Herman Jacob Knapp, MD (1832-1911).
Arnold Herman Knapp, MD (1869-1956).
Philip Knapp, MD (1916-1991).
Truhlsen SM. The Knapps. Arch Ophthalmol. 2005;123(5):676-680. doi:10.1001/archopht.123.5.676
The Knapp family is unique in the annals of US ophthalmology in that members of 3 generations achieved national and international prominence and recognition. Herman Jacob Knapp came to the United States in 1868 and became one of America’s most famous and respected ophthalmologists. He founded the Archives of Ophthalmology and the New York Ophthalmic and Aural Institute, New York, and was instrumental in establishing the first specialty section of the American Medical Association. He taught many of the future leaders in US ophthalmology. Arnold Herman Knapp followed his father as editor of the Archives of Ophthalmology; was professor of ophthalmology at Columbia University College of Physicians and Surgeons, New York, NY; and was recognized as one of the foremost ophthalmologists of the first half of the 20th century. Philip Knapp, the third generation and the only US-trained member of the family, was a clinical professor of ophthalmology at Columbia University College of Physicians and Surgeons. He lectured nationally and internationally, and was widely recognized for his contributions in the field of ocular motility.
It is extremely unusual for one family to produce 3 successive generations of illustrious and internationally known ophthalmologists.
Herman, Arnold, and Philip Knapp compose one such family. Each in his own time was widely recognized and enjoyed an exceptional reputation.
By the mid 19th century, ophthalmology was emerging as an accepted medical specialty. The eye clinics of Europe were recognized as the leaders in ophthalmic clinical care and scientific research.
Herman Knapp, Prussian by birth, benefited from an explosion of new knowledge regarding the eye and its diseases in the mid 19th century (Figure 1). After studies at the universities of Munich, Würzburg, Berlin, and Leipzig, all in Germany, he earned his doctor of medicine degree from the University of Giessen, Giessen, Germany, in 1854. He enhanced his ophthalmic knowledge at clinics with Frans Cornelis Donders in Utrecht, the Netherlands; Sir William Bowman and George Critchett in London, England; Albrecht von Graefe in Berlin; and Hermann von Helmholtz in Heidelberg, Germany.1,2
According to John T. Flynn, MD, who has access to Herman Knapp’s private letters, Knapp moved to Heidelberg after working with von Graefe in Berlin. He had studied physiologic optics while in Donders’ laboratory and had written his thesis on “The Optical Constants of the Eye.” His friend Helmholtz may have influenced the selection of this topic. His thesis was accepted, which qualified him for a faculty appointment at the University of Heidelberg, Heidelberg, in 1859. With the help of his wife, who acted as nurse, bookkeeper, and hospital administrator, he opened an Augenklinic and Krankenhaus in 1862, modeled after von Graefe’s clinic. Because of his prominence and teaching ability, he was appointed a professor at the University of Heidelberg in 1865.
Knapp and his wife continued to run the hospital and clinic using mostly their own resources; however, they had some assistance from a local duke and the city of Heidelberg. In addition to his teaching and writing, Knapp developed a large clinical practice.
Knapp petitioned the university to recognize his hospital-clinic as an official university clinic to help defray his costs and expenses. Despite the support of Helmholtz and others, his request was turned down in April 1868. He had traveled to America in 1867 and apparently was impressed by opportunities he found there. Perhaps because of this rebuff or disappointment in the decision by the university, in August 1868, at the age of 36 years, he resigned his professorship and moved to New York City. The same year, he founded the New York Ophthalmic and Aural Institute, New York. J. Hirschberg, a German ophthalmic historian, stated, “never before had a doctor of such high academic reputation migrated to the United States.”
Knapp was a man of exceptional energy and seemed to have been very ambitious, which may have caused professional friction. In December 1872, questions of the ethics and the legal corporate structure of the New York Ophthalmic and Aural Institute, which Knapp had modeled after European clinics such as von Graefe’s, were raised.3 Cornelius Agnew and Henry Noyes, prominent New York ophthalmologists, founders of the American Ophthalmological Society (AOS), and members of the staffs of the New York Eye and Ear Infirmary and the Manhattan Eye and Ear Hospital, both in New York, and others questioned the personal involvement of Knapp in a public charitable institute that he and other physicians also operated as a private professional business in which they were the chief beneficiaries.
The situation was described to the members of the New York Ophthalmological Society. In a letter responding to the charges, Knapp listed them as (1) legal, (2) ethical, and (3) of a personal nature. He stated that the charges related to the incorporation of the institute “do not belong in the forum of the Society.”
