that the truth be not forgotten


jotta totuus ei unohtuisi (2004)


Parts of this book are translated, please read below:

Foreword

My life, as probably that of many others, has been almost like a continuum of incredible, near enough telepathic coincidences and important junctures hand-picked by my Guardian Angel which would have been worthy of being recorded. It is a pity that I did not have the sense to do it at the time.

This decision of mine to start mapping the milestones of my life was just such a coincidence. For several years  I had resigned from active work, and suddenly at the beginning of 2004, I experienced a revival. “I must put my life on paper, telling my story to generations coming after me.” It came to me like a New Year’s resolution, something I had rarely done.  It was then that I decided to buy myself a computer, something I had been wanting for a long time. In fact, for the previous ten years, I had regretted not having gotten one, with my only excuse being I didn’t feel smart enough to use one. To my children it was such an obvious right move for me to use a computer for this writing project.

Thanks to my Guardian Angel, this miracle of coincidences kept happening to me! Professor Otto Meurman, our good friend who knew I do not subscribe to the medical journal Duodecim, telephoned on the 3rd of February 2004 to ask if I had seen the latest issue. He read to me from an article edited by professors at the Department of Ophthalmology (Tervo & Laatikainen) that had appeared in the ophthalmology news column. At the end of their summary they wrote: “…this is not a new idea. Twenty years ago, the  Finnish ophthalmologist Kaisu Viikari raised this issue.” (I note that their estimate was short by a decade. I wrote about this in two of my books, Tetralogia (11) in 1972 and Panacea (22), in English in 1978).

From the beginning of time, especially in medicine, novel observations and innovations have been discouraged and prevented from receiving public acceptance. One salient example, which my husband, Sauli, so often mentioned, sticks with me. In the clinic of the famous professor of surgery, Ferdinand Sauerbruch (1875-1951),  one of his doctors, Dr. Forsman, had in 1929 performed on himself – assisted by a nurse – a cardiac catheterization. When the Professor heard about his, his laconic reaction was, “Sie sind fristlos entlassen!” (You are fired immediately!”)

The revolutionary discovery made by medical student Ivar Sandstöm from Uppsala in 1880, the parathyroidea glands, the last major organ to be recognized in man, on the other hand, did not receive attention in the medical world of that era, and was forgotten for another 11 years.

It takes the passing of at least one or preferably two generations before a controversial issue can raise its head again objectively. Although a wise person once said that when an issue is being debated, it has already become a dogma. Knowledge itself is not subject to debate, but new knowledge must overcome the inertia of dogma.

My bliss over this rehabilitation (as I see it) is shadowed by two things. I am sorry that Sauli, who so unreservedly empathised with me and supported me in my efforts, is no longer here to witness it. I am convinced, however, that he is with me in spirit, as even at the time, some two decades ago, he expected me to come back to these issues, and even suggested a title of the book: “For the Unknown Migraine Patient”.
I am also sorry that my good friend and colleague, ophthalmologist Aune Adel, who understood me and was my best supporter in this cause and an irreplaceable help in exchanging experiences, is no longer with us.

When these truths started becoming clear to us, Sauli said that I had avoided being confused by too much  information! Quite right, by cutting through to the essentials, it was possible for me to isolate the most important elements. Sauli’s statement agrees with what Goethe said, “The one who does not understand the elements of a problem cannot solve it.” The course of events also shows how easy it is for the great masses to start thinking with a uninformed collective brain – and when a stupid and a wise person are having an argument, it is the stupid one who comes out as the winner (as a Finnish writer of aphorisms recently said).

As I have explained in the forewords of my books – which I am not going to list here, they and their numerous detailed examples can speak for themselves – the reason that led me to look for these truths was as clear as a day to me. In outpatient work during our training, doctor-patient relationships mainly were so short that we had little chance, or should I say little obligation, to see how successful e.g. prescriptions for glasses were and what their long-term effects were like. Thus we could hold on to the illusion that our work was successful.

After starting my private practice I came to realize that however well I had followed the teaching given to me, the patients could not get rid of their ailments: headache, stinging eyes, itching, and tiredness. I was quite well aware of the significance of latent hyperopia and, in general, a deficiency in the plus direction, and the advice for prescribing glasses that was taught to us and that goes back for centuries was ringing in my ears:
“The strongest plus glasses, the weakest minus ones.”
It appears, however, that in everyday practice, this advice was not being implemented successfully, despite of cycloplegia (disabling of accommodation).

