1916-1984
olle holm
I first met Jørn in the early seventies when Bruce Cohan of Ann Arbor brought JBA from his home town of Copenhagen to the eye clinic of Lund; Jørns first visit back to where he got his initial ophthalmology training. At the time I knew nothing of JBA...had not even heard of him. I quickly understood that there were all kinds of conflicts hidden. It took a little longer to understand that JBA was one of the true ophthalmology pioneers of the time. There is little doubt that Jørn Boberg-Ans was one of the real innovators in Nordic ophthalmology. Had he early been given a university chair, ophthalmic micro-surgery had come here ten years earlier.
It is with great satisfaction I now take the chance to present him to a wider audience. In the column to the left two of JørnÉs collegues and friends in the US tell their stories. To the right is a fresh interview with son Jannik.
Here comes the obituary from Oftalmolog, 1984, written by wife Sonja and son Jannik:
"Jørn was taught to fight and to rely on himself from his earliest youth. His mother sent him off to school wearing his oldest sisters' clothes: 'This coat was warm enough for your sisters, so it'swarm enough for you'. Jørn found the coat not just warm, but hot... for he knew what awaited him at school - teasing and being beaten up by his schoolmates every day! Perhaps it was due to those early experiences that the words of Søren Kierkegaard : What else is truth but fighting for an idea?' made such an impact on him later in life. During the war Jørn joined the underground movement ' getting Jews out of Denmark and was later forced.to escape to Sweden himself. His future life as an ophthatmologist was actually decided when he received his lirst training in this field in Lund, with Professor Sven Larsson. When the war ended, he returned to Denmark to continue his formal education, with ophthalmology as his specialty. In 1952, he completed his doctoral thesis on cornea sensibility and, in connection with this, constructed the Boberg-Ans sensibilometer. Jørns job became his hobby, and his private operating theatre his hobby room. He enjoyed performing anterior segment surgery, often on cases given up as hopeless elsewhere. His motto was: Leave the eye as you wish to find it next day - nature does not put tissue back in place without the help of the surgeon.
To improve his surgery technique and study new developments, Jørn never stopped travelling - establishing close and inspiring contacts with colleagues all over the world. Many of them became his closest friends, and many visitors from abroad came to our theatre to watch his operations.
Jørn had an enormous capacity for work, saw patients 9 h a day - an operating day usually included 7 operations (total about 300 a year), and his evenings were spent reading the latest literature in his field. Before or after working hours, he found time to ride his horse, play tennis, do the garden, maintain the house - with himself in the role of plumber, carpenter, or electrician (he mastered all kinds of tools). He became a pioneer within intraocular-lens implantation - started implanting lenses in about 1958, with good results. He designed an anterior chamber lens and, later, the Boberg-Ans Anterior, iris-fiixated lens, which became very popular.
JBA arranged four international COC con-ferences in Charlottenlund with 30 invited participants each time carefully chosen on the basis of a few criteria: they had to be highly recognized surgeons, they had to be entertaining to be with, and, most important of all, they had to have a good sense of humour.
Jørn was one of the founding members of I O.M.S.GU in 1966 and one of the courag-eous twelve who founded IIIC in 1968. As a person Jørn was relaxed and informal in his approach to patients and friends, expecting to be met in the same way. Not everyone accepted his direct, sometimes rough sense of humour. In the crowded waiting-room, he might suggest that a patient mow the lawn: "As l am delayed, you may as well have a little exercise instead of just sitting there". Mostly, his suggestions were accepted. Jørn was always doing several things at a time; talking on two phones, dictating a letter, and giving orders to his secretaries - often with a grandchild to be looked after in a chair in the corner of the operating theatre. His family was closest to his heart - he loved to have all of us around him and was never too busy to give a hug or acomforting hand - he was always in a good mood, never lost his temper. And we loved him. Would that he had lived to experience the honour and respect paid to him today! ' What does living as an ugly duckling matter when you end as a swan! "
We let Jørn continue
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(TBE regrets the limited accessibility of the next article. Part of its strength would be lost in translation. Our apologies to those who do not read Danish. oh)
UDBYTTET AF VIDENSKABELIGE MØDER
Ur Nordisk Medicin, dec 1958
Af Jørn Boberg-Ans
De sædvanlige former for vore viden-skabelige og faglige møder indenfor de nordiske lægeselskaber, måske sarlig inden-for specialselskaberne, bærer præg af en vis konservativ stivhed i planlœgningen, selvom møderne sikkert for de fleste forløber pâ en som sadvanlig tilfredsstillende facon.
