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BBHiimaiMBiiflfflr /MiBfliiaiimBB' 

The Development of 

Ophthalmology in America 

1800 to 1870 

A Contribution to Ophthalmologic 
History and Biography 



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I I 

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90 Wabash Ave., Chicago 



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Copyright. 1907, 




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1850 96 










Through the earnest solicitations of numerous es- 
teemed confreres, I have been induced to republish in 
book form the address which I had the honor to present 
to the Section of Ophthalmology of the American Med- 
ical Association at Atlantic City, N. J., June 4, 1907. 
In doing this I have availed myself of the opportunity 
to revise the text throughout, to rewrite portions of it, 
to make several additions to it, and to incorporate a 
number of cuts and selected portraits. These portraits 
are of men who have distinguished themselves more or 
less in ophthalmology during the period which I have 
reviewed. Some of them have never before been given 
to the public, and it is only through the extreme courtesy 
of professional and other friends that T am enabled to 
publish them now. Those who have been especially 
helpful to me in this regard are Drs. B. Joy Jeffries, 
Hasket Derby, Edward Eeynolds and Edwin H. Bing- 
ham, of Boston; Mr. Charles P. Fisher, librarian of the 
College of Physicians of Philadelphia; Mr. John S. 
Brownne, of the New York Academy of Medicine, and 
Dr. Herman Knapp, of New York; Dr. Walter S. 
Steiner, of Hartford, and Drs. Samuel Theobald and 
Harry Friedenwald, of Baltimore. This collection of 
portraits, only two of which are of living men, viz.. 
Dr. Derby and Dr. Knapp, adds interest, it seems to 


me, to the biographical sketches, and also serves to 
reveal in their physiogomy something of the character 
of the men who have been instrumental in establishing, 
advancing and dignifying ophthalmology as a specialty 
in America. 

I can not let this little volume go forth without warn- 
ing my readers that it is not intended to embody a com- 
plete survey of American ophthalmology from 1800 to 
1870. It simply sketches the principal factors of its 
development — the men who have been most conspicu- 
ous in connection with it, and the institutions, in their 
beginnings, which have become perpetual fountains of 
ophthalmologic knowledge and experience, as well as 
harbingers of relief to the suffering and blind. I realize 
that almost any one subject herein touched upon merits 
in itself a more detailed consideration — a chapter if not 
a volume ; but I trust that even the outlines and incom- 
plete sketches which I have given will not be entirely 
devoid of historical interest, and that they may at least 
serve as landmarks to guide some future historian into 
a wider field of study. 

The story of the progress of ophthalmology from 1870 
to the present time is an interesting one, as I know 
from the material which I have collected and which I 
had hoped to use when I was first invited to deliver this 
address. Whether or not it is to be told in the future 
depends largely on the judgment which is passed upon 
this first installment. A. A. H. 

212 Franklin Street, Buffalo, N. Y. 


AMERICA; 1800 TO 1870.* 



In undertaking to indicate the factors that have con- 
Ntributed to the development of ophthalmology in Amer- 
ica, I have found it obligatory to limit my study to 
Canada and the United States. This has been necessary 
because of lack of time and readily available resources 
to go farther, and also because our interests in American 
ophthalmology center in these two great nations. 

An important question has also arisen in this connec- 
tion, viz., who are they, in this restricted sense, that are 
Americans? Are they those alone who were reared and 
educated in one of those two countries? Or should 
those be included who, although foreign born and for- 
eign educated, have come to these lands to live, and who 
. have identified themselves with these peoples, their 
thought, their work, their purposes and their institu- 
tions? America, in the sense above indicated, and in 
which I shall hereafter use the word, is essentially cos- 
mopolitan, and every man is an American who sub- 
scribes to the laws of the country, makes himself an in- 

♦ I have tj^ken the liberty of changing the title which the officers 

of the Section of Ophthalmology of the A. M. A. assigned to me 

at the time I was honored by an invitation to deliver this address. 

The subject suggested was "What America Has Contributed to the 

Advancement of Ophthalmology." 



tegral part of its national life, and labors hand in hand 
with others for the common weal, whatever may have 
been his birthplace or in whatever country he may have 
received his education and scientific training. Herman 
Knapp and Ferdinand C. Hotz, for example, are to-day 
ae truly American in sentiment and spirit, and through 
ties of scientific interests and aflSliations, as are Hasket 
Derby or G. C. Savage ; and it is both my pleasure, pride 
and duty to recognize them as Americans, and their 
labors here, as American, tod all who, like them, have 
adopted America as their own. I thus define what I 
mean by Amei*ica and American that there may be no 
misconception of these terms for the purpose of this 


In its evolution, ophthalmology has advanced at times 
very slowly and at other times almost by bounds. With 
the announcement of Maitre-Jan and Brisseau of the 
true nature of cataract in 1706 to 1709, with Cheselden^s 
operation for artificial pupil in 1728, with DaviePs pub- 
lication in 1752 of a new method of curing cataract by 
extracting it, with the discovery of sulphuric ether 
anesthesia in 184G, with von Helmholtz's invention of 
the ophthalmoscope in 1851, with von Graefe's newly- 
found surgical relief for glaucoma in 1857, with Bon- 
ders' revelations in regard to the refraction of the eye 
and its anomalies in 1859 to 1864, with Lister's teach- 
ings of antisepsis and the protection of operative wounds 
from the invasion of germs in 1867, with Koller's an- 
nouncement of ocular anesthesia by cocain in 1884, 
ophthalmology took tremendous leaps. Other advances, 
such as those pertaining to anatomy, physiology, path- 


olog}^ and therapeutics, have made slower pace, but 
nevertheless they have been ejffective, and by a gradual 
and cumulative accretion have united with the more 
rapid advances to bring to a higher degree of perfection 
the special department of medicine, whose interests it 
is our accredited privilege to promote. 

Not only, therefore, is some new and marvelous dis- 
covery in ocular pathology and therapeutics a contribu- 
tion to the advancement of ophthalmology, but so is 
every well-studied and well-reported case; so is every 
well-planned and well-executed experiment having for 
its purpose and result the corroboration of previous 
findings or the establishing of new facts, the importance, 
however, varying inversely as the substantiated verity of 
past conclusions or the need of new and additional facts 
decrease or increase. Dr. Osier has said^ that "truth 
grows, and its general evolution may be traced from 
the tiny germ to the mature product." So it is with 
ophthalmology. Out of the germinating stages of the"^ 
dim and distant past it has emerged as a vital part of 
the great body of medicine, and, like the majestic trunk 
to which it belongs, it has gradually grown and extended, 
sometimes opposed by the most blighting influences of 
ignorance and cupidity and sometimes sustained by the 
invigorating accessions supplied by intelligence and 
genius; but always has it grown by the accretion and 
assimilation of countless experiences, for the most part 
trifling and unnoticed, seldom striking and far-reaching, 
until to-day it has attained a degree of perfection, a 
proportion of completeness that are the pride, if not the 
wonder, of our whole profession. Not alone, then, has 

1. Brit. Med. Jour., Oct. 27, 1906, p. 1077. 


the genius of Daviel, of von Helmholtz, of Bonders and 
others brought ophthalmology to its present proportions, 
but the thousands on thousands of lesser and often most 
trivial observations, devices, inventions, suggestions and 
experiments of the past have also been essential factors 
in its growth and permanency. 

I agree with Dr. C. A. Oliver, who says, in a private 
letter, that "it seems to me that each man, in accord- 
ance with his opportunities, contributes his mite; that 
each institution gives its fruits in direct relationship 
with those in charge, and that he who now may be the 
least known and the most humble in American ophthal- 
mology may be really the greatest.'^ 

If ophthalmology has not developed as rapidly in 
America as in Europe, it must be remembered that 
there have been suflBcient reasons. With few exceptions 
the medical institutions of America, both clinical and 
teaching, have been the outgrowth of private enterprise 
aind supported by private gain. The exceptions have 
been the few instances where, through the foundation of 
state university organizations, provisions have been 
made for medical teaching, and hospital facilities. 
Physicians and surgeons have seldom been paid for 
teaching or for serving a hospital, except, perhaps, either 
directly through the proceeds of private patronage of 
the institutions which they may have been serving, or 
indirectly through the increased private practice which 
they may have obtained by the publicity given them 
through their medical school aflBliations. The result has 
been, therefore, that, without such a living salary as is 
paid to those attached to the government schools and 
hospitals of Europe, our American medical teachers and 


hospital attendants have had to earn their living out- 
side in private practice, and in doing this it has con- 
sumed nearly or quite all of their time and energy. 

Besides this, there has been the insufficient qualifica- 
tion of our medical men, incident to the free develop- 
ment of our medical institutions. The great liberty 
that has been allowed in their organization, the envious 
and often bitter strife that superfluous numbers of them 
has engendered and the lamentable lack of government 
restrictions and oversight in their operations, have pro- 
duced from the beginning a gradual lowering of medical 
standards, both for entrance and graduation of students, 
and for license to practice, until in the '60s these were 
reduced to the most meager proportions, or to nothing. 
Our country, therefore, became flooded with ill-prepared, 
incompetent and often fraudulent practitioners, who 
had been sent out by these inferior, ill-equipped private 
medical schools. It was thev who, in turn, obtained 
positions in our hospitals, or created hospitals of theii 
own, and who became, in large part, our teachers. I do 
not wish to be understood as putting all institutions or 
all practitioners into these classes. Their proportionate 
numbers were simply in excess. Many young men be- 
gan the study of medicine with better qualifications 
than were demanded. Some faculties, with a high 
sense of responsibility, rose above their environment 
and had ideals higher than private gain. These formed 
a residi^m of professional men whose ability, whose 
skill, whose intellectual attainments, whose moral 
breadth and depth made them ornaments and an honor 
to our ranks and maintained the dignity and the sanc- 
tity of the high and noble principles of our profession. 


Such men saved us from utter disgrace; and in their 
struggle they were greatly aided by such movements as 
the organization of the American Medical Association 
and of the American Medical College Association, by the 
special initiative of the State of Illinois in establishing 
a state board of health with powers to demand higher 
standards on the part of thoee who would practice in 
that state, and by the creation of state boards of medi- 
cal examiners in New York, Pennsvlvania and other 
states, which made it incumbent on those who would 
practice in those states to possess certain qualifications 
preliminary to entering a medical school, which required 
medical colleges to maintain certain standards and 
courses of study, and which finally required the appli- 
cants for license to pass specific examinations in the 
principal subjects of medicine. A great revolution in 
professional standards and qualifications has followed 
since the various states have thus taken the licensing to 
practice out of the hands of medical faculties ; and this 
progress, too, has gone on in spite of the continued pri- 
vate character of most of our medical institutions. 

The necessity, however, of relying on private gain or 
private aid to meet present and future demands of re- 
search and teaching has not ceased. It has been, and 
still is, the great obstruction that impedes our medical 
progress in America, notwithstanding that our medical 
men, on the average, have to-day just as well-endowed 
brains, just as astute and resourceful minds as medical 
men in Europe. In fact, they arc of European stuff. 
They simply lack opportunity. And this condition must 
continue till some government scheme prevails by which 
the living of our medical teachers and investigators is 


made secure without consuming all of their time and 
energy in practice for this purpose. But our ophthal- 
mologists are aliVe to the importance of research work, 
and, in spite of the environment, they are making com- 
mendable progress, and their rewards are growing richer 
and richer. 




The factors that have contributed to the development 
of ophthalmology in America are found in our special 
ophthalmologic institutions; in the eye clinics of gen- 
eral hospitals and dispensaries; in the observations and 
clinical teachings of our pioneer laborers in the ophthal- 
mologic field of practice, and, in a more limited way, 
of our great surgeons ; in the writings of these men, and 
in the literature, both American and foreign, which 
they have disseminated throughout the profession; and 
in inventions and discoveries bearing on ophthalmologic 
science and practice. This review must, necessarily, be 
most incomplete, barely taking a glimpse here and there, 
and merely noting a few of the beginnings, some of the 
special claims, and a few of the most enlightening ob- 
servations and suggestions. 


In regard to institutional and clinical eye work, our 
special institutions take first rank, and their origin and 
development are of deepest interest. 


The first effort to establish an institution for the 
treatment of diseases of the eye in this country was 
that of the New London Eye Infirmary. 

In a biographic sketch of Elisha North,^ it is stated 

2. Biography of Eminent Am. Phys. and Surg., by R. F. Stone, 
1892. p. 356. 


that he established in New London, Conn., the first 
eye infirmary in this country. He did this in 1817. 
His institution was in active operation in 1819, as 
is shown by an advertisement in The Connecticut Gch 
zette, a New London newspaper, in which Dr. North 
says : "I had the pleasure to prevent total blindness and 
restore sight to twelve or thirteen persons during the last 
three years. These would now probably be moping about 
in total darkness and would be a burden to society and 
themselves had it not been for my individual exertions.^' 
How long his "infirmary^^ continued to exist is un- 
known, but it is possible that it was still alive as late as 
1829, as Dr. North at that time added to his name, on 
the title page of the book later referred to. the words 
"Conductor of an Eye Infirmary." I include it in the 
historical sketches of those whose history we know, with- 
out regarding it as one of especial importance. 


The next attempt to provide an institution for the 
relief of the poor, afflicted with diseases of the eye, was 
in New York City in 1820. The motive of this effort 
can best be described by quoting one of its founders and 
one of its first physicians, the late Dr. Edward Dela- 
field,^ of that city. 