In other words, I had to think of something else, and this was the starting point for developing strong fogging to examine the refractive power of the eye, which later was implemented in a variety of different ways.

Tetralogia and Panacea saw the light of the day not because of me, but because of the plight of my patients. By publishing Tetralogia in Finnish I wished to offer my colleagues a chance to help their patients as quickly as possible.
I would like to thank the entire computer generation of our clan for willingly helping me with technical problems, and in particularly Heidi, the fourth one of Jorma’s five daughters, and my practised proofreaders, Eira and Jorma!

Kaisu Viikari

autograph

Turku, November 2004

Part II – My Struggle

The concept of pseudomyopia (spurious short-sightedness)

The “Bible” of ophthalmology, the tome written by Duke-Elder (10) (Vol V, p. 469) features a section titled Spasm of Accommodation. It contains an excellent account of spurious or pseudomyopia, with an adequate description of its symptoms, diagnosis and aetiology. (Diversifying the fogging examination (18) is what I have tried to add to his diagnostics).
This section relates the history of pseudomyopia:

…accommodative spasm, first adequately described by von Graefe (1856)… expended by the parasympathetic nervous system…

… a spurious or pseudomyopia (Liebreich, 1961) is thus induced wherein the hypermetrope becomes apparently less ametropic, the emmetrope myopic and the myope more short-sighted (Agraval, 1965, Bessiére and Vérin, 1965)

This point had, however, already been realised by Arnold Berthold in 1840 (1). He notes how various degrees of myopia are one of the most common ailments affecting the eye, and how they have no doubt increased with the improved level of education of the humankind and the spreading of reading and writing skills. He indeed refers to this state as “Dieses Übel” (this ailment), capturing the spirit of the expression I read somewhere, “Myopia is violation of seeing!”

Having understood the existence of the accommodation cramp, he writes:

…allein schon die Fälle periodischer, spastischer, plötzlich entstandener Myopie…lassen sich ohne dasselbe nicht erklären.

…periodical, spastic, suddenly occurring myopias alone…cannot be explained without this (cramp).

At the end of his article, he also suggests a simple apparatus for curing myopia by gradually increasing the reading distance.

It is difficult to understand how a basic issue like this, so unavoidably associated with the every-day work of an ophthalmologist, can have received so little attention, not to mention the need to defend the very existence of the phenomenon a century and a half after these pioneering insights! It is not enough to read this paragraph line by line; you must focus on it word by word. As this much information has been available about the problem of pseudomyopia, after all, and hundreds or even thousands of conferences have over the years been dedicated to preventing myopia, even the lay person must be wondering why the actual breakthrough remains unachieved. We are aware of the problem and it keeps raising its head, but debate is in a standstill, limiting itself to compiling and exchanging myopia statistics. It may also be possible that scientists are not adequately aware of the great inexactitude that always shadows clinical medicine. The occurrence of this inexactitude to a great extent also concerns research on accommodation and refraction. Innumerablevariables arising from the psyche, the soma and the circumstances make the quantitative assessment of stress and the scientifically exact evaluation of results impossible and may explain many conflicting outcomes. The number of genuinely effective attempts to treat myopia is low compared to all other activity. How much “evil” could have been avoided, if only we had taken a more serious attitude to this dogma.

My book Panacea is unlikely to ever become less topical, because a new generation will always emerge, making it necessary to start again from the basics. This is especially true now that the development seems to have broken out to a different track altogether, and patients wishing to undergo an operation are by no means considered undesirable.

There is an explanation for this inefficiency, but it should not be an obstacle. Getting on top of the situation requires such unlimited energy and relentless hard work from the ophthalmologist faced with a patient stressed out and exhausted by work, often with his or her own narcissistic traits complicating matters. Additionally, ideal progress requires financial sacrifices on the part of the patient to purchase perhaps several new pairs of glasses. In most cases, patients themselves do understand this, and after getting off to a good start, a motivated patient is a pleasure to work with.

