• Legacies: Pondering a Path from Isabelle Rossignol to Charles Schepens

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    The Nightingale by Kristin Hannah (St. Martin’s Press, 2015) is a current New York Times’ best-selling novel. In this compelling tale of two sisters snared in the Nazi occupation of France in World War II, the younger woman, Isabelle Rossignol, joins the French resistance fighters, where her major task becomes the shepherding of Allied pilots of downed aircraft from France over the Pyrenees into Spain. During my getting into this saga, a proverbial light bulb soared into my superior visual field! Had not Charles Schepens, the iconic father of modern retinal surgery in the Unites States, served in a similar role in Belgium and France during that war?

    I first searched a compact 2008 publication of the Retina Research Foundation that honored Dr. Schepens and heralded the establishment of the annual Charles L. Schepens, MD, Lecture at the 2008 AAO annual meeting. In this well-illustrated booklet, Dr. Schepens’ life is briefly described, including the fact that he indeed had assisted Allied pilots, prisoners of war, and others escape from the Nazis into Spain. In addition, reference was made to a more-detailed publication, The Surgeon and the Shepherd by Meg Ostrum (University of Nebraska Press, 2004), and this book provided more extensive details regarding the involvement of Dr. Schepens in the Belgian resistance movement. And the more that I read, the more the fictional story of Isabelle Rossignol appeared to mirror the true exploits of a future giant in vitreoretinal surgery.

    Legacies are by definition passed on, and many novelists rely on prior tales, both fact and fiction. In preparing to write The Nightingale, Ms. Hannah has noted that the character of Isabelle is based upon the history of a genuine World War II heroine, Andree De Jongh (1916 –2007), who assisted more than 400 Allied soldiers escape Belgium via the Pyrenees into Spain and who later, after surviving in a prison camp for over two years, received the United States Medal of Freedom and many similar awards from the British, French, and Belgium governments. Interestingly, Ms. De Jongh was in turn said to have been deeply influenced by the legacy of Edith Carwell (1865 – 1915), a Dutch nurse who helped over 200 Allied soldiers escape from German-occupied Belgium during World War I, an effort that subsequently cost her life via a firing squad. How fortunate that Charles Schepens avoided a similar fate, for his legacies required his surviving to develop a remarkable device and to establish the genuine sub-specialty of vitreoretinal surgery in the United States.

    At least three additional similarities between the novel and genuine history are worthy of comment. First, the use of false names: The fictional Isabelle Rossignol employed the label of Juliette Gervaise, whereas Jacques Perot became the alias of the young ophthalmologist in Belgium. Second, both fictional and genuine resistance fighters relied profoundly upon the services of Basque guides to lead them on desolate paths through the Pyrenees and into Spain. In the case of Juliette Gervaise, this individual was known as “Aduardo”; Jacques Perot’s accompanying guide and counselor was Jean Sarochar, the “shepherd” in The Surgeon and the Shepherd mentioned above. Third is the influence of World War I upon both Charles Schepens and the fictional Isabelle.

    The latter was severely distanced from her father who had been physically and psychologically-damaged during that war. For Dr. Schepens, it was not only his boyhood observations of nearby battles, but also his parents’ dealing with the destruction and deprivation during the German occupation of Belgium — facts that were repeatedly verbalized, leaving lasting imprints in his memory.

    Charles Schepens was born the son of a physician in 1912. He entered medical school in Ghent in 1930 and decided upon a career in ophthalmology. No ophthalmology training programs existed in Belgium at that time, so he enlisted in the medical corps, which would provide a salary and an opportunity to study abroad. Married to his life-long wife Cette in 1936, he began an internship at Moorefield Eye Hospital, and this was followed by a shorter residency in Utrecht, Holland, where he worked with Prof. H.J.M. Weve, an early disciple of Jules Gonin, with whom he is pictured in a photograph in Volume 10 of the 1967 Duke-Elder series. (Surely this exposure to a recognized expert in retinal detachment surgery was influential to this house officer). He subsequently divided his time between a private ophthalmology practice in Brussels and general medicine in a local military complex. In 1940, Schepens became active in the Belgium underground, first in arranging for local transfers of packages and envelopes and many months later, after a move to France and acquiring a role as a sawmill owner and operator, as a smuggler of materials and later, individuals, over the mountains. During this time he was visited at least twice by Nazi interrogators who were unsuccessful in discovering the plans of the resistance fighters, as indicated by his assisting more than 100 Allied pilots pass over the Pyrennes.

    By late 1943, Dr. Schepens believed it best to be smuggled out of France and on to Lisbon and then London, where he was joined by Cette and two of their children. By 1945, a third child had been born and Charles had resumed a practice in ophthalmology. And importantly, work began on the prototype of the modern binocular indirect ophthalmoscope. At the end of the war, he returned to Brussels and continued work on the device, and in 1946 he delivered a paper regarding the instrument at the AAO annual meeting in Chicago, where he then spent six weeks as a visiting surgeon in the city and began pursuing a position at an institution in the U.S. In 1947, he and his family moved to Boston, where he had begun work as a research fellow at the Howe Lab and Harvard. He subsequently founded the Retina Research Foundation, AMO became the manufacturer and distributor of his binocular indirect ophthalmoscope, and the rest, as they say, is history. Dr. Schepens’ legacy lives on.

    The importance of the Schepens’ ‘scope in the advancement of retina surgery cannot be overstated, for the device truly revolutionized the field. The addition of scleral depression made stereoscopic visual access to the peripheral retina a reality, and this in turn resulted in improved diagnostic skills, as well as better surgical outcomes. Still, the initial use of this device was difficult for most practitioners, a fact not lost upon trainees currently beginning careers in ophthalmology. One of my mentors, Harrell Pierce, became the first fellow of Dr. Schepens’ newly formed Retinal Fellowship Program at the Massachusetts Eye and Ear Infirmary in March, 1951. When he returned to the Wilmer Institute and began a retina practice, he observed that few if any were skilled in the new visualization techniques. But by the time that Bob Welch returned from a similar position with Dr. Schepens in 1959 and became a co-director of the Retina Clinic at Wilmer, retina specialists around the world had become facile with the then new device. And the Schepens’ ‘scope has changed little since then other than for improved comfort and illumination.

    So sure enough! Reading a contemporary novel regarding two sisters in Nazi-occupied France unearthed a proverbial treasure chest of information regarding a courageous young ophthalmologist who became a resistance hero on his way to developing an instrument that lead to improved lives for millions. The novel is quite good, but its story is inferior to a similar, but true tale regarding a remarkable colleague.