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J. Lawton Smith, MD (1929–2011)

Siatkowski, R Michael MD; Kline, Lanning B MD

Journal of Neuro-Ophthalmology: March 2011 - Volume 31 - Issue 1 - p 1-2
doi: 10.1097/WNO.0b013e3182118bf5
In Memoriam
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The end of an era has passed with the death of Joseph Lawton Smith, MD, at age 81. Lawton died on January 10, 2011, in Miami after complications following surgery for a broken hip.

Lawton had many interests in life-jogging, eating (his favorite catch of the day was cow!), and playing the bassoon. But there were 3 things he loved more than anything.

One of these was practicing and teaching medicine. Born into a family of physicians, Lawton received his bachelor's degree from Emory University and his master's from Duke. He completed his residency training at the Wilmer Eye Institute, and under the tutelage of Dr. Frank Walsh became enthralled with the burgeoning field of neuro-ophthalmology. He did a fellowship with Dr. David Cogan at the Massachusetts Eye and Ear Infirmary, returning to the Wilmer as chief resident, and then joining the ophthalmology faculty at Duke for several years. In 1962, he was recruited by Dr. Ed Norton to join the newly formed Bascom Palmer Eye Institute at the University of Miami. His instructions from Dr. Norton were “I want you to work hard but I don't care what you do, just so long as you go home tired every day.”

And work hard he did. Lawton was truly a phenomenal doctor. He did the most thorough exams (including 45-minute “doctor-killing” refractions to the 0.12 diopters and single degrees of axis) and made extraordinarily detailed clinical observations. Not infrequently he arrived at diagnoses that were elusive to multiple previous examiners. His fund of knowledge and memory of the literature were phenomenal. His own extensive contribution to medical science included 335 articles, books, and editorials. Along with various notable coauthors, he reported at least 20 completely novel entities or clinical findings, including ischemic optic neuropathy, fundus findings in choroidal hemangiomas and Leber hereditary optic neuropathy, clinical uses of ophthalmodynamometry and OKN testing, fluorescein angiographic findings in retinal artery occlusion and giant cell arteritis, and ophthalmic and neurologic manifestations of Lyme disease and seronegative syphilis. In a field that had few treatments, he strived to find new ones (hemianopic prisms, retrobulbar steroids for optic neuritis, medical treatment for superior oblique myokymia, and radiation therapy for optic nerve sheath meningiomas) and founded the Journal of Clinical Neuro-Ophthalmology in 1981. He also strove to give patients hope for the future and ways to cope despite their illnesses. His motto was to practice “first class medicine in a spirit of love”, and he succeeded every time.

Perhaps, even more than he loved practicing medicine, Lawton loved to teach. For many of us in the field, he was the most amazing teacher we have ever had. He could make the most difficult concepts seem crystal clear and made it all fun. Ed Norton often said that Lawton was the best instructor in the entire University of Miami School of Medicine. I have seen students and house officers absolutely transfixed by his teaching. I have even counseled medical students who could not stand the sight of an eyeball yet tried to pursue ophthalmology simply due to their exposure to Lawton. To truly understand his teaching methods, one needed to learn the particular lexicon that Lawton had developed, all spoken in his distinctive South Carolina twang. For example, to get ready to work hard was to “swing into action totalis”; when he really piqued your interest, he was “working you up to fever pitch”; but if you got too excited and wanted to order too many tests, you were like “a blind dog in a meathouse”; if you incorporated new technology, you were using “twin smitties”; and when he really liked you, you became a “pie.”

Another one of Lawton's true love was people. He was intensely devoted to his wife of 56 years, Elizabeth, and greatly loved his 3 children and grandchildren. And Lawton loved his residents and fellows. He mentored more than 50 fellows and hundreds of residents and medical students in his career. He always wanted to get to know them personally and invest in them spiritually. He also loved the Bascom Palmer and his fellow ophthalmologists there and throughout the world. Lawton coupled his love for medicine and his love for people by founding the Christian Ophthalmology Society in 1977 to provide a forum where doctors and their families could learn new advances in ophthalmology and renew their professional and personal lives. Today the group that started with 25 doctors has grown to a group of more than 600 with annual meetings throughout North America.

And finally, most of all, Lawton loved God. In his younger days, Lawton did his fair share of carousing. I have heard many stories from him and from others that make “Animal House” look tame! But his life was dramatically changed when, in 1963, he met one of his old residency classmates, Dr. Jack Cooper, who told Lawton that he had given his life to Christ and since then his practice went better, his friendships were better, and his family life was better. As Lawton would say, this “ate into his brain like a rat” and shortly thereafter he became a Christian. Lawton has said that from that time on, the presence of “Jesus in his heart far eclipsed” every other aspect of his life. His overriding purpose became to know God more intimately and to encourage others to find the overwhelming joy and peace that he had found. Although we shall greatly miss Lawton, we celebrate the tremendous accomplishments of his life.

R. Michael Siatkowski, MD

Equal to his reputation as the consummate clinician, Lawton Smith was an educator par excellence. He possessed the uncanny knack of using examination techniques and “down home” phrases to share his astute clinical observations with fellows, residents, and medical students. He was able to take complicated clinical findings and make them understandable and practical. He described himself as a “treating doc” and wanted his colleagues to always keep the credo of “help the patient” at the forefront of their clinical practice.

Creating the Journal of Neuro-Ophthalmology was a natural extension of Lawton's teaching zeal. In the early years of publication, many articles were followed by “editorial comment” or “new pearls checklist,” in which he would emphasized the importance of a particular manuscript and highlight how it would help in clinical practice. He cared deeply about his patients and wanted to make sure that readers of the Journal had the latest and best information to deliver that care.

Those who knew Lawton and were fortunate enough to see him “in action” fully realize how lucky they were. Lawton Smith was a unique individual-a great physician, educator, and mentor. We are proud that his legacy lives on in the Journal of Neuro-Ophthalmology!

Lanning B. Kline, MD

To read more about Dr. Smith's career, see “For J. Lawton Smith” by Joel S. Glaser, MD (J Neuroophthalmol 1996;16:233).

© 2011 Lippincott Williams & Wilkins, Inc.