Some time in the year 1816 two young men, recent gradu- 
ates in medicine of the College of Physicians and Surgeons of 
this city, who had spent together the previous year in the 
New York Hospital, one as house physician and the other as 
house surgeon, sailed for Europe. Their object was to im- 
prove themselves in the knowledge of the profession of their 
choice. . . . They thought then that they understood the 

3. Address deUvered by Dr. Delafield at the dedication of the 
new building of the New York Eye Infirmary, April 25, 1856. 


nature and treatment of diseases of the eye as well as any 
part of surgery; and when they sought abroad for additional 
knowledge, it was with no especial view of learning more on 
this subject than any other in medicine. 

With these impressions they arrived in the city of London, 
where they had determined to pursue their studies, and among 
other public medical charities were induced to become pupils 
of the London Eye Infirmary, then recently founded by Mr. 

And here they soon made a discovery which is the best pre- 
lude to all study, that they were profoundly ignorant of the 
surgery of the eye, and that what they had been taught on 
that subject was almost of no value. Knowing at the same 
time that they learned from the same sources as the rest of 
their countrymen, they drew the inference, which the result 
proved true, that ophthalmic surgery was comparatively un- 
known in America. The thought flashed on them that here 
was an open field in which they might walk, and with the 
ardor of youth they devoted themselves to this new branch of 

On their return to their country in the year 1818, the sub- 
ject of diseases of the eye engaged their earnest attention, and 
they soon came to the resolution that they would establish 
in our city for the first time in America, an infirmary for cur- 
ing diseases of the eye. 

. . . To demonstrate the good to be derived from such 
an institution, they agreed, unaided and alone, to make the 
experiment, and to call for no public assistance, until they 
could already show results of a character and number sufficient 
to prove how many poor suffered under diseases of the eye, 
and how much could be done for their relief. 

Accordingly, two rooms were hired in the second story of a 
building in Chatham Street, then in a central situation, and 
the few articles provided the humble institution required. 
Some students of medicine volunteered to perform in rota- 
tion the duty of apothecary, and the landlord from whom the 
rooms were rented acted as superintendent. Small as was the 
scale on which our infirmary started, it had everything essen- 
tial to a public charity; except, indeed, money, and little of 


that was required, as nobody was paid for his Bervices. It 
WBB made publicly knovn that all poor person? applying at 
No. 46 Chatham Street, on certain days and houra of each 
week, with diseases of the eye, would be ei^tuitously treated, 
and the necessary medicines and appliances furnished them. 

A single week proved that our infirmary would succeed, for 
immediately many poor persons, thus suffering, applied for 
relief, and in a short time our small apartments were crowded 
with them, and the labor of caring for so many proved far 
greater than wag anticipated. 


The undertaking was commenced in the month of August, 
1820, and in a period somewhat less than seven mouths 436 
patients had applied and received the care and treatment of 
the surgeons of the infirmary. ... 

. . . Having, then, in this manner, demonstrated that 
an infirmary for curing diseases of the eye would be a great 
boon to the suffering poor of our city and country, it was de- 


termined to bring the subject before the public, and appeal to 
them for the means of founding and continuing a public char- 
ity for the cure of diseases of the eye in the city of New 

Of the two young men who thus adventured on an experi- 
ment whose success is this day demonstrated, one was the 
late Dr. John Kearney Rodgers, and the other now addresses 
you — abundantly rewarded for all the labor he has bestowed 
in founding and continuing this charity, by the satisfaction 
of meeting you in this admirable building, erected and now 
to be dedicated for the New York Eye Infirmary . 

The first officers and directors of the institution were 
elected April 21, 1821, and were William Few, presi- 
dent; Henry I. Wyckoff, first vice-president; John 
Hone, second vice-president; John Delafield. Jr., treas- 
urer; James I. Jones, secretary; Nathaniel Eichards, 
Benjamin L..Swan, William Howard, Henry Brevoort, 
Jr., Joshua Jones, William Howell, Jamee Boggs, Isaac 
Pierson, Jeromus Johnson. Isaac Collins, Cornelius 
Heyer, Henry Rankin, Benjamin Strong, Samuel F. 
Lambert, Edward W. Laight, Gideon Lee; consulting 
surgeons, Drs. Wright, Post, Samuel Borrowe ; surgeons, 
Drs. Edward Delafield, J. Kearney Rodgers. 

Thus through the public spirit and sagacity of two 
young men began the now celebrated New York Eye and 
Ear Infirmary, in the month of August, 1820. Its be- 
ginnings were small, but its needs were manifest, and 
from time to time receiving the financial support of the 
public and the active cooperation of the medical pro- 
fession it developed into one of the largest and most 
philanthropic institutions of the world. 

During the year ending Sept. 30, 1906, 2,789 persons 
were treated in the wards of the infirmary and 40,311 
cases were treated in the out-patient department. The 


daily average number of all cases treated in both the 
out-patient and in-patient departments was 502. 

The records of the infirmary show that since its open- 
ing in August, 1820, with the exception of three months 
during the prevalence of an epidemic fever in 1822, the 
doors of the infirmary have never been closed to patients. 
From the month of August, 1820, to Sept. 30; 1906, 
there have been treated at the infirmary a total of 
1,051,892 patients. This number includes ear, nose 
and throat, as well as eye patients. Its further history 
must be told at another time. 



The next movement toward the establishment of an 
institution for the treatment of diseases of the eye was 
in Philadelphia in 1821. It seemed to be the outcome 
of the energy and public spirit of Dr. George McClel- 
lan of that city, a young and ambitious man, then 25 
years old, who was just entering on his career as sur- 
geon, and who afterward greatly distinguished himself 
as such. 

Early in 1821 a notice was published in a Philadel- 
phia medical journal* of an intention to start such an 
institution in the following words: 

Dispensary for Diseases of the Eye. — For the increasing 
number of indigent blind people in the city of liberties, a 
number of gentlemen have been contemplating the institution 
of a society to afford gratuitous relief; and though circum- 
stances at present prevent more than a limited foundation, 
they indulge reasonable expectations of being able, in the 
course of a few months, to establish a much more extensive 

4. Am. Med. Recorder, April 14, 1821, iv. 402. 


The object of this communication is to notify those who, 
afflicted with any diseases of the eyes, can not compensate 
medical services, that arrangements have been made with Dr. 
McClellan for surgical attendance, and with Mr. Marshall, 
Chestnut Street, for medicines, which will be afforded gratui- 
tously. Application to be made at Dr. McClellan's office. 
Swan wick Street, near Walnut, above Sixth. 

In the spring of 1822 a further publication was 

made,* stating that : 

The Institution for the Diseases of the Eye and Ear had, 
during the past year, been conducted in the form of a dis- 
pensary, and the poor have been supplied with medicines and 
attendance, at the expense of a few subscribers, from the office 
of Dr. McClellan in Swanwick Street. The operations which 
were performed for cataracts, etc., on a respectable number of 
blind people, proved so successful, that considerable interest 
has been exciteil, and we are happy to announce that the 
institution has in consequence recently been extended into a 
hospital. We understand that more than one hundred of the 
most influential citizens of Philadelphia have associated them- 
selves together to support this interesting establishment, that 
a charter has been obtained from the Supreme Court and 
attorney-general, and that in a few days it will go into regu- 
lar operation as an organized hospital, for the relief of dis- 
eases of the eye and ear. 

The following prominent citizens composed the first 
board of managers: Hon. Chief Justice Tilghman, Right 
Rev. Bishop White, Hon. Judge Duncan, John B. Brin- 
ton, Edward S. Burd, John W. Condy, James C. Fisher, 
Paul Beck, Hon. Benjamin R. Morgan, Richard H. Bay- 
ard, Thomas Kittera, John M. Scott and Benjamin 

The surgeon's first report was in part as follows, bear- 
ing date of March 26, 1822 : 

5. Am. Med. Recorder, 1822, v, 393. 


Gentlemen;^ — In the month of March, 1821, an association 
of ten individuals was formed in this city for the purpose of 
establishing an institution for the relief of diseases of the eye. 
By the gentlemen who composed that association, S. Badger, 
Esq., was elected treasurer, with power to make all necessary 
purchases; Mr. Marshall, in Chestnut Street, apothecary, and 
I was honored with the appointment of surgeon. On the 14th 
of April, 1821, an advertisement was inserted, by a committee 
•appointed for that purpose, in the Medical Recorder and in 
some of the daily prints of this city, announcing the formation 
of the institution, and inviting the poor to partake of its 
benefits. Since that period many physicians and other respect- 
able citizens have recommended poor persons afflicted with dis- 
eases of the eye to my care, and in no instance has any 
patient so recommended, or in any other way introduced, been 
refused the charities of the institution. 

The report was signed, "George McClellan.'^ 
Then follows an abstract of the cases treated during 
the year, together with a detailed report of some cases 
operated on. There had been ten cataract operations, 
two of which were by extraction and eight were by 
"division^^ or by "depression.^^ Eight other cases of 
cataract had not yet been operated on. The total num- 
ber of cases of all kinds was fifty-one, twenty-five of 
which had applied and been registered during the "pres- 
ent month.^^ 

The American Medical Recorder (vol. vi, p. 382) next 
takes notice of this institution in 1823 by announcing 
"by request" that the "distinguished and public spir- 
ited" managers of the new "Philadelphia Hospital for 
Diseases of the Eye and Ear have so far organized the 
institution under the provisions of the charter as to pro- 
vide for the gratuitous treatment of patients from every 
part of the country." It adds that Dr. McClellan, sur- 
geon of the institution, invites his professional brethren 


to send poor patients. This will "confer a favor on the 
managers and will forward the interests of science/' 

This institution seemed to start auspiciously, but for 
unknown reasons, perhaps some higher personal aspira- 
tions on the part of its promoter, such as the founding 
of Jefferson Medical College, which was consummated 
in 1825, and in which he was the moving spirit, it was- 
short-lived, as little or nothing is heard of it after 1824. 
It is possible, also, that rivalry had something to do 
with its decline, as another Philadelphia institution was 
organized at about the same time as this, and was backed 
by a strong professional support, and also appealed with 
equal and probably greater force to the public. 



This fourth organization in the United States, and the 
rival of Dr. McClellan's "Hospital,^' had its beginning 
in 1822. I am indebted to the interesting account pub- 
lished by Dr. Charles A. Oliver^ for the principal facts 
which I here present in regard to it. 

Several gentlemen in Philadelphia met on Feb. 8, 
1822, for the purpose of organizing an infirmary for 
treating the poor afflicted with diseases of the eye and 
car, when, as appears from the first address to the public 
in which the constitution was included, with the names 
of the oflBcers, the following managers were chosen : 
James Gibson, William Meredith, Charles N. Baucher, 
Manuel Eyre, Robert M. Patterson, M.D., Clement C. 
Biddle, William Mcllvaine and Richard C. Wood. Mr. 

6. A Brief Account of the Pennsylvania Infirmary for Diseases 
of the Eye and Ear, established in the City of Philadelphia in the 
year 1822. Medical Library and Historical Journal, New York. 
April, 1903. 


James Gibson was made chairman of the meeting, Dr. 
Isaac Hays, secretary, and Mr. Richard C. Wood, treas- 
urer. Drs. George B. Wood, Isaac Hays, John Bell and 
Robert E. Griffith were appointed surgeons, and Drs. 
Phillip S. Physick and William Gibeon, consulting sur- 
geons. The surgeons were ex officiis members of the 
board of managers. Among other transactions of the 
meeting, a resolution was passed constituting the sur- 
geons a committee "with authority to procure a room for 
an infirmary and to make arrangements for carrying 
into effect the objects of the institution.'^ The commit- 
tee was also instructed to prepare an address to the pub- 
lic, to have two hundred and fifty copies of it and a 
constitution printed in pamphlet form, and to frame a 
system of by-laws, all of which was to be reported on at 
the next meeting of the board. 

A managers' meeting was held twelve days later at 
which Mr. William Meredith presided. The committee 
reported a second-story room at No. 4 South Seventh 
street at one hundred dollars a vear, that it had made 
arrangements with Messrs. A. M. and E. L. Cohen to 
furnish medicines at a reasonable rate, and that it had 
prepared an address and a constitution and had them 
printed, as authorized, in pamphlet form. A body of 
by-laws was also adopted at this meeting, and certain 
forms and methods for carrying on the work of the in- 
stitution were agreed on. 

The original "address to the public" of 1822, with the 
constitution omitted as published by Dr. Oliver, is as 
follows : 

The Pennsylvania Infirmary for Diseases of the Eye and Ear. 
Established at Philadelphia. 
In calling the attention and soliciting the patronage of the 


public to an institution which is to embrace the relief of a 
class of diseases having so important a bearing on individual 
happiness and social comfort, we need but advert to the suc- 
cess which has attended similar ones in Europe, more particu- 
larly those established at London and Vienna. In these cities 
thousands have been anually relieved and cured of diseases of 
the eye and ear, who otherwise would have lost the use of these 
all-important organs, and proved a burthen to themselves and 
to society. Like benefits have resulted from institutions of the 
same nature in some of our own cities, and we mqiy now con- 
fidently hope that the citizens of Philadelphia, distinguished 
for their zeal and liberality in the support of whatever tends 
to usefulness and charity, will not suffer the present oppor- 
tunity to escape without testifying their approbation of the 
institution already organized, and prepared to commence its 
beneficial operation, as will be seen from the subjoined con- 
stitution, adopted at a respectable meeting of the contributors 
on Friday last. 

