Adolph Barkan, MD.

With grateful thanks to J. Fraser Muirhead, MD, UCSF Clinical Professor of Ophthalmology, Ret. Published by the Cogan Society, March 2013.

Adolph Barkan lived almost half of his 90 plus years in San Francisco, California. Born before the Crimean War in Hungary, he died in Germany just a year after Hitler came to power. As a child Barkan saw Cossacks scour his family’s dinner table for food, as a medical student in Vienna he was shocked by the news of Lincoln’s assassination, and as a practicing ophthalmologist-otolaryngologist in San Francisco he was shaken by the 1906 earthquake. While interned in Germany in World War I he intermittently entered in a diary-memoire some accounts of his early life and his current living difficulties. (Barkan 1917-1918) The diary reveals many details of his early years. Therein lies the explanation of his decision to leave his excellent prospects in Vienna, to spend his entire professional life in a rowdy, young city on the West Coast of North America.

Early Years

His family were restaurant – bar keepers, his father a wine importer, in a small town near Eperjes (presently Prešov, Slovakia) in the Hungarian part of the Austro-Hungarian Empire. His diary recounts Cossacks in Hungary during the Crimean War to support the hated Hapsburgs, breaking into his family’s house and commandeering all the food, even some milk Barkan was about to drink.

“Suddenly a door is thrown open, and into the room rush a half a dozen Russian Cosacks (sic). We scatter apart like the beasts of the field — loud screams –some calls for help — because there sit the hungry, dirty devils with their long rifles and bayonets still between their legs in our places — shove the food down their mouths, drink down everything standing on the table, spoon up every bit of food and throw the contents of the large spoons full of hot milk and cream down their gullets –(may God punish them for that, and their children, and their children’s (sic) children!) — and depart as hurriedly as they had come in!” (Barkan 1917-1918)@ p.11

This memory led him wish to live where such lawless behavior was not tolerated. Living with a blind aunt, to whom his mother daily read, nurtured his desire to become an ophthalmologist.

Education

He left home at age 16 to attend Vienna University Medical School. He mentions close student contact with Hyrtl, Brucke, Rokitansky, Skoda, and Hebra. A semester with Billroth in Zürich was especially rewarding, “…the most useful and beautiful semester of all my medical life.” (Barkan 1917-1918@p. 64). In his last year he spent 10 to 12 clinic hours daily with Ferdinand von Arlt. He wrote,

”An entire year as concentrated as it could be made; every afternoon from 4 to 6 o’clock the inspection of the fundus with the ophthalmoscope and then supper, and in the evening, the operative course with one of Arlt’s assistants.”

“No wonder that at the end of the year, we could feel that we had established a satisfactory record. I had done all except the very delicate operation on the human eye. I think I could fairly be looked upon as a specialist who had a good future in front of him.” (Barkan 1917-1918) p.71

In his diary he describes publishing a research paper in 1866 on the movement of the

“retinal pigment backward into the deeper layers of the retina under the influence of sunlight.” (Barkan 1917-1918@p. 73)

However, the Lane Library contains a reprint of an 1866 paper by him entitled,”Beiträge zur Entwickelungsgeschichte des Auges der Batrachier”, which deals with frog lens embryology. (Barkan 1866)

After graduation he spent a year at the University of Graz with Professor Rolet as assistant in physiology. Then, he says “…I returned to Vienna and spent a further year in the eye department of Professor Jäger as a volunteer assistant, without pay without privilege of operating on the living, but seeing and handling the immense material of the eye clinic, all of which was at our disposal.”. (Barkan 1917-1918). . p. 76

Professional Career

In 1869, after spending a year as Resident Physician at the Maryland Eye and Ear Hospital in Baltimore, he arrived in San Francisco and set up practice.
In 1872 Barkan joined the faculty of one of the two newly founded medical colleges in San Francisco, the Medical Department of the University of the Pacific. He became the first subspecialty professor appointed to the faculty when this school expanded its medical staff to include subspecialties {Barkan, 1954 #2 @ 151} This institution evolved via the Cooper Medical College into the Stanford University of Medicine.

During his four-decade affiliation with the Cooper school he was very active in its administration. He supported admission of women as full students to Cooper Medical School. He advocated the addition of basic science departments such as pathology and physiology. He served on the Board of Directors of Cooper Medical School and was elected president of the Board shortly before it disappeared in Stanford University. His importance may be judged by the statement of another member of the board of directors, Dr. Rixford. At a private meeting held to decide how to deal with the Dean of the School, Dr. Ellinwood, who was not honoring his agreement to share Mrs. Lane’s legacy with the school, Rixford wrote that he keenly felt Barkan’s absence, “I am greatly troubled… Dr. Barkan is away – and an unwarrantedly large responsibility rests on me.” (Rixford 1906)

In 1912 Barkan retired from Stanford Medical School as Emeritus Professor of Structure and Diseases of the Eye, Ear and Larynx.

