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Show Journal of CliniCJ21 Neuro-ophthalmology 13(4): 281-287, 1993. History of the Frank B. Walsh Society David L. Knox, M.D. © 1993 Raven Press, Ltd., New York I have chosen to write this history of the first 25 years of the Frank B. Walsh Society because I saw a need to document facts about the ideas, places, and people who started and have participated in the continuing development of a meeting that has been and continues to be an extraordinarily rich learning experience. Because of my original role and continued involvement, I have the advantage of having seen the beginning and watched the various trends that have occurred. At the time of organizing the first meeting in 1969, the Verhoeff Society of Ophthalmic Pathology, the Retina Society, the Muscle Club, the Ocular Microbiology and Immunology Society, and the Pupil Colloquium were the only subspecialty groups in Ophthalmology that met regularly on a formal basis. The Verhoeff Society had case presentations with slides for all participants to examine during the meeting and to take home. Frank Walsh and Richard Lindenberg had begun their collaboration in 1958, so that by 1961, along with Joel Sacks, who joined them in 1966, they were actively working on their book Neuropathology of Vision: An Atlas. Lindenberg brought to Walsh a vast experience in neuropathology. He was trained by the German neuropathologists, who had led the world in the early twentieth century. He had seen a huge amount of trauma, both as a pathologist for the Luftwaffe in the 1939 to 1945 war and as neuropathologist for the Maryland Medical Examiners Office where traumatic, accidental and unexplained deaths were studied. Lindenberg wove all aspects of the case into his evaluation. The least of these was the microscopic aspect. The gross appearance and location of lesions were his great skill. Four years after Bill Hoyt's fellowship with From the Wilmer Ophthalmological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A. Address correspondence and reprint requests to Dr. David L. Knox, Wilmer Ophthalmological Institute, The Johns Hopkins Hospital, Baltimore, MD 21287, U.S.A. 281 Frank Walsh, from 1957 to 1958, he and Frank began work on the third edition of Walsh's textbook Clinical Neuro-Ophthalmology. In the mid-1960s, Hoyt came to Baltimore every three to four months to review their progress on the book. The next factor in the development of the Walsh Society was a joint experience of The Howe Laboratory, The Massachusetts Eye and Ear Infirmary, The Neurology and Neuropathology services of the Massachusetts General Hospital in Boston. In the academic year 1961-1962, Dave Cogan and I started a neuro-ophthalmic pathology conference in Boston. In the 1960s, Ed Maumenee was exhorting all ophthalmologists to obtain tissue for pathologic examination. This included asking that families remember the need for tissue obtained postmortem. The final building block in the formation of the Walsh Society was David G. Cogan, who was scheduled to be the Visiting Professor at the Wilmer Institute for a week in February 1969. We thought that at the end of Cogan's visit it would be interesting to hold a meeting where neuroophthalmologists from the United States and Canada would come to Baltimore, bringing interesting clinical case material, which included pathologic definition of the disease. The idea was received with great enthusiasm and the first meeting was held in the lecture room of the Wilmer Institute. Lorenz Zimmerman, head of Ophthalmology Pathology and Kenneth Earl, head of Neuropathology Sections at the Armed Forces Institute of Pathology in Washington, were present at the first meeting. Also present were Bill Hoyt, Richard Lindenberg, Ron Burde, Bob Hepler, Stan Thompson, and others. In the first three meetings, all of which were held in Baltimore, case presentations were given all day Friday and for the first two hours on Saturday morning. Promptly at 10:30 A.M., Frank Walsh took over and conducted one of his classic clinical conferences. Patients, often in the middle of their evaluation, were presented with current 282 D. L. KNOX laboratory data. Discussion began with local and visiting experts giving their opinions and advice. Patients in midworkup had always been the richest aspect of Walsh's conferences. Too often, when the answer was already known, we sensed it and were less interested. The requirements for a case to be presented at the first meeting have changed only a little. The details of a patient's presenting symptoms, signs, laboratory testing, surgery, and outcome are presented CPC style. The cases are then opened for discussion with questions from the audience, which the presenter answers as fully as he can, sometimes withholding as much critical information as possible until the end. The case-giver then presents gross photographs of surgical or brain tissue and photomicrographs of the histology. In the first meetings, clinicians were