It is interesting to note in this connection that pro- 
vision was made in the constitution "that clinical in- 
struction may be given under such regulations as shall 
be provided by the by-laws." 

It will be seen by this "address'^ that these managers 
entirely ignored Dr. McClellan^s institution, although 
it had already been in operation for a year, and although 
they must have known of its existence. 

The Pennsylvania Infirmary had somewhat of a strug- 
gle to live, but it was kept in more or less successful 
operation for at least seven or eight years. It was not 
incorporated, however, till early in 1826. Dr. Oliver 
says that the last meeting of the board that he can find 
recorded was held on May 1, 1829. But at that meeting 
a committee was authorized to collect subscriptions, and 
other actions were taken looking toward its continued 
support and work. In 1829 Dr. Isaac Hays, in an article 


of much detail and interest on "Diseases of the Cor- 
nea/^^ subscribed himself as one of the "Surgeons of the 
Pennsylvania Infirmary for Diseases of the Eye and 
Ear/^ showing that he was still active in the institution, 
and not ashamed of it. How long it lived after 1829 or 
1830 I can not say. Perhaps it did so till James Wills' 
legacy became effective in 1834, when place and means 
were provided for the work of the staff of surgeons, and 
for lack of which this was made difficult, and without 
the desired efficiency. 


The fifth institution that was organized in this coun- 
try and which, unlike the first and last two above re- 
ferred to, has lived to the present time, and has been 
both a credit and pride to American opththalmology and 
to the medical profession. This was the Massachusetts 
Charitable Eye and Ear Infirmary of Boston, which was 
founded in 1824. Like the New York Eye Infirmary, 
it had its beginnings through the enterprise of two young 
Boston physicians. Dr. Edward Reynolds and Dr. John 
Jeffries. I can not do better in introducing this brief 
historical sketch than to quote from an address of one of 
its founders, Dr. Reynolds, delivered at the dedication of 
its new building, on July 3, 1850. Among other things. 
Dr. Reynolds said : 

As the London Eye Infirmary owes its origin to the Insti- 
tution at Vienna, so the Massachusetts Infirmary, where we 
are this day assembled, must claim its parentage from that. 
The valuable work of Saunders, published in 1816, and the 
occasional reports of the infirmary of which it was the first 
fruits, began to excite a spirit of inquiry among several emi- 

7. American Medical Recorder, xlil, 324. 


nent individuals in our country. But no general movement 
was made in its favor until 1821 (1820) ; when the first eye 
infirmary in America was established by Dr. John Kearney 
Rodgers and Dr. Edward Delafield, two of the most distin- 
guished physicians and surgeons in New York, who may be 
called the fathers of American ophthalmology. Filled with the 
spirit first received at the London institution, and finding on 
their return from Europe a great number of poor people 
afflicted with diseases of the eyes, they were desirous of ex- 
tending a similar blessing to their native city. Accordingly, at 
the request of several of the senior members of the profession, 
they founded the New York Eye Infirmary. 

Two (four) years after, in the latter part of 1824, the 
example was 'followed in Boston, and the first effort made, 
whose noble result we are this day assembled to celebrate. 
Perhaps, on this occasion, I may be pardoned in saying that 
the Massachusetts Charitable Eye Infirmary partly originated 
in the fact that one of its founders had the happiness of 
restoring a beloved father (Edward Reynolds, Esq.) to sight 
by the operation of cataract. The tender relation in this case 
of surgeon and patient, becoming extensively known among 
the small population then composing our community, brought 
to his observation a large number of ophthalmic patients; and 
soon revealed the fact that the poor and laboring classes are 
peculiarly liable to these diseases — a fact now familiar to 
every one acquainted with the results of these institu- 

. . . In the month of November, 1824, the speaker, in 
conjunction with Dr. John Jeffries, hired a room in Scollay's 
buildings; fitted it with such conveniences as their limited 
means enabled them to procure; and invited the poor, afflicted 
with diseases of the eye, to come there for gratuitous aid. 
After having continued their daily attendance for the period 
of sixteen months, it was found that during this time, al- 
though the population of the city did not exceed 50,000, no 
less than 886 persons had applied at the rooms. . . . 

Having thus satisfactorily tested the experiment, the sur- 
geons now thought the time had arrived which authorized 
them to present the claims of this large class of the poor to 


the attenlion of the public Accordinglv a meeting waa 
called on March 13 1826 at which the Hoi John Wells pre 
sided The report wax real Its aimple statement of facta 
impreaied all the gentlemen present uith a conviction of the 
usefulness and importance of the institution and determined 
them to gne it a more perfect trial as a public tharity In 
accordance uith a \ote there passed a subscription nas com 
menced By the personal e\ertiona of one gentleman Mr 
I UC1U1 Manlius Sargent more than t lo thousand dollars «ere 

[ ni ( 


collected in one neek as a peimanent fund and nearh three 
hundred dollars in annua! subscriptions 

The first meeting of the subscribers »ho had thus promptly 
replied to the call of the committee was held at the Exchange 
Coffee House on (he evening of Marth '0 I8>6 Mr Richard 
D Tucker presided The result of Mr Sargent s efforts being 
Diade knoun bv Mr Bryant P Tilden uas regarded as a spon 
taneous expression faioralle to the establishment of the in 
stitution AccordingU it was then regulaily organiaed under 
the title of the Boston Infirmary bj the election of a boird 
of officers comjiosed of the following gentkmen Ediiard 


Tuckerman, president; Lucius M. Sargent, vice president; 
William B. Reynolds, secretary; Bryant P. Tilden, treasurer; 
Richard A. Tucker, Edward H. Robins, Robert G. Shaw, Henry 
Sargent, Henry Rice, Nathaniel G. Snelling, James C. Dunn, 
Thomas C. Amrory, and Rev. John Codman, managers. 

In February of the following year it was incorporated 
by the legislature of Massachusetts under the title of the 
Massachusetts Eye and Ear Infirmary. 

From this time till the fall of 1836 the infirmary was 
"housed^' in different places, and was used only as a dis- 
pensary, serious cases being cared for by the staff else- 
where. The requirements for hospital accommodations 
became so imperative that a building, the Gore House 
on Green street, was then purchased, and was remodeled 
and adapted to both dispensary and hospital purposes. 
This building was opened for admission and treatment 
of patients on July 19, 1836. The number of patients 
registered during this year is recorded as 689. It rapidly 
increased to such an extent that additional room and 
facilities were found necessary, and once more an effort 
was made to provide larger quarters, which resulted suc- 
cessfully in the purchase of a lot on Charles street in 
1848, and the erection of a new building which was com- 
pleted in 1850 and dedicated on July 3 of that year, the 
dedicatory address above quoted from being delivered 
by one of its founders. From that year the number of 
patients increased from 2,00-1 to nearly 20,000 in 1895. 
The building of 1850 had thus become inadequate for the 
needs of the institution and it was decided to purchase 
adjoining land and to erect a new building. This was 
done, and the new hospital was built, and was ready for 
occupancy in 1899. In connection with this a ward for 
contagious diseases of the eye was provided in an adjoin- 



ing building, and is the first of its kind to be erected in 
this country. The infirmary building to-day is, like that 
of the New York Eye and Ear Infirmary, a model of its 
kind. According to the last annual report, 1906, the 
number of patients of all kinds treated at the infirmary 
during the preceding year was 35,319. 

Ophthalmic clinics in the institution were begun as 
early as 1836, and both Dr. John Jeffries and Dr. E. 
Reynolds and later Dr. George A. Bethune gave regular 
courses on the diseases of the eyes. At the present time 
clinical instruction is given to the students of Harvard 
and Tufts medical colleges. 



In 1823 Dr. George Frick, of Baltimore, published 
"A Treatise on Diseases of the Eye." In the preface 
Dr. Frick says that "opportunity has been considerably 
augmented since his (the author's) return to his native 
country, by his appointment to the Baltimore Dispensary 
for the Cure of Diseases of the Eye." Dr. Isaac Hays, 
of Philadelphia, in reviewing Dr. Frick^s work in a 
Philadelphia medical journal,^ says that "with respect 
to the institution at Baltimore he has but little informa- 
tion to communicate. It is attached to the Baltimore 
Dispensary and is committed to the author of this 
(Frick's) work.'' Dr. Cor dell says, in his "History of 
the University of Maryland," that the foundation of the 
Baltimore Dispensary was laid in 1823 and patients 
were received the same year. There were four wards, of 
which "one was reserved for eye cases, instruction in 

8. Phlla. Jour. Med. and Phys. Sci., 1825, pp. 409 to 427. 


ophthalmic surgery forming a prominent feature in the 
course/' This being in the time of Frick's early activity, 
this prominence given to ophthalmology was probably 
due to him, and it was he who delivered the lectures re- 
ferred to. 

Dr. Harry Friedenwald® says that on Dr. Frick's re- 
turn from Europe, about 1819, "to engage in the practice 
of ophthalmology, he was appointed surgeon to the Bal- 
timore General Dispensary, where he established the first 
eye dispensary in Baltimore in 1824.'^ This dispensary 
must, however, have been started before 1824, if Dr. 
Frick's own statement above quoted from his book be 
correct, for his work was published in 1823, and also 
according to CordelFs statement, which I have above 

I can obtain no further record of the Baltimore insti- 
tution, and it is even doubtful if it had an organization 
independent of the general dispensary. Being a first 
effort, however, at establishing a special eye clinic in 
Baltimore contemporaneously with the beginnings of 
eye infirmaries in New York, Philadelphia and Boston, 
it is worth mentioning. 


In following up the historical references to the early 
institutions for the treatment of diseases of the eye which 
have contributed in various ways to the advancement of 
ophthalmology, the next in chronological order is the 
Wills Eye Hospital of Philadelphia. This institution was 
created by the benevolence of a wealthy Philadelphian, 

9. The Early History of Ophthalmology and Otology In Balti- 
more (1800-1850), reprint from Johns Hopkins Hospital Bulletin, 
Baltimore, 1897. 


James Wills, who was boni in England in 1760 and died 
in Philadelphia in 1830, His fortune was. in part by in- 
heritance and in part from his own business in Philadel- 
phia, where he was an honored member of the Society of 
Friends. At his death he left a will providing for the 
founding of a "hospital for the indigent blind and 
lame." A question arose as to the legality of his be- 


quest, and for some time it was in process of litigation. 
The decision of the court, however, upheld the provisions 
of the will, and, after satisfying other bequests, there 
was a sum of $108,396.35, with its accumulations, mak- 
ing a total of $123,548.57, available for the purchase of 
a lot and the erection of a building in compliance with 
the wishes of the benefactor. The place selected by the 
officers of the organization was on Race street, between 


Eighteenth and Nineteenth streets, on which was erected 
a building, the foundations of which were laid on April 
2, 1832. On March 3, 1834, the hospital was opened for 
the reception of patients. On the completion of the 
building, all expenses had been paid, and there was a 
residue of $65,344.88 for the future support of the in- 
stitution. The first surgeons were appointed in 1834, 
and were Drs. Isaac Parrish, Squier Littell, Isaac Hays 
and George Fox. Those entitled to the privileges of the 
hospital were persons in indigent circumstances, and on 
application they wore expected to give satisfactory evi- 
dences of respectable character. Since the erection of 
the first building many alterations and additions have 
been made, until now it is provided with offices, oper- 
ating and clinic rooms and one hundred beds for interne 

From the earliest days of the hospital, eye diseases 
were most prominent among the patients who applied 
for assistance. As early as May, 1834, two operations 
were performed for cataract by couching and, to quote 
the report of the visiting committee, "these cases were 
watched with the utmost interest as to the outcome of 
the operations.'^ At first the full capacity of the house 
was twenty patients, and the physicians and surgeon? 
{it tended but once or twice a week. The institution wa^ 
then known as "Wills Hospital for the Blind and 
Lame.'' The character of the cases became more and 
more limited to eye diseases, until in November, 1837, 
It was reported that there were no medical cases for 
treatment. A few years later the office of attending 
physician was abandoned. Almost without a single mo- 
ment's hesitation has the institution received kindly rec- 


ognition and a helping hand. It has been so well sup- 
ported by state and private benefaction that the work 
has steadily grown from sixty cases the first year to over 
sixteen thousand annually at the present time. 

The present building is most suitably arranged for the 
proper treatment of diseases of the eye, and has all the 
modern improvements and facilities. 


In this connection I may properly mention the Mon- 
treal Eye and Ear Institution of Montreal, Canada, the 
organization of which was undoubtedly inspired by Mr. 
Henry Howard, of that city, and which began its exist- 
ence in or before 1846. Information is not at hand 
which will enable me to give any definite account of this 
institution and its duration. 