On accommodation and pseudomyopia

Accommodation refers to the ability of the eye to focus at various distances. When we talk about preventing myopia, we must first of all stress that this means controlling pseudomyopia to prevent if from growing stronger, in time also leading to an irreversible increase in the axial length of the eyeball and actual myopia.

The refractive power of the eye is not a simple concept. Emmetropy, the borderline between the two main types of refraction, hyperopia or farsightedness on one hand and myopia or short-sightedness on the other, is an extremely rare and highly labile state.

The refraction of the eye could be described as a linear quantity, at one end of which we find hyperopia, H, and at the other myopia, M, with the borderline between them being made up of emmetropy, or E.

An eye in which parallel rays of light coming from a distance are exactly refracted on the retina, as a result of which the person then sees distant objects clearly, is described as emmetropic. In order to see well at a short distance, an eye of this type, too, needs to accommodate in order to focus. A child is usually born a hyperope, however, meaning that without accommodatino, he or she could not see clearly to a distance, either. In other words, the eye strives to make up for this shortcoming by accommodating.

During the first years of a person’s life, the eye strives to adjust the inborn hyperopia towards ±0. This is referred to as emmetropization.

Accommodation is performed by a ring-shaped muscle inside the eye, which is able to contract to increase the refraction of the eye and to focus at different distances. This means that the accommodation muscle in the eye is working continuously.

The actual “trick” of the accommodation event is the paradox that as the muscle contracts, the fibrils supporting the lens relax, allowing the lens to become thicker and, thanks to its own elasticity, refract more light.

In the beginning of time, rather than doing a lot of near work, humans were mainly designed for looking at a distance, for hunting and similar activities. But as we all know, the modern human does a lot of near work that requires great precision, to a great extent continuously and without a break. This forces the eye to perform muscular work for hours, and a muscle that is forced to contract a lot is easily driven to a state of spasm, a cramp, quite similarly to such as a writer’s cramp in the fingers or a cramp suffered by a marathon runner in the calf muscle. This cramp, however, is not released on its own. In an accommodation cramp, the eye has got stuck on a target that is close, and seeing at a distance begins to suffer. When a person lifts his eyes for example to look at the blackboard, he cannot see clearly.

This at the least should be the first alarm signal – unless for example headaches, blinking, bloodshot eyes, itching and tiredness have occurred earlier – after which we must start putting the breaks on the situation. Once we are aware of the course of events described above, we also know how to treat the problem. Prevention must be the objective of the treatment. This means that accommodation should be alleviated as early as possible, also for looking at a distance – preferably, we should be born with plus glasses on our noses! – or at the latest when a child starts doing near work. Plus glasses increase the refraction of the eye and thus reduce the need for accommodation. The eye feels that muscular work no longer is useful, gives up and gradually, the cramp is released.

In most cases, however, we end up with a situation where strenuous accommodation effort has been allowed to continue, and the cramp becomes tighter than ever, until refraction has passed the point of emmetropization and slipped onto the minus side – at this stage, fortunately, it is often still reversible, or pseudomyopia. Much of myopia prevention aims at undoing pseudomyopia.

At this point, plus glasses should urgently be prescribed for near work, and to obtain the greatest benefits, these should be half-glasses with the top section empty or plano = ±0. These special bifocals can be worn continuously without blurring the distance vision, and will automatically facilitate distance viewing. But when a person at this stages rushes to the ophthalmologist or an optician and complains about poor distance vision, which can in a flash be “corrected” with a slight minus, he or she is prescribed minus glasses, and for continuous use no less. The cramping continues as before, and myopia progresses.

Difficult enough to find parents, or children, who would consent to acting differently on time, if they can get away without it!

As late as in 1972 in the journal Terveydenhoitolehti, an experienced Finnish ophthalmologist said that even in cases of minor myopia, glasses should be prescribed (this is precisely the moment when we should take preventive action by prescribing weak plus glasses for near work). She further said that this problem no longer affects adult eyes, even though we see a continuous stream of people coming to ask for additional minuses, until they start being affected by presbyopia. She also claimed that reading without minus glasses makes the eyes worse and, incomprehensibly, that if your room is too small to arrange a viewing distance of 4 metres to the television, you must get a smaller TV set!!! – when it is precisely a small image and text that are apt to make accommodation strain worse. And then professional journals go and publish articles like this!

