

Belli, Melvin, 68 

Benedict, William L., 200-203 

Bennett, Cliff, 73 

Berens, Conrad, 197 



258 

Berwin Clinic (New York City), 12-13 

Bettman, Jerome W., Sr., 54-55, 68, 72-73, 105 

Billingham, Rupert E., 136 

Binkhorst, Cornelius, 155-156 

birdshot retinochoroidopathy, 162 

Black, Harvey, 167 

Bloomfield, Art, 56 

Bonaccolto, Girolamo, 146 

Borkovich, Katy, 160 

Boyd, Benjamin F., 198-199 

Braley, Alson E., 42 

Breckinridge, Aida de Acosta, 34 

Bricker, Connie, 200 

Bromberg, Frank, 6 

Brownley (ophthalmologist), 122 

Brown, Bob, 47-48 

Burch, Edward, 35 

Burky, Earl L., 24 

Bush, Mrs. Gage, 11 



Camp Detrick, Maryland, 45-46 

Capote, Truman, 3 

Carmichael, Emmett, 11 

Casaamata, 153 

Cassady, J. V., 202 

Castroviejo, Ramon, 135 

cataract extraction, 148-152 

microscope use in, 150-151 
surgical techniques in, 151-152 

Chandler, Paul A,, 112-113 

chemical warfare research, 43-44 

Choyce, Peter, 156 

Christian Eye Ministry, 193 

Clark, Graham, 132 

Clay, Grady, 23 

clinical trials, large-scale, 104-105 

Cogan, David G., 44, 71, 103, 131, 137, 179, 205 

conjunctivitis, shipbuilder's, research on, 28 

Connor, William, 102, 198 

Constantino, Elizabeth F., 40 

Constantine, Frank H., 40 

Cordes, Frederick C., 33, 55-56 

cornea 

endothelium, pump mechanism of, 142-143 
graft rejection, 135-136 
hypersensitivity reactions in, 98, 139-140 
immunologic privilege of, 97-98, 136-137 
regeneration of cells, 51-52, 135-136 
swelling of, 137 
transplantation, 141, 175 

Cornell University School of Medicine, 11-15 

Corner, George W., 27 

cortisone, 138-139 

cryoprobe, 65-66, 134 



259 

Custodis, Ernst, 130 



Damon, Gus, 14 

Daviel, Jacques, 148 

Day, Robert, 160 

de Schweinitz, George E., 22, 35, 186 

diabetic retinopathy, 133 

diathermy, 132-133 

Douvas, Nicholas, 147 

Dowling, John E., 92, 95, 98-99, 102 

Drance, Steven, 115 

Duane, Tom, 180 

DuBoise (professor), 11 

Duke-Elder, Sir Stewart, 22, 55-56, 96, 114, 117, 128, 186-188, 191, 213 

Dunnington, John, 42 



Einstein, Albert, 21 

Eisenhower, Milton, 101-102 

Elliot, Robert Henry, 106 

epithelial invasions, treatment of, 62-66 

Ewing, James, 14 

eye banks, 34-35, 60-61 

eye donation, 164-166 



Pell, H. B. ( 170 

Ferree, Clarence, 35, 103 

Filatov, Vladimir P., 61 

Filbert, Alvin B., 102 

filtration surgery, failure in, 108-109 

5-FU, 108 

Flieringa, H. J., 146 

Flocks, Milton, 68, 73 

fluorescein angiography, 67-69, 175 

Focal Point, 40-41, 128 

Forster, Helenor Wilder, 25 

Fothergill, 45 

Franceschetti, Adolph, 188-189 

Francois, Jules, 187, 190-191 

Frankfurter, Felix, 21 

Friedenwald, Jonas S. 

characterized, 21-22, 88 

coauthor of pathology textbook, 49-50 

death, 32 

research projects, 27, 35, 43 

on uveitis, 160 

mentioned, 25, 53, 55, 56, 87-88, 135, 147, 157, 165, 176, 211 
Friedenwald, Louise, 128 
Fuchs, Hofrath Ernst, 164 



