Biomedical subjects
Publications and source records attributed to M Norn.
Descriptions of animal eyes in the Middle Ages in the learned work Physiologus from the 4th century, based on Aristoteles, Plutarc, the Bible etc. are commented on. The modern biologist is horrified, the historian understands the ethical - religious aspects behind the edifying stories concerning the lion, gazelle, eagle, snake, lizard, swallow etc. Medical science and theology were not separated in the Middle Ages.
The contagiousity of tuberculosis was demonstrated by Carl J. Salomonsen in 1877, injecting human caseous material in rabbit eyes, causing granulomatous iritis. It was five years before Robert Koch found the bacterium: Mycobacterium tuberculosis (MT). Marius Tscherning as professor emeritus from the University of Copenhagen, injected bovine MT and sanocrysin (Mølgaard's goldderivate) into rabbit eyes, causing corneal phlyctenules, but no ophthalmic reaction developed with only MT or sanocrysin alone (1928-29), not published). Emil Frandsen in 1959 examined 113 BCG vaccinated persons, who developed benign phlyctenules in 11%, 6-8 weeks after vaccination, and some cases of chronic iridocyclitis and chorioiditis. In 1158 non-vaccinated, some with serious tuberculosis, Frandsen found serious phlyctenules, chronic iridocyclitis, chorioiditis (especially disseminated) and periphlebitis, but not acute iridocyclitis of tuberculous origin. Phlyctenules and other TB-eye-diseases are described from Greenland 1926-76. Ophthalmic tuberculosis is still an important issue, also in Denmark today.
Two novels with different aspects of blindness seen through the doctors eyes. The Portuguese Nobel-prize winner José Saramago's story of a city struck by an epidemic of "white blindness", where the truth is what we cannot bear to see. The Danish author and unskilled labourer Albert Bang's (synonym with Karl E. Rasmussen) crime novel describes a blind or pretend to be blind butcher, who is a witness to a murder. Both novels are lyric, thought-provoking and insightful.
The Danish sculptor and painter Rudolph Tegner (1873-1950) has built his own Museum in Dronningmolle, where his sculptures enrich the unique landscape. His last and incomplete plaster on a simple, raw wooden scaffold sculpture The Blind from Marrakech (Fig. 1) show five persons moan about, carrying a dead body. All persons are missing their arms. Tegner had a number of years earlier been in Marrakech and had watched a funeral procession, where blind beggars had carried a dead old woman raised high above the bearers on a kind of pall. In a small version of the statue cast, later in bronze from 1963, showed 15 bearers, on both sides of the bier (Fig. 2 & 3). Nine and 15 bearers are looking up, two right in front, and the rest are looking down. Totally blind people can not see the light but can see up to the divine Heaven. Some blind have kept the gleam. The confusion with the eye direction shows that they really are blind. However 10 of the 15 blind people had hollow in the eye (excenteratio orbitae) in contrast to the dead woman. The dead woman had been the blinds' mistress. The last work The Blind in Marrakech may also be the despair of the artist.
Poul Braendstrup (PB 1912-80) was the best qualified to become head of the eye department at Kommunehospitalet (KH) in 1957, with an eminent great scientific production. He continued this work all his life. Three assistant doctors with different specialities were appointed 1966-72: M. Norn (external eye), K. Norskov (strabism) and Sv. E. Lorentzen (retina). Reasons for the ideal cooperation in the department are described (staff-meetings, christmas-staff-arrangements, meetings, courses etc). The number of operations increased steadily in the period, especially cataract-extractions. The newest techniques and instruments were used (cornea-grafting, vitreous surgery, xenoncoagulation (PB study tour in 1962) before laser-treatment etc). The scientific production increases, surpassing Rigshospitalet after 1967. The education was effective at all levels: In the eye-department, doctors evenings, A-and B-courses for eye specialists to become, referring eye specialists, students (from 1972 as an independent part (sect IV) of the University of Copenhagen with an ordinary professor from 1975). It was disturbing with the many removals at KH and at last the final total removal to KKHH (Hvidovre), causing loss of some of the best staff members, instrument breaks, increasing waiting lists up to one year, inconvenience for the patients and many other difficulties. This could be a warning against the continued great movings of departments in Copenhagen (H:S). The administration is criticised. PB's rationalisation of the duty-plan for all Copenhagen eye departments already from 1966 independent of the administration is mentioned.
