Jay taught me many things, not the least important one how little normal ophthalmologists know about optics and imaging. I hope he will find time to outline how future eye care professionals shall best cooperate instead of fighting each other.
Jay Enoch also knew Hans Goldmann well and worked with him closely. The Baltic Eye is permitted to print Jay´s treatise on HG....read and learn oh
Cogan Ophthalmic History Society Meeting, 2007
Hans Goldmann’s Golden Year in St. Louis:
Daily Research Bench Rounds with The Master!
Jay M. Enoch
School of Optometry
University of California at Berkeley
Berkeley, California 94720-2020
<jmenoch@berkeley.edu>
Abstract: The late Prof. Dr. Hans Goldmann took a well-earned year of sabbatical leave, shortly after having stepped down as Rector Magnificus of the University of Berne, Switzerland and from his Chairmanship of the Department of Ophthalmology in the School of Medicine at the University of Berne, Switzerland. Hans spent that sabbatical year (1967?) at the Department of Ophthalmology at Washington University Medical School in St. Louis, MO. He and Bernard Becker (and many of us in the Department) were long-time associates and friends. And what a year it was! Those who were present still speak of it with awe and respect. What fun, what excitement – what work!
Each of us had a variety of fascinating personal interactions with Hans. However, a single set of salient experiences stands out in all of our memories! Early-on, he established a daily routine of going from laboratory to laboratory on the 10th and 11th floors of McMillan Hospital in order to conduct daily bench rounds with each of the individual faculty/investigators. Mornings, he would appear in a well pressed and fresh lab coat, greet us with a gleaming smile, and upon entry into your lab, he would ask, ”Huh, Huh, so what’s new today?” And it was expected that you would have new data, or experimental results to show to him! He would then ask penetrating questions about your work, techniques employed, the data presented, etc., as well as make suggestions for improvements. He also usually had some kind words of encouragement. If you did not have something new, he had something new and exciting to tell you of his own! Questions on the latter were almost always considerably more difficult to answer, than if you had something new to offer!
As a result, the research faculty and staffs were literally driven to a creative frenzy in order to have something new to discuss or to demonstrate when the good Professor made his anticipated daily entry into the laboratory. The faculty operated in high gear. Every morning, the techs would lean out of our doors, and indicate to their investigator toiling away, “He is coming very soon; he is in the next lab now!” Oh, to finish in time!
Key words: (The late) Prof. and Rector Emeritus Hans Goldmann; Department of Ophthalmology, Washington U. Medical School in (St. Louis, MO); U. Berne Department of Ophthalmology (Switzerland); glaucoma; utrocular discriminations, i.e., the ability to distinguish which eye was stimulated by light; Stiles-Crawford effect, i.e., the directional sensitivity of the retina; anomalous color vision, protanomaly.
Background: Hans Goldmann (1899-1991, Fig. 1) was certainly one of the World’s most outstanding ophthalmologists and vision scientists. He had incredibly broad interests and an amazingly keen intellect. His personal library, contained on shelves which ran from floor to ceiling, adorned most of the numerous rooms in his lovely Berne home (and also in much of his second/vacation home in Gadero sopra Brissago). They contained a remarkable collection of all manner of books on ophthalmology and medicine in general, on vision science, on optics, and on a variety of interests of Hans (many of his interests lay outside of medicine and optics). I had the extra-ordinary good fortune to spend extended time periods in his company and at his homes for more than a decade. While technically I was not his student, I came to regard Goldmann’s contributions to my understanding of many issues as seminal. For 8 years I served as the liaison between ongoing NIH sponsored research organized and administered by Dr. Murray Goldstein of the NINDB and its successor organizations. This activity was jointly undertaken by the Department of Ophthalmology at Washington University in St. Louis, Chaired by Professor Bernard Becker, and by the Department of Ophthalmology at the University of Berne, Switzerland, Chaired by Professor Hans Goldmann. Much of this research addressed glaucoma, but certainly not all of it.