One wonders if the arrival of a young and highly successful ophthalmologist/otologist from Europe may have entered the equation, along with the differing professional ethics of the 2 disciplines.
After much discussion, in January 1873 the issue was resolved without rancor by the New York Ophthalmological Society when it disapproved of the manner in which the institute operated.4 The following May, the institute was reincorporated to avoid any conflict with existing US standards of ethics and propriety, which removed any blemish on Knapp’s reputation.5 Thereafter, Herman Knapp personally made up deficits of the institute.
As he established his reputation in New York City, he was asked to join the faculty of New York University and was professor of ophthalmology from 1882 until 1888. In 1888, he was appointed professor of ophthalmology and otology at Columbia University College of Physicians and Surgeons, New York, a position he held for 14 years until 1902, when he became an emeritus professor. He trained a generation of ophthalmologists, many of whom became leaders in the profession, including Alexander Duane, Adolf Alt, John Weeks, Emil Greuning, Charles May, Carlos Findley, Harold Gifford, and Otto Schirmer. He was said to be a teacher who portrayed his Germanic heritage, a man of great dignity and integrity, stern, sometimes brutally honest, an uninhibited critic, and at times impatient and discourteous.1,2
In 1869, 1 year after arriving in New York, Knapp and S. Moos, MD, of Heidelberg founded the Archives of Ophthalmology and Otology (which was simultaneously published in Germany as the Archiv fur Augen-und-Ohrenheilklinde). In the forward to the first volume, they stated that “no journal of either ophthalmology or otology exists.” (Julius Homberger, MD, had published the first series of the American Journal of Ophthalmology from 1862 to 1864.) Herman Knapp published 5 articles in the first edition.6 Ten years later, the ARCHIVES was split into the Archives of Ophthalmology and the Archives of Otology.
In 1877, at the annual meeting of the American Medical Association (AMA), it was stated that the Section on Surgery and Anatomy was overcrowded with matters of interest to the general practitioner and little time was devoted to ophthalmology, otology, and laryngology and that there were many members who devoted themselves to that area of medicine. In 1878, at the annual meeting, a Section of Ophthalmology, Otology, and Laryngology was created, with Herman Knapp as its first chairperson. This was the first specialty section of the AMA. Herman attended every meeting of the section from 1879 through 1910 and read many papers. At the 1910 meeting, Albert Bulson, MD, announced the formation of The Knapp Testimonial Fund along with its sponsorship of the annual presentation of the Knapp Medal for major scientific contributions.7 As the AMA Section of Ophthalmology, Otology, and Laryngology became less involved in scientific presentations, the corpus of The Knapp Testimonial Fund was transferred to the stewardship of the AOS, which administers it today as the Herman Knapp Testimonial Fund to provide funding for a second year of postgraduate fellowship training in ophthalmology and a special 2-year ophthalmic pathology fellowship (F. Gutman, MD, written communication, 2003).
The AOS was founded in 1854 by physicians especially interested in ophthalmology. Herman Knapp read a paper at the first meeting he attended and was elected a member of the society (1869). This was 1 year after his arrival in America. He read 3 papers at the second meeting he attended in 1870. During his career, he read 39 papers at AOS meetings, sometimes reading 2 or 3 at the same meeting. He was elected an honorary member, an exceptional honor, in 1910.8
Knapp studied pathology while with Bowman in London. He was the first US ophthalmologist to have a marked interest in pathology. He performed autopsies, served as president of the New York Pathological Society, and wrote a text on intraocular tumors.9
In addition to his contributions to the Section of Ophthalmology, Otology, and Laryngology and the AOS, he contributed more than 150 articles to the ARCHIVES and many to other journals on many subjects, including cataracts, trauma, glaucoma, and tumors. He also invented several instruments, including an improved eyelid speculum, a knife needle, and roller forceps for trachoma.1
Sir Stewart Duke-Elder stated that Herman Knapp was “the founder of modern American ophthalmology.”10
Arnold Knapp was educated at Harvard College, Cambridge, Mass, and Columbia University College of Physicians and Surgeons, receiving his doctor of medicine degree at the age of 22 years (Figure 2). He served an internship at Roosevelt Hospital in New York City. As was common at that time, he obtained his ophthalmological training in the European clinics in Vienna, Austria; Berlin; and London. He returned to New York, where he joined his father in practice until Herman’s retirement in 1909. In 1913, 2 years after Herman’s death, the New York Ophthalmic and Aural Hospital was moved, under the direction of Arnold Knapp, to 10th Avenue and 57th Street and renamed the Herman Knapp Memorial Hospital. It limited its care to diseases of the eye.11,12 Arnold Knapp was a strict and demanding teacher, according to Gordon Bruce, MD, a student and associate of his.13 He was intolerant of inadequate preparation. He continued teaching and had a large consultation practice until 1940. That year, the hospital merged with the Institute of Ophthalmology of Presbyterian Hospital, New York, bringing along 12 endowed beds and an endowment of $60 000. At the time of the merger, the Herman Knapp Memorial Hospital established the Herman Knapp Memorial Foundation, which funded the Knapp Research Laboratories and the Knapp Laboratory of Physiologic Optics, both administered by Columbia University for the advancement of postgraduate study, teaching, and research in ophthalmology.8 He worked there until he retired.