De fleste af medlemmerne kommer til møderne, mâske ikke fordi programmet fagligt interesserer dem særligt, so for at møde kelleger og ved sin nærværelse vise, at de stadig ikke er gâet i stâ men fortsat er videnskabeligt intresserede. De forskellige videnskabelige foredrag følges ofte uden synderlig opmærksomhed, idet medlem-merne dog engang imellem i almindelighed nikker genkendende til visse pâstande og nyheder, som de synes at have hørt om tidligere - og derved falder sikkert mange til ro ved bevidstheden om, at det var en meget interessant aften, som man her passivt overvœrede, og der fremkom ikke noget sarlig nyt, som man ikke tidligere havde vidst lidt om. De sœdvanlige to, tre professorer og andre professionelt eller vanemassigt vågne siger nogle bemœrk-ninger. Ved formandens afsluttende spørgs-mâl, om nogen har noget at sige, ser de fleste interesserede pâ klokken i det håb, at det snart er tid til det fœlles spisebord.
En fornyelse af denne mødesform med mere aktivitet fra auditoriets side er måske vanskelig at foreslâ, men ikke mindre tiltrængt af den grund. Det har man ogsâ forstået i udlandet, særligt i Amerika, men ogsâ ved forskellige kliniske og videnskabe-lige centrer i Europa.
Man har ved et kort inledende orienterende føredrag, efterfulgt af direkte personlige diskussioner med deltagelse af alle for-modede kyndige indenfor omrâdet, medin-draget største delen af auditoriet i aktiv deltagelse i diskussionerne. Uden hensyn til den enkeltes personlige opfattelse af sin egen ufejlbarlighed og værdighed bliver diskussionen prœget af divergerende anskuelser, begrundet i de enkelte del-tageres egen erfaring og opfattelser.
Som dirigent ved sâdant et møde vœlges en person, som har særlig kendskab bâde til emnet og til de forskellige synspunkter og gerne samtidig er i besiddelse af en tilpas mangel pâ œrbødighed for diskussionsdel-tagerne, sâledes at han kan stille tilstrakkelig indiskrete spørgsmâl. Det er nemlig altid forfriskende og lererigt at høre en erfaren læge besvare sporgsmål om, hvad han gør med de tilfœlde der ikke går, som de skal, og hvormange det er, samt hvorfor han vedvarende anvender den eller den metode, når so og so mange andre synes, der er nyere og bedre.
Disse konferencer kan efter optagelse pâ band siden redigeres og udgives, og er til stor nytte for interesserede som pâ denne måde får adgang til intens diskussion og belysning af små, afgrænsede emner. Det kan gøres i bogform eller i et tidsskrift. I modsætnlng hertil står de sœdvanlike larebogskapitler, der først bliver tilgænge-lige so sent, at nyhederne i dem allerede har overlevet sig selv. Indholdet i de nœvnte bøger har kun interesse for en sarlig lille specialistkreds, men deres planlagning og form har mere almen interesse som forslag til et mønster for nogle af de kommende videnskabelige møder og diskussioner.
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TBE sent assistant editor M. Holm to listen to Jannik Boberg-Ans talk about his father:
Who was JBA? The following anecdote gives a good glimpse.
Jørn had been to England and Spain and seen good results of cornea transplants. He wanted to perform them at the eye clinic in his home-town Copenhagen, but the boss said no. So he did it secretly at night with the help of an anesthesiologist.
The procedure was not customary at the time, but Jørn meant it was the right thing to do - so he did it. The results were presented at the Danish Ophthalmologic Society and the audience said he lied about the results. So twelve of his patients were brought into the room and were examined by help of torch-light.
Said one professor: "This eye is not operated on at all!"
Answered Jørn: "Oh yes, it is, if you look very care-fully you can see the margin of the transplant".
Responded the professor having looked extra carefully: "Yes indeed.....and then it should not be said that you have lied after all!"
Jørn was born in 1916. He was the son of a carpenter. During WWII, when the Nazis occupied Denmark, Jørn joined the under -ground movement involved wwith getting Jews out of Den-mark and was forced to escape to Sweden himself. Thus Professor Sven Larsson in Lund gave Jørn his first training in ophthalmology. When the war ended he returned home to continue his formal education. In 1952 he completed his doctoral thesis on cornea sensitivity and constructed the 'Boberg-Ans sensibilometer'. There are many references to it in articles about contact lenses and refractive surgery,
WHEN READING ABOUT YOUR FATHER, THE WORD INNOVATOR APPEARS FREQUENTLY.
