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  • David G. Cogan, MD: Life of Discovery and Humility

    David Glendenning Cogan, MD, was born on Feb. 14, 1908 in Fall River, Mass. His father was an Episcopalian minister whom Dr. Cogan described as “an ascetic who didn’t communicate much … worked on Sundays and spent the rest of his week with his books.”

    Consequently, his father’s personality allowed Dr. Cogan a relative amount of freedom in his actions when growing up, which he treasured. In Dr. Cogan’s oral history interview in 1990, he was asked what he considered the highlight of his career. His response: “I suppose the one word that says it all is freedom — freedom to pursue what I thought was right and promising, freedom to associate with persons whom I admire and respect, and freedom to identify with institutions that serve the common good.” Dr. Cogan’s life certainly demonstrated all these concepts.

    Dr. Cogan had outside jobs during his school years, which he stated imbued him with “good work habits.” This ethic, incubated early in his life, continued and was the engine propelling Dr. Cogan’s intellect to produce a significant impact on ophthalmology and motivate those around him. While I was a fellow with Dr. Cogan at National Institutes of Health (NIH), I overheard another doctor say, “I don’t think Dr. Cogan works as hard as he used to — he doesn’t come to work until 10 a.m.” That doctor didn’t know that Dr. Cogan awoke at 6 a.m. every day and read or worked on manuscripts from 7 a.m. until he went to work at 10 a.m. Even at age 83, Dr. Cogan was working more than most of the staff at NIH, five days a week and often on Saturdays.

    David Glendenning Cogan, MD
    David Glendenning Cogan, MD

    Dr. Cogan’s decision to go to medical school was undoubtedly influenced by his aunt and his mother who were both MDs. In fact, his mother was an ophthalmologist - the first woman ophthalmologist at the Boston Dispensary, and one of the first women doctors at the Massachusetts Eye and Ear Infirmary (MEEI). Around 12 years old, he was allowed to accompany his mother to her clinics at Mass Eye and Ear on Saturdays.

    It’s perhaps no surprise that by the time he was a sophomore at Dartmouth Medical School at age 21, he had decided on ophthalmology as a career. The decision was nurtured by his mother’s “high regard for ophthalmology and ophthalmologists” and enriched by his relationship with first The Dartmouth Eye Institute, and then with Mass Eye and Ear after his transfer to Harvard Medical School for his third and fourth years. During his medical senior year Dr. Cogan applied for an ophthalmology residency at Mass Eye and Ear, which was a natural choice derived partly from his familiarity with that institution, his mother’s successful tenure there, and the intellectual stimulation he experienced at Mass Eye and Ear while at Harvard Medical School, particularly with his adviser Dr. Edwin Dunphy, an ophthalmologist, who would later become Chief of Mass Eye and Ear and Chairman of the Department of Ophthalmology.

    Dr. Cogan began doing research in ophthalmology while a resident at Mass Eye and Ear and immediately after finishing residency was appointed to the Howe Laboratory staff by Dr. Frederick Verhoeff, with whom he’d developed a close relationship. He performed research for nine months of the year and saw patients during the other three months, all for $600 per year. Dr. Verhoeff retired at age 65 per Harvard rules, and Dr. Cogan at age 32 became acting director, and then director of the Howe Laboratory.

    As director, Dr. Cogan fostered an environment based on freedom of thought and avenue of research, “I believe it is important to appoint a person of promise and let him develop his ideas as he sees fit.” Although research applicability to clinical ophthalmology was encouraged, observations in the basic sciences were supported as Dr. Cogan knew that clinically pertinent findings might evolve. To this end, active discourse between clinicians and basic scientists was facilitated, including during the “brown-bag” lunches he held in the Laboratory wherein even the most junior staff were encouraged to actively participate. As Dr. Cogan  stated, “Few patients realize the benefits they gain from what goes on in the back rooms of research.”

