Dr. Victor Grima is an American medical practitioner of Maltese descent who was an early “specialist” in ophthalmology in the United States and who, with others that studied in France, played his part, in shaping the "French period" in American medicine. Biographical material about Dr. Victor Grima is extremely scanty. The date of his birth has not been traced but the evidence available shows that he must have been born between 1836 and 1844. It is certain that after qualifying he studied for some time in Paris where in 1868 he presented a thesis on Traumatic Cataract for the M.D. of the Medical Faculty of Paris. The title-page of this work states that he was born in New Orleans, Louisiana. On his return to the United States, he was appointed surgeon to the Eye Wards of the Charity Hospital of New Orleans and Lecturer on Eye Diseases in the Medical Department of the University of Louisiana.peer-reviewe

Cassar, Paul

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14 DR. VICTOR GRIMA A Maltese-American Eye Specialist of the 19th Century PAUL CASSAR S.B.St.J., M.D., B.Sc., D.P.M., M .R.e.psych., F .R.Hist.S. Hon. Fellow of the Royall University of Malta, Consultarvt Psychiatrist Health Department, Teacher in C!inical Psychiatry Royal University of Malta. Almost two hundred years ago, in the year 1780, a certa'in Francois Albert Xa-vier Grima from Birklrkara, son of Gio. Mafia and of Catherine Montaldos, Ieft Malta, went to North America and settled in New Orleans, Louisiana. In the early 18th century, Louisiana belonged to France, New Orleans having been founded in 1718. In 1763 this terri-tory was transferred to Spain but in 1802 the Spaniards ceded Louisiana to Napo-leon who, in the following year, sold i,t to the Amer~can Union (Nicholas, 1950). When Francois Albert Xavier Grima reached New Orleans he was thirtythree ye.ars of age, having been born in the Pa-rish of St. Helena (Birkirkara) on the 1st March 1747 (BaptismaI Records, 1747). In New Orleans he married Marie Anne FiEosa, the daughter of Sylvain Filiosa, a Parisian cavalryman in the service of the French King Louis XV by whom he had been granted Timballier Is~and in the Gulf of Mexico in recognition of his heroic stand against the Indians in 1727. Francois Grima had two sons, Barto-lomeo who settled in Mexico, and Felix who remained ,in New Orle.ans. Felix was born in 1798, studied law, was called to the bar in 1819 and appoint-ed judge of the Criminal Court of New Orleans in 1828/29. In 1831 he married Adelaide Montegut whose gr,andfather -Dr. Joseph Montegut - had emigrated from France to Louisiana in 1760. Dr. Montegut became Chief Surgeon of the Charity Hospital of New Orleans in 1775 and eventually Secretary of the Treasury of Louisiana in 1800. During the Civil War (1861-65), when New Orleans was occupied by Federal troops, Felix was forced to leave the city. He moved to Georgia with his family but returned to New Orleans at the, .end of hostilities. Here he Eved at 96 St. Louis Street in a "noble old house" with an old-fashioned garden representing a "blend-ing of F'rench and Spanish" architecture. That house, 'acquired by Felix in 1840, was still inhabited by his descendants in the present century, the last resident being the youngest ~ of his offspring, Adelaide, who died in 1921. Felix died in 1887. He h,ad nine child-ren, the second of whom was Victor (Ar-thur et aI., 1931; King, 1921; Biographical and Historical Memoirs, 1892) who even-tually studied medicine and specialised in ophthalmology. Biographical material about Dr. Vic-tor Grima is extremely scanty. The date of his birth has not been traced but the evidence ava'ilableshows that he 'must have been born between 1836 and 1844 (Arthur et aI., 1931; Rosenthal, 1971). It is also not known in which medical school he pursued his studies 'and gained his me-dica'l degree. His name is not found in medical directories ,in b:ographical dictio-naries and in accounts of .the history of medicine in Louisiana and of American ophthalmologists of the last century (Duffy, 1958; Hirschberg, 1915). It is certain that after quallifying he stu-died for some time in Paris where in 1868 he presented a thesis on Traumatic Cata-ract for the M.D. of the Medical Faculty of Paris. The title-page of this work states that he was born in New Orleans, Loui-siana. From colon:al days to the 20th cen-tury, American medical men had been vi-siting Europe to widen their professional experience. They went to Leyden in the 17th, to London and Edinburgh tin the 18th and to Paris in the 19th century. It has been est' mated that between 1820 and 1861 over six hundred American doctors visited Paris for purposes of study at a time when the French capital was at its high-est reputation as a medica'l centre. On their return to the United States, these medi-cal men exercised a great