I have thus taken the time to briefly outline the origin 
of these earlv institutions, because those that have sur- 
vived have been the greatest of the sustaining and devel- 
oping forces of American ophthalmology. But it must 
still be borne in mind that these have been reinforced by 
the organization from time to time of ophthalmic serv- 
ices in connection with general hospitals and general dis- 
pensaries by men more or less interested in diseases of 
the eye. The Baltimore Disp^sary, in which Dr. Frick 
took an active part as early as 1823, and to which I have 
already referred, was one. Another, the Philadelphia 
Dispensary, a charity said to have been organized by 
Benjamin Eush, always had a certain proportion of 
patients with eye diseases, and they were attended to by 
the physicians on service. The Philadelphia Hospital 
and the Pennsylvania Hospital of Philadelphia, the New 


York Hospital, the Massachusetts General Hospital of 
Boston, the Baltimore Hospital, and others throughout 
the United States had their surgeons who were more or 
less skilled in ophthalmic operations. 


Some of the early surgeons of Philadelphia who were 
thus skilled were Thomas Bond (1712-1784), who, with 
Benjamin Franklin, founded the Pennsylvania Hospital 
in 1752 (the first of its kind in America) ; William 
Shippen, Jr. (1736-1808), Philip Syng Physick (1768- 
1837), William Gibson (1788-1868), John Syng Dorsey 
(1784-1818), nephew of Physick; George McClellan 
(1796-1847), Jacob Randolph (1796-1848), and George 
Fox (1806-1882). In New York there were such dis- 
tinguished surgeons as John Jones (1729-1791), later 
of Philadelphia, Wright Post (1766-1822), Samuel Bor- 
rowe, J. Kearney Rodgers (1793-1857), Valentine 
Mott (1785-1840), Gurdon Buck (1807-1877), Willard 
Parker (1800-1884), and Alfred C. Post (1806-1886). 
In Boston there were John Warren (1753-1815), his son 
John Collins Warren (1778-1856), George Hayward 
(1791-1868), and John Jeffries (1796-1876) ; in Balti- 
more, John Beale Davidge (1769-1829), Horatio G. 

Jameson (1778-1855), John Harper ( 1831), 

Granville Pattison (1791-1851), and Nathan R. Smith 
(1797-1877) ; at Dartmouth and Yale, Nathan Smith 
(1762-1829), the father of the Baltimore surgeon, and 
himself a great physician as well as surgeon of his day; 
in Chicago, Daniel Brainard (1812-1866) ; in Transyl- 
vania, Ky., Benjamin Winslow Dudley (1785-1870), 
and so on in all large towns throughout the country. 


of which the aboye is a very incomplete list and does not 
include those surgeons of a little later period who were 
more or less celebrated for their skilful operations on 
the eye. 

Those who stood out more exclusively for ophthalmol- 
ogy were George Frick of Baltimore, Isaac Hays and 
Squier Littell of Philadelphia. Edward Delafield, of 
New York, served the New York Eye Infirmary many 
years, but was actively engaged in other departments of 
practice. Dr. J. K. Eodgers was also faithful to the same 
institution, but his service was incidental to his surgical 
work. John Jeffries, George A. Bethune, John H. Dix, 
Eobert W. Hooper and Edward Reynolds, in Boston, 
who attended the Massachusets Charitable Eye and Ear 
Infirmary, were also general practitioners. Samuel D. 
Gross, Philadelphia, was a great surgeon, and he also 
did eye surgery. The same is true of D. Hays Agnew, 
also of Philadelphia. 

The lives of some of these men deserve further record 
in this connection and I shall, therefore, give sketches 
of them very briefly. 



George Frick, Baltimore, was the first in America 
to undertake to restrict his professional work almost 
exclusively to ophthalmology. He was born in Balti- 
more in 1793. After completing his medical studies and 
graduating from the University of Pennsylvania in 
1815, he was licensed to practice in his native city in 
1817. He visited Europe, where he became a favorite 
pupil of the celebrated Vienna ophthalmologist, Beer. 
He came to feel deeply the dearth of knowledge of dis- 
eases of the eye in America and set himself to work to so 
qualify himself under the great master that he might 
return to his home and give some enlightenment and a 
scientific uplift to a neglected department of medicine. 
After a prolonged period of study, and enthused by the 
example of Beer as an exclusive specialist, he returned 
to Baltimore in 1818 and undertook in a measure to fol- 
low his teacher's example. He at once began his plans 
for ophthalmologic work. He organized a special eye 
clinic in connection with the Baltimore Dispensary and 
established a course of lectures on the eye in the Uni- 
versity of Maryland. He was naturally retiring in dis- 
position, and without demonstration he undertook this 
innovation. There is sufiicient evidence extant to show 
that his work as an ophthalmologist was approved in 
Baltimore, and had it not been for a frail physique and 
the infirmity of deafness he would undoubtedly have left 
a more impressive and lasting record than he has. 

DE. ISAAC HATS (1796-1878.) 


Nevertheless, his clinical work in ophthalmology be- 
came an inspiration to others, and his ophthalmologic 
contributions to the American Medical Recorder of Phil- 
adelphia and his "Treatise on the Eye" (1823) are 
enduring monuments to his learning. Unfortunately, 
as his infirmity increased, and having tastes for other 
pursuits, he was led to abandon his profession so well 
begun. He finally repaired to Dresden, where he died 
in 1870, at 77 years of age. (For these facts regarding 
Dr. Frick's life I am indebted to Dr. Harry Frieden- 
"wald's "Early History," etc., above cited.) 

Isaac Hays. — The next who did much credit to early 
ophthalmology was the distinguished Isaac Hays, who 
was born in Philadelphia in 1796 and died there in 
1879, spending the whole of his life in that city in most 
arduous and productive labor. He graduated in medi- 
cine from the University of Pennsylvania in 1820, and, 
unaided by friends or by the patronage of the great and 
influential of his city, he began the world's struggles, 
and at once won the confidence of the most distinguished 
physicians with whom he came in contact. Fitted by 
Xature and by training for literary work, he neverthe- 
less took a deep interest in ophthalmology, both scien- 
tifically and practically, and so far as he practiced medi- 
cine at all it was chiefly in this field. He began the 
practice of ophthalmology early in life, and when the 
Pennsylvania Infirmary for Diseases of the Eye and 
Ear was founded in 1822, undoubtedly as a rival to Dr. 
McClellan^s hospital, he was one of its first surgeons. 
His services there were faithful and eflficient, and it was 
also to his influence and energy that it was kept alive 
till the time when James Wills died in 1830 and left a 


bequest, whereby there would be means to support an 
institution in which charitable work of this kind could 
be done in accordance with higher ideals and with less 
worry over insuflficient financial support. At the open- 
ing of the Wills Hospital for the Blind and Lame in 
1834, Dr. Hays became one of its surgeons. Here his 
masterful influence greatly dominated its work, and 
here, too, he built up an enviable reputation as a skilled 
and progressive ophthalmologist. Jn the meantime he 
contributed numerous learned articles on ophthalmologic 
subjects to the journal with which he became identified 
when a young man, viz., the Journal of the Medical and 
Physical Sciences, afterward the American Journal of 
the Medical Sciences, a journal which has come down to 
our own time, and which has ever been the pride of our 
profession and an honor to its editors and its publishers. 
Dr. Hays' service at the Wills Hospital continued till 
1854, a period of twenty years, when the pressure of lit- 
erary work led him to resign. During all of those years 
of institutional work, from 1822 to 1854, the knowledge 
which he acquired of ophthalmology, both practical and 
theoretical, was most efficiently and advantageously re- 
flected to the public in the lectures which he gave in Dr. 
Godman's private school and at the eye hospitals with 
which he was connected; in the editorial work of his 
journal; in his original articles, and in the notes which 
he discriminatingly added to his American edition of T. 
Wharton Jones' "Principles and Practice of Ophthalmic 
Surgery," and to his two editions of Lawrence's "Treat- 
ise on Diseases of the Eve." 

Dr. Hays, besides contributing many articles of great 
value to his journal, made important devices in ophthal- 


inic instruments, occupied many positions of trust, and 
kept alive the newer and more progressive ideas touching 
the science and practice of ophthalmology. The extent 
and value of his labors in this field alone can not be 

On withdrawing from the Wills Hospital, he also 
withdrew from the practice of ophthalmology; but as 
long as he lived his interest in the subject was never 
lost. Although he did not endeavor to make it an ex- 
clusive department of practice, the world will always 
claim him as the great American editor-ophthalmologist 
of the first half of the nineteenth century, whose learn- 
ing and skill were the admiration and inspiration of the 
practitioners of that period. 

Squier Littell. — A third name that stands out in 
bold relief in the same historical period is that of Squier 
Littell. He was born in Burlington, Vt., in 1803 and 
died in Philadelphia in 1886. He was one of a family 
who was endowed with literary tastes. It was his 
brother who founded that old and still popular maga- 
zine, "LittelFs Living Age." Dr. Littell also possessed 
a strong religious nature, and his literary predisposition 
was shown both in medicine and in religion. After 
studying medicine with Dr. Joseph Parrish of Phila- 
delphia, he graduated from the University of Pennsyl- 
vania in 1824. He then entered into general practice, 
making his first attempt at this in South America, but 
returning to Philadelphia in 1826, where he remained 
the rest of his life. His retiring and modest disposition, 
his consequent lack of aggressiveness, contributed to a 
slow acquirement of practice. The death also of his 
young and charming wife, who left to him a little daugh- 


ter and an infant son^ so overwhelmed him with ^ef 
from which he did not recover in years, that it in a great 
measure stifled his ambition and diverted him into chan- 
nels of thought and labor, which, to say the least, did 
not contribute to enviable success in general practice. 
Not to dwell, however, on these or on his literarv labors 
in medical journalism and in religious publications, it 
should be mentioned that he early contributed several 
important papers on general medicine and was esteemed 
a physician and medical writer of merit. In 1834, on 
the organization of the Wills Hospital, and perhaps 
through the kind offices of Dr. Parrish, his preceptor 
and friend, he was appointed one of its surgeons. He 
was a faithful and conscientious attendant to this insti- 
tution for thirty years, resigning in 1864. He disclaimed 
any title to being a specialist, and regarded himself sim- 
ply as a general practitioner, and yet his attachment to 
an eye hospital had more or less effect in making his oph- 
thalmic practice disproportionately the larger part. His 
experience in the Wills Hospital and in private practice 
bore good fruit, for, while Dr. Littell did not write ex- 
tensivelv, his best contributions were in the interests 
of an advanced ophthalmology. His "Manual on Dis- 
eases of the Eye," 1837, was his most conspicuous and 
helpful production. In 1853 he edited the first Ameri- 
can edition of H. H. Walton's "Treatise on Operative 
Ophthalmic Surgery/' adding some useful notes. 

The first article which the doctor published in a med- 
ical journal was in 1821 and the last was in 1873, 
numbering in all about twenty. Of these only three or 
four were on the eye. On the discovery of the ophthal- 
moscope Dr. Littell at once recognized its value and its 


practical application to diagnosis and treatment. He, 
although conservative by nature and slow to adopt new 
methods, at once devoted himself to mastering the diflfi- 
culties of the new instrument and used it habitually and 
intelligently in his practice. 

Dr. Littell, having had a good constitution and having 
led a regular and temperate life, had kept comparatively 
young to advanced age. As he approached his eightieth 
year his sight began to fail him from a chorioidal affec- 
tion and was one of the severe trials of his old age, but 
he made no complaint, and to the last, as his blindness 
increased, he adapted himself to his privation. 

Like Dr. Hays, this pioneer ophthalmologist portrayed 
those qualities of mind and heart which should stand as 
an example to all young men in generations to come. 


These three men, Frick, Hays and Littell, unlike all 
others in the first half of the last century, almost com- 
pletely divorced themselves in practice, though not in 
theory, from other departments of medicine. Each one 
was modest and conservative by nature, each was refined 
and cultured, and each was endowed with literary tastes. 
Each was full of the feeling of the great responsibility 
of his work, and each had an unselfish desire to better 
the ophthalmic practice of his time and to lead others 
to a higher plane of ophthalmologic knowledge. They 
practiced according to the best information and expe- 
rience available, and they opened their clinics to those 
who would come. In ophthalmology they stood above all 
others in the extent of their practice, in their seif-sacri- 
ficinff devotion to their wdrk and* in -the lJterapy-coi)tri- 


butions which were the outgrowth of their knowledge 
and experience, and which served so effectually to ad- 
vance the science in America and to enlighten the pro- 
fession on a neglected subject. 


There were others, however, who were the contem- 
poraries of Frick, Hays and Littell, or who came later, 
who did less writing, but who did most important service 
in ophthalmology. Their careers should also be briefly 

Elisha North (1771-1843), of New London, Conn., 
attempted to make ophthalmology more or less promi- 
nent in his practice, even earlier than did either of the 
three men whose lives I have sketched. He was the son 
and grandson of physicians, and studied medicine in 
Hartford, and subsequently in Philadelphia under Ben- 
jamin Eush. After being admitted to practice he settled 
in his native town, Goshen, Conn., and engaged in the 
pursuit of his profession until 1812, when he removed to 
New London, Conn. He was a man of progress and was 
among the earliest to practice vaccination in the United 
States, being the first to introduce vaccine matter in New 
York City, sending it to Dr. Edward Miller of that town. 
In New London he devoted special attention to diseases 
of the eye, and in 1817 established there the first eye in- 
firmary in this country. According to information fur- 
nished me by Dr. Walter E. Steiner, of Hartford, Conn., 
Dr. North in 1829 published a book entitled 'The 
Science of Life.^^ In it he refers to his work and insti- 
tution as follows : '^e had attended to eye patients be- 
fore that time (1817), but it occurred to us then that 
.we^wight.mitltigly Jh^ n^umbter of cases of that descrip- 

c WW 

l>i. «>• •'••«*tov 

W V V \. ^ 

BLrSHA NOBTB (1771-18*3). 



tion and hereby increase our knowledge, advertising the 
public in regard to an eye institution. This was done, 
and we succeeded, although not to our wishes in a pe- 
cuniary view of the case. Our success or exertions prob- 
ably hastened in this country the establishment of larger 
and better eye infirmaries (i. e., for larger cities)." Lit- 
tle is really known of Dr. North^s institution or his oph- 
thalmic practice, but the fact that he was thus interested 
in ophthalmology is worthy of record here. 

