Saturday, February 16, 2008

9 - arlt's line , arlt's operation , arlt's syndrome - carl ferdinand von arlt

Carl Ferdinand Ritter von Arlt

German ophthalmologist, born April 18, 1812, Obergraupen near Teplitz in Bohemia; died March 7, 1887.

Arlt's line - Carl Ferdinand Ritter von Arlt - Horizontal, linear scarring of the upper tarsal conjunctiva. A classical sign of trachoma.

Arlt's syndrome: a contagious eye infection caused by Chlamydia trachomatis.

Arlt's operation: transplantation of eyelashes back from the edge of the eyelid for treatment of distichiasis.

Carl Ferdinand Ritter von Arlt was the son of a poor mining smith. He had a rough childhood and study time, attending the gymnasium in Leitmeritz and the University of Prague. He was trained in ophthalmology by professor Johann Nepomuk Fischer (1777-1847), the founder of modern eye medicine in Bohemia, and was conferred doctor of medicine in Prague in 1839. From October 1846 to July 1849 he worked as a supplementary at the chair of ophthalmology in Prague, and from August 1849 to July 1856 was professor of ophthalmology in Prague.

Upon the death of Anton Edler von Rosas (1791-1855) he was called to take over his chair in Vienna, holding this tenure from the autumn of 1856 to the end of July 1883, when he retired at the age of 70. However, although regulations forced him to leave office, Arlt continued his scientific and practical work. No less was expected from a man whose iron will and great intellect had brought him up from poverty to the peaks of academic prestige.

Arlt's great achievement lies not only in his own research and his skill as an eye surgeon, but as much in his influence on the development of ophthalmology. His brilliant lectures attracted large number of students, one of them the 17 year younger Albrecht von Graefe, who looked him up in Prague. Arlt was instrumental in influencing von Graefe to concentrate exclusively on this branch of medicine.

Despite his high office he lived in a simple, undemanding way, always opening his hand to people in want, and a fatherly friend to poor students. He maintained a lifelong attachment to his home in the Bohemian Erzgebirge, and every year visited his birthplace in order to assist the numerous people in the vicinity suffering from diseases of the eyes.

Arlt was a prolific writer. Besides his numerous books and articles, he wrote a brochure on the eye care in which he urged eye physicians to establish the strength of eyeglasses themselves, not to leave it to the optician. In his work on the diseases of the eye he presented the proof that short-sightedness is normally a consequence of an elongation of the sagittal diameter of the bulbus of the eye.

He died of Gangraene senilis on March 7, 1887. His son, born December 28, 1842 in Prague, also named Ferdinand Ritter von Arlt, followed his father into the discipline of ophthalmology. He worked at the University clinic and for years was the private assistant of his father. He practiced ophthalmology in Vienna and died there on February 23, 1917.

It was still early in his career when Arlt began publishing his large work on diseases of the eye, and in 1855, with Franz Cornelis Donders (1818-1889), became a co-editor of the journal Archiv für Ophthalmologie, which had been founded by Albrecht von Graefe.

Arlt described an operation for transplantation of the ciliary bulbs in the treatment of distichiasis.


Bibliography:

  • Pflege der Augen im gesunden und Kranken Zustande, neben einem Anhange über Augengläser.

  • Prague 1846; revised editon, Prague, 1868.
  • Die Krankheiten des Auges.

  • 3 volumes, Prag, F. A. Credner & Kleinbub, 1851, 1853 and 1856.
  • Retinitis nyctalopica, From ”Der Bericht ueber die Augenklinik.”

  • Translated, with consent of the author, by J. F. Weightmann, M. D., of Philadelphia.
    23 pages. Philadelphia, Lindsay & Blakiston, 1868.
  • Treatment of lachrymaal affections. Translated, with consent of the author, by J. F. Weightmann, M. D.

  • Philadelphia, Lindsay & Blakiston, 1868.
  • Operationslehre.