influence on American medicine through the diffusion of French medical thought and practice giv-ing rlise to the so-called "French per.iod" of American medicine. Not aB these men, however, earned French medical degrees; in fact only twenty-four did so and twenty of them were natives of New Orleans. So when Grima went to study in Paris he was fol-lowing not only an establdshed Amerkan pattern but a specifically New Orleans tra-dition. Some of these doctors began to study the budding specialities, ophthalmo-logy being one of them (Russel, 1970). Here again by taking up the study of this branch of medicine ,in Paris in the late sixties, Grima followed the current trend. At that time, the understanding and treatment of eye diseases was registering ~,',cmentous adv.ances. J. E. Purkinje (1787-1869) had discovered the pflinciple of the examination of the eye fundi; Sir William Bowman (1816-1892) originated the ope-rafon of iridectomy; Albrecht von Graefe (1828-1870) first used iridectomy for glau-coma (1856); Johannes MUller (1801-58) found that the rods and cones were the light sens,itive parts of the retina; Chris-tian Ruete (1810-67) invented the indirect ophthalmoscope to be developed later on (1850) by another pioneer, H. L. von Helm-holtz (1821-94). On ,the other hand, Grima 15 did not live long enough to profit from the use of cocaine as a topical anaesthetic, first advocated by Karl Koller in 1884, and from the introduction of antisepsis in ophthalmology on the part of Alfred Carl Gr,aefe (1830-99) in May 1877. He also missed the introduction of the instiHation of a 2'% Silver Nitrate solution in the eyes of the newborn infant proposed in 1884 by C. S. Crede (1818-92) as prophylaxis against ophthalmia neonatorum (Arring-ton, 1959; Snyder, 1967). It is of interest to note, however, that Grima had already used that solution in the treatment of a case of gonorrhoeal conjunotivitis in an adult in 1875 as will be told further on. On his return to the United States, he was appointed surgeon t'O the Eye Wards of the Charity Hospital of New Or-leans and Lecturer on Eye Diseases in the Medical Deparment of the University of Louis:ana. His lite·rary contributions to contem-porary ophthalmoLogy are four, as far as I have been able to asce,rtruin. They are briefly summarised and rev.iewed below. (1) De La Cataract Traumatique, Essai de Description Clinique. This is the thesis for the Doctorate in Medicine pre-sented to the Faculty of Medicine in Paris on the 3rd March, 1868 and published in Paris in the same year (Grlima, 1868). He made no claim for his thesis being a "work of erudition"; 'it was simply .a cli-nical desC.f11ption which, he was aware, contalined many gaps that his series of sixteen cases did not allow him to fill. The work, which runs into 81 pages, was the result of his personal observation suppont-ed by reference to contemporary litera-ture. It is divided linto five sections: (a) a d:scussion of the mechanisms underlying traumatic cataract; (b) a description of the clin'ical manifestatIons; (c) the develop-ment 'Of .its cltinical course; 0d) an analysis of its p.athological anatomy; and (e) treat-ment recommended. Treatment was of two minds - medi-cal and surg:cal. Medical remedies con-sisted in the instillation of atropine sul-phate drops, to forestall prolapse of the iflis, and cupp:ng with scarification of the temporal 'reg,ion to prevent an acute in-flammatory reaction. Surgical treatment 16 indicated was the removal of the lens by linear extraction or by the a,id of the serretele. The various stages. of the ope-1 ation are given in detail. Th0 dinical fea'tures of ,the sixteen cases studded are descr~bed at lengbh with almost daily entries carefully recording the deve~opmer:t of the 'illness. Grima ex-presses h~3 graUude to Dr. A. Desmarres who placed the resources of his clinic at his disposal. A perusal of th's thesis shows that Gruma was famHiar with iridectomy and the use of the ophthalmoscope. (2) In July 1873 he published a short but detailed paper entitled Contribution to the History oj Ocular Syphilis (Grima, 1873) in which he described the clinical feature of syphJitic involvement of the eye which he had observed, until then, "among coloured people exclusively". The disease began as an ordinary case of ca-tarrhal conjunctl\nitis except that the con-junctiva of the lids was dotted with white opaque pustules which formed "the strik-ling feature of rthe disease". The second stage was that of ir,idocycEtis with rapid softening and atrophy of the eyeball or with the formation of gummata in the kis with destruction and atrophy of the eye-ball. He discussed the differential diagno-sis from tubercular granulations and ma-lignant growths; the prognosis and the results of treatment by means of local ap-pl>ications of silver rritrarte, the free use of atropine ,and