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with resources for registrars. Lecture notes may be made available.Audio lectures with downloadable slides could be made available onmore difficult topics. The option to have discussions online with atutor present and for registrars to upload materials to share withothers could be beneficial. Over time, a wealth of resources couldbe built to supplement or act as an alternative to learning fromtextbooks. Trainees in the smaller programmes, who suffer fromlack of pooled resources which is afforded by greater number oftrainees in the bigger programmes, will especially benefit from aportal.

Additionally, a survey of recent ophthalmology graduates in theUSA found at least 60% reported not being well prepared in thenon-clinical areas of business operations and finance, personalfinancial management, practice management skills, coding andreimbursement, political advocacy and exposure to practice settingmodels.3 To remain at the cutting edge of training the College couldsurvey recent Australian and New Zealand graduates to gauge thelocal experience and initiate measures to address graduates’concerns.

Ilesh Patel MBBS MPHDepartment of Ophthalmology, Royal Adelaide Hospital, North

Terrace, Adelaide, South Australia, Australia

REFERENCES

1. Francis IC, Woo TL, Playfair TJ. Basic clinical training in oph-thalmology: correct misfires quickly! Clin Experiment Ophthalmol2007; 35: 395.

2. Sligar D. Hold on, first check that target! Clin Experiment Ophthal-mol 2007; 35: 395–6.

3. McDonnell PJ, Kirwan TJ, Brinton GS et al. Perceptions of recentophthalmology residency graduates regarding preparation forpractice. Ophthalmology 2007; 114: 387–91.

More facts and fewer myths aboutLudwik Zamenhof’s life

I have read KR Littlewood’s article with a great interest.1 However,the article based on two biographical books and two wikipediawebsites needs some comments.

The appropriate name of the secondary school that Zamenhofgraduated from was the ‘Second Male Gymnasium in Warsaw’, notthe ‘Second Philological Gymnasium’.2

The story that the Ludwik’s father burnt all his Esperanto manu-scripts during his studies in Moscow is not based on any documentsor verified by testimony of any member of the Zamenhof’s family,thus it should be treated as apocryphal rather than real. It should bementioned on this occasion that biographies, especially thosewhich are literary rather than scholarly (especially with no refer-ences included, as is the case with both of them) cannot be treatedas a sufficient source in a serious historical treatise.

The idea that Zamenhof chose ophthalmology because ‘helacked the temperament for general practice’ is very controversial.There could be at least four other reasons. First, as is well docu-mented, Zamenhof was myopic, and as wearing glasses in tsarist

schools was forbidden,2 it – according to some researchers – influ-enced his final decision to specialize in ophthalmology. Moreover,Zamenhof very successfully passed the ophthalmology exam inthe first year of his Moscow studies, which testifies to his keeninterest in ophthalmology from the very beginning of his medicalformation. The third reason for Zamenhof’s choice of ophthal-mology could simply be following the advice of his father, whosaw better financial perspectives in that profession. And, finally,the fourth reason could have been related to his expectation thatthis would allow him to find enough spare time for indulging inhis great passion –Esperanto. Concluding, his real reason forchoosing ophthalmology is not so easy to pinpoint and certainlyshould not be oversimplified by relating it to his alleged ‘lack oftemperament’.

Zamenhof started his training in ophthalmology, which is notmentioned in the article, in the Jewish Hospital in Warsawunder the supervision of the famous ophthalmologist ZygmuntKramsztyk.3

Later, in 1886 Zamenhof spent several months in Vienna pursu-ing additional ophthalmology training. Not much is known aboutthat visit, and certainly there is no evidence that he was attached toProfessor Fuch’s department, as is suggested in the article. In 1886in Vienna there were two chairs of ophthalmology, one headed byCarl Stellwag von Carion (1823–1904) and the other – by ErnstFuchs (1851–1930).

Moreover, in one of his letters Zamenhof described this periodin the following words: ‘Then I studied for some time in clinics ofVienna (Austria).’3 It points that he visited both Vienna’s ophthal-mology departments. And then, after a short stay in Warsaw, hewent to Vienna again for a kind of refresher course in ophthal-mology in August 1897, and he stayed there until the end of theyear.4 Thus, the fact given in Littlewood’s article that ‘In 1901Ludwik returned to Vienna for a refresher course in ophthalmol-ogy’ is at least very unlikely and should be supported by detailedreference.

There are many medical aspects of Zamenhof’s life that wereomitted in the article: his ophthalmological work in Cherson(Ukraine), Grodno, Plock;5,6 his contacts with Javal – there arepublished more than 40 letters between them;3 three of his brotherswere physicians and his son Adam was a professor of ophthalmol-ogy in Warsaw University, wrote more than 30 scientific articlesand invented his own model of the ophthalmoscope.

The conclusion of these somewhat chaotic and loosely struc-tured comments seems to be very clear, namely, that Zamenhof’sprofessional life still awaits thorough study and description.

ACKNOWLEDGEMENTS

The author wish to thank: Dr Ilona Koutny, Mrs Zofia Banet-Fornalowa, Mr Zbigniew Kórnicki and Dr Marjorie Boulton fortheir continuous support and guidance in Esperanto documents andthe details of Ludwik Zamenhof and his family’s life; ProfessorWaldemar Marton for help with proofreading the English text; DrIlona Koutny for help with translations of Hungarian articles intoPolish; Professor Michael Hubenstorf from the Department of theHistory of Medicine in Vienna University for his guidance in thehistory of Vienna ophthalmology departments in the 19th century;Ms Olga Kerziouk, Curator-Cataloguer, Ukrainian and EsperantoCollections, British Library, for her support in accessing originalEsperanto documents.

