• Dr. Frank B. “Pappy” Walsh: A Remembrance

    Written By:

    On Nov. 27, 1978, Dr. Frank B. “Pappy” Walsh, emeritus professor at the Wilmer Eye institute, passed away from oat cell carcinoma. He was 83 years old. In a memorial service, Robert Welch, also a fixture at Wilmer and unofficial historian, described him as an academician, teacher, and gentleman: “He was a father of neuro-ophthalmology, a steadying influence, and the backbone of the Wilmer institute.” 

    Dr. Frank Walsh

    Welch was not exaggerating. Dr. Walsh was connected to the Wilmer Eye Institute from 1930 until his death 48 years later. His work at Wilmer spanned nearly five decades, a time when the institute was chaired by William Holland Wilmer, Alan Woods, A. Edward Maumenee and Arnold Patz. Dr. Walsh truly was a part of the foundation of the Wilmer institute, having helped to formulate an essential component of its educational mission.

    Dr. Walsh’s family was Irish in origin. He was born on Oct. 18, 1895 in Oxbow, Saskatchewan. His grandfather was a trapper and prospector, and his father was a printer, farmer and small businessman. Early on, he learned to play the piano, clarinet and organ. Growing up in the wilds of rural Canada, he not surprisingly became interested in Canadian football, baseball and hockey while attending a local school. The original source of his aequanimitas possibly came from his postgraduate work as a schoolteacher.

    Dr. Walsh enrolled at Queen’s University in Canada in 1913 but resigned in 1915 to enlist in the Canadian Army Medical Corps. He was stationed in England, sent to Egypt and later returned to England for officer training before being sent to France as a lieutenant. He was wounded at the Battle of Ypres when a piece of shrapnel pierced his lung. He had complications after his injury and was discharged from the Army after apparently having been diagnosed with tuberculosis. Afterwards, Dr. Walsh returned to Canada and entered medical school at the University of Manitoba, graduating in 1921.

    Dr. Frank Walsh (R) with his co-author Dr. William Hoyt (L)

    Following an internship at Winnipeg General Hospital, he entered general private practice in Estavan, Saskatchewan, a town of 5,000. His practice was truly general and included appendectomies. Tullos Coston (later chairman of ophthalmology at the Dean McGee Eye Institute in Oklahoma) liked to tell the story of Dr. Walsh’s catheterization of an elderly patient experiencing urinary retention. Later, long after he had entered ophthalmology, he found a catheter in his luggage.

    Dr. Walsh traveled to Scotland twice in the 1920s, where he met Norman Dott, one of the founders of British neurosurgery. In 1928, Dr. Walsh received the FRCS degree from the Royal College of Scotland in Edinburgh.

    It is often difficult to determine how individuals became interested in a subspecialty. Writing in his text, “Clinical Neuro-Ophthalmology,” Dr. Walsh states that “F.B.W. had been sitting in a lecture room for an hour and feeling well. On arising at the termination of the lecture, there was a sudden sensation of the visual fields closing in from the periphery, and within a few seconds everything appeared dark. Assistance was obtained in walking from the third-floor lecture room to the ground floor and along a long hall. When outdoors was reached, there was a sudden expansion of the visual fields with, for a few seconds, a sensation of dazzling white light immediately in front of the eyes. During the following 20 years he suffered occasional attacks of blurred vision and scintillating scotomas in rare instances followed by mild headache lasting not more than a half-hour.”

    This personal experience Dr. Walsh had with ocular symptoms of migraine headaches was influential in his decision to pursue further training in ophthalmology and eventually in neuro-ophthalmology. Unlike Osler, who wrote to Bowman and was informed that Bowman had taken his “one Canadian” for the year, Dr. Walsh chose to write to William Wilmer, who had recently opened an institute at the still-young Johns Hopkins University. In spite of the fact that Dr. Walsh was married (not acceptable to Osler as a house officer), had children and was substantially older than other trainees (35), Wilmer accepted him as a resident, impressed by Dr. Walsh’s level of maturity and forthright personality.

    When Dr. Walsh arrived at Johns Hopkins, his chief resident was Ben Rones and fellow residents were R. Townley Paton, George Heidelman, William Rowland, Milton Little, and Rowland Merrill (subsequently professor of neurology at Columbia University). It must have been a challenge for Dr. Walsh on a salary of $25 a month (although his meals and uniforms were supplied). Apparently, he showed outstanding aptitude during his residency, was invited to become senior resident in 1933 and completed his chief residency in 1934. During that time, he introduced the use of rubber gloves to ophthalmology (originally used by Halsted and made thinner by Walter Dandy, chairman of neurosurgery). Likely aware of Jules Gonin’s work, he advocated diathermy for retinal detachment.