He was a good teacher although Dohrmann Pischel spoke of his Germanic, or perhaps better said autocratic, clinic manner. (Hughes 1987). His private practice was very successful, no doubt partly assisted by publicity from newspaper coverage of foreign body removals (or attempts) by magnet. (Democrat 1910) Pischel remarked that Barkan’s influence assured that San Francisco ophthalmology would be the equal of any city in North America.(Hughes 1987).

He served as assistant editor of the Annals of Ophthalmology for several years. (Anon 1902).

He wrote primarily on clinical subjects, both eye, and ear, nose and throat. The latter dealt with chronic otitis media purulenta with temporo-sphenoidal lobe abscess, radical surgery for frontal sinusitis, bronchoscopy, hemorrhage after tonsillectomy, use of the burr in mastoidectomy, and radical mastoidectomy.

His eye articles generally presented case histories; such as central and branch retinal arterial occlusions, serpiginous corneal ulcer, and a gumma of eye and adnexa. Exceptions were a report on systemic diseases affecting the eye and another condemning the negligible amount of ear, nose and throat teaching in medical schools.

Current medical advances were a continuing interest of Barkan. After his return from one of his European trips, during which he trained with Ludwig Stacke, he performed the first radical mastoidectomy done in California.

His report on his use of cocaine anesthesia for cataract surgery appeared shortly after Koller’s 1884 article. It presents the reader with a vivid picture of the problems of pre-cocaine cataract surgery and the relief cocaine anesthesia provided. (Barkan 1887)

“…in precocain (sic) times… percentage of loss … under unfavorable conditions of chloroform or ether narcosis,and without antisepsis …losses … probably no more than about … 5:100 “

“Although distressed at the failure of this, my first case of senile cataract with cocain (sic) {due to … panophthalmitis}, my confidence in the drug was not shaken. I used it, therefore, for the next case of senile cataract, and on eighteen subsequent cases, and am happy to record an uninterrupted series of nineteen successful cataract extractions.”

“Setting aside the greater precision with which we are now enabled to perform the different parts of the operation, cocain (sic) exhibits its blissful effects in preserving the eye from pain, and body and eye in a state of quietude during the hours immediately following the operation, that short, yet very important space of time, during which nature makes her first commencement in uniting the wound–thus preventing any disease germs from entering the eye.”

He wrote many articles on magnetic removal of foreign bodies in the eye, four on the giant magnet of Haab (Still 1980). He imported the first Haab giant magnet brought to the United Sates. (Rixford 1935)

A more interesting article connects Barkan with today’s slit lamp biomicroscope. Combining the Gullstrand illumination system with the Czapski biomicroscope from Carl Zeiss Jena created the essential features of our current device. (Butler 1927). Barkan had evidently used a Zeiss monocular corneal microscope designed by Czapski and Schanz in the late 1800’s (Schanz 1893) quoted in (Czapski 1899@ p. 230). In 1895 while visiting Siegfried Czapski at Carl Zeiss Werk in Jena, Barkan told Czapski that he was “dissatisfied with the (Shanz) instrument from the beginning” and,

“… when visiting Zeiss’ famous optical institute in Jena four years ago I suggested to Dr Ozapsky (sic) one of its scientific heads, the construction of a binocular loupe with electric illumination for examination of the eye. This is the only merit I claim in the matter, for the construction part was all done by the Jena scientists.” (Barkan 1900@ p. 451)

Czapski confirms in Barkan’s description of the encounter,

“Several years ago, when demonstrating a monocular corneal microscope – designed by the writer together with Dr. Schanz – Dr. Barkan at the University San Francisco Cal emphasized the need for an analogous binocular instrument, to which challenge the company Carl Zeiss gladly responded.” (Czapski 1899@Figure 1)

Barkan brought home from Jena the first Czapski instrument made and demonstrated it to the local ophthalmological society. (Barkan 1900@Figure p. 451)

Barkan had been asked before a European trip to invite Sir William Macewan of Glasgow to give the first Lane Course of Medical Lectures. When Sir William visited to San Francisco in 1896 to deliver these lectures, he was Barkan’s house guest.

