Francis I. Proctor,MD and his wife Elizabeth C. Proctor: Their lives and legacy

The year 2017 marks the 70th anniversary of the Francis I. Proctor Foundation for Research in Ophthalmology, established in affiliation with the University of California, San Francisco on 29 September 1947. The mission of the Foundation has remained constant since its inception: the study of infectious and inflammatory eye disease and the prevention of worldwide blindness. ¹

Francis I. Proctor (1864–1936) (Figure 1) was born in Peabody, Massachusetts to a socially prominent a family which had lived in New England from Colonial times. A namesake of his had fought as an officer in the Continental army during the Revolutionary War. OPEN IN VIEWER

He attended Phillips Academy at Andover, Massachusetts, and Harvard University for both his baccalaureate and medical degrees. His postgraduate training in ophthalmology was in Germany and at the Massachusetts Eye and Ear Infirmary. He practiced in Boston from 1892 until he retired in 1927. Proctor was a very successful ophthalmologist, catering to the so-called “carriage trade.” He was an attending surgeon to the Massachusetts Eye and Ear Infirmary and an instructor in ophthalmology at the Harvard Veterinary School. His philanthropic interest led him to volunteer at the Perkins School for the Blind near Boston – the oldest school for the blind in the United States – demonstrating his early commitment to help the blind and visually impaired.^2–4

Elizabeth C. Baker (Figure 2) also came from a wealthy, prominent family in Baltimore and was known for her beauty, grace, and social standing. Elizabeth’s first husband was Albert Ritchie, an important lawyer and politician in Maryland. They were married in 1907 and divorced in 1916.^5,6 After the divorce, Ritchie served as governor of Maryland for 15 years. OPEN IN VIEWER

The commonly repeated story about Francis and Elizabeth's marriage is that when they first met, they were still married to their first spouses. They fell in love, both divorced their spouses and then married each other. This second marriage was said to have caused such a scandal in East Coast society circles that they were ostracized and had to move away. This story may be quite romantic, but it is not supported by the results of this research.

Our research shows that Elizabeth was divorced in 1916 but she did not marry Francis until 1928. While it is unknown how Francis and Elizabeth met, she was already divorced, and was living part-time in Camden, South Carolina. Francis, who also spent time in Camden, had already left Boston several years before. Having retired at about age 60 in financial security, he had also been divorced for several years before they married. They settled in Santa Fe, New Mexico.^7–9

Francis had the luck, or perhaps foresight, to cash out most of his stock investments just before the 1929 market crash. They also had the insight to buy 100 acres of land in what later became downtown Santa Fe. Francis was obviously financially astute, as he was able to preserve his fortune during the Great Depression and upon his death leave a considerable estate of at least $370,000 (the equivalent of $5 million in today’s dollars).

They became interested in the problems of Native American Indians, where blinding trachoma was widespread on the reservations. At this time, trachoma was one of the leading causes of blindness in the world and was especially prevalent on the Indian reservations where trachoma was endemic. Studies demonstrated that between 20 and 35% of all Native American Indians examined were trachomatous. Among school children, the incidence varied between 30% and an astounding 92%. ¹⁰

The Proctors wished to establish a laboratory to investigate the cause and treatment of trachoma. Because the infectious agent of trachoma was not firmly established, the Proctors pursued research to find the causative agent and encouraged investigators to address this problem.

They chose Phillips Thygeson, MD (Figure 3), then at the University of Colorado as their lead investigator. Phillips Thygeson was born in 1903 in St Paul, Minnesota, and moved to Palo Alto, California for his father’s health concerns. He attended Stanford University for both his undergraduate and medical degrees, and interned at Colorado General Hospital. Thygeson received his ophthalmologic training under the well-known ophthalmologist Edward M. Jackson, MD at the University of Colorado and was awarded the degree of Doctor of Ophthalmology in 1930. By this time, Thygeson had developed his interest in trachoma and external disease, and was awarded the degree of Master of Science in bacteriology from the same institution in 1933. After publishing his first paper on trachoma in 1929, Thygeson came to the notice of Proctor, who had been appointed ophthalmic consultant in the field of trachoma for the Bureau of Indian Affairs of the Department of the Interior.^11,12 Francis and Elizabeth learned laboratory and bacteriologic techniques so they could help in the laboratory. ⁴ (Figure 4) OPEN IN VIEWER

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Figure 4.

Elizabeth and Francis Proctor studying bacteriology at a Tucson hospital, early 1930s (Courtesy of Jenny Benjamin).