If the patient is already wearing minus glasses, an attempt will be made to revert the situation as follows:
1) avoid prescribing stronger distance glasses but
2) reintroduce the glasses the patient had before their current pair for indoor use,
3) only use the current pair for driving,
4) for reading, use old minus glasses that are even weaker,
5) or depending on the strength of the patient’s strongest glasses (-3.0 – 4.0), read completely without glasses (preferably with half-glasses where the lower section is empty or plano = ±0).

These steps are equal to the “healing powers of plus glasses”, as making the minuses weaker equals moving towards the plus direction by reducing the minuses.

In the literature, I have encountered one article discussing the impacts of near work on myopia that I feel is above the others. It was a report concerning the American Cadet School, West Point (19), and it convincingly shows how myopia in a more or less linear fashion increases every year over three years; and this in adults. This quite obviously involves two factors, near work andstress. The same article also mentions that as early as in 1813, attention was paid to the considerably higher incidence of myopia among officers compared to the rank and file. Neither is it a new observation that various general “Referred Symptoms” (9) that require treatment and even result in operations, have for a long time been associated with accommodation strain, but in routine work we forget to dwell on this. Only when an ophthalmologist consciously asks about a patient’s symptoms and monitors him or her for some time does the whole set of symptoms associated with accommodation strain start becoming clear, and above all the fact that we are dealing with symptoms that do not require any substances (e.g. medicines!) brought in from the outside (the organsim is cleared by its own physiology) or procedures to eliminate. The physiology of the body itself will rectify the situation, once we relieve the strain caused by the eyes. The significance of this fact cannot be overstated. And in most cases the patient, after having been relieved of his or her ailments, forgets how it all happened.

One of the greatest stumbling blocks is talking about “as accurate a vision as possible”, which you often hear people almost competing about. Striving for this is apt to tighten the accommodation muscle, a means by which a hyperope can easily achieve accuracy, or a myopic sees more and more “clearly”. These details are difficult for a lay person to understand, but for a professional they should be obvious, and aiming for this objective should be strictly discouraged.

To avoid attributing the accommodation cramp solely to precise near work, it is necessary to highlight the role of stress, rush and pressures caused by responsibility. Being hyperopic enough has saved many from ever sliding to the minus side.

I would like to appeal to all thinking people:
Please open your eyes to see in the media and all around you the outline of the faces of those millions and again millions of important people distorted by strong minus glasses (see the cover image of the book showing how the outline of the face is distorted to a concave shape when seen through strong minus glasses, while the outer outline is realistic),and you will then have an idea of the magnitude of this problem.

It will then also become apparent that we cannot reach out for the moon; an ideal state is beyond our reach. We are unlikely to find means for managing stress, but alleviating accommodation strain is a “Methode der Wahl (current care method), which can achieve a lot – as to a great extent has happened in Finland, especially for those who know enough to ask for this method.

Tetralogy

Tetralogy (11), born from the insight that adequate means for revealing spurious hyperopia had not been achieved in prescribing glasses, came out for Christmas 1972. Its cover shows a composition consisting symbols of my four main findings: plus glasses for hyperopia, vertical lines on the forehead for accommodation strain, a zigzag pattern for migraine and an ophthalmotonometer for increased intraocular pressure.

Just before Christmas, I set off to Helsinki with my load of books, and together with my sister Mirja (Marsio, ceramic artist who graduated from Ateneum Art School), we distributed them to the homes of as many of my fellow ophthalmologists as possible with me driving the Beetle and Mirja acting as the “delivery girl”.

And not before too long, I received a flurry of thank-you letters expressing delight and gratitude: “easy to read”, “makes you think”, “What a pleasure to read your book. It was written in such an original style, it was like you were physically present when I was reading it…” “I have myself been impelled towards so very similar methods (but maybe not quite as systematically)”, etc.