  • In Edwin Theodor Saemisch and Albrecht von Graefe: Handbuch der gesamten Augenheilkunde. Volume 3. Leipzig 1874.
  • Die Verletzungen des Auges. Vienna, 1875.

  • Die Kurzsichtigkeit, Enstehung und Ursachen. Vienna 1878.

  • Klinische Darstellung der Krankheiten des Auges zunächst der Binde-, Horn- und Liderhaut, dann der Iris und des Ciliakörpers. Wien, Braumüller, 1881.

  • Zur Lehre vom Glaucom. Vienna, 1884.

  • Meine Erlebnisse. Autobiography, Wiesbaden 1887.

  • Otto Becker, pupil of Arlt, completed his autobiography: Letzte Lebensjahre, Krankheit und Tod. Bibliography; list of honours.

    A selection of his journal papers:

  • Aphoristische Bemerkungen über einige Augenkrankheiten.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1844.
  • Physiologisch- und pathologisch-anatomische Bemerkungen über die Bindehaut des Auges.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, volume 12: 70-79.
  • Ueber Trichiasis und Entropium.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1845.
  • Zur pathologische Anatomie des Auges.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, volume 14: 44-61.
  • Ueber das Trachom.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1848, 18: 41-68.
  • Zur pathologische Anatomie des Auges.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1847.
  • Ueber Trachoma.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1848.
  • Zur Nosographie und Nosogenie des Flügelfelles.

  • Vierteljahresschrift für die praktische Heilkunde, Prag, 1848, 18, 73-92.
  • Ueber den Thränenschlauch.

  • Archiv für Ophthalmologie, Berlin, 1855, I.
  • Form und Lage des Corpus ciliare und der Iris.

  • Archiv für Ophthalmologie, Berlin, 1857, III.
  • Der Ringmuskel der Augenlieder.

  • Archiv für Ophthalmologie, Berlin, 1863, IX.
  • Zur Behandlung der Thränenschlauchleiter.

  • Archiv für Ophthalmologie, Berlin, 1868, XIV.
  • Zur Lehre von Hornhautabscesse.

  • Archiv für Ophthalmologie, Berlin, 1870 XVI.
  • Winke zur Staaroperation.

  • Archiv für Ophthalmologie, Berlin, 1885, XXI.

    8 - tay sach's disease - bernard sachs

    Bernard Sachs

    American neurologist, born January 2, 1858, Baltimore, Maryland; died 1944


    Tay-Sachs disease = an autosomal recessive disorder involving the lysozymal enzymes. The result is neuronal degeneration and cherry red spot of the eyes. Death occurs before 3 years of age.


    Bernard Sachs’ parents were of Jewish descent. His father was a teacher who had grown up in a small town in Bavaria near Schweinfurth. Whilst studying in Würzburg, he eloped with a girlfriend to Hamburg in 1847 and boarded a ship to the U.S.A. They had six children.

    Although he early decided to pursue a medical career, Bernard Sachs first concentrated his studies on literature and the classics. He studied at Harvard Medical College in Cambridge from 1874 to 1878. One of his teachers, the psychologist and philosopher William James (1842-1910), was having trouble with his eyes and asked a member of the class to read a chapter from Wilhelm Wundt’s Psychology. Sachs undertook this task and this aroused his interest in the study of mental disorders.

    Sachs graduated B.A. from Harvard with honours in 1878 and went to Europe where he studied medicine in Strassburg, Vienna, and Berlin. He chose Strassburg because of the strong medical faculty at the time. He was most impressed by Adolf Kussmaul (1822-1902) but also found von Fredrich Daniel Recklinghausen (1833-1910) an inspiring teacher. Sachs quoted a comment of Wilhelm von Waldeyer-Hartz (1836-1921) who did not like any of the textbooks of anatomy except Josef Hyrtls (1810-1894) because “it contains anecdotes: you will remember the anecdotes and promptly forget the anatomy.”