Philip Syxg Piiysick. — In making special note of 
the early general surgeons who should be remembered 
in connection with the development of ophthalmology 
the name of Philip Syng Physick should, perhaps, come 
first. He was born in Philadelphia in 1768 and died 
there in 1837. He received a collegiate education from 
the University of Pennsylvania, where he graduated in 
arts in 1785. He studied medicine with a physician in 
his native town for three vears, and went to London in 
1789, where he became the private pupil of John Hun- 
ter, with whose family he lived. He was a great favorite 
of Hunter, and received manv attentions and consider- 
ations from him. It was through Hunter's influence 
that he was appointed to the house staff of St. George's 
Hospital, London, in 1790. In 1791 he went to Edin- 
burgh, and in 1792, after one course of study in the 
University of Edinburgh, he graduated in medicine. 
He then returned to Philadelphia and began practice 
under most favorable conditions. In 1794 he was ap- 
pointed surgeon to the Pennsylvania Hospital, which he 
served for manv vears. In 1800 he was taken into the 
medical department of the University of Pennsylvania, 
first as lecturer, and in 1805 as professor of surgery. In 


1818 he was transferred to the chair of anatomy, which 
lie occupied till 1830. 

Br. Physick is said to have been a man of medium 
height, with "pale classic features/' reserved and rather 
forbidding in his manner, pessimistic in his tempera- 
niGnt, and devoid of the sense of humor. In his teach- 
ing he was precise and emphatic and commanded the 
profoundest deference from his pupils. He was not a 
ready speaker, and for the most part read his lectures" 
to his classes. As a surgeon he was skilful and accurate 
m operating, and always conservative. He was not a 
^man of books," neither writing much nor reading much. 
Dr. Gross has said of him that he had no books worth 
nientioning, either medical or non-professional. In his 
practice he was essentially an empiric, apparently being 
guided altogether by the light of experience. He had 
no theories of his own, and was intolerant in his teach- 
ing and practice of the theories of others. He possessed, 
however, one of the richest endowments of a profes- 
sional man, namely, strong common sense, and this was 
his great bulwark in every situation. Although cold and 
^^nisocial, yet at heart he was full of sympathy for suffer- 
ing humanity. 

It was he who originated the idea of the use of animal 
ligatures as I shall elsewhere note, and he is said to 
have been the first to wash out the stomach, in. cases 
of poisoning, with a gum-elastic catheter and syringe. 
He devised many new surgical appliances and instru- 
nients, and in many ways advanced surgical practice. . 
He was an expert operator on the eye, especially for cat- 
aract and artificial pupil, as is made evident by Dorsey, 
bis nephew, in the first volume of Dorsey's "Elements 

DR. PHlLir 8VNG I'HI'SICK (1768-1837). 


of Surgery/^ Among the original devices of Dr. Physick 
for ophthalmic operations is a forceps-punch (see illus- 
tration) for removing a piece of iris for artificial pupil. 
Dr. Physick wrote scarcely anything for publication, 
yet, fortunately, his work and memory have been per- 
petuated, at least partially, through the writings of oth- 
ers, particularly of his distinguished nephew, John Syng 
Dorsey, and of his son-in-law. Dr. Jacob Eandolph. Dr, 
Physick^s surgical originality and genius have won for 
him the distinction of being regarded as "the father of 
American surgery .^^ 

Physick's punch-forceps for making artificial pupil. 

William Gibson, anotlior eminent surgeon who 
thought and acted for himself and who contributed ma- 
terially to ophthalmologic knowledge and practice, was 
the successor to Physick in the chair of surgery in the 
Universitv of Pennsvlvania, to whicli ho was called in 
1819. He was born in Baltimore in 1788 and died in 
Savannah, Ga., in 1868. He graduated in arts in 1806 
from Princeton College with high rank as a classical 
scholar. He then repaired to Edinburgh, where he 
studied medicine under John Bell, graduating in medi- 
cine from the university of that city in 1809. From 
there he went to London, where he studied for some time 
under Sir Charles Bell. From London Dr. Gibson re- 
turned to Baltimore, and was soon in successful prac- 
tice. He was appointed professor of surgery in the med- 


ieal department of the University of Maryland in 1812. 
ITe occupied this position till he removed to Philadel- 
phia in 1819. His connection with the University of 
Pennsylvania continued until 1855, when he resigned. 
Dr. Gibson was the first to ligate the common iliac artery 
in 1812, but his greatest feat, a feat which made hie 
name widely known, both in Europe and in this coun- 
iry. was the performance of the Cesarean section twice 
on one woman, saving mother and child in both in- 
stances. His reputation as an expert operator extended 
far and wide, and while at times his ill temper betrayed 
him into unkind expressions, yet he never failed to 
command the highest respect of most of his confreres. 
He was an able and impressive teacher, his character- 
istic qualities being clearness, accuracy and earnest- 
ness. He made no pretentions to eloquence. Dr. Gross 
in his sketch of him says : "He handled his knife with 
great skill and was one of the foremost operators of his 
day.^^ Dr. Gibson made many contributions to the prac- 
tice and- literature of general surgery and some to the 
surgery of the eye. His most noted literary production was 
his "Institutes and Practice of Surgery,^' the first edi- 
tion of which was published in 1824, the last, the eighth, 
in 1850. The first volume of this work contains an ex- 
cellent resume of the diseases of the eye and their treat- 
ment, in which is embodied the undoubted results of the 
experience and study of a man versed in the ophthal- 
mology of his time. His discussion of cataract is es- 
pecially authoritative. He was the first surgeon to per- 
form the operation for convergent strabismus, which 
was afterward made so popular by Dieffenbach. Unfor- 
tunately, he did not record his operation in time to re- 

ni{. GEORGE MoCr.KLLAN m8e-1847). 


ceive due credit for priority. This subject is reviewed 
elsewhere in this paper. I have also detailed on other 
pages some of his procedures and instruments for opera- 
tions of the eye, showing the originality and resource- 
fulness of his intellect. Gibson will long remain a 
prominent figure in the history of ophthalmology as well 
as surgery. 

George McClellan^ — As 1 have in the preceding 
pages briefly rehearsed Dr. George McClellan's effort to 
establish an eye hospital in Philadelphia in 1821, it 
seems appropriate to add a few words in regard to the 
man himself. He was born in Woodstock, Conn., in 
1796 and died in Philadelphia in 1847, 51 years of 
age, from an ulcerative perforation of the small intes- 
tine. He graduated in arts from Yale College in 1815, 
and began the studv of medicine with Dr. Thomas Hub- 
bard, of Pomfret, Conn. He afterward became the 
pupil of the celebrated Philadelphia surgeon. Dr. John 
Syng Dorsey. He graduated in medicine from the Uni- 
versity of Pennsylvania in 1819. After receiving his 
M.D. degree he began the practice of his profession in 
Philadelphia, where he labored during the remainder 
of his life. Immediately after locating in Philadelphia 
he began to teach anatomy and surgery, privately, and 
his lecture room soon became a rallying point for many 
pupils. It may be said that Dr. McClellan's private 
school, which grew into great popularity, was the germ 
from which the Jefferson Medical College sprang later. 
In 1825, with the assistance of other Philadelphia physi- 
cians, particularly John Eberle, he organized the Jef- 
ferson Medical College, in which he became the professor 
of surgery, a position which he occupied till 1838, when 


he was coiiipelltd to withdraw, limiiediatelv after this 

change he, with others, founded the medical department 

of the Pennsylvania College of Gettysburg in 1839. The 

department was closed, however, after four annual 

courses of lectures, and he then retired to ])rivate prac- 

Dr. McClellan as a young man was aspiring and ag- 
gressive, and both in the "Institution for Diseases of the 
Eye"- and in the Jefferson ^ledical College he was, as 
Dr. Gross says, the "master genius.'' His teaching in 
the medical college included both anatomy and surgery, 
and his vivacity and fluency of speech attracted large 
classes. His lectures wore "extemporaneous'' and they 
achieved a popularity and produced an effect seldom 
equaled. He was full of energy and enthusiasm, but 
utterly without system. Every student was strongly 
attracted to him, and "Mac'^ was the name by which he 
was generally designated. As an operator he was showy 
and at times brilliant, but it was claimed by his adherents 
that he lacked judgment and patience. McClellan wrote 
and published very little. A posthumous work on the 
"Principles and Practice of Surgery" was published by 
his son, the late Dr. John H. B. McClellan, which, how- 
ever, attracted indifferent attention. I have already 
shown that Dr. McClellan was especially interested in 
ocular surgery, and no doubt this interest was lessened 
only by being overshadowed by that in general surgery It 
appears that he had similar "troubles and tribulations,^^ 
however, in this branch of surgical art to those which 
frequently befall ophthalmologists and surgeons of the 
present day, for in 1828 a suit for malpractice was 
brought against him on account of alleged want of skill 


in a case of cataract, in which a verdict of $500 was 
rendered in favor of the plaintiff. Dr. Gross has re- 
minded us that "the suit, as most frequently happens, 
had been instigated by professional enemies/' Notwith- 
standing the criticisms and inuendos which his enemies 
in the profession saw fit to make, he was recognized as 
a practical surgeon of high rank. The school which 
he founded has contributed through its graduates many 
eminent surgeons and teachers. He is also to be re- 
membered as the father of Gen. George B. McClellan, 
of Civil War fame, and grandfather of George B. 
McClellan, the present mayor of the city of New York. 
John Kearney Rodgers was born in New York City 
in 1793 and died there in 1851, his death being caused by 
"phlebitis of the liver followed by peritonitis.^' He ob- 
tained big classical education at Princeton College, and 
afterward studied medicine under Dr. Wright Post, who 
was a distinguished New York surgeon. He graduated 
from the College of Physicians and Surgeons in 1816. 
After his graduation he and Dr. Edward Delafield went 
to London, where they pursued their studies at the hos- 
pitals of that city under the famous masters of the me- 
tropolis, giving special attention to diseases of the eye. 
In 1818. soon after his return to New York, Dr. Rod- 
gers was appointed demonstrator of anatomy in the col- 
lege from which he graduated. Four years afterward 
he was made surgeon to the New York Hospital, an 
oflBce which he much coveted and which he retained up 
to the time of his death — a period of thirty years. He 
was a practitioner of great eminence, and with Dr. 
Delafield, was the founder of the New York Eye In- 
firmary, in 1820, which institution he served for many 


years. He was especially noted for his sterling integ- 
rity, his active and generous mind, and for his adroit- 
ness and ease as an operator. It has been said that as 
an operator he had no superior in this country, except, 
perhaps, Valentine Mott, who go long wielded the scep- 
ter on the American continent. The principal opera- 
tion which gave him great honor throughout the sur- 
gical world, and for all time, was the ligation of the left 
subclavian artery within the scaleni muscles, in 1845, 
on account of a large aneurism of that vessel, a feat 
which up to that time was universally regarded as im- 
practicable. In consultations he was the wise counselor, 
and under all circumstances he was the sympathizing 
and trusted friend and physician. His contributions to 
medical literature were not numerous, and it is to be re- 
gretted that the record of his vast experience has been so 
insufficient. Meager as his contributions were they, how- 
ever, leave a mark which will not be easily erased. 

Edwakd Dela field was during his whole life a prom- 
inent figure in New York professional circles. He was 
energetic, skilful and courteous and occupied many posi- 
tions of trust. He had a very large practice, and was 
for a long time professor of obstetrics and diseases of 
women and children in the College of Physicians and 
Surgeons. He was born in 1795 and died in 1875. He 
graduated in arts at Yale College in 1812 and in medi- 
cine at the College of Physicians and Surgeons of New 
York in 1815. After a period of service as interne in 
the New York Hospital, he and Dr. John Kearney Eodg- 
ers went to Europe for special study. Soon after re- 
turning Dr. Delafield, with Dr. Eodgers, organized the 
New York Eye Infirmary in 1820, as above detailed. 



. He acted as surgeon and gave clinical lectures there on 
diseases of the eye for many years. He was one of 
the active promoters of the organization of the Ameri- 
can Ophthalmological Society in 1864 and was unani- 
mously elected its first president, a fitting acknowledge- 
ment of what he had done by his example and labors 
during many years to make ophthalmology an honor- 
able department of medical practice in the estimation 
of the public and profession. Clinical teaching at the 
New York Eye Infirmary was early instituted by Dr. 
Delafield and was carried on by himself and associates 
for many years. He wrote and published very little. 
His ophthalmologic writings were chiefly reports of ex- 
periences from his practice in the infirmary, a few of 
which will be found in the early transactions of the Oph- 
thalmological Society, and his notes to his American 
edition of "Travers on tlic Evo," to bo referred to later. 