My thoughts at that time are perhaps best described by my reply to assistant professor Ahti Tarkkanen:

“In the end, I took my book to the printers in a bit of a rush, as my objective was to secure a “paper free” Christmas for Sauli. My reading skills in general are abysmal, and I am now overly familiar with the text, which is why minor errors escaped my eyes, and Sauli refused to act as my proof-reader; he only read the book for the first time when it was finished (!), and seemed to find his Christmas present amusing and enjoyable. The reception here has been utterly exulted, and specialists for internal medicine, surgeons, and even pathologists have been reading it almost as their Bible this Christmas. A doctor and professor of another field was able to rid himself of his headaches by getting himself +1.00 glasses. I never could have expected the praise of my ophthalmologist colleagues around Finland; it quite brought tears of joy to my eyes. Never in my born days could I have expected that my criticized and defamed person could be the object of such delightful warmth emanating from my colleagues. I would like to stress that in addition to my own fanatical enthusiasm, a vital role has been played by the fact that it was not crucial for our existence whether I could deal with four or eight patients a day. This is why I see the publishing of this book as paying my debt to life.

It has meant years and years of extreme asceticism in a great number of different areas. In order to complete this project and to save time and energy, I even gave up my singing lessons last term (=autumn 1972), which I had been continuing without interruption since the time of writing my dissertation. (And as regards the price in health I refer to, that is also true. I do not wish this to become public knowledge, but now that I have got off to a good start, I can tell you that in autumn 1971 I became so exhausted that my heart was beating quite erratically. I slept one night with an EKG monitor, and when it turned out that roughly one beat out of six was superfluous even in my sleep, I bit the bullet and, instead of taking all sorts of obscure beta blockers, I switched down to the second gear and prescribed myself a small dose of digitalis; the extra beats vanished in a few weeks, and I have managed quite well up till now. My leaning unrelentingly on my patients for years, keeping them under tight reins until I got to the truth, nearly cost me my life.”

Quite recently, I have obtained a great relief from the hell of paper in my home, which disturbed my peace of mind and upset the whole extended family, and which even the reader can easily imagine, after I had written my dissertation and three other books. I happened to open a work about our famous Finnish professor of surgery and military surgeon Richard Faltin (1867-1952), violin-playing bachelor. In that book, professor Wichmann’s wife Gertrud, describes Faltin’s 70th birthday party.

“Such a home of a scientist I never saw before. Everything showed that Faltin cared nothing about his surroundings and its tidiness, even on his birthday. I will never forget those piles of papers and books that covered not only the tables but also floors and corners. Elle, the maid, had not been allowed to touch them, not before and not now.”

But Tetralogy also provoked other types of thoughts: “Pseudomyopia is such a new idea that I cannot form a clear opinion of it all of a sudden, but every one of our colleagues who is honest will certainly have to admit that now and then you witness a surprising and inexplicable conflict between objective and subjective refraction in young myopes (or are they myopes?)” And in estimation, this writer is one of my finest colleagues.

Someone even wished to buy another copy for a friend. In its sophistication and culturedness, the best reaction was a quotation from our national poet Runeberg: “I read a line, I read two, and my blood was running hotter.” As a good-natured warning, I was sent the instructions of Jesus of Sirach dating back 2100 years: “Help your neighbour as best you can, but make sure you do not draw misfortune onto yourself.”
A male colleague of mine announced: “In any case, my capacity has already been halved!” referring to the time it took him to examine a patient.

The wide variety of feedback included almost everything possible and was revealing, as it showed to what extent each person was affected by preconceived attitudes in this matter. Another one, who was a professor of an unrelated field, declared himself suspicions of the whole idea: “…I don’t really believe in your spasm theory, or I would like to express my scepticism about spasms like this being released.”

A short quotation from the large manual by Walsh (8) might be of interest to the reader:

“Spasm of accommodation accounts for varying amounts of myopia. In its mildest form, it is seen frequently in hyperopes who at manifest refraction required a weak concave lens to obtain their best visual acuity. Pronounced spasm of accommodation may persist over a period of years during which there may be an apparent myopia as high as 10-12 dioptres [cf. …permanent spasm sometimes increasing the dioptric power of the eye by 25 or even 30 D (10)] This curious condition may appear at any time up to 50 years of age.” [cf. …it has been observed in patients of 60 years and over (Leplat, 1927; Prangen, 1937) (10)].

The most illuminating comment and best illustration of the difficulty of implementing the examination is the story often reiterated over the years by Aune Adel, nee Koistinen. After receiving the book, as a complete surprise like everybody else, she read it straight away, without leaving her seat, understood everything fully at once and immediately started putting it to practice. She then continues: “I could never forgive myself that it took me a whole year before I started getting a grip of the patient and obtaining results.” After this, however, she enjoyed a nation-wide reputation and a flood of migraine and myopia patients.