In my role, for the better part of a month each year, I was often invited as a guest in Hans and Erna Goldmann’s home(s) either in the Swiss Capital, Berne, or in Gadero sopra Brissago which was above Lago Maggiore and was located very near to the Italian border. For some time, the Goldmann’s owned two homes in the Brissago area, one directly on Lago Maggiore, and a second home some distance up the hillside from the Lake. It was in the latter home that the Goldmann’s lived when they were at the Lake. On occasion, the Goldmann’s kindly offered my wife and me the pleasure of staying in the lakeside home. It was common for us to spend quite a number of days working together during each visit. We discussed and debated data, protocols, approaches to problems, etc.
Together we would take walks, visit local restaurants, or often, Hans’ wife Erna would make rather simple but always tasty meals. After dinner, Hans would build a small fire in a quiet niche outside his hillside house overlooking Lago Maggiore, and together we would look-out across this body of water at the twinkling lights of the scattered houses and at the myriad of stars above. Hans often brought out a large woven-straw-covered bottle of Brolio Chianti Reserva or a fine white wine from Orvieto to be shared, and he would sing folk songs of his native Czechoslovakia and of the Swiss Cantons well into the night! For me, these were golden times.
Robert Moses from St. Louis took a one-year sabbatical in Berne with Goldmann. Bob used to tell of his first day(s) in Berne, at which time he was invited to join Professor Goldmann when he conducted regular bed rounds. After introductory presentation of a case by a resident, Goldman commented at some length on the patient’s management. Apparently Bob Moses (as he might do in St. Louis), said something like, “But Professor have you considered the XYZ approach….?” Immediately following this question, the assembled group of students, residents, fellows and faculty emitted an audible gasp! Apparently, it was unheard-of for someone to question Herr Professor. Knowing Hans well, he loved it!
Franz Fankhauser, one of the senior faculty at Berne (quite famous in his own right!), worked both with the late Paul Cibis and me during his extended stay in St. Louis. Franz was my first post-doc (or was I his – does it matter?) – I taught Fankhauser much about retinal optics and retinal functional properties; Franz brought me a gift from Hans, an advanced version of a Haag-Streit quantitative perimeter, and taught me how to use it properly! Franz’s first wife Verena served as my lab technician; Balder Gloor, and others of the Berne group spent extended time periods in St. Louis as well. Thus, when Hans Goldmann came to St. Louis on his sabbatical, there were numerous existing close friendships, often based on common interests.
There is uncertainty as to the precise year when Goldmann spent his sabbatical year in St. Louis. I consulted Bernard Becker and Franz Fankhauser on this matter. It was before publication of a joint research paper by Goldmann and me (Ref 1) was published in June, 1969, but it was after Hans retired from his administrative posts in about 1964.
Hans Goldmann’s Daily Bench Rounds: Shortly after his arrival in St. Louis, HG started to conduct “daily research bench rounds” (for want of a better term) in the Department of Ophthalmology at Washington University in St. Louis. This started out rather casually, but, in a rather short time, this developed into a daily ritual which endured until he returned home – and it was enthusiastically embraced by the faculty as a whole, both individually and collectively. We loved it. I had never heard of, nor had he ever seen such a thing!
It all appeared so very simple. That said, the writer assures the reader it was no simple matter. The diversity of active research projects at St. Louis was broad indeed, and the breadth of knowledge needed to engage in the sort of give and take daily performed by Goldmann was very extensive. Every morning, Hans would appear in a well pressed and fresh lab coat, greet each of us in our own laboratory with a gleaming smile, and ask enthusiastically, ”Huh, Huh, so what’s new today?” And it was expected that you would have new data, or newly determined experimental results to show to him! He would then ask penetrating questions about your work, techniques employed, the data presented, etc., as well as make suggestions for improvements. He also usually had some kind words of encouragement. If you didn’t have something new, he had something new, different, and exciting to tell you of his own! Questions on his new thoughts were almost always considerably more difficult to answer, than if you had something new to offer!