Garron, Levon K, 58 

Gass, J. Donald M., 39, 69-70, 120, 154, 164, 166 



260 

Geeraets, Wolfgang A., 152 
Germuth, Fred, 140 
Giovanonni, Richard, 173 
glaucoma 

congenital, 109, 113-114 

low-tension, 117-118 

malignant, 146 

recessed-angle, 110 

surgical techniques, evolution of, 106-108 
gloves, surgical, 30 
Goebel, Albert, 103 
Goldberg, Morton F., 52, 119, 127, 174 
Goldmann, Hans, 67, 117 
goniopuncture, 107-108, 110 
gonioscopy, 106 
goniotomy, 72-73, 110 
Gordon, Daniel, 139 
Gospodarowicz, Denis J., 170 
Cradle, Harry S., 101, 197 
Grant, W. Morton, 44, 111 
Green, Keith, 142 
Green, W. Richard, 50, 71, 94 
Guerry, DuPont, III, 132 
Guy, George, 20 
Guy's Hospital (London), 141 
Guyton, David L., 120 
Guyton, Jack S., 25, 32, 38, 51, 112, 144, 149, 199-200 



Haffee, Paul, 144 

Halsted, William S., 29, 35 

Harms, H., 144 

Harriman, W. Averell, 73 

Hartline, Keffer, 116 

Hartman, Tom, 28 

Hassler, John, 174 

Hatfield, Mark, 178 

Hayes (physician), 14 

Hayes, Guy, 28 

Hayreh.S.S., 114-115 

Heidelman, George, 35 

Hellman, Louis M., 27 

Hendricks, Tom, 171 

Henkind, Paul, 115 

Hickman, John B., 68 

Highlights of Ophthalmology, 198 

Hill, Lister, 178-180 

histoplasmosis, 160, 164 

Hitler, Adolph, 10 

Hogan, Bart, 47 

Hogan, Michael J., 58, 158, 161, 179, 205 

Rollings, Fritz, 183 

Rollings, Peaches, 183 

Holman, Emile, 51-52, 56 

House, Howard, 201, 203 



261 



Hubel, David, 99 
Hughes, Fred, 14 
Hughes, William F., 32, 41 
hypotony, 112 



Indianapolis (ship), 47 

International Agency for Prevention of Blindness (IAPB), 186, 188-189, 195-197 

International Association for Prevention of Blindness. See International Agency for the 

Prevention of Blindness 

International Congress of Ophthalmology, 185-188 

International Council of Ophthalmology 

committee on uveitis, 161 

history of, 185-191 

prevention of blindness programs, 192-193 
intraocular lenses, 152-157 
iridectomy, 106 
iridenocleisis, 106 
I-Scrub, 173-174 
Ivermectin, 196 