often upstaged by the experience of the senior neuropathologists. As the society continued, clinicians came better prepared, knowing and able to speak authoritatively about minutiae of material they were presenting. The key was the pathology of the disease-a true Cpe. As stated by Lorenz Zimmerman, one of the joys of the meeting was that presenters could bring interesting material, not necessarily their own, enjoy the discussion, and go home without the chore of preparing a manuscript in time for a deadline. It was fun. At the first meeting, Frank Walsh and I hosted a dinner for those participants who came from out of town. The group was small and our financial burden minimal. In these ways, neuro-ophthalmologists from different parts of North America met for the first time as a group, to relax, talk, and share experiences. One of the joys of such a meeting is that it gives clinicians a chance to compare their patient care experiences. The first three meetings, known as the NeuroOphthalmic Pathology Symposium, helped to solidify the society and mold its style. At the end of those three years, I had grown weary of doing the details of the meeting. We also realized that what we were doing was such a rich learning experience that other academic centers might enjoy having the meeting at their institution. Joel Sacks had returned to Chicago and his alma mater, Northwestern University. We asked Joel to host the first meeting away from Baltimore. One of the purposes of meeting in different cities has been to demonstrate to different neuroscience communities the depth and breadth of North American neuro-ophthalmology, which provided the intellectual support for their local practitioner. J Clin Neuro-ophthalmol. Vol. 13, No.4, 1993 Other advantages of meetings away from Baltimore have been the innovations in style and minutiae of the meeting developed by each host. Planning and running a meeting has been a learning experience for the host neuro-ophthalmologist. Each organizer has done it his or her way, asking for advice from those who have given preceding meetings. There has been no overriding control or even attempts at it by any of the founders. It is this approach that has fostered innovation. My main advice to someone who undertakes the conduct of a meeting, is to recognize that one cannot please everybody. Inevitably someone will be unhappy, sometimes intensely unhappy. What constitutes "too many" or "too unhappy" is a judgment call. All but one meeting has been held in an academic center. This enables interested neuroscientists, residents, and medical students to attend and enrich their experience. Traditionally, the meeting has been held all day Friday and Saturday morning, allowing participants time to return home on Saturday afternoon. This is easy when the meeting is on the east coast or in the midwest. Returning to the east from California gobbles up a whole day for those unwilling to stay up all night on a "red-eye special." The meeting always has been a day and a half, perhaps reflecting my own inability to sit any longer than that. Another reason for a short meeting is consideration of cost to individual participants. Interested residents and fellows, or their departments, appreciate only two nights of hotel costs. The current lower cost of air travel with Saturday night spent at the point of destination, has prompted Jacqueline Wintercorn and her New York colleagues to organize the 1993 Meeting to occur all day Saturday and Sunday morning. Participation by fellows and new practitioners is exciting for them and their preceptors. This requires attention to the gathering of detail and minutiae. The clear, concise writing of an abstract, development of the bibliography, and then preparation of the case presentation-mastering of the clinical details, laboratory evidence, radiographs, and pathology-are important. Awareness that questions will be asked by knowledgeable seniors and peers is a powerful motivator for thorough preparation. This is a basic technique in academic a~d professional development. Bibliographies provided by each presenter are distributed at the end of the day. These rich sources of information are a joy and permanent resource for those attending the meeting. They are up-to-date and thorough collations of pertinent literature. At the beginning, neuropathologists were the HISTORY OF THE FRANK B. WALSH SOCIETY 283 main voices of authority at these meetings. Kenneth Earle was present with Richard Lindenberg at the first two meetings, and W. Richard Green came to many meetings bringing knowledge of ocular pathology. With successive meetings, we recognized that, in addition to neuropathology skill, these consultants needed to be both verbal and humorous. Lucien Rubenstein, the neuropathologist who participated in two of our meetings, gave us the first insight into the need for lucid and elaborate verbal exposition. He also demanded that he be given a chance to examine the pathologic slides before the meeting. In