Julius Hirschberg also stayed with Barkan at his Mill Valley home when Hirschberg was in the Bay Area during his 1905 tour of the United States (Kauffmann-Jokl 2001). Perhaps Hirschberg learned from Barkan and Pischel on this trip of the binocular vision research of Joseph Le Conte, President of the University of California. (Hirschberg 1915@p. 192)

Library

The Cooper Medical School library in 1895 contained only three hundred volumes. In response to the request for funds for journal subscriptions by the new adjunct professor of surgery, Dr. E. Rixford, Barkan made the first contribution of ten dollars. This was immediately matched by Dr. Hirschfeld. Barkan added forty dollars, which Hirschfeld matched. The ante became one hundred, also matched by Hirschfeld.

The Lane Medical Library at Stanford University now houses a very extensive a historical collection (280,000 volumes), acquired late in the nineteenth century and in the early decades of the twentieth, particularly from the New York Academy of Medicine and the Surgeon General’s Library (O’Malley 1951).

In 1910 Barkan donated ten thousand dollars for the establishment of a special eye, ear, nose and throat diseases library. Funds for this library were later transferred to the nascent Barkan Library.

After World War I Barkan became interested in historically significant medical books. Thus arose his idea for a historical collection. Barkan described it thus,

“In 1919-1920 I was very much interested in reading some of the early volumes of several archives. I was impressed with the large measure of gratitude which we owe to the great men who have left us these records of scientific investigation … I conceived the idea of adding an historical part to the Ophthalmological collection.” quoted by (O’Malley 1951@ p. 148)

He gained the support of the Medical School administration,

“I suggested to President Wilbur the foundation of such a department for Lane Medical Library, … A small bagfull of our native gold, hidden in one of the financial pigeonholes of the library fund, was brought to light by that incomparable conservator …. This, in addition to private donations, started us on our search for old books and manuscripts. After two short years of effort we now have “a very respectable collection,” to use the words of Prof. Sudhoff, that great authority who kindly and wisely directed our steps … .” (Barkan 1923)

He had the idea and the means, but not the expertise for the task.

“I was diagnosed as an ignorant old meddler in old books” (Barkan 1923)

He found counsel with Dr. Karl Sudhoff, writing that,

“Without Prof. Sudhoff’s painstaking, systematic & competent work, who looked through every list, etc., I could have done nothing.” (Barkan 1921)

Their major acquisition was the outstanding collection of Dr. Ernst Seidel, brought ashore in California in “18 big cases” (O’Malley 1951). The collection was particularly strong in Persian and Arabic medicine. (Norman 2012)

For many years after the Seidel acquisition Barkan continued to support the library. In 1927 he gave an additional fifteen thousand dollars. This collection, Barkan Library of the History of Medicine and Natural Science Books has been subsumed into the general collection of the Lane Medical Library.

Non-Medical Activities

Vincent Czerny, a close friend of his Vienna years, introduced him to Louise Desepte. Their marriage in 1881 brought forth four children: 3 boys (Hans and Otto, well known ophthalmologists, and Fritz, a diamond merchant) and a girl (Fanny). Lane Public Lectures were very popular events in the late ’80’ and ’90’s. Barkan was asked to participate almost every other year. His subjects varied from historical (Helmholtz and Koch) to popular medical ones (sight, hearing, emotion, voice, and old age).

His English is remarkable. For example, here are his opening remarks from Old Age and Its Hygiene,

“What in the world made you choose such a topic! an English friend of mine asked me. Dryly and sadly I replied, Pardon me, I did not choose the topic, the topic chose me. At first it only hinted at me, so to speak. I remember, tho the day when I was going to jump off the car: ‘do not jump’ the observant conductor suggested, ‘only the other day an old gentleman jumped and sprained his ankle’. Thank you, I said, whilst inwardly grumbling at the officiousness of this well-meaning public servant, for surely it was my thought that ‘that secret old thief’, old age, and I are still far from one another.”

