Highlights in Danish Ophthalmology 1880-1900.
In 1880 very few Danish ophthalmologists travelled or treated patients in foreign countries. It is remarkable, that Jørgen Vilhelm Ammundsen (1846-1886) was in Turkey. He was born in Jutland. He had a busy ophthalmologic practice in Kolding, Jutland including cataract extractions. His experiences were from his remarkable ophthalmologic practice in Turkey, in Smyrna= Izmir and in Erzerum 1877-78. The period in Turkey was complicated with the war and serious typhoid epidemic. Sadly, he died of typhoid fever in Kolding, Denmark, only 40 years old.(1).
About 1880 some remarkable scientific works were done. Carl Julius Salomonsen (1847-1924) injected tuberculous caseous material from a patient into four eyes in rabbits. They contracted tuberculous nodular iritis, demonstrating the contagiousity of the common serious disease at that time. It was in 1877, five years before Robert Koch found the bacil (mycobacterium tuberculosis, M.T.).
In 1883 Salomonsen became the first bacteriological teacher at an university in the hole world. His laboratory was in a little room in the first floor in the library building in the Botanic Garden in Copenhagen (2).
Jannik Petersen Bjerrum (1851-1920) defended his medical thesis in October 26. concerning “Formsans” (distinction angle, Snellen letters) and “lyssans” (minimal light sense or contrast sensibility). He also examined vision in darkness, measured with Javal- Bjerrums gray tone letters in 5 Snellen plates and with Massons rotating discs.(Fig 1 and 2).
Bjerrum examined 50 patients. Some conclusions: Contrast sensibility is often diminished in optic nerve atrophy, dark sensibility is often diminished in chorioretinitis (3).
In the same year Grut was appointed temporary lecturer at the University (4).
In 1882 Marius Tscherning (1854-1939) examined 7500 men liable for military service concerning myopia. The examinations were done with one of the first electric ophthalmoscopes. This M.D. thesis is a very important scientific work, because we can compare the frequency in Denmark from Tscherning’s 8,3% in 1882 to E. Goldschmidt’s 14,5% in 1964, decreasing to N. Jacobsen’s 12,9% in 2004.- Contrary to most of the world, with increasing, nearly explosive development of myopia, cf. Hong Kong and also Greenland.
It should be remembered, that early ophthalmology without electric light was difficult, with Helmholtz’ three glass ophthalmoscope from 1850 and Coccius’ eye - mirror from 1853.,cf. Fig. 3, Liebreichs ophthalmoscope. The Danish Edmund Hansen Grut described the optic nerve in glaucoma as extreme prominating instead of excavated in his MD thesis in 1857.
From 1884 Marius Tscherning became assistant for Emile Javal at the Sorbonne University in Paris. In 1887 he defended his French medical thesis concerning Listings law, based on examinations with a gigantic perimeter, 4 m in diameter.
He measured the tilt of a vertical line in various positions of the eye, depending on the pull of the eye muscles, resulting in torsion.
It was necessary for Tscherning to get a French doctor degree, because the Danish M.D. was not accepted. He got only a part of Javal’s salary, because the economy of the University after the French German war was very miserable. In the beginning, Tscherning was not allowed to practice in France.
In 1887 he measured the curvature of lens in accommodation in his modified electric keratometer, Tscherning’s ophthalmo phacometer (5). The curvature increased centrally, most in the posterior part, but not in the periphery, perhaps caused by pressure of vitreous, after Tschernings opinion.
The very first professor in ophthalmology in Denmark was appointed in 1888: It was Edmund Gottfred Hansen Grut (1831-1907, Fig.4). The name Grut was added in 1882 from his English born mother (4). His private eye clinic from 1873 in Havnegade (Harbour Street, near the Royal Theater, not far from the University Hospital at that time: Frederiks Hospital) became the first Danish University Clinic, for surgery, with beds and ambulatory.
In the same year the Nordic ophthalmologic periodical was initiated: Nordisk Oftalmologisk Tidsskrift , with Grut as editor in chief. It disappeared for economical reasons in 1892. All together 1109 important scientific pages in Nordic languages were published.
Bjerrum described the arcuate scotoma in glaucoma in Danish together with case stories and his glaucoma theories: Nerve fibre compression in the excavated papilla, haemorrhage near the papilla, often independent of the IOP. After my opinion, Bjerrum’s conclusions could shortly be expressed in the following statements: The arcuate scotoma is almost pathognomonic for glaucoma. A haemorrhage on the papil-edge is an early sign of glaucoma and Bjerrum’s theory also include low tension glaucoma.
Five years later, Bjerrum wrote a book in Danish concerning ophthalmoscopic technique.(6).
Bjerrum was appointed professor in ophthalmology after Grut. Perhaps his position in Grut’s eye clinic was a factor, because the University should pay a new clinic for education, if Bjerrum was not appointed. On the other hand, Bjerrum’s scientific work: Arcuate scotoma and glaucoma was published and well known from 1889.
Andreas Eduard Stadfelt (1866-1924) defended his MD thesis in January 20 1899 concerning the optics of the human lens. He examined 13 lenses from 7 dead bodies 4-36 hours after death. He measured the focal point, lens thickness (with ocular micrometer) and lens curvatures (with Javal’s keratometer) . He found a radius of the anterior lens curvature: 10,95 mm, the posterior curvature 6,00; total refraction index 1,4352 and 18,77 diopters. His special devices are constructed by Ivan Werlein, Paris.The accessories are in a wooden box measuring 11 x 17 x 32 cm, now kept in Medicinsk Museion, University of Copenhagen (7).
1) Norn, M: Dansk øjenlæge i Tyrkiet 1877-78.Oftalmolog 1990; 10 (2): 25-30 (in Danish).
2) Salomonsen C J: Små - Arbejder. Levison: Kjøbenhavn. pp.462 (in Danish).
3) Norn M: Bjerrums disputats: Formsans og lyssans. Oftalmolog 2004; 24 (3) 22-24.(in Danish).
4) Dreyer V, Edmund J, Møller PM: The first Danish chairs in ophthalmology. Documenta Ophthalmol. 1992; 81,87-96.
5) Norn M, Jensen OA: Marius Tscherning. Acta Ophthalmol. 2004; 82: 501-508.
6) Bjerrum J: Den kliniske undersøgelse af synet. Priors Forlag, Kjøbenhavn 1894, pp 195 (in Danish).
7) Stadfelt A: Den humane linses optiske konstanter. C.A. Reitzels Forlag, Kjøbenhavn, pp 168 (in Danish).
Fig. 1. Bjerrums gray tone letters.
Fig. 2. Masson’s disc 1840.
Fig. 3. Liebreich’s eye mirror, Medicinsk Museion RIN 100365.