As a result, the research faculty and staffs were literally driven into a creative frenzy in order to have something new to discuss or to demonstrate when the good Professor made his anticipated daily entry into the laboratory. All of us operated in highest gear. Every morning, the individual technicians would lean out of their doors, and indicate to their investigator toiling away, “He is coming, he is in the next lab now(the Pathology lab, Bob Moses’ lab, Nancy Newman’s lab, etc.)” Oh, to be able to finish in time! It was really something to see 3 or 4 techs leaning out their individual laboratory doors in anticipation. The writer never has seen the equivalent activity performed before or since.
What if you did not have something new? It is useful to present, as an example, an instance when the author did not have something new to discuss with Hans. On one such occasion, Hans posed approximately the following question to me, “If I shine a light into one of your two eyes, and you were not told which eye had been stimulated, could you state properly which of the two eyes had been stimulated/excited?” I did not know the answer. Hans then went on to explain, in many species not having binocular vision, the individual animal’s survival depended upon correctly making such judgments. With advance of the eyes forward in the head, and both eyes facing forward, binocularity evolved. Hence, there was reduced need for this particular response capability. Thus, Goldmann properly raised the question, did modern humans retain this particular ancient perceptual capability or skill?
Goldmann and I considered this interesting question from a variety of points of view, and together, we decided to put a number of questions to the test. It turned out that this was not a simple task to conduct, because one had to rule out quite a number of clues available to the observer. Further, as we got more deeply into the matter, we looked not only at foveal and central retinal responses, but also at visual performance at different loci in the visual field. And we learned that we needed to determine if there was a practice and/or learning component associated with this form of visual stimulation.
In time, we determined that most individuals retain some degree of this ancient
capability, that this visual function proved to be stronger in the fovea and in central vision than in the peripheral visual field, that performance was related to stimulus duration, and, to some extent, practice enhanced this response capability. Additionally, it proved not to be a simple task to manage these data sets statistically, and to do so without bias. In the end, quite a satisfactory result was obtained. (Ref. 1)
Naturally, Goldmann and I asked whether previous work had been done on this and/or associated topics. A question arose as to what key word or words one needed to use in order to access available literature. It turned out that a number of prior psychophysical studies had been conducted on related topics. (see Refs. 1-3) Such judgments are termed utrocular discriminations. Utrocular discrimination was defined as the ability to distinguish which eye was stimulated by a luminous stimulus. This term is taken from the Latin uter, or utero which translates variously as (1) one of two, (2) one from two, or (3) which one of two? To prevent confusion, our paper in (then) Investigative Ophthalmology was titled, "The ability to distinguish which eye was stimulated by light." (Ref. 1) Smith (Ref. 2) wrote a then good review of existing studies relating to this topic, and he credited von Helmholtz (Ref. 3) with first consideration of aspects of the problem (in 1866). Even though these studies existed, ours made rather considerable advances regarding the utrocular discriminations.
Goldmann’s Ability to Address Critical/Significant Questions: In a recent issue of Science, in a fine book review, Stephen Frank (Ref. 4) poses the question, “How does one identify a significant idea?” He then quotes the mathematician G.H. Hardy (Ref. 5), as stating, “We may say, roughly, that a mathematical idea is ‘significant’ if it can be connected, in a natural and illuminating way, with a large complex of other mathematical ideas. Thus, a serious mathematical theorem, a theorem which connects significant ideas, is likely to lead to important advances in mathematics itself and even in other sciences.” Frank (Ref. 4) further argues that this statement can be applied to any discipline.