    Although Dr. Walsh was generally considered an excellent surgeon, he began to explore the idea of specializing in neuro-ophthalmology despite being warned by his junior resident Tullos Coston that he would “starve to death.” Even as a resident, he produced a huge model of the brain with all the tracts and blood vessels properly in place.

    In 1934, he was appointed assistant professor on the Wilmer faculty. It was at this time that Dr. Walsh also became associated with Frank Ford, a neurologist with an interest in pediatrics (who was preparing his book, “Neurology of Infancy and Childhood.” The two Franks spent a great deal of time at Baltimore City Hospital studying neurological cases of every description and finding many with eye signs. Even as a resident, he had close contact with Walter Dandy, who would often request visual fields to be done on the night immediately preceding surgery. It was said that no craniotomy was decided on without first asking for Dr. Walsh’s opinion. This continued even after A. Earl Walker took over the neurosurgery unit from Dr. Dandy. Dr. Walker, who succeeded Dandy as professor of neurosurgery, expected his neurosurgery residents to attend Dr. Walsh’s Saturday morning conference. Although Drs. Walker and Walsh could disagree, they were not infrequently found out on a golf course together. 

    As a faculty member, Dr. Walsh arranged for Saturday morning conferences. He approached Dr. Ford for joint research and began to collect cases that would demonstrate the importance of ophthalmologic observations in diseases related to the central nervous system. These case vignettes would provide the backbone to his later writing in neuro-ophthalmology and would appear in his text as well as in subsequent collaboration with Dr. Richard Lindenberg and later Dr. Joel Sacks. An early paper on clinical neuro-ophthalmology was published in 1936. He also helped to organize the Wilmer Residents Association to give former residents and Wilmer’s staff the opportunity to present meaningful research.

    In 1937, Dr. Walsh was appointed associate professor, a rank which he retained until 1958. Although Canadian by birth, he became a naturalized U.S. citizen in 1941. In 1945, he continued to head up the neuro-ophthalmology service at Wilmer, and in 1947 published his first text titled “Clinical Neuro-ophthalmology.” But in 1949, reportedly for financial reasons, he joined Charlie Iliff in private practice. This occurred shortly after Marian, his wife, became disabled following bilateral resection of frontal lobes for a brain tumor.

    In 1958, Dr. Walsh was named full professor at Johns Hopkins, reportedly the first nonchairman so elevated. Following Marian’s death in 1960, he returned to the full-time staff. Later, he married a longtime acquaintance, Josephine Morgan, the former head surgical nurse at the Winnipeg General Hospital.

    While I was at Wilmer, I was told that during the time he was working on his first textbook in neuro-ophthalmology, Dr. Walsh took one of the chapters he had written to Alan Woods, his chairman, to find out what Alan thought. When he did not hear from Alan for a month, Dr. Walsh went to ask him whether he had had a chance to look at the chapter. Reportedly, Woods’ comments were “Frank, half of this stuff isn’t even ophthalmology.” This would certainly seem consistent with Dr. Walsh’s view of neuro-ophthalmology as an inclusive specialty that broached the boundaries, not just those of all of ophthalmology, but also of those encompassing neurology, neurosurgery and internal medicine.

    A unique feature of the Dr. Walsh’s first text, “Clinical Neuro-ophthalmology,” was his incorporation of small vignettes of clinical material that he had seen. These vignettes remained throughout the second and third editions. Subsequent to the third edition, which was rewritten with his former fellow William Hoyt, the vignettes unfortunately were removed for space considerations. I always like to think that Dr. Walsh realized that in education, people remember individual cases, and so he picked cases that had heuristic value.  

    Dr. Walsh expressed his appreciation to the institution when he emphasized that “for many years I have enjoyed the privilege of working on clinical diagnoses with colleagues in several departments of the Johns Hopkins Hospital and the Baltimore city hospitals. This book has been written through a period of 10 years with this experience as a background. It has been written on the basis of a firm conviction that ophthalmologic diagnosis and other than ‘pure’ ophthalmologic cases must be based on a general knowledge of disease processes and detailed knowledge regarding the ophthalmic features of disease. Neuro-ophthalmologic diagnosis commands much more than the capacity to outline complicated pathways and devious reflexes.” Dr. Walsh goes on to credit Frank Ford for the arrangement with “anatomic, physiologic, neurologic and other basic information.”