iridectomy. It must be remembered that the Spi-rochaeta pa/lida was only discovered dn 1905 and that the Wasserman Reaction came into use in 1906. (3) In May 1874 he read, at a meet-ing of the New Orleans Medical and Sur-gical Association, a short note on Two cases of Burns of the Cornea in children (Grima, 1874). The lesions were caused by hot oil and by a heated "!instrument for .ironing linen" respectively. The result:ng opacity of the cornea together with the "future necessity of an operation for arti-ficial pupil in case of recovery" induced him to proffer .a severe prognosis. The only treament he used was to keep "a wet rag over the eye day and night". To his sur-prise the cornea, in each case, complete'1:~ recovered its entire transparency. He was prompted to reoord the two cases to (a) point out the pitfall of a hasty and "alarm-ing prognosis which proved unjustifiable"; and (b) contribute to the "very little infor-mation" available in the textboo~{s of his time on the subject. (4) He presented another paper at a gathermg of the same Ass'ooiation, ,in May 1875 (Grima, 1875). It dealt with a case of Double Gonorrheal Ophthalmia Which Presented Peculiar Features. The man, apar.t from his ocular man;festations, was suffering from acute gen:tal gonorrhoea. He was admitted to the Eye Wards of Dr. Grima "with strict recommenda,tions not to allow anyone around him but a well nurse for fear of further contamination in the ward". Grima treated the pMient with dipping of the face in a basin of water as often as he could, posslibly every fifteen minutes, "and wink his eye in the wa:ter so as to thoroughly wash out" the p.ofuse pus. He also ,touched the patient's lids w:th silver nitrate. After three days this treatment was suspended and a week later "h:s eyes looked entirely well". The patient, however, then developed pain and swelling in his knees, elhow jo:nts and wrists; and af.ter some time "rheumatic lrit:s". These cond~tions subsided w~lth iodide of potash .internally and iodine paint appl:cations to the affected joints. The pa-t:ent finally 'recovered, the whole episode having lasted about six weeks. It is notewol1thy that the treatment of gonorrhoeal ophthalmia had not changed substantially during the ensuing sixty . years until the beginning of the antibiotic era - iced compresses, sHver nitrate so-luUon and the applicClJtion of leeches to the temples being the standard therapy prescnibed (Hine, 1934). We may, however, very reasonably ask whether the a'rthritis and the iritis observed by Grima were really "rheumatic"; in fact the pre-exislt-ence of an acute gonorrhoeal infection strongly suggests that they were of the same nature; but, then, Grima had no X-rays (discovered in 1896) ItO show the loss of joint space due to cartilage des-truct:on and no faciUties for diagnostic smears and culture of the fluid aspirated from the joints as the gonococcus was only discovered four years later in 1879. Grima was one of the founders of the New Orleans Medical and Surgical Asso-oia'tion and the first member of that orga-nization to die. He died single on the 17th April, 1877 at his 'residence No. 96 St. Louis Street, New Orleans (Daily Picayune, 1877; The New Orleans Times, 1877); this house still stands but now bears the num-ber 820 and is known as "GTlima House". Lt has been restored architeoturally by a local society and is a tourist aUraction in the French Quarter (Rosenthal, 1971). Commenting on his demise the editor of the "New Orleans Medical and Surgical Journal" said: "The many situdents who a~tended his lectures will lament the un-timely death of a teacher who combined in one character unusual personal grace and personal worth with unusual scienti-fic attainments and remarkable skilfulness as an operator. While always modeslt and unassuming in his deportment, 'in the ex-ercise of his profession he exhtbited the boldness and self-confidence wh:ch are the offspring of ripe knowledge and tried ex-perience" . In a memorial address at a meeting of the Association held on the 28th April 1877, Dr. Samuel Log.an spoke thus: "Vic-tor Grima, one of the founders of this As-sociation, and one of its most zealous sup-port€trs wHl no longer answer ,to its roll call. For weeks we have missed him at our meeting; h:m who was so regular in at-tendance ... He died as he Eved, dothed with the unostentati'Ous and gentle digniJty so peculiarly his own, leaVling a record free from all stain, and graced with aB the beslt characteristics of the true gentleman, the enlightened scholar, the failthful friend, the devoted son, the loving brother, the practical philanthropist. His, my con-freres, was a character we may well emu-late; would that this world had more such and :tha't the few we have llike him were longer spared us". The foUowing resolution by the Com-mittee was unanimously accepted and