In 1930, Elizabeth and Francis accompanied Thygeson to Egypt for three months to study clinical and laboratory problems of trachoma. Egypt was a center for trachoma investigation under the direction of the pioneering trachomatologist, Arthur MacCallan.^13,14 The Proctors not only paid all of Thygeson’s expenses to travel first class with them to Egypt but also funded his research costs. Henry L. Stimson, who was the United States Secretary of State at that time, helped make the travel arrangements for the Proctors and Thygeson. Stimson probably knew Francis from the Phillips Academy, where they were fellow students. The Proctors and Thygeson worked at the Memorial Ophthalmic Laboratory in Giza, which was founded by MacCallan. This institute was probably the inspiration for the trachoma research laboratory which the Proctors helped Thygeson establish at the Fort Apache Indian reservation in Arizona. Not only did the Proctors financially support this laboratory, they were actively involved in the research.

In this facility, Thygeson and his associates performed much of the seminal research on trachoma on the Native American Indians. Within two years of establishing this laboratory, they made an important discovery. This finding, arising from the collaboration of the Proctors and Thygeson, was the Clarence Brown experiment. The story of this clinical research is compelling and is an important milestone in trachoma research. They demonstrated that the elementary bodies from the Halberstaedter-Prowazek inclusions in the conjunctival cells were the etiologic cause of trachoma. Using epithelium scraped from the eyes of infected children, they produced an ultrafiltrate of elementary bodies which they initially inoculated into the eyes of baboons. All the animals developed the signs of active trachoma, and laboratory cultures showed that the bacteria-free ultrafiltrate was infectious. In order to extend this research to humans, Thygeson and Proctor then inoculated this material into the eye of a human volunteer, Clarence Brown. Brown’s left orbit had been exenterated due to advanced conjunctival epidermoid carcinoma, but the tumor had spread to his brain. Since he knew he was going to die, he volunteered to be inoculated in his remaining eye with the filtrate, and he developed a classic case of trachoma. Treatment with copper sulfate applications eventually produced a complete cure. Unfortunately, soon after his cure, Brown and his wife were killed in an automobile accident. Thygeson and Proctor reported this experiment and its results in the American Journal of Ophthalmology in 1935, documenting the etiologic cause of trachoma.^15,16 Over the next few years, Thygeson and his colleagues performed further inoculation experiments, proving that the infectious agent of trachoma was a filterable virus, although at this time there were no techniques available to culture the agent. The final culmination of this research was the isolation and cultivation, in the chicken egg yolk sac, of Chlamydia trachomatis in 1957.

A few words are indicated about what informed consent or inducement was offered to Brown prior to the inoculation in his only eye. Brown was a native of Iowa City, Iowa, and he and his medical case were presumably known to Thygeson, as Thygeson was on the staff of the Department of Ophthalmology of the University of Iowa between 1933 and 1936. It is known that Brown volunteered for this study, but that in addition he received a payment of $1000 from Francis himself for his participation in this historic experiment.^17,18 Although such a monetary grant would not be considered ethical by today’s standards, in view of the known terminal illness of Brown, it could charitably be considered that this payment was considered to serve as a pension for his wife.

Francis remained actively involved in these studies, but soon after this discovery, he died unexpectedly from a cerebral hemorrhage at age 71. Francis’s will left much of his estate to his wife, with the expectation that she would endow a laboratory for the study of trachoma and other infectious diseases. He also bequeathed over $70,000 to Phillips Academy, Northland College, Perkins School for the Blind, the Congregational Church, and other organizations and friends. The breadth and quantity of his bequests totaled $370,000, again testifying to the strong philanthropic beliefs which Francis and Elizabeth held. ¹⁸

The fulfillment of this legacy had to be deferred due to the outbreak of the Second World War in 1941 and Thygeson’s service in the army medical corps. Thus, it was not until 1947 that Elizabeth, in collaboration with Thygeson, who was now on the faculty of the University of California in San Francisco, began the Foundation as a memorial to her husband. Thygeson recommended that the Foundation be associated with a university. Since Santa Fe did not have a medical school, the Foundation was established in San Francisco in association with the University of California. Dr. Michael Hogan was the first Director, and Thygeson served as the second Director from 1957 to 1970. The Foundation’s initial mission was the study of trachoma and other infectious diseases of the eye, but has grown to encompass research and teaching on infectious and inflammatory ocular disease around the world and is internationally recognized for its contributions. Since its inception, the Foundation has grown from a single laboratory room with a small part-time staff to a research and clinical organization consisting of more than 12,000 square feet of laboratory, clinic and office space with a faculty and staff of more than 50. Elizabeth made many other gifts to the Foundation including one in 1953 for the construction of a medical office building for the Foundation faculty practitioners. Over 240 fellows have been trained, and 40% of them have come from outside of the USA.

Elizabeth also established the Proctor Medal in 1949, the first personal achievement award of the Association for Research in Vision and Ophthalmology. The first awardee in 1949 was Jonas Friedenwald, and since then a total of 73 men and women have been honored with this medal. Fittingly, Thygeson was awarded this medal in 1950. Elizabeth also endowed the Elizabeth C. Proctor Distinguished Professorship and The Ruth Lee and Phillips Thygeson Distinguished Professorship. Elizabeth died in 1975 at age 93.