Dr. Edward Eeynolds was born in Boston, Mass., 
in February, 1793, and there closed his long life in 
1881. He graduated in arts at Harvard College in 1811, 
and afterward for several years was a private pupil in 
medicine of Dr. John Collins Warren. He then availed 
himself of the very great advantage of three years of 
training abroad. In London he studied under Aber- 
nethy and Astley Cooper, and at Paris with Bichat and 
Dupuytren. He also followed, at London, the lectures 
of Sir William Lawrence on diseases of the eye, and 
with his fellow-students was carefully taught, among 
other things, to perform ophthalmic operations, using 
sheep^s eyes set in a mask. It was perhaps owing to the 
influence of his European teachers that he acquired a 
preference for surgery, and especially for ophthalmic 


surgery, although he always enjoyed an extensive gen- 
eral practice. During Dr. Eeynold's * lifetime modem 
specialization of the medical profession was not known, 
and he never lost his interest in the pursuit of gen- 
eral professional work. 

After returning from abroad, he found his father, at 
GO years of age, blind with cataracts in both eyes. He 
had the rare courage to perform the depression of the 
two lenses at one sitting. Happily the operation proved 
a complete success. It had never before been under- 
taken in Boston and, becoming widely known, formed 
the foundation for a reputation which made him the 
leading surgeon in diseases of the eye in Boston and 
throughout New England for many years. 

In 1824 he and Dr. John Jeffries, son of the fa- 
mous aeronaut and man of science of that name, es- 
tablished a dispensary which developed into the well- 
known Massachusetts Charitable Eye and Ear Infirmary 
above referred to. After the withdrawal of Dr. Jef- 
fries, Dr. Keynolds long continued to be the senior sur- 
geon of the infirmary, training for it a staff of able 
men, devoted to ophthalmic practice. His connection 
with the institution, first as surgeon and later as teacher, 
lasted until 1870, but his interests in it continued un- 
abated to the end of his days. 

He was one of the founders of the well remembered 
Tremont Medical School, and was for many years its 
professor of general surgery. During a prolonged ab- 
sence of Dr. Warren in Europe he also taught anatomy 
and surgery at the Harvard Medical School. As an 
eye surgeon his fame was such that in 1864, on the or- 
ganization of the American Ophthalmological Society, 
he was made an honorary member. 




Physically he was a giant among men. His fine and 
commanding presence, his always genial humor, and the 
ready generosity of his character made for him a host of 
friends and followers in his community. There was 
an entire absence of professional jealousy in him, and 
he was as kind as he was unselfish. He lived to be for 
many years the Xestor of the local profession and, except 
for an increasing deafness, retained all his faculties and 
capacity for the enjoyment of life to within a few 
months of his death, which occurred at the end of his. 
eighty-ninth year.* 

John Jeffries, who with Dr. Edward Eeynolds,. 
founded the Massachusetts Charitable Eye and Ear In- 
firmary, was born in Boston in 179G and died in 1876. 
He was the son of a distinguished surgeon of revolu- 
tionary times. Dr. John Jeffries. In 1815 he graduated 
in arts from Harvard College, and in 1819 received from 
the same institution the degree of doctor of medicine. 
He was one of Boston's most distinguished practitioners, 
and from the foundation of the Massachusetts Chari- 
table Eye and Ear Infirmary in 1824 until 1841 he was 
one of its surgeons. While he was recognized only as a 
general practitioner, his ophthalmologic practice, never- 
theless, was large. He was universally respected and 
beloved as a citizen and as a physician. 

Horatio Gates Jameson was an early Baltimore 
surgeon whose work included the treatment of diseases 
of the eye. He was born in York, Pa., in 1788, and 
died in Baltimore in 1855. He graduated in medicine 
from the University of Maryland in. 1813, and imme- 

* From information Ijindly f umistied me= by tiis grandson, Dr. 
Edward Reynolds, of Boston, and to whom also I am indebted for 
the accompaning portrait. 


diately located in Baltimore, where he soon attained 
high rank as a surgeon and physician. He was the 
founder in 1827 of the Medical Department of Wash- 
ington College (afterward the Washington University 
School of Medicine), Washington, Pa., and was its pro- 
fessor of surgery from the time of its organization to 
1835. Besides being a practical surgeon, he made numer- 
ous contributions to surgical literature. Perhaps one 
of the most important of these was the prize essay of 
1827, on "Observations upon Traumatic Hemorrhage, Il- 
lustrated by Experiments upon Living Animals,'^ in 
which he demonstrated anew the use and value of animal 
ligatures. His teaching, however, on this subject, al- 
though sustained by the authority of Dr. Physick, was 
not appreciated by contemporary surgeons, and it was 
forgotten until after the method became popular as one 
of the features of antiseptic surgery. 

Jameson, besides being an excellent surgeon, was also 
a journalist of considerable note and was the author 
of several books and papers on medical subjects which 
received high commendation. 

Although a distinguished general surgeon and prac- 
titioner, it is his contributions to early American oph- 
thalmology that especially concern us here, as he ap- 
pears to have been much interested in diseases of the 
eye. He undoubtedly included them in his surgical 
practice and teaching and wrote some instructive pa- 
pers pertaining to them. Dr. Harry Friedenwald^® cites 
some of them which were published in Jameson's own 

journal. The Maryland Medical Recorder. One was on 

•— 1 

10. The Early History of Ophthalmology and Otology in Balti- 
more (1800-1850), Johns Hopkins Hospital Bulletin, August-Sep- 
tember, 1897. 


the "Pathological Sympathy between the Eye and the 
Larynx ;^^^^ another was on "A Case of Enlargement of 
the Eye Following, the Entrance of Steel into the Eye/'" 
probably panophthalmia; another was one describing 
"Two Cases of Ossification of the Lens with Luxation 
Through the Pupil/'^^ and another was on "Amaurosis 
Associated with Inordinate Thirst."^* He also pub- 
lished^^ another paper giving an account of the success- 
ful removal of "An Encysted Tumor of the Orbit/' 

John Mason Gibson was another Baltimore man 
who aspired to do ophthalmologic work and evidently 
to make it an exclusive practice. He was admitted into 
the "Faculty'' of Maryland in 1825. Very little is re- 
corded of his life, but his ambition was made apparent 
by the publication of a book entitled "Condensation of 
Matter upon the Anatomy, Surgical Operations and 
Treatment of Diseases of the Eye," in 1832. I shall 
refer to this book elsewhere. 

John Harper. — Still another surgeon of Baltimore 

was John Harper ( 1831). He is mentioned by 

Dr. Harry Friedcnwald and also by Dr. R. M. Reese 
in his x\merican edition of "Cooper's Dictionary of Prac- 
tical Surgery" as one of the most successful surgeons in 
this country. He was a native of Ireland and graduated 
at Glasgow. He died in Baltimore in 1831. The Mary- 
land Medical Recoi'der (vol. ii, p. 179) refers to him as 
"well-known as an oculist." He was one of the early 
surgeons who, according to Dr. Reese,^^ operated f re- 

11. Maryland Med. Recorder, 1831, ii, 117. 

12. Ibid., p. 601. 

13. Ibid., p. 608. 

14. Ibid., p. 664. 

15. The American Medical Recorder of Philadelphia, xii, 340. 

16. Cooper's Surg. Dictionary, 1842, 1, 272. 


quently for cataract. He seldom adopted any other 
operation for it than the laceration of the capsule and 
lens substance, repeated "as often as necessary on the 
same eye." 

Nathan E. Smith was another notable Baltimore 
surgeon and teacher who was also eminent as an ophthal- 
mic surgeon. He was born in Concord, N. H., in 1797 
and died in Baltimore in 1887. He was the son of 
the great physician and surgeon, Nathan Smith, of 
New Haven, and received both his classical and medical 
education at Yale, in which his father was one of the 
professors. He graduated in medicine from that insti- 
tution in 1823. Dr. Smith was successively attached to 
medical schools in Philadelphia, Lexington, Ky., and 
Baltimore, the principal part of his professional career 
having been spent in the last mentioned city. He had an 
inventive mind and added considerably to the instru- 
mental and operative improvements of both surgery and 
ophthalmolog}\ Some of his ophthalmologic instru- 
ments will be referred to later. Dr. Smith was the 
grandfather of our distinguished colleague, Dr. Samuel 
Theobald of Baltimore. 

Samuel D. Gross. — It would be quite unjust to limit 
my references entirely to those whom I have already 
considered. Certain other surgeons of a little later 
period were so active in this department of practice that 
some mention should be made of them also. I wish 
first to take note of Samuel D. Gross, who was not only 
one of the greatest surgeons of his time, but practiced 
ophthalmology and contributed to ophthalmologic liter- 
ature from the earliest periods of his professional life 
almost to the time of his death. In fact, at the time of 


DB. 8AMDEL D. QROBS tlS0S-18S4). 


his graduation his thesis had for its subject "The Nature 
and Treatment of Cataract/^ to the composition of which 
he devoted unusual care and labor. In his autobiography 

(vol. i, p. 39) he says: "I had seen many cases of this 
disorder during my Philadelphia pupilage.^"' It is a 
subject which during my prolonged professional life has 
deeply interested me." So prominent was he in ocular 
surgery at the close of the first half of the nineteenth 
century that he was elected one of the delegates from the 
United States to the first international ophthalmologic 
congress, held in Paris in 1857, and contributed to it an 
important paper in regard to the prevailing eye diseases 
of this country. He was also one of the first to operate 
for strasbismus, and he wrote a valuable paper on the 
subject, which was published in the Western Journal of 
Medicine and Surgery in 1842. One of his cotemporaries 
said that this article "abounded in discriminating criti- 
cisms on popular errors on the subject and furnished the 
best statistics on the subject anywhere to be found."^^ 

Dr. Gross was born in 1805 and died in 1884. He 
was a student of medicine of the celebrated Dr. George 
McClellan, to whom I have already made reference, and 
graduated from the Jefferson Medical College in 1828. 
The first period of his career was in the then West (Cin- 
cinnati and Louisville). He finally took up his resi- 
dence in Philadelphia, and in 1856 was made professor 
of. surgery in the college from which he received his 
medical degree. He was a voluminous writer, but one 
of the most charming^ clear and systematic of medical 
authors. He will, of course, be especially remembered 

17. Probably under Dr. McClellan. 

18. Dr. Reese in Cooper's Surgical Dictionary, Am. Ed., 1842, 
p. 128 of supplement. 


for his "System of Surgery/^ the first edition of which 
appeared in 1859. A man of his versatility, of his sur- 
gical judgment and skill and of his diversified practice 
will never be forgotten; and, inasmuch as he was so 
distinguished in ophthalmologic practice, our own "cult" 
should show him special homage. 

Alfred C. Post. — Still another practitioner who con- 
tributed to the advancement of ocular surgery was 
Alfred C. Post, who lived and practiced in New York 
City. He was born in 180G and died in 1886. He grad- 
uated in arts from Columbia College in 1822 and from 
the College of Physicians and Surgeons in medicine in 
1827. He afterward continued his medical studies in 
Paris, Berlin, Vienna and London, returning to New 
York in 1829, where he began the practice of surgery. 
As a teacher of surgery he served first the College of 
Physicians and Surgeons, and afterward the Medical De- 
partment of the University of the City of New York. As 
a surgeon he was attached, at different times, to the New 
York Hospital, the Presbyterian Hospital, St. Luke's 
Hospital and others. He achieved great fame in sur- 
gery, being noted for precision and dexterity in his 
operations. He also exercised much mechanical inge- 
nuity in devising instruments and methods of operating, 
laboring particularly to improve plastic surgery, both 
generally and in the region of the eye. His first case 
of blepharoplasty was reported as early as 1842, in a pa- 
per entitled "Blepharoplastic Operations for the Cure 
of an Aggravated Case of Ectropion.''^'* He also read an 
important paper on the same subject before the American 

19. New York Medical Gazette, vol. 11, 1842, p. 23. 

, DB. ALFRED C. POST (1806-18881. 

DR. JOHN II. DIX (1S13 1S84). 


Medical Association in 1878.^^ His deep interest in 
ocular surgery was manifest on various occasions and 
should not be forgotten. His principal writings were 
published in medical periodicals, with the exception of 
a small volume on strasbismus, which was issued in 1841. 
Dr. Post was the son of Joel Post and was born in New 
York, where he lived during his whole life. 