Yes, Jørn started with intraocular lens implantation as early as 1958, something that was not widespread in Scandinavia until the end of the sixties. He designed an anterior chamber lens (made by Raynor), which was inspired by Binkhorst drawings. Some of today's lenses are very similar to that. And later, the Boberg-Ans posterior iris-fixated lens, which was much more widely used and was made until the end of the eighties.
HOW DID HE BECOME INTERESTED IN EYES?
I am sure the fact that my mother's father (Christian Lottrup-Andersen) was an ophthalmologist inspired Jørn. He had an early interest for ergophthalmology and wrote several articles about it. The importance of sight for work and necessity of protective glasses was stressed. In his old age he wrote articles about how to illuminate roads and mark them; it was a passion of his.
No child surrounding our family could play with a bow and arrow. If he saw it, he would simply break it in half, to avoid eyes being hurt.
YOU REFER TO YOUR FATHER AS AN UGLY DUCKLING IN AN ARTICLE IN OFTALMOLOG (Number 3, August 1988, see left).
Well, he opened his private office in Charlottenlund as early as 1959. This was quite provoking at the time when surgery was the domain of university professors and was done at hospitals. Patients were made to sign documents to bring in their passports including the text: "As my eye has been implanted by an intraocular lens, it is very interesting for science and ophthalmic research to reexamine and therefore I donate my eye to science and please in case of my death explant my eye and send it to further pathology examination at this institution". The eyes were gathered and sent to USA for further examination by Greene, a pathologist, therefore we have a good view of how the eye was affected by lenses.
Jørn enjoyed performing surgery, often on cases that were considered hopeless. People who hade given up about improving their sight came to him, and this was a challenge. The results were usually very good. His approach was "if there is a chance we have to take that chance with the patient". But he was not rash on other people's behalf. His motto was: Leave the eye at the end of the surgery as you wish to find it the next day - nature does not put tissue back in place without the help of the surgeon.
Jannik tells about the importance of traveling for Jørn, establishing contacts with colleagues all over the world. He especially mentions Barraquer, Dermot-Pierce and Binkhorst. Many became good friends and came to Charlottenlund to visit. Five international COC conferences were arranged there, every time with 30 participants. Jørn was one of the founding members of International Ophthal-mic Microsurgery Study group in 1966, with the purpose to improve instruments and technology.
WHAT WERE HIS WEAK AND STRONG SIDES?
He could see very clearly in crisis situations, as solving problems and during surgery. He never made a problem bigger than it was. At the same time this was a weakness, in the sense that when he had thoroughly examined a problem and found a solution, he stuck to it - no matter what other people meant or what was considered “normal routine”. He was not very full of respect to old rules, and especially not Titles or authorities “per se”.
Jørn saw patients nine hours a day. About 300 operations in a year was the average.
Jannik is convinced that he had a more modern way of looking at the patient than was customary at the time, talking to them about life and then about the operation. Seeing them as a whole person and not as just an eye. He talked to colleagues in the same informal way and it was bound to be provoking. Not caring so much about what others thought about him, did seem very arrogant, says Jannik.
IT SOUNDS AS IF JØRN WAS PLEASED WITH HIS LIFE?
Yes, I think he was very pleased. His job became his hobby. He maintained his capacity for professional ophthalmic playfulness together with my mother. And he inspired me a lot. I had no intention of becoming a doctor, especially not an ophthalmologist, but when the choice came it was easy. My father’s joy was easy to see and that was very inspiring for me.
Writes ROBERT C. DREWS
A.B., M.D., F.A.C.S., F.C. Ophth.