There are many examples of Hans Goldmann’s skill at asking or raising critical questions, that is, questions which led to definitive developments, or to analytical assessments of a patient’s problem or data, or to further authoritative research on selected topics. He literally cut to the core of the problem. He asked decisive and trenchant questions addressing necessary and sufficient conditions of the issue being considered. (The terms decisive and trenchant are used here in their most positive senses.) The writer will cite here one of his favorite papers by Goldmann, one that literally settled a question of both theoretical and practical importance which applies to a number of retinal response functions. Sadly, this brief, but elegant work has not attracted the attention it deserves. (Ref.6)
The Stiles-Crawford Effect (SCE) was discovered in 1933.(Refs. 7,8) It was found that when considering the central retina, rays of radiant energy stimulating vision entering the eye pupil at or near to its center were more effective at inducing visual responses than rays passing through the eye pupil at points nearer to the peripheral boundaries of the pupillary aperture. After 1933, but prior to Goldmann’s paper (Ref. 6), it had been found that when testing retinal loci away from the central retina at lower radiant energy levels, there was less of a SCE found when varying ray entry location at various points in the eye pupil. Varying positions of beams entering the eye pupil affects the angle of incidence (Goldmann calls this the “azimuthal angle”) of radiant energy impinging upon or striking the retina or the photoreceptor layer, and this, in turn, alters the responsiveness of the visual system. The “simple” question Goldmann addressed was, did this rather unique response-effect occur pre-retinally in eyes of normal observers, or did it occur perhaps at the photoreceptor layer itself ? The SCE is not a small effect! Its magnitude, when sampled across the eye pupil, approaches a log unit. The magnitude of the SCE, at a given retinal locus and when employing similar stimulus conditions, is normally/ordinarily quite similar across individuals sampled.
In his paper Hans argued that discoveries regarding this matter prior to 1942 essentially met necessary, but not all sufficient conditions relative to this problem (see discussion of literature citations in Ref. 6). So saying, he added that while the evidence presented to date by others pointed most probably to a retinal-based effect, in each instance there were possible exceptions to the arguments presented. Then, to test the question, he performed a simple, but elegant experiment. He introduced two narrow equivalent beams of rays of radiant energy (contained within the visual spectrum) into the dilated eye pupils of his subjects. One narrow radiant beam passed through the center of the eye pupil, the second entered the eye pupil rather peripherally (and, thus, it was incident at the retinal plane at a somewhat oblique angle). Both of these beams were imaged at nearly adjacent points on the retina. The patient/subject could readily detect a difference in perceived brightness of these two images (as expected, and induced by the SCE). But when he, Goldmann, using an ophthalmoscope, observed these same two images upon the retinas of his subjects, he could not perceive a difference in retinal brightness of the images at the two test points sampled. He found no exception to this finding across subjects tested. Hence, in effect, he could then have concluded (from the Latin) Q.E.D. or quod erat demonstrandum, or ‘which was to be shown or demonstrated’ that the Stiles-Crawford effect described occurred posterior to the observed surface of the retinal plane.
Some Comments On The Glaucomas: I would be remiss if I didn't mention my many discussions with Hans Goldmann on the general topic of the glaucomas over a period of several years. As noted, Hans was a multi-dimensional individual/ ophthalmologist; glaucoma was only one of his interests, but it was indeed a major one. So saying, he often expressed to me his own uncertainties regarding our collective understanding of these disorders, per se; as well as matters associated with detection and management of the glaucomas. Most properly, Goldmann is well remembered for his many contributions to a wide variety of issues associated with studies addressing these diseases. Frans Fankhauser and Sylwia Kwasnieuska recently wrote a major tract titled "Hans Goldmann: The legacy of a titan." (Ref. 9) JME urges the reader to seek that source for extended citations to the contributions of Hans Goldmann. Fankhauser also called my attention to another article he wrote on Goldmann in Ophthalmic Surgery. (Ref. 10)
Goldmann was clearly troubled by the then definitions of glaucoma and our less than complete understanding of these disorders as a group. He would often return to debates on the glaucomas, per se, and particularly to consideration of either or both, ocular hypertension, and low tension glaucoma. [Here, I quote from his obituary of Prof. Goldmann published in 1994, rather than to try to reconstruct these thoughts from memory over an even more extended time period.] (Ref. 11) "He (Goldmann) worried if ocular hypertension was, in part, a 'quiet period' in the development of glaucoma and he sought to determine how to differentiate the initiation of such a quiet period before overt manifestations occurred. Also, he did not believe there was some magic number of measured intraocular pressure which signaled the need for initiation of treatment for open-angle glaucoma. However, he did establish a practical protocol for the University Eye Clinic at Berne. That is, 22.5 mm Hg was used as the dividing line. He encouraged his associate, Theo Schmidt, to conduct extended statistical studies on probability distributions designed to differentiate normal from abnormal intraocular pressures. However, he felt the issue to be complex, and the measurements used were often too imprecise to use as the sole means for discriminating the presence of glaucoma and for defining therapy."