the early years, the pathologist saw the material cold with little or no chance to prepare his mind. Too often, we heard, "1 would have liked to have seen the slides under my microscope." Now cases are accepted for presentation only if slides of the abnormal tissue accompany the abstract. Neuroradiology has blossomed as a subspecialty during the span of the Walsh Society meetings. Diagnostic imaging speaks for itself thousands of times, every day in almost every corner of the world. Accordingly, the Walsh Society has woven into its meeting format neuroimaging specialists, who are never asked to comment on pneumoencephalograms, and rarely angiograms, because computed tomographic scans and magnetic resonance images show so much more. Now, copies of pertinent diagnostic imaging studies must accompany abstracts for acceptance as a presentation at the meeting After Frank B. Walsh's death in 1978, the group assembled for the 1979 meeting at the Pacific Medical Center in San Francisco, and, by acclamation, renamed itself The Frank B. Walsh NeuroOphthalmology Society. Governance of the society has been casual, with most decisions made by those who have organized previous meetings. These "grandfathers" met for breakfast on Saturday mornings and basically the only order of business was the decision of where to hold the next or next two meetings. The basic ingredients are the desire of a person to put on the meeting, balanced by a pattern of geographic distribution between east, west, and the middle of North America. For the first 23 years, there was no formal organization, constitution, bylaws, officers, or dues. As Ron Burde paraphrased, "the best floating crap game outside of New York." In the mid-1980s, American medicine came under criticism because of the high costs to Medicare, private insurance, and other payers for patient care. Recognizing the economic tides that were building, some individuals remarked that neuro-ophthalmologists, because of their small numbers, the labor-intensive nature of their patient evaluations, and low fee schedules set by insurance carriers, were working at a disadvantage. Bob Hepler felt that we needed a politicoeconomic voice. Others spontaneously suggested the same thing, echoing Bob's call for action. At the 1987 "grandfathers" breakfast in Boston, the subject was brought up for open discussion by the largest breakfast group I could remember. By vote, the group decided that they did not want to engage in any kind of political, economic, or formal voice activities for the Walsh Society. In 1986, Bob Hepler was asked by the "grandfathers" to be our representative to the council of the American Academy of Ophthalmology. The council was composed of representatives from each state society of ophthalmology as well as representatives of subspecialty groups. Legal counsel to the Academy had advised and the Academy adopted the proposition that subspecialty groups would have voting representation on the council, if they were incorporated as "not-for-profit, tax-free" entities. In his position as a nonvoting observer of the Academy council, Bob Hepler continued to be convinced that neuro-ophthalmology should be formally represented with a full vote. At this time, the forces external to the practice of medicine were increasing in both number and intensity. More neuro-ophthalmologists became convinced that a formal voice was needed. At the 1988 meeting, the "grandfathers" and a consensus of those attending the meeting, encouraged Hepler to develop the first draft of a constitution and bylaws, which would lead to incorporation of the society. At the 1989 meeting in Philadelphia, copies of the first draft were made available for all who wished to spend the time and express their impressions and suggestions to Hepler or me. The first draft was criticized as proposing a constitution and bylaws that perpetuated the "grandfathers" style of governance, that the Walsh Society was not going to be governed in a democratic fashion, and that new, younger members felt that they had no voice. Hepler and I agreed and modified the next draft. As we pondered the pros and cons of incorporation of the Walsh Society, I had a telephone conversation with Danny B. Jones, who was guiding the Ocular Microbiology and Immunology Society on the same path to incorporation. He had been, for over 10 years, the major directive force in the society and had reached the opinion that incorporation would provide formal structure for contin- J Clin Neuro-ophthalmol, Vol. 13, No.4, 1993 284 D. L. KNOX uation and change of leadership of that society. It was this argument that convinced me that formalization of the Walsh Society was advisable. In 1990, in Indianapolis, drafts of the latest version of the proposed constitution and bylaws were made available. After lunch on Friday, a business meeting was held to present the ideas of incorporation. Ron Burde and Stan Thompson, from their current experience on the American Board of Ophthalmology, urged