    Because of the stature of the Howe Laboratory and the enlightened environment which Dr. Cogan created recruitment of a talented retinue of brilliant individuals ensued, many destined to become renown experts in their respective fields. These included Dr. W. Morton Grant whose research and amalgamation with the clinical expertise provided by infirmary surgeon Dr. Paul Chandler, developed into production of the leading textbook on glaucoma. Additionally, Dr. Grant compiled a compendium on the effects of toxic substances on the eye, which remains a premier source of information on this subject.  Dr. Grant was completing an update of the fifth edition at the time of his death. Others included Dr. V. Everett Kinsey — cornea and lens physiology and retrolental fibroplasia, Dr. Jin Kinositia — biochemistry of diabetic cataracts, Dr. Toichiro Kuwabara — corneal and retinal pathophysiology and ultrastructural pathology, Dr. Herbert F. Kaufman — herpetic keratitis and treatment, Dr. David Donaldson — photographic anatomy and pathology of the eye, Dr. Charles Schepens — binocular ophthalmoscopy, Dr. Robert Reinecke — temporal arteritis and stereopsis testing, Dr. Ephraim Friedman — choroidal and retinal blood flow, Dr. Gerald Chader — retinal pathophysiology, and Dr. Carl Kupfer — aqueous flow dynamics and lateral geniculate body innervation2 and several others.

    Dr. Kupfer later became the first Director of the newly formed National Eye Institute (NEI) in 1970. As part of his effort to build an intramural scientific core he invited Dr. Cogan and other members of the Howe laboratory to come to Bethesda. As it happens, the Howe Laboratory was in a state of turmoil due to new issues promulgated by the Dean of Harvard University, and it seemed to Dr. Cogan that from a professional standpoint, this might be as good a time as any to leave. He joined the rest of his staff at NIH for what he called “a trial period” but which lasted 23 years. The group of scientists that moved to Bethesda from Boston became known as “The Howe Lab South”.

    Dr. Cogan was pleased with the environs at the NEI as he had the same system as in Boston but in an expanded form. He had excellent facilities for videotaping patients and had a close association with the neurologic departments at the NIH. He was able to continue his pathology studies with Dr. Toichiro Kuwabara, a scientific relationship which had flourished for 35 years. “Brown-bag” lunch sessions were again instituted which proved invaluable for the fellows and faculty that attended. Like in Boston, these generated ideas for further research. One disappointment Cogan expressed about the NEI was the physical separation of the basic scientists from the clinicians.

    This was largely due to lack of space in the Warren Grant Magnuson Clinical Center (in building 10) where his office and labs were located. The basic scientists were housed in their own building a block away. Nevertheless, various conferences and meetings were arranged which eased the dichotomy to an extent. Cogan flourished at the NEI, saw neuro-ophthalmic patients and could “shift between neuro-ophthalmology and pathology freely”. A neuro-ophthalmology fellowship program was established and many of his trainees went on to become leaders in the field.

    Dr. Cogan and his wife “Did” at their vacation home in Michigan.

    The greatest sadness in David Cogan’s life was the death of two of his four daughters. His oldest daughter, Christy, was killed in an automobile accident in 1962 at age 22. While I was a fellow with Dr. Cogan, he asked me to stay at his home in Chevy Chase while he and his wife, Francis (known as “Did”) were in Germany for several months as part of the Humbolt-Stiftung Award. In the winter of 1988, I received an early morning phone call from Dr. Cogan’s youngest daughter Pricilla informing me that her sister, Ann, had been hit by a snowplow in Rochester, New York, and did not survive. Priscilla said her parents were coming home from Germany the next day. When David and Did arrived at the house, Dr. Cogan looked as despondent as I had ever seen — another of his children had been taken from him and in much the same way. It was weeks before Dr. Cogan returned to his communicative and participatory self.

    Despite thriving professionally at the NEI, Dr. Cogan found that living in Chevy Chase was a profound change from his life in Boston. His wife Did said, “If I had my choice, I’d go back to Boston”. They found Chevy Chase to be “barely tolerable in the summer”, and hence escaped to their vacation home in Michigan as often, and for as long as was possible. That home, near Leland on the shores of Lake Michigan, had been in Did Cogan’s family for three generations.