Ejler Holm (1887-1966) was the chief at the eye department, the Municipal Hospital in Copenhagen in the period 1929-57. He got the longest period in the history of the department, 28 years. Holms qualification to get the appointment are described, especially in his medical thesis concerning the yellow pigment in the central part of the retina (bleaching opsin). Never the less he got an unjustified attack from the opponent professor Marius Tscherning (1854-1939) including the theory of duplicity (day function and night function of the human eye), and the German ophthalmic science. The struggle to become professor ophthalmologiae at the University of Copenhagen in 1925 is mentioned. The eye diseases and their therapy in the period are exemplified from original patient records from 1930 (tuberculosis, venerea, dry eye, morsum hirudin etc.), 1940 (chemotherapeutica, trachoma, glaucoma etc.) and 1949 (penicillin, injections of milk i.m., cauterisation, trachoma etc.), supplemented by Holms records from own practic in 1934, surgery protocols and statistical material from the period. The number of cataract extractions (extracapsular) increased considerable with more liberal indication and regime. Also the number of squint operations are increasing, where sutures are more often used. Glaucoma-surgery increased only slightly with more filtering operations (Elliots trepanation, Holth-iridencleise) instead of simple iridectomy. Eye pathological examinations become more qualified. Psychiatric, simulating and troublesome patients are described. There are very great difference between diagnosis and treatment at that time, compared with today.
PURPOSE: To establish whether congenital colour blindness among males is still rare in Inuit (Eskimos) as indicated previously in 1893 and 1930, especially in East Greenland, as demonstrated by Erik Skeller in 1950. METHODS: The study was comprised mainly of school children. 540 Inuit in East Greenland were compared to 545 controls in East Greenland and Denmark examined by three sets of pseudoisochromatic plates (Ishihara 1932, original plate used by Skeller), Ishihara (1994), and standard P.P. 2 part Igaku-Shoin (1994). RESULTS: Only 1.0% of male Inuit (3/290) are colour blind, a significantly lower incidence than the 8.7% among Danish males in Denmark (15/173). The prevalence was the same in the three control groups, Danes in East Greenland, immigrants and Danes in Denmark. Deuteranopia is the most common type. Females showed the same low prevalence in all four groups. MAJOR CONCLUSIONS: Colour blindness is still remarkably low among Inuit in East Greenland as compared with the present three control groups.
PURPOSE: To follow the refraction values in an indigenous population group over the course of the past 50 years. METHOD: Case records from a population investigation carried out in Ammasalik, East Greeland, by Erik Skeller in 1950 were studied initially, a total of 1123 eyes were examined by sciascopy and 244 eyes could be followed sufficiently until about 1990-94. RESULT: The mean refraction was initially +0.08 D, while at the last examination the mean had increased to +0.69 D. Initially, there was no myopia, defined as at least -1.5 D, and at follow-up it was a maximum of 1%, and presumably due to immature cataract. A tendency to myopia (< -1.5 D) was found initially in 36%, but in only 22% at follow-up. CONCLUSION: The myopinizing factor in East Greenland has not affected persons born prior to 1942, even if they had a tendency to myopia (< -1.5 D).
On occasion of the total discontinuation of the independent Eye Department of the Copenhagen Municipality in December 1996 replaced by Rigshospitalet (the State Hospital) and Frederiksberg Hospital (H.S., Hovedstadens Sygehusfaellesskab) the first half of its history will be outlined below. The first municipal eye department was St. Annae Eye Hospital (Prince Willhelm's Palace) opened in 1864 to relieve the pressure on Department I of General Surgery in the Copenhagen Municipal Hospital. It was established because of the military epidemic eye disease which was due presumably to an adenovirus, in some cases complicated by trachoma, allergy, eye diphtheria or possibly gonorrhoea. The head of the Eye Hospital was Heinrich Lehmann (1815-90) who had been, as early as 1852, the first to demonstrate in Denmark the ophthalmoscope (invented by Herman v. Helmholtz in 1850). From 1855 Lehmann was in charge of a municipal ophthalmological out-patient department in Vingaardsstraede. St. Annae Eye Hospital was closed down 9 months later, as the epidemic was decreasing. Eye diseases were still treated in Department I of the Municipal Hospital under Carl David Withusen (1822-74) who was not "merely" a general surgeon, but also an eye surgeon like his father, Carl Christopher W., and published papers on cataract surgery and iridectomy, operations which his father had also done previously. ...
The tears of 225 subjects were examined for several disorders of the eye by means of a newly developed method, the quantitative tear ferning test. Of the 225 subjects, 89 were normal controls, 24 were examined before and after cataract extraction, and 112 had some disease of the external part of the eye. Using the quantitative tear ferning test, it was shown that compared to normals, the ferning area was significantly decreased in cases of keratoconjunctivitis sicca, in primary and in secondary Sjögren's syndrome. This was also the case in infectious conjunctivitis and after cataract extraction, possibly due to exudation from the conjunctival vessels. In simple conjunctivitis, however, the ferning area was normal. The ferning method has a sensitivity and a specificity of the same order as the commonly used tests for Sjögren's syndrome (Schirmer I, BUT, rose bengale, lactoferrin).
