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Hopkins Medicine Magazine - 'Lawtonesque'

Hopkins Medicine Magazine Spring/Summer 2012

'Lawtonesque'

Date: May 14, 2012


Lawtonesque

Students and colleagues of neuro-ophthalmologist  J. Lawton Smith (HS, ophthalmology, 1955-60) marveled at more than just his seemingly inexhaustible energy, encyclopedic knowledge, and exuberant innovativeness. They loved the way he talked.

Calling himself a “simple country doctor,” the lanky South Carolina–born Smith peppered his ophthalmological observations with such a unique patois that soon his protégés would find themselves describing patients and procedures in what they came to call a “Lawtonesque” way. Among the memorable expressions in what one admirer described  as “Language by Lawton” were:  blind dog in a meat house (chaos among doctors working up a medical case, as in “they are runnin’ around like a blind dog in a meat house”); glass cage in London (where an extremely rare condition may be found); Cyclops with rotary nystagmus (a very rare case, as in “like a Cyclops with rotary nystagmus”—most likely found in that “glass cage in London”); and walletectomy (part of an expensive, usually unnecessary treatment or workup).

Generations of medical students, house staff, and fellows at the University of Miami’s Bascom Palmer Eye Institute, which Smith helped found in 1962, relished such quirky terminology and revered the man who coined it. Smith died on Jan. 10, at the age of 81.

Smith’s students and colleagues also received from him the precepts of neuro-ophthalmological practice he had learned at Wilmer from the field’s founder, Frank B. Walsh (1895–1978). Among these was the importance of spending two or three hours on each patient’s first visit.  “Walsh worked up every patient completely himself,” Smith said in explaining why he didn’t “farm out” to others the taking of patients’ color fields and peripheral fields.

“I look at it this way: The difference between a general practitioner and superb internist is spending another hour with the patient,” Smith told one of his former fellows, Jonathan D. Trobe, for a 2002 profile in the Journal of Clinical Neuro-Ophthalmology, which Smith had founded. “Same difference between a general ophthalmologist and a neuro-ophthalmologist—you can be more meticulous in an extra hour. There’s no magic to it—it’s just doing hard work.”   

Smith was the author of more than 300 research papers, book chapters, and other articles. He also was a devout Christian—“the Elmer Gantry of ophthalmology,” as Trobe described him—eager to persuade others of the power of faith.  After every examination, he routinely asked patients if he could pray for them, regardless of their own faiths.

Once a month for 20 years, Smith also recorded audiotapes on the latest developments in neuro-ophthalmology. He later learned from the American Board of Ophthalmology that virtually every candidate preparing for that part of the board’s examination did so by listening to his tapes. “One doctor told me ‘yours are the only medical tapes my wife will let me listen to in the car because she likes to laugh at the stories.’” Neil A. Grauer

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