Arnold’s close ties to Columbia University began in 1903 when he became professor of ophthalmology, succeeding his father. He became an emeritus professor in 1928. Columbia University honored him with an honorary doctor of science degree in 1931; in 1933, he received their distinguished service award.
Arnold was associated with the Archives of Ophthalmology for most of his life. He inherited the editorship from his father in 1911. His superb editorial ability along with an extensive knowledge of the ophthalmic literature produced one of the premier English-language ophthalmic journals. He worked long hours. His son recalled seeing his father reading manuscripts while dressing for social events. Acceptance of an article for the first time by the ARCHIVES provided scientific prestige to a young author. Arnold served as editor until 1949, even though the AMA became publisher of the ARCHIVES in 1929. Herman and Arnold together were editors of the ARCHIVES for a combined 69 years.11,12
Arnold Knapp was active in many areas of ophthalmology. He contributed papers and discussions to the Section of Ophthalmology, Otology, and Laryngology of the AMA, the Section of Ophthalmology of the New York Academy of Medicine, and the New York Ophthalmological Society. He published a book, Medical Ophthalmology, in 1917. In all, he wrote more than 200 scientific articles.
He was active in many medical societies, especially the Section of Ophthalmology, Otology, and Laryngology of the AMA; in 1925, he served as its chairperson, as had his father. He was active in the AOS, having been elected a member in 1903. He served the society in many capacities and was elected president in 1931. He read 39 papers before the society. He received the Lucien Howe Medal for his contributions to ophthalmology and was one of the few, as was his father, to be elected to honorary membership.8
In 1937, the National Society for the Prevention of Blindness awarded him its Leslie Dana Gold Medal. In 1946, he was honored by becoming the second American to deliver the Bowman Lecture, named after his father’s mentor, before the Ophthalmological Society of the United Kingdom. He talked about “The Present State of the Intracapsular Extraction.” He was elected an honorary member of the society. He was also honored by election to the Societe Francaise d’Ophtalmologie and the Deutche Ophthalmologische Gesellschaft. He was a friend of most of the leaders of ophthalmology worldwide.
His nonscientific interests included art, the classics, travel, and collecting Chinese bronzes.13
Philip Knapp attended Phillips Exeter Academy, Exeter, NH, and, like his father, received his bachelor of arts degree from Harvard College and his doctor of medicine degree from Columbia University College of Physicians and Surgeons (Figure 3). He interned at Bellevue Hospital in New York City (1942-1943), where he met his wife, Millie. He served in the US Navy in the western Pacific on the hospital ship USS Repose from March 1944 until September 1946.
After flirting with the idea of a career in internal medicine, Phil decided to follow in the footsteps of his grandfather and father in ophthalmology. It is unknown whether he was prompted by a subconscious desire to distance himself from New York and away from the oversight of his Prussian-oriented somewhat autocratic father, but he opted to take his ophthalmology training in the Midwest. He applied for a residency at the University of Iowa, Iowa City, and during the interview, while sitting across the desk from C. S. O’Brien, MD, he was casually asked if he was related to Arnold Knapp. After acknowledging that he was, O’Brien jumped up and ran around the desk to shake Philip’s hand as if he was suddenly elevated in O’Brien’s assessment. Phil, a modest individual, found this action somewhat displeasing. He received the appointment and was at the University of Iowa from January 1947 through 1950. During his tenure there, the 2 were at times somewhat adversarial, especially during social events. O’Brien was called a “hell-raiser” by some of his residents and hosted parties for residents and faculty, where the scotch flowed freely. This suited Phil just fine, but occasionally he and the Chief, both strong-minded individuals, had significant disagreements; however, all was calm and peaceful and all was forgotten by the next day in the clinic.14
In 1951, Phil applied for a Heed Fellowship in ocular motility, which was approved by the committee composed of Frederick C. Cordes, MD; John H. Dunnington, MD; Townley Paton, MD; Hayward Post, MD; and Derrick Vail, MD. His fellowship was spent with Kenneth Swan, MD; Herman Burian, MD; and Richard Scobee, MD. He was the winner of the Heed Award in 1970 (F. Gutman, MD, written communication, July 2000 and March 2003).