Jaffe, Norman, 154-156 

Jampolsky, Arthur, 55 

Jensen, Carl D., 166, 214 

Jerusalem Seminar on the Prevention of Blindness, 193-194 

Johnson and Johnson nylon sutures, 144 



Kalt, Marcel, 150 

Kasner, David, 147-148 

Kaufman, Herbert, 144 

Kellogg, W. K, 102 

Kellogg Foundation, 102 

Kelman, Charles D., 66, 155 

Kennedy, Foster, 14, 126 

Kenyon, Kenneth R., 121 

keratinization of the conjunctiva, 169-170 

Khodadoust, All A., 1, 97, 136, 138 

Kimura, Samuel J., 58 

Knapp, Arnold, 31 

Knox, David, 168 

Koelle, George B., 21 

Kornblueth, Walter, 65, 135, 137 

Kos, Mike, 201, 203 

Krasnov, Michael, 191 

Krause, Arlington C., 35 

Kronfeld, Peter C., 108 

Krwawicz, Tadeusz, 66 

Kuffler, Stephen, 99 

Kupfer, Carl, 104, 182-183, 195 



Ladd, Lily Radcliff, 3, 5, 9 
Langham, Maurice E., 91-92, 95-96 



262 

Lasker, Mary, 178, 183 

Leajune (otolaryngologist), 201 

Leibowitz, Howard M., 98, 140-141 

Leopold, Irving H., 44, 180, 205 

L'Esperance, Francis A., 132 

Lieberraan, Mark, 115 

Lindner, Karl D., 31, 54 

Little, Hunter L., 133 

Logia, N. M., 191 

lupus erythematosus, research on, 27 



M 



Machemer, Robert, 147-148 

Mackensen, Guenter, 144 

MacLean, Angus L., 35, 69, 102 

macular disease, classification of, 69-71, 133-134 

Maghraby, Akef El, 193 

Mahler, 196 

Maichuk, Y. P., 191 

Maumenee, Alfred Edward, I (father), 2-7, 10, 15 

Maumenee, Alfred Edward, II 

contributions to ophthalmology, 61-62, 108, 111, 142, 146, 169, 215 
family background and early education, 1-7 
internship, 17-18 
medical studies 

University of Alabama Medical School, 10-11 
Cornell University School of Medicine, 11-15 
memberships in medical organizations 

American Academy of Ophthalmology, 199-201, 205 

American Association of Ophthalmology, 203-204 

American Board of Ophthalmology, 206-207 

American Ophthalmological Society, 207-209 

International Agency for Prevention of Blindness (formerly, International 

Association for Prevention of Blindness), 188-189, 195-196 
International Council of Ophthalmology, 188-193 
Pan-American Association of Ophthalmology, 197-199 
naval service, 45-48 
research. See specific topics 
residency, 29, 33, 35-38, 39-41 
Stanford Medical School 

chairman, 51-55 
on teaching, 119-120 
undergraduate studies 

University of Alabama, 7-8 
Wilmer Ophthalmological Institute 
chairman, 87-88 
fundraiser, 95 

Maumenee, Alfred Edward, III (Trip) (son), 74-75 
Maumenee, Alfred Nicholas (paternal grandfather), 1, 2 
Maumenee, Mrs. Alfred Nicholas (paternal grandmother), 2 
Maumenee, Anne Elizabeth Gunnis, 74-75 
Maumenee, Anne Elizabeth (Libby) (daughter), 74-75 
Maumenee, Irene (Rene) Hussels, 89, 202, 212 
Maumenee, James Radcliff (Rad) (brother), 4, 15, 75 
Maumenee, Lulie Martha Radcliff (mother), 3-4, 6 



263 



Maumenee, Nicholas Radcliff (son), 202 

Maumenee, Niels Kim (son), 202 

Maumenee Research Building, Wilmer Ophthalmological Institute, 90 

Maurice, Dave, 142-143 

McCarey, B. E., 144 

McCormick, Robert E., 101-102 

McLean, John M. 

characterized, 30-32, 35 

cofounder of Association of University Professors of Ophthalmology, 179 

instructor, Academy course on cataract surgery, 144, 149, 199-200 

mentioned, 38, 41, 150 
McManus, Ed, 182 
McNamara, Robert, 196 
Medawar, Peter B., 49, 134, 136 
melanoma, diagnosing, 168 
Mellanby, E., 169 
Merck, Sharpe & Dohme, 197 
Meredith, Travis A., 151 
Meyer, Agnes, 196 

Meyer-Schwickerath, Gerd, 131, 133, 168 
Michaelson, Isaac, 193 
Michels, Ronald G., 120-121 
Miller, Neil R., 91, 120, 129 
Minckler, Donald S., 116 

Mind-Brain Institute, Johns Hopkins University, 127 
Mueller, Horst, 61, 138 
Mueller and Grishaber, 145 
mustard gas research, 43-44 



N 



Naquin, Howard A., 32 

National Advisory Eye Council, 182-183 

National Eye Institute 

founding of, 178-181 
National Institute of Neurological Diseases and Blindness (NINDB) 

Congressional funding of, 178 

grants, 57 

origins, 178-181 
National Institutes of Health 

Congressional funding of, 180 

grants, 37, 57 
Nelson, Russell, 19, 88-90 
nevus, differentiating from melanoma, 168 
nevoxanthoendothelioma, 167 
New York Academy of Medicine, 14 
Newell, Frank, 179, 200, 205 
nitrogen mustard gas research, 43-44 
Nixon, Richard M., 179 
Nconan, David J-, 202, 204 
Norton, Edward W. D., 155, 212 
Novotny, H. R., 68-69 