incorporation. Hepler from his representation on the Council of the Academy of Ophthalmology urged incorporation, and I, on the basis of the need for democratic governance, urged incorporation. For the first time, those attending the Walsh Society were given an opportunity to vote by ballot. Those attending, voted 104 for incorporation and 4 against incorporation. At the "grandfathers" breakfast the next morning, Ron Burde, Bob Hepler, Stan Thompson, Nancy M. Newman, Jack Selhorst, Bob Yee, and I agreed to serve as an organizing committee for the purpose of incorporating the Walsh Society. After several months of discussion of the draft, I was authorized by the committee to seek legal counsel and incorporate in the State of Maryland where the society had originated. On June 1, 1990, I had my first meeting with Constance Baker and N. Lark Schulze, attorneys in the Baltimore law firm of Venable, Baetjer & Howard in Baltimore. Miss Schulze, with the guidance of Hepler's draft, created articles of incorporation and bylaws suitable for incorporation in the State of Maryland. These were given to me the day before we flew to England for the meeting of INOS in Winchester. At that meeting, the organizing committee, with the assistance of Bill Hoyt, met to discuss the articles and bylaws and, it was hoped, to proceed to the next step. There was vigorous discussion as to the advisability of incorporation as an isolated society or joining in some way with the North American Neuro-Ophthalmology Society, which was already incorporated and had overlapping membership with the Walsh Society. Stan Thompson wished to create an umbrella governance and voice for neuro-ophthalmology. Jack Selhorst and Nancy M. Newman wanted to develop some type of merger with NANOS. At that time, the leadership of NANOS was not receptive to either idea. Bob Hepler and I left Winchester full of gloom that we had not been able to convince the organizing committee to proceed. In September 1990, by a conference call, the organizing committee voted unanimously to proceed JClin Neuro-ophihalmol, Vol. 13, No.4, 1993 with incorporation. Miss Schulze presented the proposals to the State Department of the State of Maryland. Her knowledge of that process facilitated prompt acceptance and on December 1,1990, the Walsh Society became incorporated, as a "notfor- profit" entity with 501 3(C) tax exemption from the Internal Revenue Service. At the fall 1990 meeting of the Academy of Ophthalmology in Atlanta, the organizing committee met and appointed Bob Yee, Nancy J. Newman, and Tom Shults to develop a list of members who were willing to be nominated and serve on the first elected board of directors. The membership voted in the fall of 1990 and the following were selected. Roy Beck, Bill Hoyt, Simmons Lessell, Neil Miller, Nancy J. Newman, Tom Shults, and Bob Yee. At the first Board Meeting in Salt Lake City in February 1991, the Board selected Hoyt as President, Yee as Vice-President, Newman as Treasurer, Lessell as Secretary and Membership Committee Chairman, Tom Shults as Program Committee Chairman, and me as Executive Secretary. At this meeting, David Cogan, John W. Henderson of Michigan, and Richard Lindenberg were offered lifetime emeritus memberships in the Society. Reviewing the articles of incorporation and bylaws for both the Walsh Society and North American Neuro-Ophthalmology Society, has led me to the realization that in Maryland and New Mexico governance of corporations can be accomplished in very nondemocratic ways. In essence, a board of directors can do anything it wants short of changing the articles of incorporation and bylaws or dissolving the corporation, both of which require vote of the membership. There is no requirement that the decisions by members of a board of directors be reported to the membership at large. The board of directors can be changed at the end of a term. In essence, there is very little that is democratic about this particular style. In spite of these facts, it is a common practice to incorporate not-for-profit tax-free institutions this way. I feel that small organizations should function in democratic ways, giving mem? ers a chance to vote on what they want on many Issues other than those requiring immediate action. I have been told that legal counsel advised the American Academy of Ophthalmology that it was better to have individual States monitor the notfor- profit behavior of a component society, rather than set up a monitoring audit mechanism by the American Academy of Ophthalmology. The emphasis was apparently to keep these societies from acting in a "for-profit" fashion. One result of all these activities was that dUring the process of incorporation, Neuro-Ophthalmolo- HISTORY OF THE FRANK B. WALSH SOCIETY 285 gy in North America became very politicized. It may have done so because of economic, governmental, and certification issues that increased at the same time. As Joel Sacks said early in this process, "if it ain't broke, don't