It was while Phil was with Scobee in St Louis, Mo, that I first met Phil and started a long and enjoyable friendship. He returned to New York City to enter practice and joined the faculty of Columbia University College of Physicians and Surgeons, as had his father and grandfather. He became a member of the staff of Presbyterian Hospital, and stayed there throughout his career, retiring as an emeritus clinical professor in 1991.
With a primary interest in ocular motility, he became an authority on several aspects of the subspecialty and developed several surgical innovations, one of which is called the Knapp procedure for the treatment of double elevator palsy.15 He founded and was appointed director of the Fight for Sight Clinic at Presbyterian Hospital. As his reputation grew in this field, he was in demand for special lectures, visiting professorships, and named lectures (Constenbader, Fry, Sanford Gifford, May, Asbury, Morgan, Padfield, and Snell, to name a few). He enjoyed a large referral practice, often seeing someone else’s surgical failures. He told me about a hockey official from Canada who was referred to him because of previous surgical failures. As he started to operate on this difficult strabismus case, he said to the patient, “don’t worry we’ll get the s.o.b. this time.” And he did. A remark most unlikely from his father. His patients loved him.
He traveled the world lecturing. He developed a much-desired fellowship in ocular motility. He enjoyed his residents and fellows, and they enjoyed their time with him.
In 1950, he joined the American Academy of Ophthalmology and Otolaryngology, provided his first instruction course in 1952, and continued the course annually, except for 1 year, for more than 20 years. He received the academy’s Honor Award and Senior Honor Award and was one of the academy’s guests of honor in 1983.
Philip was a founding member of the American Association for Pediatric Ophthalmology and Strabismus and its president in 1979. He was a charter member of the American Eye Study Club and a member of the Pan American Association of Ophthalmology and many other societies. He particularly enjoyed the Squint Club, with its free exchange of ideas. He was invited to write a thesis for membership in the AOS and wrote on the “So Called ‘A and V’ Syndrome,” which helped to elucidate this complex extraocular muscle phenomenon. With his election to membership, the Knapp family was the first to have 3 generations as members of the society. From 1869 until 1991, except for 3 years, the Knapp name was carried on the membership list. The AOS is rich in tradition, and in memory of the Knapp family, the gavel base used by the president of the society was made from wood from a cabinet used by all 3 Knapps in their offices. It has a silver plate on each side for the names of each president since 1959.16
Phil Knapp was not as prolific a writer as his father and grandfather. His curriculum vitae lists 33 published articles. His main contributions to the ARCHIVES were the Annual Review on Strabismus for the years 1950 to 1953. He preferred to lecture instead.
Phil was a bit more free spirited than his stern and sometimes abrupt, if not arrogant, father. Phil was witty, liked to hear and tell stories, was socially engaging, and had many friends. A walk down the aisle of the academy exhibit area with him would be interrupted by friends and acquaintances approaching with outstretched hands and smiles on their faces.
I have letters from Phil asking that we arrive at a meeting early “for some fun and frivolity.” At one time, he had a golf handicap of 11. He won the AOS golf tournament several times, despite having the fastest back swing in the society.
This is not to say that he could not quickly become sincere, intellectually engaging, stern in his beliefs and criticisms, and generous in his accolades. He was a superb observer and analyst and had a wonderful memory and command of the literature. He was intellectually honest, as were his father and grandfather. He abhorred hypocrisy. In brief, fun was fun and business was business, and he changed his demeanor to suit the occasion.
Jampolsky, a close friend, said, “Phil had absolutely impeccable integrity.”17(p359) People enjoyed Phil’s company, and he enjoyed being with them. As Phil’s roommate at many ophthalmology meetings and as a guest in his home, or he in mine, we enjoyed talking about medicine, particularly US ophthalmology, its leaders, and ongoing changes, golf, fishing, travel, and our families. He was a good friend.
This was certainly a remarkable family.
Correspondence: Stanley M. Truhlsen, MD, University of Nebraska Medical Center, 412 N 97th Ct, Omaha, NE 68114-2395 (firstname.lastname@example.org).
Submitted for Publication: December 29, 2003; final revision received June 15, 2004; accepted July 16, 2004.
Previous Presentation: This article was presented in part at the 16th annual meeting of the Cogan Ophthalmic History Society; April 12, 2003; St Louis, Mo.
Financial Disclosure: None.