O'Brien, CecilS., 41-42, 89 
Ochterloney, M., 140 



264 

Office of Scientific Research and Development (OSRD), 43 

Offret, Guy, 135 

Oliver, Bo, 7 

onchocerciasis, reduction of, 196-197 

Ophthalmic Pathology Club, 26, 39 



Pacific Coast Oto-Ophthalmological Society, 59 

Pan-American Association of Ophthalmology, 197 

Parks, James J., 98, 140 

pars planitis, 158-159 

Pascal, Boo, 214 

patients, informing, 105 

Paton, David, 143, 146-147, 150 

Paton, R. Townley, 34, 60, 101-102 

Patz, Amall, 62, 90-91, 133 

Paufique, Louis, 135 

Payne, Brittain P., 198 

Perkins, Terry, 161 

Peter Bent Brigham Hospital (Boston), 14 

photocoagulation, 131-134 

Pierce, Dermont, 146 

Pierce, Harold, 130 

Pischel, Dohrmann K., 30, 33, 52, 55, 131-132 

Polack, Frank M., 141 

Prendergast, Robert A-, 98 

Puchkovskaya, N., 191 



Quigley, Harry A., 113, 115-118, 120, 129, 165 




RadclifF, Emma, 3 

Radcliff, Herndon, 3 

Radcliff, James, 3 

Radcliff, Stenson Smith, 3 

Rand, Gertrude, 35, 103 

Randolph, M. Elliott, 150 

Ray, Bronson, 14 

Reed, Lowell, 88 

Reese, Al, 113 

Research to Prevent Blindness, 101-103, 180 

retinal hemorrhage in newborns, 27-28 

retinal lesions, research on, 20 

retinal surgery, 130 

Rich, Arnold, 88, 140 

Richards, Victor, 56 

Ridley, Harold, 152-153 

Roberts, Seymour, 62 

Robinson, David A., 99 

Rones, Benjamin, 34, 88 

Rooney, Fred B., 180 

Royal Commonwealth Society for the Blind, 189 

Ryan, Stephen J., 162-164 



265 



Samuels, Bernard, 30 

Sanders, Murray, 44 

Sanders, Theodore E., 166 

Saudi, Prince Abdul Aziz Ben Ahmed Ben Abdul Aziz, 193 

Scheie, Harold G., 107, 109-111, 152 

Schepens, Charles L., 130-131, 158 

scleral support rings, 143, 146 

Sears, Marvin L. 

letter regarding Dr. Maumenee, quoted, 108, 110, 142, 166, 169 
Seeing Eye Foundation, 91 
Shaffer, Robert N., 58, 113, 206 
Shannon, James, 179-180 
Shearing, Steve, 154-155 
Silverstein, Arthur M. 

characterized, 142 

joins Wilmer Institute faculty, 91, 95 

research, 97-98, 136, 138, 163 

mentioned, 92, 95 

Simmons (director, Federal Food and Drug Administration), 104 
Sloan, Louise L., 30, 35, 103 

Sloan-Kettering Cancer Institute and Memorial Hospital (New York City), 14 
Smith, Henry, 149 
Smith, J. Lawton, 69, 120, 154, 202 
Smith, Ronald E., 127, 160 
Sommer, Alfred, 120 
Sourdille, G.-P., 135 
Specter, Dave, 142 

Spectra Pharmaceutical Services, 171-174, 215 
Spivey, Bruce E., 203-204 
Staggers, Harley, 180 
Stander, Henrich J., 15, 17 
Stanford Medical School, Division of Ophthalmology 

chairmanship, 51-55 

eye bank, 60-61 

faculty members, 56-57 
Stanford University Hospital, 87 
Stark, Walter J., 120, 155-156 
Steel, Elizabeth, 8 
Stein, Doris, 102 

Stein, Jules, 101-102, 179-180, 202 
Sterling, Wallace, 74 
Storz, Eric, 145 
Stough, Sellers, 7 
Straatsma, Bradley R., 134, 203 
Sulzberger, Marion B., 14 
surgical instruments, development of, 144-146 
sutures, comeoscleral, 31, 38, 143-145 
Swan, Kenneth C., 64 
Symington, Stuart, 178 