adopted: "Be it resolved that in his death this AssociatIon and the medical profes-sion at large loses a wonthy and enlight-ened member, who can ill be spared from 17 our ,ranks, the community one of lits best citizens and the poor a truly disinterested friend and charitable adviser. Be it resolv-ed, that feeHng as we do so keen an ap-preci.a,tion of our great loss, we deem i,t but meet, as a body, to tender to his af-flicted family and relatives 'Our heart-felt sympathies dn this sad bereavement. Be it further Iresolved that a page of our record be reserved ,to his memory and his name be inscribed rthereon" (New Orleans Me-dical and Surgical Journal, 1877). Such is 'Our knowledge of the life of an American medical practitioner of Mal-tese descent who was 'an early "specialist" 'in ophthalmology in the United States and who, with others rthat studied in France, played his part ,in shaping the "French period" in Amerdcan medicine. Acknowledgements I am greatly indebted to the follow-ing ladies and gentlemen for helping me in tracing sources in the U.S.A.: Dr. John B. Blake and Miss M. Stuff, National Lib-rary 'Of Medicine, Bethesda; Madame Peg; gy Richards, Loudsiana State Museum, New Orleans; Mr. C. Snyder, Lucien Howe IJib-rary of Ophthalmology, Boston; Dr. J, W. Rosenthal, New Orleans; Mr. E. N. Mac-Conomy, The Library of Congress, Wash-ington, D.C. Ref.erences ARRINGTON, G.E., "A History of Ophthalmology", New York, 1959, pp. 102, 118 and 156-9. ARTHUR, C.S. and HUTCHET DE I<ERNION, G.C., "Old Fa-mUies of Louisiana", New Orleans, 1913, pp. 334-6. Baptismal Records, Vol. VI. 1747, Parish of Birkirkara, Malta. Biographical and Historical Memoirs of LouiSiana, Chicago, 1892, p. 453. "Dai,ly Picayune", 18th April 1877, 'P. 4. DUFFY, J., "The Rudolph Matas History of Medicine ,in Loui-siana"", Louisiana State University Press, 1958-62. GRIMA, V., "De La Cataract Traumatique", Paris, 1868. GRIMA, V., "Contribution to the History of Ocular Syphilis", New Orleans Medical and Surgical Journal, 1873, 1, 65-7. GRIMA, V., "Two Cases of Burns of the Cornea", ibid. 1874, 1, 61-3. G RIMA, V., "Double Gonorrheal Ophthalmia Which Presented Peculiar Features", ibid., 1875, 2, 925. HINE, M.L., "A Manual of Diseases of the Eye", Lonaon, 1934, p. 11. 18 HIRSCHBERG, J., "Amerikas Augenartze in 19 Jahrhunderts", Leipzig, 1915. KING, G., "Creole Families of New Orleans", New York, 1921, pp. 350-6. New Orleans Medical and Surgical Journal, 1877, 4, 900. NICHOLAS, H.G., "The American Union", Hammondsworth, 1950, pp. 33-37, 98 and l1l. ROSENTHAL, J.W. (OrJ, personal communication, New Orleans, 27th July, 1971. RUSSEL, M.J., "American Doctors in Paris 1820-61", Jour-nal of the History of Medicine and AHied Sciences, 1970, 25, 143. SNYDER, C., "Our Ophthalmic Heritage", London, 1967, pp. 14 and 19. The New Orleans Times, 18th Apri I 1877 p. 4. GEN ERALlZED GANGLIOSIDOSIS I N MALTA E. A. CACHIA, M.B., Ch.B. ('ManchJ, D.C.H. J. MIFSUD, M.D., D.Bact., M.R.C.Path L. VASSALLO, B.Sc., M.D., F.R.C.P. (Ed.), M.R.C.P (LondJ, M.R.C.P. (GlasgJ P. VASSALLO AGIUS, M.D., D.C.H., M.R.C.P. St. Luke's Hospital Tay, a British ophthalmologist, des-cribed a cherry-red spot in the fundus of a retarded infant in 1881 and Sachs a few years later established the basic clinical picture of the syndrome called amaurotic family idiocy. The abnormal deposits of glycoHpid~ in neurones ,termed ganglioside by Klenk in 1940, appeared to be the basic patholo-gic a,bnormality responsible for the dis-ease. Visceral lipidosis was not a feature of the classica-l disease described by Tay and Sachs. However, atypical cases of Tay Sachs and others resembling Niemann Pick were also described. The right solu-tion for ,these problems has been recently prov,ided by the neurochemist. The key ganglioside has Ithe following ohemkal structure: * * Cer = ceramide; Glu = glucose; Gal = galactose; GalNHAc = N-acetyl galactosamine; NANA = N-acetyl-neuram'nic acid (= sialiC acid) Cer-Glu-Gal-Ga'lNHAc-Ga,l I I NANA I I NANA NANA The metabolism of th:s substance initially involves the removal of one or othe,r mo-leoule of sialic acid by specific ,lysosomal hydrolysate enzymes. Further down the metabolic pathway the terminal galactose residue is removed, again by a specific enzyme. .M least nine different main gangio-sides can normally be detected in bra,in tissue and various diseases have been attri-buted to the abnormai accumulation of a ganglioside or a related compound, due to absence or defiCiency of the specific enzyme. The chemical sltructure of gang-lioside GM, is: Cer-G 1 u -Gal-GalNHAc-Gal I NANA 

Dr. Victor Grima : a Maltese-American eye specialist of the 19th century

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Dr. Victor Grima : a Maltese-American eye specialist of the 19th century

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