In Summary: Professor Goldmann, during his sabbatical leave in St. Louis, succeeded in enriching, engaging, and greatly stimulating the ophthalmic research enterprise at the Washington University Medical School in a most gracious and remarkable way.
An added note, I presented a demonstration lecture on color mixture and anomalies of color vision to the residents during this same time period. Hans, who was known to be protonomalous (there are early citations referring to him in the European literature, calling him “the protanomalous Goldmann”), asked me to allow him to demonstrate his color mixture settings to the assembled audience. He did so and compared his settings to those of normals assembled in the audience. This most dedicated of teachers never failed to instruct and to illuminate points of interest to those about him.
I sought to adopt a number of his methods in his own laboratory in his own day to day interactions with his students, but I could never claim to have succeeded in the manner that Hans did during that golden year in St. Louis! It was not some-lightly held judgment which led the author to designate Hans Goldmann as The Master!
References:
1. Enoch, J.M., Goldmann, H., Sunga, R.: The ability to distinguish which eye was stimulated by light. Invest. Ophthalmol. 8(3): 317-331, June, 1969. A lengthy list of applicable references is enclosed.
2. Smith, S.: Utrocular or "which eye" discrimination. J. Exp. Psychology 35: 1, 1945. A review of the applicable literature.
3. von Helmholtz, Hermann : in Southall, J.P.C., ed, Handbook of Physiological Optics, Vol. III (translated from the German 3rd Edition, 1910): reproduced from the Optical Society of America Edition, in New York, by Dover Press, 1962, p. 458.
4. Frank, S.A.: Master class in evolutionary modeling. Science 314 (#5807): 1878-1879, 22 December 2006.
5. Hardy, G.H. : A Mathematician’s Apology. Cambridge, UK, Cambridge Univ. Press, 1967.
6. Goldmann, H.: Stiles-Crawford Effekt. (in German): Ophthalmologica 103 (#4): 226-229, 1942.
7. Stiles, W.S. and Crawford, B.H.: The luminous efficiency of light entering the eye pupil at different points. Proc. Roy. Soc. Lond. (Series B) Vol. 112: 428-450, 1933.
8. Enoch, J.M., Tobey, F.L., Jr.: Vertebrate Photoreceptor Optics, Vol. 23 Springer Optical Science Series, Berlin, Heidelberg, New York, Springer-Verlag, 1981. ISBNumbers 3-540-10515-8, and 0-387-10515-8. A summary of research on this topic. It includes the Stiles-Crawford Effects.
9. Fankhauser, F., Kwasniewska, S.: Hans Goldmann: The legacy of a titan. Anals del Instituto Barraquer, in press, December 2006.
10. Fankhauser, F.: Hans Goldmann. Ophthalmic Surgery 25: 8-12, 1994.
11. Enoch, Jay M.: Tribute: Hans Goldmann (1988-1991). Opthalmic and Physiological Optics 14(July): 330-332, 1994.