Tadini, 153 
Tamler, Ed, 169 



266 

Theobald, Georgiana, 64 
Thomas, J. V., 169 
Thygeson, Phillips, 58-59, 139 
Tolstoy (professor), 13 
tonography, 111 
tonometers/tonometry, 117-118 
toxoplasmosis, 25, 161 
Tranquility (ship), 46 
Trans-Pacific Yacht Race, 214 
Tseng, Scheffer C. G., 171-172 
tularemia research, 45 
Turner, Thomas B., 20, 90 



U.S. Navy (Marine Corps), 45 

University of Alabama Medical School (Tuscaloosa), 10-11 

uveitis 

classification of, 23, 160-162 

misdiagnosed as tuberculosis, 23, 25, 157-160 

immunologists' interest in, 163 



Vail, Derrick T., 68, 160, 188, 201 
Van Metre, Thomas, 159 
Verhoeff, Frederick H. 

on autohypersensitivity following cataract extraction, 149 

characterized, 26, 39, 71 

training in ophthalmology, 22 

mentioned, 25, 31, 132, 165 

Verhoeff Society. Sec Ophthalmic Pathology Club 
Vienna, ophthalmology in, 30, 33, 53-54 
visual field, theories on loss of, 114-117 
vitamin A and keratinization, 169-170 
vitamin K research, 27-28 
vitreous surgery, 146-148 
von Graefe, Albrecht, 106 
Vrabek, P., 115 



Wahlen, H. E., 160 

Wald, George, 99, 170 

Walsh, Frank B., 18, 30-32, 39, 87, 93 

Weeks, David, 102 

Weisenfeld, Mildred, 178 

Weiss, Paul A., 116 

Welch, William H., 18, 34 

Wheeler, Maynard C., 207 

WHO. See World Health Organization 

Wiesel, Torsten, 99 

Wilder, Helenor. See Forster, Helenor Wilder 

Wills Eye Hospital (Philadelphia), 124 

Wilmer, William Holland, 18, 22, 33, 35, 42, 88-89, 91, 103 

Wilmer Ophthalmological Institute (Baltimore) 

discriminatory policies, 19, 88 

fellowships, 91-92 



267 



funding, 95 

neuro-ophthalmology conferences, 93 

physical setup, 18-19, 100 

residents 

annual meeting, 39-40 

selection of, 36, 121-123 

training of, 29-30, 36-37, 94, 119-121, 123-128 

rounds, Monday and Thursday, 35-37, 92 
Wilson, Jean, 194 
Wilson, Sir John, 189, 193-195 
Winter, Prank C., 55, 61, 152, 192-193 
Wolff, Harold, 14 
Wolff, Stewart M., 110, 138 
Wolman, Abel, 21 
Wood (professor), 21 
Wood, Barry, 89-90 
Woodruff, M.F. A., 136 
Woods, Alan C. 

cataract operation, 38 

characterized, 24-25, 35, 200 

consultant to surgeon general of army, 46 

cortisone, views on, 139 

outpatient clinic, views on, 100 

retirement, 32-33 

rounds with residents, 35 

training in ophthalmology, 22, 31, 35 

uveitis 

diagnosing as tuberculosis, 23-24, 157-159, 164 
views on, 159-160 

and Wilmer residency program, 29 

mentioned, 15, 17, 32, 41, 47, 51, 53, 87-88, 90, 92, 101, 103, 107, 131, 160, 187, 211 
Woods, Alan C., Research Building, Wilmer Ophthalmological Institute, 93, 100-102 
World Council for the Blind, 189 
World Health Organization (WHO), 188, 195-196 
Wortis, Samuel Bernard, 14, 126 



xenon arc photocoagulator, 63-64, 131-134, 168 




Zeiss photocoagulator, 132 
Zimmerman, Lorenz E., 50, 164, 168, 205 
Zweng, Chris, 133, 159 



X s 

/\ 

* v % 




U. C. BERKtLbY LIBKAHIbb 




ISBN-1 -56055-068-6 



The Foundation of the 

American Academy of Ophthalmology