The superstition of the Eskimoes exists even today also with regard to disease and treatment. The author has experienced this himself as ophthalmologist in Greenland. Snow blindness is a common complaint in Greenland and different types of primitive snowglasses to protect the eyes are described. Primitive eye operations were performed by the Eskimoes as long as 250 years ago. In 1721 Denmark commenced a colonization of Greenland when the missionary Hans Egede was sent there. The first physician arrived in Greenland in 1742 but was only there for 2 years. The next one was sent 18 years later. Since then innummerable physicians have worked for Greenland for shorter and longer periods. The observations of several doctors who have seen eye diseases among the Eskimoes are mentioned. During the past 70 years eye specialists have regularly visited the country and by screening and the following treatment helped many with eye lesions.
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In 'sick building syndrome' and other questionable environmental conditions, it is important to consider eye troubles. This review deals with several objective methods relevant for pollution keratoconjunctivitis. A hypothesis is put forward: A reduced lipid layer of the tear film causes reduced break-up time, increased vital staining and increased number of cells in the conjunctival fluid.
Four different methods for transferring conjunctival fluid to stix test pads were studied. One hundred and twenty eyes from 120 cataract-extracted patients (35 in the operated eye 0-5 days post-operatively and 85 in the contralateral eye) were included in the study. Transfer of fluid by a glass rod from the lateral part of the inferior fornix was demonstrated to be the most suitable method, showing the highest sensitivity to leucocyte-esterase (83%, N = 120, p < 0.05) and with a specificity equal to that of the other methods tested (cotton, spongostan, Schirmer paper strip). The glass rod method is suitable for detecting blood, nitrite, albumin, pH, and glucose, and is a both quick and unintrusive procedure. All four transferring methods may, however, cause an increased desquamation of epithelial cells and an increased amount of mucus.
A technique for quantitative cytology of tear fluid collected by a micropipette from the tear meniscus is presented. This technique has been compared with that using the standardized Norn-pipette collecting fluid from the lateral part of the inferior fornix. The two methods show the same magnitude of sensitivity and specificity, the same coefficient of variation, as regards neutrophilic leucocytes and erythrocytes (200 samples). The normal tear meniscus contains less than 40 leucocytes or erythrocytes per microliter. The tear cell concentration is about 200 times lower in the meniscus than in the fornix inferior in normal eyes. This observation supports the compartment-theory of a rapid flow in the tear meniscus and a slow flow with insignificant admixture in the conjunctival fluid in the fornices. The tear meniscus cytology is of use in association with testing of other parameters in the tears, for instance. The conjunctival fluid cytology is quicker and more convenient for the patient. In addition, it is necessary in connection with observation for pathological epithelial desquamation, because the tear meniscus cytology brings about an artificial increase of the epithelial cell concentration.
A series of 125 healthy subjects were examined by the stix method (chemical response) for occult occurrence of blood in tears. Blood was found in 18% of fertile women, definitely most often in the menstrual phase (in 39% of 51 samples within the first week, reckoned from the first day of menstruation). The incidence was independent of use of the contraceptive pill. On the other hand, occult haemolacria was observed in no more than 7% (= 30) of pregnant women and in none at the menopause (N = 7). Among males the phenomenon was noticed in 8% (N = 24). Occult haemolacria in fertile women thus seems to be induced by hormones, whereas haemolacria most often is provoked by local factors (bacterial conjunctivitis, environmental damage, injuries).
Biomicroscopical examination of possible cumulative changes in the outer part of the eye in 217 male welders with variable welding exposure time showed conjunctival spheroid degeneration in 24% of the welders. The prevalence of changes was significantly increased in welders with the higher exposure time in an age-matched reduced material (98 x 2 eyes; respectively, over and under 40 h.y (number of daily hours of welding multiplied by number of years of welding), welders with stays abroad over one year being withdrawn. The prevalence was also increased in the latter group (41%, N = 40, against 21%, N = 177). Pinguecula was present in 57% of the welders, with a tendency towards larger area with increasing welding exposure. The frequency was increased as compared with that in a control material examined on a previous occasion (41%). Pterygium proper was found in only one subject, pseudopterygium in 5%. Corneal cicatrices were present in about one half of the subjects. The prevalence increased with increasing welding exposure (24% in subjects with short, 42% in those with long exposure; 98 x 2 eyes). Acute welding light keratopathy was experienced by 73%. The mean number of attacks in the 217 welders was 6.4. The frequency was highest in subjects with long welding exposure. The risk of chronic impairment of sight owing to cumulative welding light injuries is very little in the present material, since only 2% had spheroid degeneration on the cornea (only discrete, peripherally located); there was no preponderance of pterygium. On the other hand, the many foreign bodies on the cornea (cicatrices) constitute a risk that apparently does not decrease with increasing welding experience nor repeated attacks of welding light keratopathy.
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