But, in the words of poet Eino Leino, – “What pleasure on this earth could end but in tears!” Besides her private practice, she had also been teaching at the Department of Ophthalmology in Helsinki University, and in her position, was able to spread the “good news”, with the consequence that after a short while, her services were no longer required!

Aune Adel also wrote a review titled “Tetralogy – a view of ophthalmology” for Suomen Lääkärilehti (16), ending with the sentence, “What importance Tetralogy will have on medicine as a whole can so far only be envisaged.”

As I finished Tetralogy, I had of course been fully aware of the hornet’s nest in which I was putting my head, and this was part of the reason why I never breathed a word about writing it to anyone.

Very few condescended to review the book, while some gave sophisticated comments ex officio, without understanding the gist of the actual message. In this group I include above all the long, convoluted analysis by Professor Ahti Tarkkanen.

The start of the letter was promising, however: “…I read it immediately, noting that for once the author had been thinking of the reader. The text was easy to read, and the author’s message is clearly presented…”
The letter showed that he had not at all understood what rough assessments of refraction I was talking about in order to reveal spurious plus values, even if from the foreword on, I specifically stress how my treatment of refraction is utterly non-mathematical.

Reading it again after many years, my eyes fall on quite a similar expression in the book on refraction by our great guru, Sir Duke Elder (9), in the first paragraph of the foreword: “A simple and essentially non-mathematical form of presentation…”, and how far-reaching results you can achieve specifically with a subjective method. In general, it is surprising and sad how casually (ignoring the message) people can read things, quite similarly to what has happened with my books: if the theme does not appeal to you or make you stop, it is all “casting pearls before the swine!” I realise that I react in a very similar manner to some of other people’s ideas. How much more progress we could make, if not everyone had to start from the beginning, not realizing that there is so much ground (“grund”) already broken in the world, to borrow a word that was often used by Professor Klossner.

The letter by Professor Tarkkanen also contained an emerging idea about continuing training for specialists provided in small groups. “The author would in that case be without a doubt considered for a teacher on the subject of refraction…” – a topic that he never touched on again! However, I was allowed to come and give to the doctors of the Ophthalmology Department a presentation, which the Professor himself did not attend; for him, of course, it could not contain anything new.

The most tragicomic one was the reaction of Professor Arvo Oksala. The first weekday after Christmas he telephoned Sauli, hurling abuse at him for having allowed such a scandal to go ahead. At this point I cannot help but recall one of the many wisdoms often reiterated by Professor Lauri Rauramo, an intellectual now deceased: “Remember that if they say nothing about you (not even evil), you should look at yourself! Nobody will bother reacting to a zero.” The gist of the following aphorism is rather similar: “Pity comes for nothing, jealousy must be earned.”
I have also been told that Tetralogy created quite a buzz at some meetings of the medical field, where it was passed from briefcase to briefcase under the counter.

But then! When my colleagues tried to put to practices the binocular fogging method, which requires time and effort, they realised that getting a grip of the patient was not quite as simple as that, and obtaining results was difficult: it was a far cry from “the coin dropping into the box” every 15-20 minutes. In general, it is an extremely difficult task to try and change the established routines of a person who has been working in the field for years. And when results could not be produced immediately, this sparked more or less public criticism.
Once again, the quotation used by Aarno Kaila in his column inUusi Suomi on 27 February 1988 was proven right: “According to Macchiavelli, the reformer has enemies in all those who profit by the old order.” Opposition to change has not disappeared from the world – nor will it ever disappear.

The situation is aptly described by the second-last aphorism on page 208 of Tetralogy, which was by no means placed there by accident. It goes like this: “The fact that the truth is so simple annoys people… They should think that they will get a chance of taking plenty of trouble over applying it in practice in order to benefit from it.”

The most beautiful metaphor for my life’s work came from Vieno Räty, a reporter for Turun Sanomat. Her extremely insightful interview dealing with the message of Tetralogy was published under the heading: “We will all need glasses at some point in our lives” in Turun Sanomat in May 1973 (12). As we were talking together, she told me that she had all the time been reminded of Seagull Jonathan, the forty pages of which book it took Richard Bach, a direct descendant of Johann Sebastian Bach, eight years to write. I dashed out to purchase a copy – and indeed, “the flock huddled miserably on the ground” could not fail to bring associations of our meetings. I am grateful to her for this hint.