John H. Dix. — Belonging to this period was John H. 
Dix. He was born in Boston in 1813 and died there in 
1884. He graduated in arts from Harvard College in 
1833, and in medicine from Jefferson Medical College, 
, Philadelphia, in 1836. He at once began the practice of 
medicine in his native town, giving especial attention 
to diseases of the eye. In 1846 he visited Europe, where 
he continued his study of this subject. At home he was 
one of the most active workers in that field, and was a 
frequent contributor to the ophthalmologic literature of 
his time. He was always alert to the latest discoveries 
and was the first^^ in America to follow the example of 
Dieffenbach in the operation for strabismus, reporting 
his case in September, 1840. He again operated Oct. 16, 
1840, in the presence of Drs. Reynolds, Jeffries, Hooper, 
Bethune and Charles Ware.^^ He is said to have been 
a skilful operator and a very close and discriminating 

D. Hayes Agnew. — Only a brief sketch can be given 
here of this great surgeon, although, like others to whom 
I have similarly referred, he is worthy of a more de- 
tailed presentation and study. He came into surgical 

20. Transactions of the American Medical Association, vol. xxxix, 
1878, p. 353. 

21. Boston Medical and Surgical Journal, Sept. 30, 1840. 

22. Medical Examiner, Philadelphia, 1840, iii, 760. 


prominence soon after Dr. S. D. Gross had risen to his 
zenith. He, too, practiced ophthalmology in connection 
with general surgery. He was born in Nobleville (now 
Christiana), Lancaster County, Pa., in 1818, and died 
in Philadelphia in 1892. His father was a physician 
of local renown and belonged to the family of Agnews, 
who have been more or less distinguished both in Europe 
and America since the Norman conquest of England. 
Young Agnew received a good classical education, al- 
though he never took a degree in arts. He studied med- 
icine witli his father, and in 1836 entered the Medical 
Department of the University of Pennsylvania, from 
which he graduated in 1838. He then returned home 
and for five years practiced with his father, after which 
he endeavored to establish himself elsewhere in different 
places, but without success. Between the years 1844 
and 1847 he undertook a business enterprise, which re- 
sulted in failure. He then returned again to the prac- 
tice of his profession, first in the country and afterward 
in Philadelphia. He removed to that city in 1848 and 
at once began a career of teaching and practice which 
culminated in his being one of the most famous sur- 
geons in the United States. It would be untimely for 
me to take note of the various steps which led up to such 
renown. In a general way I may say that his profes- 
sional relations to hospitals were numerous. His pop- 
ularity as a teaclier, both in his private schools and in 
the Universitv of Pennsvlvania, was unrivaled. As a 
writer he contributed many papers and monographs to 
the literature of surgery of much value. The great 
work, however, of his life and that which will stand as 
an enduring monument to his memorv was the "Prin- 



ciples and Practice of Surgery," in three volumes, the 
first being published in 1878 and the last in 1883. 
Immediately after its publication Dr. Gross was asked 
what he thought of it, and in his impressive style 
he said: "I sat up nearly the whole of the night 
before last reading this work, and I will venture to as- 
sert that ^Agnew^s Surgery' will be read and consulted 
by the medical world long after the dust has settled for- 
ever on the covers of similar works." To an added in- 
quiry, "How do you think it compares with your own 
work?" Dr. Gross modestly replied: "Why, sir, mine 
is in comparison a pigmy." In a letter to Dr. Agnew 
later Dr. Gross said : "You have produced a great and 
noble work, one creditable alike to yourself, your pro- 
fession and vour country." The subiect of diseases of 
the eye was carefully and fully considered, and the sec- 
tion devoted to it gives ample evidence of the author's 
familiarity with it. It is a most creditable production. 

Dr. Agnew's personality was impressive and attrac- 
tive. He was tall, like his ancestors. It is said that 
his father, who was the shortest of seven brothers, had 
a height of six feet and two inches, the tallest of the 
seven being six feet and seven inches. As a man and 
physician (and he practiced "internal medicine" as well 
as surgery to the end of his life) he was greatly honored. 
He was never morose, never discouraged, always calm 
exteriorly. Although reticent and undemonstrative, he 
was always cheerful. He had no jealousies and was ever 
ready to assist the weak and struggling practitioner. 
He did not attain his preeminent position in surgery 
suddenly. The first fifteen years of his professional 


life seemed to him fruitless and unsatisfactory, but by 
patient industry and tireless application, wise judgment, 
thorough knowledge, consummate skill, honest purpose 
of word and act, he rose to a distinction in the profes- 
sion seldom attained. 

Dr. Agnew took great interest in ophthalmic surgery 
and was one of the surgeons to Wills Eye Hospital from 
1864 to 1868. He was an expert operator on the eye. 
and his thorough knowledge of the subject is made evi- 
dent by the manner in which he has presented it in his 

William Clay Wallace. — A man who will long be 
remembered, not for his eminence in the profession, 
but for a work on the comparative anatomy of the eye. 
and especially of the ciliary muscle of that organ, includ- 
ing its physiology, is William Clay Wallace of New York 
City, who styled himself "oculist.^' It is because of Dr. 
Wallace's work on the ciliary muscle, which included 
original and careful dissections, and his theory of the 
accommodation of vision to different distances, that I 
hereby refer to his name. I am, however, unable to ob- 
tain a sketch of his life. I shall refer to his work in 
another connection. 

That Dr. Wallace had a recognized standing is proved 
by the fact that Dr. Eeese included him in his list of 
American surgeons who were his collaborators in pro- 
ducing the American edition of "Cooper's Surgical Dic- 
tionary" in 1842. 

Mr. Henry Howard — In the history of the ophthal- 
molog}^ of Montreal I find one man who early undertook 
to limit his practice exclusively to the treatment of dis- 


eases of the eye. This man was Mr. Henry Howard. He 
studied this subject undoubtedly with a great deal of 
care under the instruction of the distyiguished Professor 
Arthur Jacob of Dublin Ireland, and he was found en- 
gaged in this special practice in Montreal for several 
years beginning in 1846. 



The books that were published during this period by 
American authors were few and their merits varied. 
Some were excellent both in subject matter and style and 
others were inferior. Several English works were re- 
published in this country with the revisions and addi- 
tions of our best men. I will speak of this literature 
very briefly. 


The first American book on ophthalmology was that 

of Dr. Frick entitled : "A Treatise on the Diseasec> of the 
Eye, Including the Doctrines and Practice of the Most 
Eminent Modern Surgeons, and Particularly those of 
Professor Beer. By George Frick, M.D., Ophthalmic 
Surgeon to the Baltimore General Dispensary. With 
an engraving. Baltimore : Fielding Lucas, Jun., 1823.^' 

This is an octavo volume of xx-320 pages, with one 
plate illustrating instruments for operation for cataract. 

The book is a precious souvenir of the early ophthal- 
mology of America, first, because it was the first Ameri- 
can treatise on diseases of the eye, and, second, because it 
was the production of a young man who had had un- 
excelled training and a diversified experience under the 
tutelage of Dr. George Beer of Vienna, the greatest 
ophthalmologist that the world had then ever known. 


The author says in the introduction that the volume is 
little more than the abstract of a course of lectures 
which he had prepared on diseases of the eye and repre- 
sents the teaching of Dr. Beer, to which "he has en- 
deavored to add what he has conceived most important 
from the experience and practice of others, together with 
such remarks as his own observations have supplied/' 

The arrangement "is founded on the variety of tex- 
tures which enter into the structures or composition of 
the eye, and is comprehended under four general divi- 
sions. The first includes the various forms of inflam- 
mation of the eye; the second the effects of sequelae of 
this inflammation; the third comprehends the various 
diseases of the appendages, and the fourth such diseases 
as attack at the same time several or all of the tissues of 
the organ.'' 

Dr. Frick laments "that the pathology of the eye has 
not kept progress with the advanced state of pathologic 
science in general, and this is attributable, no doubt, to 
the circumstances that this branch of the healing art has 
been confined for so long a time to exclusive oculists," 
and also that diseases of the eye have "obtained but a 
small share of the attention of the profession." The 
work is a model, from the literary standpoint, and is 
clear and concise in expression. 

I can not dwell on the contents of this book, but I 
wish to call particular attention to his chapter on cat- 
aract. After describing, with the utmost clearness, the 
nature of cataract and the different methods of its treat- 
ment, including its extraction and absorption, he comes 
to the following conclusion : 


We may lay it down, as a general rule, to extract in all such 
cases where the cataract occurs in a healthy subject, without 
any complication of other disease, and is of the species denom- 
inated dura, where tlie eye remains firm and quiet under the 
knife, where the pupil is large and dilated, and where the 
anterior chamber is large and full. These are on the whole 
the most favorable cases for any operation, (p. 214.) 

On page 175 he defines the most important proper- 
ties of a good knife, and such a knife, it seems to me, 
would meet the most refined requirements of those who 
to-day perform the flap operation. His description of 
the operation represents also the ideal of mechanical 

He says that in extraction "many circumstances may 
occur to mar the success of the operation. The most 
important of these is a section of the cornea of insuf- 
ficient magnitude to admit of the easy escape of the 
lens.'^ Operators of to-day all agree with Dr. Frick in 
this regard. 

On the whole, our first American treatise on the eye 
was a fine example of what a manual should be, and for 
many years it was the leading text-book on the subject 
in this country and was recommended by teachers and 

His work was so well thought of in England that it 
was republished there in 1826 with notes by Eichard 


"A Condensation of Matter on the Anatomy, Surgical 
Operations and Treatment of Diseases of the Eye, To- 
gether with Kemarks. Embellished with Twelve Litho- 
graphic Plates, Illustrative of the Anatomy and Morbid 
Appearance. By John Mason Gibson, Member of the 


Medical and Chirurgical Faculty of Maryland. Balti- 
more : Published by W. K. Lucas, 1832/' 

This was the second American book on the eye and its 
diseases. It is a small quarto volume of 204 pages, be- 
sides the plates and the descriptions of them. As a con- 
tribution to ophthalmologic literature it was practically 
a failure. It was badly written, illy arranged, in many 
cases incorrect as to facts, and the illustrations were 
very inferior. It is a book that is scarcely ever heard of, 
and deserves oblivion. 

littell's manual. 

*^A Manual of the Diseases of the Eye. By S. Lit- 
tell, Jr., M.D., one of the surgeons of the Wills Hospital 
for the Blind and Lame ; Fellow of the College of Physi- 
cians of Philadelphia, etc. Published by John S. Littell, 
Philadelphia, 1837.^' 

In 1846 a second American edition was published by 
Hogan and Thompson, of Philadelphia, under the title, 
'"A Manual of the Diseases of the Eye : Or, Treatise on 

This manual of Dr. Littell was not a compilation 
merely, but it represented, especially in the last edition, 
the results of the large experience of himself and his 
colleagues in the Wills Hospital. It not only received 
the highest commendation in this country, but also in 
Great Britain. The British and Foreign Medico-Ghi- 
rurgical Review, at the time of its publication, said : 

It is no small triumph to Dr. Littell to be able to say that 
he has introduced almost all that is valuable and everything 
absolutely necessary to the student within a compass of 250 
pages. . . . It is replete with information, yet so terse in 
style and compressed in bulk, as at once to entice and repay 


It was thought so well of in London that the first 
edition was revised and enlarged by Hugh Houston, 
Member of the Eoyal College of Surgeons, London, and 
published there by John Churchill in 1838. 


"The Anatomy, Physiology and Pathology of the 
Eye. By Henry Howard, M.E.C.S., Surgeon to the 
Montreal Eye and Ear Institution. London: John 
Churchill. Montreal: Armour and Eamsey. 1850." 

This is an octavo volume of xii-518 pages, and is 
a good compilation, representing, without great detail, 
the ophthalmology of the last part of the first half of 
the nineteenth century. Mr. Howard had been a stu- 
dent of the celebrated Dr. Arthur Jacob, of Dublin, and 
"for the last four years, as surgeon to the Montreal 
Eye and Ear Institution, has devoted his labors exclu- 
sively to the treatment of diseases incident to these or- 
gans." The work is well arranged, is clearly written, 
and, although not containing anything new, is a cred- 
itable production. It covers the ground indicated by its 
title, and due proportion is preserved throughout in its 
various divisions. 


Another small book which attracted much attention 
was by William Clay Wallace. It was first published in 
1836. The second edition, 1839, which is in my posses- 
sion, was entitled, "A Treatise on the Eye, Containing 
the Discoveries of the Cause of Near and Far Sighted- 
ness, and of the Affections of the Eetina, with Eemarks 
on the Use of Medicines as Substitutes for Spectacles/^ 
This edition was a 12mo volume of about ninety pages, 


and dealt with the anatomy of the eye of both man and 
some of the lower animals. The last chapter of this 
volume was reprinted from an article read before the 
New York Medical and Surgical Society, Oct. 21, 1837. 
The volume has very little intrinsic merit. In 1841 a 
third edition was issued, somewhat modified, and with 
the title, "Wonders of the Vision: A Treatise on the 
Eye.^' Illustrated. This edition I have not seen. 

In 1850 Dr. Wallace published another book of thir- 
ty-six pages in duodecimo form, entitled "The Accom- 
modation of the Eye to Distances.'^ New York: John 
Wiley, publisher. While containing some of the subject 
matter and illustrations of the previous volumes, this, 
on the whole, was an entirely different work. The au- 
thor says : "The substance of the following essay has al- 
ready appeared in Silliman's Journal for 1835, the Lon- 
don Medical Gazette for 1842, and the Boston Medical 
andSurgical Journal for 1844." The distinctive features 
of this essay are the description of the structure of the 
ciliary body based on the author's own dissections, and 
contains his theory of its functions and of the "accom- 
modation of the eye to distances.'' The current opinion 
of his work in 1839 was expressed by Professor Knight, 
of Yale College, as follows : 

"He has made interesting discoveries which throw 
much light on hitherto obscure points in the physiology 
of vision." 

Professor Silliman said : "I have been very favorably 
impressed by his various communications on the eye and 
topics relating to that organ." 

Sir David Brewster, at the eighth meeting of the 
British Association for the Advancement of Science, 


laid before the meeting a series of preparations of the 
eye made by Dr. Wallace which, he said, were calculated 
to establish some important points in the theory of vision. 


''The Eye: Its Imperfections and Their Prevention/^ 
published by the author, 1847. 