    Idyllically named “Nepenthe” (which in Greek means “that which chases away sorrow”) the property figured prominently in Dr. Cogan’s life and career. He and Did were married there on July 14, 1934. His “little books,” “Neurology of the Ocular Muscles, and Neurology of the Visual System,” were written in the garage on the property converted into a study, “It was just me and the chipmunks.” Dr. Cogan had invited several of his collaborators and friends to Nepenthe, including Drs. Everett Kinsey, Morton Grant, Lorenz Zimmerman, Marshal Parks, ex-Sen. William Fulbright, Toichi Kuwabara, and others (including myself), where lively discussions transpired surrounding ophthalmologic problems and other salient topics. Of course, there were relaxation periods, but Cogan also spent a lot of time writing manuscripts and reading, “The cruelest thing you can do to a man is to expect him to sit on the beach and leave his work back in the laboratory.” Besides offering relative solace for him to work, Cogan saw Nepenthe as “a place to garden do carpentry around the house, go hiking through the woods, and to beat my daughter in tennis.” He complained that he physically couldn’t do what he used to do, but he continued these activities well into his 80s. Additionally, Dave renewed his interest in playing the piano late in life (age 72) and would get up in the middle of the night and play, “It relaxes me and allows me to be creative in a different milieu.”

    Dr. Cogan’s scientific creativity was far ranging and robust. This combined with his acute observational insights led to the descriptions of several clinical entities which now bear his name. He disliked the use of eponyms and thought eponyms should be used only if the descriptors for the problem were cumbersome or the etiology was unknown. Nevertheless, several entities he reported are now related using his appellation.

    Because of his meticulous note-taking and unique record keeping system, Dr. Cogan was able to recognize that, of the many patients he had seen in clinic, there were 4 who exhibited a fluctuating inflammation of the cornea and at some time also the abrupt onset of vertigo and deafness. He published these cases in 1945 and proposed the entity be called “Syndrome of nonsyphilitic interstitial keratitis and vestibuloauditory symptoms.” However, as additional cases around the country were recognized, the entity began to be called “Cogan’s Syndrome”. Dr. Cogan had a similar explanation for why his description of four cases of “congenital oculomotor apraxia with jerky head thrusts,” first presented in his Jackson Memorial Lecture in 1952, was often called “Cogan’s syndrome, type 2”. He said, “I would not opt for an eponym in this case …”

    In 1963, Dr. Cogan presented a paper at the American Ophthalmologic Society outlining a microcystic keratopathy in five patients calling it “Microcystic dystrophy of the corneal epithelium”. And as had happened before, subsequent investigators referred to it as “Cogan’s microcystic corneal dystrophy”, although now it goes by the moniker “Map-dot- fingerprint corneal dystrophy”. In 1965 Dr. Cogan published a review of myasthenia gravis with a description of twitch movements in ptotic eyelids of myasthenic patients with movement from infraversion to the primary position. This is still described as “Cogan’s lid twitch.” Also, in 1965, Dr. Cogan along with Dr. Toichiro Kuwabara, his primary collaborator at the time, published a description of “Focal senile translucency of the sclera,” which has become known as “Cogan’s calcific scleral patch”.

    At a meeting of the Verhoeff Ophthalmic Pathology Society in 1968, Dr. Cogan discovered both he and Dr. Algernon Reese brought iris pathology specimens to share that depicted a hitherto undescribed disorder. In these cases, a cuticular membrane covered the surface of the iris with small, pigmented excrescences protruding through the membrane, dotted along the iris surface. Peripheral anterior iris synechiae and glaucoma were present. Details of these cases were published in 1969 by Cogan and Reese and the entity became known as the “Cogan-Reese Iris Nevus Syndrome.”