Letters to the Editor 97

© 2007 The AuthorsJournal compilation © 2007 Royal Australian and New Zealand College of Ophthalmologists

Andrzej Grzybowski MD PhDDepartment of History of Medicine, Medical School, Karol

Marcinkowski University, Poznan, Poland

REFERENCES

1. Littlewood KR. Ludwik Zamenhof: a colleague of raredistinction. Clin Experiment Ophthalmol 2007; 35: 281–3.

2. Halina-Dokumento pri la studenta jaroj de L.L.Zamenhof. Osaka: Esper-anta Servo-Centro Osaka, 1977.

3. Leteroj de L.L. Zamenhof, Prezentado kaj komentado de G. Waringhien.Paris: S.A.T., 1948, vol. 1: 195.

4. Lapenna I. ed. Memorlibro. Eldonita Okaze de la Centjara Datreveno de laNaskigo de Dro L.L. Zamenhof. London: Universala Esperanto-Asocio Centro de Esploro kaj Dokumento, 1960.

5. Ignatowicz FI. Medyczna i społeczna działalnosc LudwikaZamenhofa w Grodnie w latach 1893–1897. MedycynaNowozytna 1998; 5: 127–32.

6. Koekeny L, Bleier V. Encyklopedio de Esperanto. Budapeszt: Liter-atura Mondo 1933–34, vol. I: 264–5.

More facts and fewer myths aboutLudwik Zamenhof’slife: response

My purpose in writing the brief biography of Zamenhof1 wasexplicit in the final sentence – ‘to draw the attention of the Oph-thalmology profession to a colleague of rare distinction’. It was notintended as a pedagogical treatise as all the background reading wasdone in English, however, I welcome the added attention this letter2

brings to the topic. The lamentable paucity of accessible referencesis a problem that Dr Grzybowski may wish to address; however,most of his criticisms should be directed to Marjorie Boulton as inher biography3 she translates his school title as the ‘Second Philo-logical Gymnasium’ on page 10, on page 19 she states Zamenhof’sfather burnt his work and on page 30 she states he lacked thetemperament for general practice. Perhaps her biography is not a‘serious historical treatise’ as it is not referenced to source materialbut it remains the single most authoritative resource available inEnglish. Only Dr Boulton could defend these statements withappropriately sourced references.

As well as the references cited in my article I corresponded witha Polish speaking author who provided unpublished translationsand with contacts from the Esperanto society and did considerablebackground reading but the scope of the final version was dictatedby the word limit and the knowledge that there is a biography ofAdam Zamenhof in preparation.

The assertion that ‘there is no evidence that he was attached toProfessor Fuch’s department’ may be true and is not in dispute as Ihave not asserted that he was attached to Professor Fuchsdepartment. It might be more accurate to say ‘Dr Grzybowski hasno evidence’, but where evidence is lacking it is reasonable to acceptthe most likely hypothesis. Given the nature of specialist medicaltraining in 19th century Vienna, which relied heavily on the indi-

vidual reputations of a few leading clinicians, and given the limitedlearning opportunities available to Zamenhof, the likelihood of himnot being directly influenced by the teaching of Fuch’s wouldappear small.

I must acknowledge one possible error concerning the date onwhich he made a brief visit to Vienna to take a refresher course. Itis likely that this visit was in early 1898, around the time his familyreturned to Warsaw from Grodno, rather than in 1901 as I previ-ously asserted. We may have differing opinions about the details ofhis struggle but I am confident we can agree on the greatness of hispurpose.

Kenneth R Littlewood FRANZCOMidland Eye Clinic, Midland, Western Australia, Australia

REFERENCES

1. Littlewood KR. Ludwik Zamenhof: a colleague of raredistinction. Clin Experiment Ophthalmol 2007; 35: 281–3..

2. Grzybowski A. More facts and fewer myths about LudwikZamenhof’s life. Clin Experiment Ophthalmol 2008; 36: 97–8.

3. Marjorie Boulton. Zamenhof, Creator of Esperanto. London: Rout-ledge and Kegan Paul 1960.

A ‘reluctance to dispense with theanaesthetist’: for valid reasons

Murray et al. report a retrospective database review and suggestthat anaesthesia presence is necessary in only 11% of cataractprocedures.1 Our experience does not support their conclusions. Inour practice, specialist anaesthesia involvement is routine for allintraocular procedures. The role of the anaesthetist includes theprovision of patient specific titrated intravenous sedation, adminis-tration of the sub-Tenon’s block and assurance that there is onededicated caregiver whose primary responsibility is the monitoringand observation of the patient.

Murray et al.’s1 database of 6661 patients reported only one‘serious systemic complication’; an elderly woman who presented tothe local hospital with an arrhythmia. We agree that an anaesthetistcould not have managed this complication after clinic discharge.However, as most surgery/anaesthesia-related arrhythmias arise inthe immediate perioperative period, we feel that arrhythmia andothers might have been recognized if a practitioner trained incardiac rhythm abnormalities was present at the time.

The five anaesthetists undertaking regular cataract lists at ourclinic were recently surveyed for their recall of patients having hadserious cardiovascular events during their cataract surgery at theclinic. Serious events were recalled in five patients going back3 years. Three patients were diagnosed with rapid atrial fibrillation.One of these patients presented in the last month and at the timeof writing was being assessed by cardiology for electricalcardioversion. Two patients, both having cataract surgery undertopical anaesthesia, sustained severe vagally mediated symptomatic

98 Letters to the Editor

© 2007 The AuthorsJournal compilation © 2007 Royal Australian and New Zealand College of Ophthalmologists