fix it." In retrospect, the academic purity of the Walsh Society became vulnerable to dilution by political-economic issues. Several factors were working to produce the next phase. Throughout the process of incorporation, there grew an increasing sentiment for a single voice for neuro-ophthalmology in the United States and Canada. This reached its peak, at a Saturday afternoon meeting in February 1991, in Salt Lake City. Jack Selhorst and Stan Thompson asked that people stay after the regular meeting to discuss and vote on the possibility of continuing two separate organizations, merger of the two organizations (Walsh and NANOS), or developing an umbrella organization to speak for both societies and assign responsibilities for different problems and projects. After opening remarks, definitive statements by Tom Carlow and myself, there were short comments by many of those attending. The predominant thoughts expressed were that there was overlap and redundancy in the two societies and that there was a need for a single group, as large as possible, unified for economic or governmental influence. A printed ballot was distributed, voted on, and counted, with the result overwhelmingly for merger of the two societies. The 1991 meeting of NANOS followed at Park City, Utah, where informal discussions continued. In the ensuing months, both NANOS and FBWNOS polled their full memberships, both those attending and those not attending either meetings. The final steps were accomplished by asking the memberships to vote for merger, either directly at the meeting in February 1992 or by proxy. The final legal work was completed by September 1992. From an organizational standpoint, the Walsh Meeting is now a subgroup function of the North American Neuro-Ophthalmology Society. This function is guided by a committee that was first chaired by Neil Miller with Roy Beck, Bill Hoyt, Simmons Lessell, Nancy J. Newman, Tom Shults, Jacqueline Winterkorn, Bob Yee, and myself as members. At the meeting in New York City, March 1993, Nancy J. Newman and Tom Shults agreed to cochair the committee. It is my belief that leadership needs to develop methods for deciding the locations of continuing meetings. It is also necessary to develop a governance of the cost of these meetings. Some meetings finish and have an excess, which has been given to the society's treasury, while others have overspent their expectations. A major concern is the risk that with NANOS, FBWNOS, and the INOS as well as a section of Neuro-ophthalmology research at the Association for Research and Vision in Ophthalmology (ARVO), our academic exchanges will be diluted because few people can take time from work and bear the financial cost of attending all meetings. The most important function of the Walsh Society has been the exchange of information. New facts, ideas, understandings, and diseases have been presented at these meetings. The formal presentations were supplemented by informal discussions, both by those who were curious about unclear facts and by those who had similar patients. From these have come single reports and a series of interesting patients. Some have criticized the meeting because specific diseases have been reported more than once. In defense of this practice is the need to refresh memories and to consider that newer participants may not have heard previous presentations. For the 1979 meeting in San Francisco, Nancy M. Newman prepared an index of cases presented prior to that meeting. For the 1993 meeting, Larry Frohman has prepared an index of cases presented since 1979. This was prepared with computer technology and distributed on micro-floppy disks. In an effort to enrich this report, I have chosen to recapitulate some of the presentations that I remember. In the style of modern journalism, I have solicited memories from many who have been frequent attenders of the meeting. In 1971, Frank Walsh presented in his clinical session, a 51-year-old woman with peculiar ophthalmoplegia, a masked facies, myotonic facial twitches, and a history of recurrent iritis. In the week before the meeting, I had seen her sitting in the hall between our offices, but had not been invited to evaluate her or give an opinion. It was mentioned that she had had bouts of diarrhea and urinary tract infections. In the discussion following the demonstration of her clinical findings, I suggested that polyarteritis nodosa or recurrent septicemia needed to be considered, but that Whipple's disease should also be considered because of supranuclear ophthalmoplegia in the presence of multisystem disease. The patient did have Whipple's disease and was presented at the meeting in Chicago in 1972, with pathologic confirmation of the disease in her gut. She was reported. From that point on, there has been a continuum of cases of Whipple's disease presented at the JGin Neuro-ophthalmol, Vol. 13, No.4, 1993 286 D. L. KNOX Walsh Meeting. Jack Selhorst has been responsible for many of these. I did not recognize