A MAN OF MANY TALENTS

Franciscus Cornelius Donders was born on May 27, 1818 in Tilburg as a youngest child and only boy in a family of nine children. His father died soon after his birth. According to Duke-Elder, he was so spoilt by his mother and sisters and became so unruly that at the age of seven he had to be sent to school at Duizel. There he soon showed a talent for arithmetic, and in the age of 11 became the paid tutor. When he was 13, his mother decided that he should become a priest, and send him to the monastery at Boxmeer for three years where he studied Latin, English, French, German and Greek. Although later he exhibited unusual proficiency in languages and music, at the age of 17 he decided to study medicine at the Military Medical School in Utrecht. In 1840 he received the degree of doctor of medicine from the faculty in Leyden.

In 1842, he was invited to teach anatomy, histology and physiology in the reorganised Military Medical School in Utrecht. In 1847, the University of Utrecht invited Donders to become an extraordinary professor with the option to select his own subjects for lecturing. He selected forensic medicine, anthropology, general biology and only as an accidental addition, ophthalmology.

In 1851 he went to London, where he founded the lifelong collaboration and friendship with two other giants of 19th century ophthalmology, William Bowman and Albrecht von Graefe. It is notable that 1851 was also the year when Helmholtz presented the idea of the ophthalmoscope, opening a new era in the development of ophthalmology.

After coming back to Utrecht, Donders started ophthalmic practice and due to his activity the first eye hospital in the Netherlands and the ophthalmology research institute that bears his name were built in Utrecht. In 1864 he published his magnum opus “On the Anomalies of Accommodation and Refraction of the Eye; with a Preliminary Essay on Physiological Dioptrics". It contained the explanation of astigmatism, the definition of aphakia and hypermetropia, distinction between myopia, hypermetropia and presbyopia; his concepts regarding the excessive convergence and resulting convergent strabismus; the concept of accommodation based on the action of ciliary muscle on the lens. The work was soon translated into English, German, French, Polish, Russian, Spanish and Italian.

Donders was the first to underline the role of testing corrected visual acuity in the diagnosis of visual dysfunctions. In 1864 he wrote: “As the ophthalmoscope is important for the objective diagnosis of defects of the eye, so is a collection of spectacle-glasses for their subjective investigation. Such glasses are indispensable for the determination not only of anomalies of refraction and accommodation, but also of the accuracy of vision, so that without them an examination of the functions of the eye is impossible." Donders also created majority of main terms used in refraction today, including hypermetropia, emmetropia, ametropia and aphakia; retained myopia as an old term and defined astigmatism.

Donders dealt also with other ophthalmic subjects, including studies of the muscæ volitantes, the use of prismatic glasses in strabismus, regeneration of the cornea, the invention of the ophthalmotonometer, colour vision and colour blindness. He was the first to argue that glaucoma is not necessarily the result of inflammation and might be just related with increased intraocular pressure. While waiting for Helmoholtz’s ophthalmoscope he invented one himself, in which the silvered mirror with central perforation was substituted for the superimposed glass plates. Regarding the eponimic terms still in use, Donders's Table is presenting the change in the amplitudes of accommodation with age, whereas Donders's Law argues that for any one gaze direction, the eye always assumes the same unique orientation in three dimensions regardless of how it got there.

Donders published many articles including paralytic symptoms in diphtheria, the energy expended while pile-driving, the speed of mental processes (recognised the sensory, cognitive and motor components still cited today), muscle contractions including the heart mechanisms, nerve conduction and the chemistry of respiration, the acoustic and phonetic properties of speech. He was the first to study the cerebral circulation in a living animal. He also made an important observation regarding brain metabolism, that the oxygen content of blood returning from the brain was decreased compared to incoming blood and concluded that oxygen had been consumed. This research created the fundamentals for PET and fMRI scans and enabled the development of modern cognitive neuroimaging.

At the end of his scientific career Donders was one of the most respected European scientists; his retirement in 1888 was celebrated by many distinguished guests, including Joseph Lister, Jonathan Hutchinson, and Hughlings Jackson. Less than a year after, in March 1889, he suddenly died in Utrecht. His legacy remains and it is amazing that one man was able to contribute so much in so many different fields of medicine.