    While working with Friedrich Leopold Goltz (1834-1902) Sachs wrote his first paper which appeared in Virchow’s Archiv für pathologische Anatomie und Physiologie und für klinische Medicin in 1882. He visited and worked with Karl Friedrich Otto Westphal (1833-1890) and Rudolf Virchow in Berlin. After receiving his degree from the University of Vienna in 1882 Sachs, along with fellow student Sigmund Freud (1856-1939), remained to continue postgraduate studies in cerebral anatomy and neuropsychiatry with Theodor Hermann Meynert (1833-1892). Later, in 1885, Sachs translated Meynert’s classic treatise Psychiatrie.

    To round off his education in medicine and neurological science Sachs spent a year with Jean-Martin Charcot (1825-1893) in Paris and John Hughlings Jackson (1835-1911) in London.

    Sachs sailed back to the U.S.A. in 1884 to live in New York, where his parents had settled. He spent three years in New York as an assistant to Isaac Adler (1849-1918), before establishing a private practice for the treatment of mental and nervous diseases. In 1887 Sachs, now recognized as one of America’s leading clinical neurologists, became an instructor at the New York Polyclinic Hospital.

    At this stage he wrote his article on arrested cerebral development with special referance to its cortical pathology, in which a cherry red macula had been noted clinically by his associate Herman Jakob Knapp (1832-1911). Later on, recognising the familial nature of the condition, he called the disorder “amaurotic familial idiocy”. He was unaware that Tay had already published an account of brownish-red circular spot in each macula surrounded by a whote halo in an infant. Tay considered the change to be similar to the picture of embolism of the central artery of the retina. Hughlings Jackson had been called as a consultant and was unable to find any evidence of cerebral problems. Later it was recognised that Tay and Sachs were seeing different facets of the same condition.

    In 1893 he was appointed consultative neurologist at Mount Sinai Hospital in New York and consulting physician to Manhattan State Hospital. At Mount Sinai he helped arrange for the establishment of a neurological bed service, the first separate division of its kind in a New York health facility.

    Sachs was an intelligent man with a strong sense of humour. He was outspoken and could be very sharp in repartee, but he was also a very generous man. As a neuro-psychiatrist he was often called to court cases and in his autobiography tells the story of a lady who was suffering from senile dementia and who had left most of her money to the lawyer who had drawn up her will. “I suppose’, asked the cross-examining lawyer, “that it is very easy for you, Dr. Sachs to tell whether a person is sane or insane. I presume you can tell by looking at me whether I am sane or insane.’ Very promptly I answered ‘Not by looking, but possibly by listening to you.’ That settled him.”

    He had a lucrative private practice but he lost most of his money when the stock market collapsed. Gradually, however, he regained his losses to become a philantrophist and art collector.

    Sachs published almost 200 articles and several books including The Normal Child (1926) wherein he largely advocated that parents should be guided by common sense and not pyschological theories, and in which he particularly attacked Freudian pyschology. This followed an earlier work directed at the medical profession rather than the lay public, Nervous and Mental Disorders From Birth Through Adolescence.


    Bibliography:

    • Die Hirnlähmungen der Kinder.

    • [Volkmann’s] Sammlung klinischer Vorträge, Leipzig, 1892.
    • A treatise on the Nnervous Diseases of Children.

    • New York, 1895; 2nd edition, 1905.
    • Syphilitic and Parasyphilitic Diseases of the Central Nervous System.

    • In: Modern medicine: its theory and practice, in original contributions by American and foreign authors", edited by William Osler, assisted by Thomas McCrae. Philadelphia and New York: Lea & Febiger, 7 volumes, 1907-1910. Volume 7, chapter XVII, pp. 682-720.
    • Amaurotic Family Idiocy (Tay-Sachs disease).

    • In: Modern medicine: its theory and practice, in original contributions by American and foreign authors", edited by William Osler, assisted by Thomas McCrae. Philadelphia and New York: Lea & Febiger, 7 volumes, 1907-1910. Volume 7, chapter XXI, pp. 868-874.
    • Nervous and Mental Disorders From Birth Through Adolescence.

    • With L. Hausman. New York, 1925.
    • The Normal Child. New York, 1930.
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