And the story goes on. One Sunday, Sauli and I were walking along Kungsgatan in Stockholm, and as we were passing a shop window, we were stopped by a painting of a lone seagull soaring across the blue sky. Sauli told me that as soon as we got home, I should ring the shop and tell them to send that painting to us, and thus Vieno Räty is part of my life, even today.

But now, after opening once again Seagull Jonathan, my peace of mind was greatly disturbed. I found a typewritten note inside the book without the name of the writer. This is unlike me not having noticed it before and figured out its origin; I would so much like to know who is behind these words.

The note says:
“When I read this for the first time, I would have needed dark glasses to cover my eyes that were red from crying… after the fourth reading, I had to get straight to the bookshop and buy my own copy, otherwise I would never have had the heart to give it back…
but I have known for some time that you are more than Seagull Jonathan…

Lataa kirja PDF tiedostona (134 s.)

 

Esipuhe

Elämässäni, niin kuin varmaan monella muullakin, on ollut melkein jatkumo uskomattomia, miltei telepaattisia yhteensattumia ja ”Hyvän haltijan” sormella osoittamia, tärkeitä kohteita, jotka olisivat ansainneet tulla kirjatuiksi. Harmi, etten sitä ajoissa hoksannut tehdä.

Vähän samantapainen oli tämä päätökseni ryhtyä kartoittamaan elämäni virstanpylväitä. Oltuani vuosia, mitä ”karriääriin” tulee, jokseenkin ”kesannossa”, resignaation epäaktiivisessa tilassa, tulin tässä vuodenvaihteessa 2003–2004 herätykseen, että ei – kyllä nämä asiat täytyy panna paperille, vaikkapa ei muun vuoksi kuin jälkeen jääville tiedoksi, ja totesin, että sehän käy esim. uuden vuoden päätöksestä, jollainen ei lainkaan kuulu tapoihini. Päätin jopa hankkia tietokoneen, jonka hankkimatta jättämistä olen viimeiset kymmenen vuotta harmitellut, kas kun en luottanut aivoihini. Suureksi ihmetyksekseni molemmat lapsenikin pitivät sen hankintaa itsestään selvänä – tietoisina(!), mihin tarkoitukseen.

Niin silloinkos jatkui tämä yhteensattumien ihme kohdallani! Professori Otto Meurman, hyvä ystävämme, tietäen, että minulle ei tule Duodecim-lehteä, soitti helmikuun kolmas päivä, vuonna 2004, olenko nähnyt viimeistä numeroa ja luki sieltä Silmätautien erikoislääkäriuutisista Helsingin silmäklinikan professoreitten (Tervo & Laatikainen) toimittamana artikkelista, jonka referoinnin lopussa he sanovat: ”…asia ei ole uusi. Kaksikymmentä vuotta sitten suomalainen silmälääkäri Kaisu Viikari puhui tämän asian puolesta” (tosin 11 vuoden virheellä; kirjoitti kahdessa kirjassaan,Tetralogia vuodelta1972 (11) ja Panacea (22), englanniksi, vuodelta 1978).

Kautta maailman sivun tieteessä, ei vähiten lääketieteessä, on ollut esteitä uusien havaintojen esiin pääsylle. Jos sallitaan suuruudenhullu esimerkki, jonka Sauli niin usein mainitsi ja on siksi jäänyt mieleeni: Kuuluisan kirurgian professorin Ferdinand Sauerbruchin (1875–1951) klinikassa, Berliinissä, tri Forsman oli v. 1929 tehnyt itselleen – hoitajattaren avustamana – sydämen katetrisaation, ja kun professori kuuli tästä, hänen lakoninen reaktionsa oli: ”Sie sind fristlos entlassen!” (Olette välittömästi erotettu!”)

Tai uppsalalaisen lääketieteen ylioppilas Ivar Sandströmin vuonna 1880 tekemä mullistava (vägbrytande)löydös, lisäkilpirauhaset, viimeinen suuri ihmisestä tunnistettu elin (the parathyroidea glands, the last major organ to be recognized in man), ei sen ajan medisiinisessä maailmassa lyönyt läpi, vaan jäi 11 vuodeksi unohduksiin.