three of them because the patients with CNS Whipple's disease were so demented that they could not remember migratory arthralgias or other systemic symptoms, because the questions were not asked of the families, or because the patients had not had these symptoms. Supranuclear ophthalmoplegia, myoclonic facial movements, and dementia, more often in men, have become almost diagnostic. In one patient, Selhorst demanded a second jejunal biopsy because he was convinced (in spite of a negative first biopsy) of the clinical syndrome. He was right. In the time of these meetings, many of us were introduced to the nuances and variations of reticulum cell sarcoma, now called large cell lymphoma. Diffuse carcinomatosis of the meninges and multiple giant intracranial aneurysms have been presented. In many ways, those who remember outstanding cases do so because of their direct involvement or because the cases reinforced something they were working on or had presented in the past. Ron Burde recalls hearing for the first time about Aicardi's syndrome and the blue nevus syndrome. He also emphasizes that Mel Alper brought to the group the results of CT scans and MR imaging long before the rest of the country had the equipment. Bob Daroff remembers the 1973 meeting in Boston, where two presentations defined anterior vermis metastasis and medullary infarction as the abnormalities associated with upbeat nystagmus. Because he had had a case recently, Bob was able to identify the vermis lesion before the pathology was presented. He and Todd Troost later had a descriptive letter published in JAMA. John Keltner first articulated to me that the meeting helps him in his care of individual patients with neuro-ophthalmologic problems. Modes of presentation, differential diagnoses, and most appropriate studies are rapidly reviewed with each case presentation. These provide refresher courses covering all of neuro-ophthalmology. Cancer-associated retinopathy was first presented by Ralph Sawyer. Then, in 1980, Keltner and Alan Roth presented their pathology, which led them to other studies defining that an unusual immune process was causing the loss of retinal function. In 1976, John also presented a case of optic nerve decompression for chronic papilledema. He also recalls Jack Kennerdell's suggestion that pressure from swollen muscles was responsible for optic nerve dysfunction in patients with dysthyroidism. J Clin Neuro-ophihalmol, Vol. 13, No.4, 1993 Richard Lindenberg presented the thrombosis from his own carotid artery. Alf McKinna and many others remember that they first heard of the neurologic and ocular complications of the, at that time, new disease, AIDS. As mentioned above, the variations and enigmas associated with reticulum cell sarcoma also become apparent as different cases were presented at different meetings. At one meeting, the presenter had not recognized the characteristic morphology of cells shown in his photomicrographs. Many of the audience instantly recognized the cells from the pictures shown. Neil Miller recalls that whenever Jerry Maitland or Jack Selhorst gave a presentation, he learned an extra amount. In his unassuming way, from a private practice away from a university center, Jim Copetto has done the same thing-given us something extra. At the 1973 Boston meeting, Joel Sacks presented a case with progressive multifocalleukoencephalopathy. His terror of presenting before E. P. Richardson, the neuropathologist who had first worked out the pathology, was ameliorated by Richardson's narcolepsy. Having sailed with Richardson, I can testify that he is awake for many things. Jack Selhorst, in his usual self-effacing way, did not mention his role in the expansion of recognition of the neurologic complications of Whipple's disease. He recalls David Novacks' pathology of a cavernous sinus in a patient with mucor mycosis, Ralph Sawyer's cancer-associated retinopathy, Neil Miller and Mary Hotchkiss' patient with unilateral Duane's syndrome and Schwartz' oculomasticatory myorhythmia. Jack's specific words were "at the Walsh Society we saw and heard the cutting edge of neuro-ophthalmology, one or two years before it made the literature." He also thought it was a splendid format for young neuroophthalmologists to develop their professional skills in evaluating and presenting a worthwhile report. The above-mentioned presentations are a meager sample of the over 500 case reports given through the years. Each and every presentation has contributed to the facts, spirit, and traditions of the Walsh Society. It is impossible to highlight them all, but presenters should carry with them t~e knowledge that their efforts have been appreCiated. Fortunately, the indexes prepared by ~ancy ~. Newman and Larry Frohman help in Identifymg presenters and subjects. For me, one of the most interesting aspects of the Walsh Society Meeting has been the evolution of the dynamics of this group of people who meet HISTORY OF THE FRANK B. WALSH SOCIETY 287 once a