    Dr. Cogan’s contributions to ophthalmic understanding included much more than just the eponymic disorders listed above. For instance, after visiting Hiroshima and Nagasaki in 1949 (under the auspices of the Atomic Bomb Commission), he authored the first description of radiation cataracts derived from atomic fallout. He elucidated important oculomotor factors in cerebellar disease, internuclear ophthalmoplegia, and the usefulness of optokinetic nystagmus in parietal lobe disease, praeter plura.

    Dr. Toichiro Kuwabara transferred to the NIH with Dr. Cogan. Together Cogan and Kuwabara authored 64 seminal papers on histopathologic and pathophysiologic findings for a wide range of topics including corneal fat metabolism, vasculopathy in diabetes mellitus, fat deposition in arcus senilis, corneal cystinosis, Gaucher’s disease, lecithin-cholesterol-acyltransferase deficiency (LCAT), among many others. Dr. Kuwabara brought ultrastructural analysis to many of Dr. Cogan’s descriptions. Dr. Cogan ‘s wife, Francis C. Cogan, MD, spent two years in Kuwabara’s lab, learning evaluation and management techniques and participating in research. In the early years after their marriage, she participated in research activities in the Howe Lab and at Mass Eye and Ear. An accomplished scientist in her own right, she published numerous papers on experimental studies in ophthalmology especially on microwave induced cataracts in 1976. Of the first 10 papers that Dr. Cogan wrote, his wife was co-author on six.

    Dr. Cogan playing his piano at 1 a.m.

    Dr. Cogan loved ophthalmology, the complexity of visual perception, and investigation of the maladies which interfered with it. David never stopped working, even up until his death on September 9, 1993 at age 85. He was laid to rest in Leland near the grave of his daughter Christy. “Did” died on January 18, 2002 and is buried alongside her husband of 68 years.

    David Cogan’s legacy lives on through his seminal and classic publications, and through application of his name to endeavors he believed in. At Mass Eye and Ear, the David G. Cogan Pathology Laboratory was dedicated in his honor. Two endowed chairs have been established there, the David Glendening Professorship in 1969, and The Edith Ives Cogan Professorship named for his mother, one of the first women ophthalmologists at Mass Eye and Ear. The David Glendenning Cogan Library at NEI was established in 1985. His extensive clinico-pathologic collection was digitalized and can be found at “The David G. Cogan Ophthalmic Pathology Collection”. Important elements of his neuro-ophthalmologic case collection are available on the Neuro-Ophthalmology Virtual Education Library (NOVEL) internet database — “The David G. Cogan Neuro-Ophthalmology Collection”.

    Dr. Cogan was a founding member of several institutions including the Ophthalmic Pathology Club (now the Verhoeff-Zimmerman Society) and the Association of University Professors of Ophthalmology (AUPO). He established the Paul A. Chandler Visiting Professorship at Mass Eye and Ear. Because of his concern that details of ophthalmic history were being lost, David invited a group of interested ophthalmologists and historical scholars to present and discuss historical aspects of ophthalmology at the National Library of Medicine in Bethesda, Md. This first meeting of the American Ophthalmic History Society was in 1988 with 26 attendees and was followed thereafter with annual meetings in Bethesda. The society quickly grew, and now, 33 years later, there are over 60 active members of what is now known as the Cogan Ophthalmic History Society.

    Although the above cognomen will keep his name alive in perpetuity, the personal memories of him, held fondly by his hundreds of students and colleagues are transcendent. David at no time was condescending or dogmatic. He taught compassionately via the Socratic method and avidly encouraged the careers of young and upcoming scientists and clinicians. The Cogan Award, given at the Association for Research in Vision and Ophthalmology (ARVO) meeting honors young and productive leaders.

    Dr. Cogan’s gifts to ophthalmology live on through his seminal and classic publications, and his extensive clinico-pathologic collection and neuro-ophthalmology cases now available on the internet. When asked how he would like to be remembered, David said “I think I would rest comfortably if they said, ‘He had his assets, he had his liabilities, he made mistakes, and he made contributions, but the contributions and accomplishments outweigh the mistakes.’ ”

    David Cogan’s humility from a place of greatness, is an indelible part of his considerable legacy.