Vaatii vähintään yhden, mielellään kahden polven poistumisen välistä, jotta kiistelty asia voi uudelleen nostaa päätään objektiivisella tavalla. Tosin joku viisas on sanonut, että silloin, kun asiasta kiistellään, se on jo muuttunut dogmiksi.

Tätä rehabilitaation, hyvityksen, (jollaisena sen näen) auvoa varjostaa kaksi asiaa. Suren sitä, että Sauli, joka niin varauksetta myötäeli ja tuki minua näissä pyrkimyksissä, ei ole tätä näkemässä.  Olen kuitenkin vakuuttunut hänen hengessä mukanaolostaan, sillä aikanaan, jo pari vuosikymmentä sitten, hän oletti minun palaavan näihin asioihin ja hänellä oli ehdotus kirjan nimeksikin: ”Tuntemattomalle migreenipotilaalle”.

Samoin suren sitä, että hyvä ystäväni, silmälääkärikollegani Aune Adel, joka parhaiten ymmärsi ja antoi tukensa tälle asialle sekä oli korvaamaton kokemusten vaihdossa, ei enää ole joukossamme.

Sauli sanoi silloin, kun nämä totuudet alkoivat seestyä, että minua eivät liiat tiedot ole olleet sekoittamassa! Aivan oikein, siten on ollut mahdollista paneutua elementaari-(perus-)asioihin ja toteamus on mitä sulimmassa sovussa Goethen sanomaan: ”…joka ei ymmärrä ongelmien alkutekijöitä, ei voi niitä ratkaistakaan”. Tapahtumien kulku myös osoittaa, miten helposti massa ajattelee massan aivoilla – ja tyhmän ja viisaan väitellessä tyhmä voittaa (on äskettäin sanonut suomalainen aforismi-kirjailija).

Kuten olen kirjojeni, joita en aio tässä lähteä kertaamaan, ne saavat detalji-paljouksineen puhua puolestaan – esipuheissa selostanut, itselleni on päivänselvää, mikä johti näitten totuuksien etsimiseen. Koulutusaikanamme, poliklinikkatyössä, potilassuhteet olivat enimmäkseen niin lyhytaikaisia, että esim. lasimääräysten onnistuneisuutta ja niitten pitkäaikaisvaikutuksia ei juuri päässyt, tai olisiko parempi sanoa, joutunut näkemään. Siten sitä sai säilyttää illuusionsa, että työ oli

ollut onnistunutta.

Mutta sitten, kun olin aloittanut yksityisvastaanottoni, sainkin huomata, että vaikka kuinka oli toiminut saadun opetuksen mukaisesti, niin potilaatpa eivät päässeetkään vaivoistaan:päänsärystä, silmien kirvelystä, kutinasta, väsymyksestä. Olin varsin hyvin tietoinen piilevän kaukotaitteisuuden ja yleensä plussuuntaisen vajauksen merkityksestä ja vuosisatainen opetettu ohje silmälasien määräämisessä: ”vahvin pluslasi, heikoin miinus”soi kuin iskostettuna korvissa. Ilmeisesti sen toteuttaminen sykloplegiasta (akkommodaation lamauttamisesta) huolimatta ei kuitenkaan ollut riittävästi onnistunut.

Oli siis keksittävä jotakin muuta ja siitä lähti silmän taittovoiman tutkimiseksi vahvan sumuttamisen (fogging) kehittely, joka sitten sai mitä moninaisimpia toteuttamisen muotoja.

Tetralogia ja Panacea eivät nähneet päivänvaloa minun itseni vuoksi, vaan potilaitteni hädän vuoksi, ja julkaisemalla Tetralogian suomeksi, halusin tarjota kollegoilleni nopeata pääsyä ”asian päälle”.

Kiitän klaanimme koko tietokonesukupolvea auliista avunannosta teknisissä pulmatilanteissa ja erikoisesti Heidiä, Jorman 4./5 tyttärestä sekä tottuneita oikolukijoita Eiraa ja Jormaa!

autograph

Turussa marraskuussa 2004