Professor of Clinical Ophthalmology
Washington University School of Medicine, St. Louis
about Jørn
"I gave the Jørn Boberg-Ans (Memorial) Lecture at the 6th EIIC meeting in Copenhagen, August 14-18, 1988. As I said, I did not publish the lecture, so I do not have written comments on Jørn. The lecture was entitled “Micro-chips and the New Microsurgeon” and dedicated to him with the caveat that he would certainly have been in the forefront of these developments and “would have been teaching us new tricks with them.” Sonja (JBAs wife) had just had her massive brain hemorrhage a day or two before and was starting her very slow, partial recovery. All the Boberg-Ans children were there. I pulled my file for the lecture: most of the slides are missing: pirated for other lectures. A few notes remain…
Jørn was one of the true pioneers of lens implantation, but not only that. It is my understanding that his private office was unique at the time in Scandinavia; surgery was the domain of University Professors. His operating room in his home (!) included an automatic faucet for the sink that turned on when you put your hand under it so you did not have to touch any handles; stainless steel cabinetry throughout; a ceiling mounted operating microscope; etc. He designed many of his own instruments. Patients coming to see him were seated in the entrance hall – the entrance to the living room of the family home, coming off to the left, and the entrance to the office to the right. To make any wait congenial, Sonja would serve them a glass of schnapps! And the passage to the examining room was through the stainless steel operating room! With perfect Danish humor, Jørn said that if he wanted to get more personal and social history from a reluctant patient he would just ask: “How’s your sex life?” (!) Then everything came out.
Unfortunately I was never privileged to watch Jørn operate. I did see a few, very difficult situations pre-op. And a number after really complex decisions and surgery. He was obviously a fine surgeon, and other colleagues often were the source of challenging cases. Discussing cases with him was always stimulating. His Charlottenlund Ophthalmological Conferences were limited to select leaders, by invitation only. It was a marvelous privilege to attend these delightful and insightful meetings. Not surprising that he and Sonja were among the founders of the IOMSG and the IIC (later IIIC).
Delightful friend, raconteur, gentle leader, innovator, kind teacher, humble … missed"
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Another of Jørn´s high caliber friends in the US wrote this:
"I recount meeting JBA first at a conference in June 1968 in Switzerland on the Bürgenstock. During the funicular ride down to the lake, he asked, "Where in Canada are you from?" His perfect English was British-accented, but he knew my accent was not.
I first visited Jørn in Charlottenlund in the summer of 1970, and several times thereafter, there and in his summer home near Gentofte. During a visit in 1971, I observed him perform his first lens implant with the Binkhorst 4-loop lens on an architect with a traumatic cataract; the operation was complicated by fluid vitreous into which the implant sank. That September, he visited Ann Arbor and projected on a wall in my home a series photographs of about 16 eyes on which he had performed cataract surgery with that implant. The results were stunningly perfect. I asked him to send me some lenses, and a few weeks later 3 of those lenses arrived. In November 1971, I performed the first lens implant in the Midwest (even earlier than Bob Drews' first) and in earlyDecember two more. (The first eye of that first patient, who died last year in her 90s, was still seeing 20/20 when I last saw her.) After the third case, I called Jørn to ask about learning more about the technique. He recommended that I visit Case Binkhorst. In early January 1972, I made the first of three visits over the years to Case.
I'm sure you saw Jørn's "clinic" -- a tiny, fully equipped operating room to the right of the entrance hall of his home, and behind it, an examining room. His operating room had more advanced equipment than most of the eye operating rooms in the industrial world. It included a ceilingsuspended Zeiss surgical microscope with motorized focusing, and a surgeon's chair of his own design, constructed by his auto mechanic, with the heights of its seat and each arm powered by an electric motor, controlled by foot pedals. Sonja, would come in from their living quarters during each surgery and assist for those few critical minutes of the lens extraction and implant placement.
Jørn's pre- and post-operative routines were also unique. Patients and family members would arrive, sit in the living room, to the left, chatting with Sonja, and sometimes have a whiskey. After the operation and this routine was repeated, the patient was escorted to a comfortable nearby nursing facility, for a few days of the initial recovery period. Jørn would make daily rounds.
I had heard that Jørn had the only, or one of the few private practices in Denmark, and even of Scandinavia. Also, that he was not on good terms with the 'official ophthalmological powers' in Copenhagen. This was not unusual at that time for most of the pioneers in modern cataract surgery, as has been the case with many breakthrough medical advances throughout history. However, I never heard him say even a slightly critical word about the professors.
At that time, many advanced cataract surgeons were professionally somewhat isolated. While Jørn introduced us to numerous distinguished Danes outside the medical community, professionally, his creative, enthusiastic, gregarious nature led him to close associations with microsurgeons from western Europe, the US and Isreal. I attended a number of the meetings he organized in or near Copenhagen, the last, as I recall, in 1975. He was gracious to everyone, including German colleagues who had been in practice during the war.
Almost all of Jørn's generation are gone, and few in ours remember or appreciate this remarkable man. I look forward to what you write about him in TBE.To me JBA was unfailingly kind, generous, skilled, creative, honest, modest.
writes Bruce Cohan of Ann Arbor
(a well known name to TBE-readers)