year. For many years, the first hours of the meeting were stiff and formal. Questions were asked cautiously, there was little laughter and few jokes. After the first coffee break, where old friends had more time to relax, things loosened up. The camaraderie of the previous years returned and we became, once again, a happy family. There are no turf battles, no one-upsmanship, no political games. There is exultation in the exchange of knowledge and the challenge of figuring out the disease from the given facts. The pride of thinking of the disease is enriched by the enjoyment of testing and then telling one's friends what one has learned. For many years, I saw the pattern of cool first hours, and then when we met in New Orleans in 1983, for the first time it was instant camaraderie. Walking through the doors of LSU's curved-stair auditorium, there was laughter and good spirits, which lasted the whole meeting. I've never been sure if it was New Orleans, the style of our host, Henry Van Dyke, Fred Jacobiac, the pathologist, the presence of Lawton Smith, or some peculiar maturity of the group. There is no question in my mind that the curved, sharply inclined, amphitheater- type meeting room is ideal for the Walsh meeting. Seeing the faces of persons speaking, increases both what one hears and the attention given. Our CPC style is a very American thing, open, with people not afraid to ask a question or to expose areas of their own ignorance. The style of this meeting has been infectious with similar groups meeting in the United Kingdom and Australia. The loudest and most raucous meeting I can remember was held in Salt Lake City, in February 1991. Many of the presentations were deliberately humorous, racked with puns or with clinical events so bizarre, that the audience alternately groaned or exploded with laughter. To this were added the lightning bolts of Ann Osborne, the neuroradiologist who challenged, tweaked, and delivered bawdy blows whenever possible. Jeanette Townsend, the neuropathologist, added to the merriment. Kathleen Digre had invited them very wisely. The contributions and participation of Bill Hoyt and Norman Schatz must be emphasized. Sometime before the death of Frank Walsh in 1978, but clearly afterward, the leadership of North American Neuro-Ophthalmology was shared by Cogan, Hoyt, Schatz, and Lawton Smith. Hoyt had coauthored with Walsh the third edition of Walsh's textbook. His training in Vienna and Baltimore, experience in San Francisco, scholarship, and precision forged his authority. This authority produced a constant drive for excellence among his friends, peers, students, and fellows. Norman Schatz's facile mind had been recognized by Nate Schlessenger at Wills Eye Hospital. His knowledge came from the management of a huge practice composed of patients referred by former residents who were practicing in the cachement area of their alma mater, the Wills Eye Hospital. In many meetings Schatz' exuberant manner repeatedly revealed that while there was very little that Hoyt did not know, Schatz had usually seen it and recognized it in spite of various disguises. The meeting always thrived on a competitive camaraderie among all who attended. Simmons Lessell always reminded us that everything, including "meatballs," had been described in the German literature. In recent years, Neil Miller's scholarship has maintained these traditions by providing authoritative reference to authors and articles that help to clarify what we know about a subject. Some are nostalgic for the early meetings when attendance was small. If our major message is to increase knowledge and understanding, then the larger the audience, the more who learn and understand. The final aspect to discuss is social. As time went on, the small dinners given by Frank Walsh and myself grew. There were more people to feed and they were asked to pay for their food. Organizers chose better and better places. I can remember Richard Lindenberg, surrounded by Egyptian statuary in the Philadelphia Museum, giving a talk about his experiences. In 1980, when the Walsh meeting was a section of INOS, at the farmer's dinner in Valbella-Lenzerheide, fresh ox tongue cooked in spices with a light mustard sauce was permanently imprinted on my memory. In Cleveland we wandered among old automobiles and farm and industrial equipment. The first Los Angeles dinner was held at the museum built over the LaBrea Tar Pits. For anyone who grew up hearing Jack Benny and Bob Hope make jokes about La Brea, this was a joy because the museum was so beautiful. The first two Los Angeles meetings were graced by the beautiful fauna of UCLA's Westwood campus. The Children's Museum in Indianapolis was also a rich experience. This history of the Walsh Society serves the purpose of putting on record some facts, thoughts, and ideas that are deemed important. It is the responsibility of the next generation to carry on that which has become a tradition. I Clin Neuro-ophthalmoi, Vol. 13, No.4, 1993 |