    “During my association with the Johns Hopkins Hospital, at first under the direction of the late Dr. W. H. Wilmer and now under Dr. Alan C. Woods, I have been given complete freedom to pursue my studies according to my interests. I am indebted to them for this opportunity.”

    In 1973, Dr. Walsh’s textbook titled “Neuropathology of Vision: An Atlas” was published. His coauthors included Richard Lindenberg, a lecturer in forensic pathology and director of neuropathology and legal medicine at the Maryland State Department of Health and Mental Hygiene, and Joel Sacks, associate Professor of Ophthalmology and Neurology and subsequently Professor of Ophthalmology and Neurology at Northwestern University Medical School in Chicago. The first part of the textbook contains descriptions of the anatomy, the second part is concerned with descriptions of the arrangement of the visual fibers from the retina to the visual cortex and the third part deals with topical diagnosis of lesions situated at various levels.

    During his time as a fellow with David Cogan at the Massachusetts Eye and Ear Infirmary, David Knox began a series of conferences regarding the pathologic basis of neuro-ophthalmic manifestations in various patients. In 1969, with the advantageous appearance of David Cogan as a visiting professor at the Wilmer Eye Institute, David Knox, Joel Sacks and others joined Dr. Walsh to form the first Neuro-Ophthalmic Pathology Symposium. The symposium has continued. In 1978, after Dr. Walsh passed away, it was renamed “The Frank Walsh Society” and which was subsequently incorporated into the North American Neuro-Ophthalmology Society (NANOS).

    The society continues to utilize individual cases of outstanding heuristic value to explain mechanisms of disease in patients from across the country and around the world. Perhaps the society is also channeling Harvey Cushing, who as a faculty member at Johns Hopkins, emphasized the importance of the ophthalmic evaluation. Cushing’s approach, which initially involved the use of the optic disc and later incorporated visual fields technologies, expanded to include the evaluation of patients with neurologic disease and those that were determined to have neurosurgical pathology.

    In the early 1950s, besides having migraine headaches, Dr. Walsh developed intermittent peripheral claudication. He was diagnosed as having peripheral vascular disease and underwent femoral bypass by Denton Cooley. He also had a mature reaction to his diagnosis of lung cancer in 1978 when he developed shortness of breath. Those who knew him felt he never lost his sense of humor, despite these challenges.

    Dr. Walsh’s contributions were well recognized during his lifetime. He received honorary degrees from the University of Western Australia (ScD 1948), University of Manitoba (ScV 1958), Queens University Kingston Ontario (LLV 1962) and Johns Hopkins University (LLD 1972). He was also named an honorary fellow of the Royal College of Physicians and Surgeons, Winnipeg-Manitoba Canada (1975), and as already mentioned, had been a Fellow of the Royal College of Surgeons of Edinburgh since 1928.

    Individual awards included an American Medical Association prize in ophthalmology and the Howe Medal – both from the American Ophthalmological Society and the Buffalo Ophthalmology Society. He was also awarded the first Jules Stein Award from Research to Prevent Blindness, the AMA’s Proctor Award, the Karl-Leidrecht prize from the German Ophthalmological Society and the Proctor Medal from the Association for Research in Vision and Ophthalmology (ARVO).

    Dr. Walsh was a human being. As one who knew him well, Tullos Coston pointed out that when irritated, Dr. Walsh would develop a “deep pink flush in the shape of a butterfly that would appear in the center of his brow.” This was subsequently often referred to as “Walsh’s sign of mad.” Dr. Walsh could express displeasure when his advice was not adopted.

    As described in his induction to the American Society of Cataract and Refractive Surgery Hall of Fame, “Dr. Walsh developed a body of knowledge, recorded that knowledge, and shared it in an organized and systemic fashion which had not been improved upon, even to this day.”

    Probably the most important tribute to Dr. Walsh was the establishment of the Frank Walsh Chair in Neuro-ophthalmology at the Wilmer Eye Institute, the first of its kind. Coston, in summarizing his personal observations of Frank Walsh quoted Shakespeare’s words in Julius Caesar: 

    “His life was gentle, and the Elements

    So mixt in him, that Nature might stand up,

    And say to all the world; This was a man.”

    Ophthalmic History Editors: Daniel M. Albert, MD, MS Donald L. Blanchard, MD