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, 1948—1955; 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 school1?
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 faculty1?
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 ophthalmology1?
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 diamond1?
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 ship1?
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 idea1?
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
PW«MTIO« 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 glaucoma1?
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 removed1?
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; 64:540—49.
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 "uveitis1: 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; 40:18—41.
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 ah1 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
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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
committee1?
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 hah0 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 [1985—1986]. 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 racing1?
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 1939—42;
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), 1944—46.
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, 1955—78.
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, 1982—90.
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, 1969—71;
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, 1972—75.
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 7:430—34, 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 29:110—16, 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 54:532—41, 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 44:445—83, 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.
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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 3:11—25,
1972.
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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; 235—49;
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.
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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.
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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 Tc199 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.
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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 11:99—101, 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 89:31—45,
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.
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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, 106—11, 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 103:422—25,
1985.
308. Terry AC, Stark WJ, Newsome DA, Maumenee AE, Pina E. Tissue toxicity of
laser-damaged intraocular lens implants. Ophthalmology 92:414—18, 1985.
309. Maumenee AE, Stark WJ, Esente I, eds. Cataract Surgery and Visual Rehabilitation.
Proceedings of the Third International Congress, Florence, Italy, May 9—12, 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 92:1675—80, 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 17:644—49,
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 86:3—4,
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
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