And from The Prevention of Blindness,

“A glorious Sunday morning in the foothills; early springtime! Nature all astir – warm sunshine and a blue sky; the air filled with the fragrance of the blossoming fruit trees; meadows everywhere, strewn with lovely wildflowers of every hue; ‘A day when the eyes forget the tears they shed, and the heart forgets its sorrow and ache’. Before us unrolls the magnificent panorama of the rounded green hills, and the sparking water of our San Francisco Bay; we stand on one of the fairest spots of fair California, we gaze on one of the loveliest sights. What gorgeous colours in the sky above, on the water and earth at our feet! Appealing in manifold ways to our minds and hearts, through the medium of our sense of sight.”(Still 1980)

Munich University named him “Ehrenbürger” on July 22, 1924 in recognition of his aid to needy students during those difficult economic years. (Anon 1924)

The University of Glasgow awarded him an LLD in 1901, on the occasion of the 450th anniversary of its founding. At the ceremony Lord Kelvin was the convention speaker, and Sir Joseph Hooker and Lord Lister were honored guests. Andrew Carnegie’s name appears just below Barkan’s in the list of LLD recipients. (Glasgow 1901) p. 79

In addition to being a talented musician, he was on the founding Board of Directors of the San Francisco Symphony. (Evans 2012)

For a short time he and a neighbor in Mill Valley kept an aviary with tropical birds. Their organization, “The Society for Propagation and Acclimatization of Singing Birds in Mill Valley” and the project were abandoned when their first bird release failed. (Spitz 1997@ p. 71)

Diary

An entry in his diary explains his childhood decision to go to the West Coast of the United States; to San Francisco to live and work. In 1856, he read an article that changed his whole life, an account of the Committee of Vigilance (Anon 1856@p. 560-563). This article presented the Committee’s actions rather differently than the way they are viewed today. Then they were thought justifiable efforts of an honest citizenry, who, lacking effective government and honest police protection, sought to restore order in a rough and crime ridden city.

“How did I come to America? … My mother always read some book which busied her heart as well as her head and on one occasion an illustrated paper fell into her and my hands which still appears as the “Gartenlaube”.…I read the descriptions of the time when the vigilante committee had been organized and that in a city with no laws and with constant crimes, the citizens had organized to promptly execute the gamblers, rowdies and murderers who infested the community.”

… “I see the article still before me relating that the journalist ‘King of William’ was shot in broad daylight by some criminal whom he had criticized and severely handled in an editorial.”

This had occurred in the open street. Another picture showed the vigilantes surrounding the county jail, a one-story building, with cannons directed toward this little prison, and the three criminals who had been judged by the vigilantes being taken out on a platform through a window and then promptly hung.”

He continues the story briefly then,

“From this year dated my decision to go to California, to become a doctor and eye specialist: the decision … to devote my life skill to the inhabitants of California never left me. I hated intolerance, and the absolute government of the house of Hapsburg, and decided never to bend my neck to that sort of government.”

“I wanted to devote myself to the land which had freed millions of slaves and to the ideals which Lincoln and Grant had given birth and life.”

SUMMARY

Adolph Barkan, a Hungarian otologist-ophthalmologist trained in Vienna in the mid-19th century, spent all but one year of his professional career and nearly half his life in San Francisco, California. His motivation to leave a promising career in one of the most advanced centers of European medicine to emigrate to a rowdy, new city on the west coast of the United States seems strange. The answer lies not in anti-Semitism, lack of economic opportunity, or beckoning relatives in that remote location. Rather his diary describes how this childhood ambition to work in San Francisco was stimulated by reading a popular magazine account praising the San Francisco Committee of Vigilance, a group actively pursuing and punishing malefactors shortly after the California gold rush.

Shortly after arriving in San Francisco, he assumed his first academic post, no doubt aided by his excellent training. Through four decades he exercised a great influence on the development of the medical school that ultimately was annexed by Stanford University as the Stanford Medical School. His continued close contact with European scientific and medical developments, including new instruments, strongly influenced West Coast ophthalmology.

Siegfried Czapski, co-head of Carl Zeiss in Jena, recounts that Barkan had suggested to him the idea of an electrically illuminated stereoscopic corneal microscope. Czapski designed and built the instrument. Four years later Barkan brought the first model of this this important precursor of the slit lamp back to California. Barkan also bought the first Haab giant magnet to be imported into the United States.

He had multiple non-medical interests, ranging from public lectureships, to music, and even to raising tropical birds.

He became an international figure. He was awarded an honorary LLD from the University of Glasgow in 1901 and named “Ehrenbürger” of Munich University in 1924. After retirement as Emeritus Professor of Otology-Ophthalmology from Stanford University he returned to Europe where he lived the rest of his life. During this period, he contributed much effort, time, and money to the enlargement of the historical collections in the Lane Medical Library at Stanford University. His library, The Barkan Library of the History of Medicine, and Natural Science Books, has been subsumed into the Lane Medical Library.

He died at Bühlehöhe, a health spa in Germany’s Black Forest, a year after Hitler took power in Germany.