This is a small octavo volume of 140 pages, pub- 
lished, probably, more for the purpose of advertising 
the author than of enlightening the profession. It deals 
in the most meager manner with the "anatomy and 
physiology of the organ of vision, rules for the preven- 
tion, improvement and restoration of sight, with re- 
marks on near sight and aged sight, on optics, and the 
uses and abuses of spectacles, with directions for their 
selection.^^ The author signs himself a member of the 
College of Surgeons of Ireland and '^oculist and aurist,'^ 
and says his hours of attendance at his residence and 
ofl&ce, 261 Broadway, New York, are from 9 to 4. At 
the conclusion of the book he wishes, also, to inform per- 
sons residing at a distance that they may obtain his 
"opinion on various affections of the eye and ear by 
writing a description of their case and enclosing a fee 
of three dollars." Dr. Powell was a pupil of the cele- 
brated Dr. Arthur Jacob, of Dublin, whose lectures, 
and those of others, he attended from 1828 to 1833. 
Undoubtedly Dr. Powell was a well-informed man, but 
his book shows that a commercial spirit dominated cer- 
tain physicians half a century ago, as well as in our own 


As soon as Dr. Dieffenbach, of Berlin, had published 
his operation for strabismus, the profession of the world 


was very much aroused over a procedure which appar- 
ently gave such marvelous results. As has always been 
the case, American surgeons caught the enthusiasm and 
many were the reports of operations made by them 
throughout the United States, and many were the im- 
provements that were suggested. A number of "treat- 
ises^^ were also soon published. It is the latter that I 
desire to chronicle in this connection. 

As I have already stated, Dr. John H. Dix, of Boston, 
is said to have been the first to perform Dieifenbach^s 
operation in the United States. In 1841 he published a 
small book covering the causes, symptoms and operative 
treatment of strabismus. It is entitled "A Treatise on 
Strabismus, or Squinting, and the New Mode of Treat- 

In the same year, 1841, Alfred C. Post, of New York, 
published a small 16mo volume on the same subject, 
with excellent colored plates, illustrating the anatomy 
of the muscles involved, the instruments used, and the 
methods of operation. It was entitled "Observations on 
the Cure of Strabismus, with an Appendix on a New 
Operation for the Cure of Stammering.'^ 

Following the small works of Dix and Post was that 
of James Bolton, of New York, in 1843, which he enti- 
tled "A Treatise on Strabismus, With a Description 
of New Instrunients Designed to Improve the Oper- 
ation for Its Cure, in Simplicity, Ease and Safety.^^ 
This was a small octavo volume treating the subject of 
strabismus very much as the others had done. Bolton 
was a young man and had undoubtedly been attending 
the clinics at the New York Eye Infirmary, and, 
through one of his teachers. Dr. John Kearney Eodgers, 


to whom he dedicated the volume, he had become very 
much interested in the subject, had studied it carefully, 
and embodied in his "treatise" the best conclusions of 
the time. 

Four years after the works of Dix and Post, Dr. 
Frank H. Hamilton, at that time professor of surgery 
in Geneva Medical College, Geneva, N. Y., published a 
very small IGmo volume, entitled "A Monograph on 
Strabismufi, with Cases." Buffalo, N. Y., 1845. It was 
scarcely more than a bound pamphlet, which, he stated, 
was for the use of his medical students. 


Another small book which attracted considerable at- 
tention was one by John H. Dix, of Boston, entitled 
"Treatise on the Nature and Treatment of Morbid Sen- 
sibility of the Eetina, or Weakness of Sight." Boston, 
1849. This little book was the republication of an 
essay which gained the Boylston prize for 1848, and, 
from the standpoint of ophthalmologic knowledge then, 
it was esteemed an important contribution. 

Aside from the binding into book form of a few 
papers of minor importance, no other ophthalmologic 
books than those above mentioned were written by 
Americans having a professional standing during the 
first half of the nineteenth century. 



I will now supplement the above notices of American 
works on the eye by a list of English works which were 
republished in this country under the editorial super- 
vision of American practitioners. Several works were 


also republished here, besides the ones that I shall men- 
tion, such as the works of Saunders, Vetch, and early 
editions of Lawrence and Mackenzie, but without Amer- 
ican revision. The first in the list was Delafield's edi- 
tion of Travers' work: "A Synopsis of the Diseases of 
the Eye and Their Treatment, to Which Are Prefixed a 
Short Anatomical Description and a Sketch of the 
Physiology of That Organ, by Benjamin Travers, 
F.E.S., surgeon to St. Thomas' Hospital, with notes 
and additions by Edward Delafield, M.D., surgeon to 
the New York Eye Infirmary and lecturer on diseases 
of the eve. First American from the third London 
edition. Published by E. Bliss and E. White, New 
York, and H. C. Carey and I. Lea, Philadelphia, 1825,^^ 
8vo, pp. xxi-474. 

This book was brought out by Dr. Delafield in this 
country not long after he and Dr. Rodgers organized 
the New York Eye Infirmary. In its English form, 
the work was a very desirable manual, but its value was 
materially enhanced by the numerous additions and 
notes, as well as illustrations, which Dr. Delafield incor- 

"A Treatise on Diseases of the Eye, by William 
Lawrence, P.R.S. A new edition, with many modifica- 
tions and additions, and the introduction of nearly two 
hundred illustrations by Isaac Hays, M.D." Svo, pp. 
900. Philadelphia : Lea & Blanchard, 1847. 

William Lawrence's work on the eye was encyclopedic 
in character, and in its revised and enlarged form it was 
cordially received by the American profession. 

"Principles and Practice of Ophthalmic Medicine and 
Surgery, by T. Wharton Jones, F.R.S., etc., with 102 


illustrations. Edited by Isaac Hays, M.D., surgeon to 
Wills Hospital/' 12mo, pp. 510. Philadelphia Lea & 
Blanehard, 1849. 

This work of Mr. Jones was issued by the same pub- 
lishers and under the same editorial supervision as that 
of Lawrence. It was more concise and was intended to 
serve the profession in another way. In the words of 
the editor, "it was one of the series of manuals in- 
tended for students. By its conciseness and systematic 
arrangement the author was enabled to embody such ma- 
terial as would be suitable for the student within a 
small compass.'^ 

"Spectacles: Their Uses and Abuses in Long and 
Short Sightedness, and the Pathologic Conditions Re- 
sulting from Their Irrational Employment, by J. 
Sichel, M.D. Translated from the French by permis- 
sion of the author by Henry W. Williams, M.D. Bos- 
ton: Phillips, Sampson & Co., 1850.^' 

This was not a republication of an English author, 
but was a translation of an excellent French work by the 
learned Dr. Sichel, which gave the latest views on the 
abnormal refractive conditions of the eyes, several of 
which, he believed, were caused by the abuse of spec- 
tacles. While these views have radically changed since 
that time by the teachings of Donders, yet the book has 
a recognized historical value. 


From the very beginning of the last century our 
American medical periodicals have always been more or 
less alive to the importance of that department of medi- 
cine pertaining to diseases of the eye. The American 
Medical Recorder, the Journal of the Medical and Phys- 



ical Sciences, and the successor to both of these, The 
American Journal of the Medical Sciences, of Philadel- 
phia, and the contemporary New England Journal of 
Medicine and Surgery, of Boston, and several medical 
journals that were started at about the same time in New 
York and the West, all contain articles of more or less 
ophthalmologic interest. 

Dr. Frick, of Baltimore, in 1821, 1822 and 1823, 
contributed, each year, to the American Medical Re- 
corder (Philadelphia). His articles were on the sub- 
jects of conjunctivitis, cataract and the various modes 
of operating, and on modes of operating for artificial 
pupil. They were in reality an extended summary of 
what was known in regard to those subjects at that 
time, and to the medical historian are to-day of much 
interest. Since Prick published his book, little or noth- 
ing is found written by him. 

The writings of Dr. Isaac Hays were almost without 
exception published in the journals in which he had an 
editorial interest. As early as 182G and 1827 we find 
long and well written articles on inflammation of the 
conjunctiva and of the sclera, in 1828 on the diseases of 
the cornea and their treatment. From that time to 
1850 he published many valuable and interesting papers, 
abstracts and discussions on various ophthalmologic sub- 

Dr. Littell was not a prolific writer. The few arti- 
cles, however, that he did write were published in the 
same journals as those of Hays, and were meritorious. 
The most frequent contributors in Boston to medical 
journals were John Jeffries (a few reports), John H. 
Dix with great frequency, and later George A. Bethune. 


The ophthalmologic contributors in New York, Balti- 
more, Louisville, Cincinnati and other cities were less 
numerous, but after the announcement, through the 
medical journals, of Dieffenbach's operation for strabis- 
mus, the periodical literature on that subject became 
quite voluminous and was widel}' scattered throughout 
America. In fact, there was so much of it that I shall 
not undertake to review it. 

Many reports on rare cases of diseases of the eye, 
many experiences and different views on ophthalmologic 
subjects were published here and there in the numerous 
medical periodicals of the United States. These are 
so diversified in character and the authors so many that 
they, too, cannot be specifically referred to. One feature 
of medical journalism in this country, embodied espe- 
cially in The American Journal of the Medical Sciences, 
was reports of the progress of the medical sciences, with 
a department given up exclusively to ophthalmology. I 
believe it is impossible to measure the good that Dr. 
Hays did to the American profession by publishing, 
from quarter to quarter, the essentials of the current 
ophthalmologic contributions of the world. The ab- 
stracts were of sufficient length to make the subjects 
under discussion intelligible, and, through this channel 
alone, he advanced very materially the knowledge of 
ophthalmology in this country. At the time when this 
was done it was impossible for any but an experienced 
ophthalmologist, like Dr. Isaac Hays, to realize the 
professional needs and to be able to supply them so well. 
For this, if nothing else, ophthalmology, to-day, owes 
this great man an undying gratitude. 



Besides the journalistic contributions, I find a num- 
ber of theses, or dissertations on the eye or its diseases, 
of special interest, and among them I may mention one 
on cataract by Isaac Cleaver, University of Pennsylva- 
nia, 1805 (dedicated to Dr. Phillip Syng Physick) ; 
another on the nature and treatment of cataract, by 
Samuel D. Gross, Jefferson Medical College, Philadel- 
phia, 1828 (dedicated to George McClellan), and still 
another on the same subject by Arthur B. Stout, College 
of Physicians and Surgeons, New York, 1837 (dedi- 
cated to Drs. Edward Delafield, John Kearney Eodgers 
and James Edward Cornell) ; one on the eye and on 
vision by Elisha DeButts, University of Pennsylvania, 
1805 (dedicated to Dr. Casper Wistar) ; one on oph- 
thalmia, by David Morre, University of Pennsylvania, 
1807 (dedicated to Drs. John Claiborne and John 
B. Walker, both of Virginia), and one on Iritis, by 
Kichard Kissam, College of Physicians and Surgeons, 
New York, 1839 (dedicated to Drs. Edward Delafield 
and John Kearney Rodgers). These essays have dis- 
tinct merit as representing the knowledge of the times 
in which they were written. There undoubtedly were 
many other theses on ophthalmologic subjects, but these 
serve to indicate that ophthalmology was by no means 
entirely neglected in the teachings of our early medical 

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I also send you notes of two cases of strabismus on which I 
have operated successfully. Your obedient servant, 

Henby Wheaton Rivers, M.D. 

Providence, Feb. 8, 1841. 

Dear Sir: — I observe from the newspapers that you have 
operated with great success in several cases of strabismus, or 
squinting. I have also noticed this operation spoken of as a 
new discovery in the art of siu"gery, and is said to have lately 
originated in Germany. Now, sir, I think we should give honor 
where honor is due. In the years 1812 and '13 I attended 
courses of surgical and anatomic lectures delivered before the 
Medical School of Brown University, by William Ingalls, M.D., 
of Boston, then the professor of anatomy and surgery in that 
institution ; being subject myself to this -infirmity (strabismus), 
Dr. Ingalls took frequent opportunities to explain to me the 
method of its surgical cure; he did this by discecting the eye 
itself, explaining the power and disposition of several muscles 
appertaining to that organ, and showed me how by division 
of one or more of them, the eye might be brought to its proper 
place. In my own case I know he proposed to divide the 
rectus internus. So strongly was I impressed with the prac- 
ticability and success of this operation, that I strongly urged 
my father to permit me to submit to the operation; but upon 
the nature of the operation being explained to him, he de- 
clined the permission, because he feared the effect might be to 
turn the eye the other way. 

I make this statement in justice to my friend and quondam 
master, and to show that we have surgeons in this country as 
learned in their profession as some in Europe. Respectfully, 
your obedient servant. Samuel Y. Atwell. 

To Henry W. Rivers, M.D., Providence, R. I. 

Then follows a report of two cases successfully oper- 
ated on by Dr. Elvers on Dec. 23, 1840, and Jan. 13, 
1841, respectively, by dividing the rectus muscle (ex- 


ternus, first case, divergent; intemus, second case, con- 

Soon after that William Gibson, who was then pro- 
fessor of surgery at the University of Maryland, actual- 
ly operated for this condition. Dr. M. D. Reese, in 

1842, in hi? supplement to the "Surgical Dictionary^' of 
Samuel Cooper (p. 127), refers to the subject in thes« 
words : 

It appears from the "Institutes of Surgery" that Professor 
Gibson attempted the cure of strabismus by dividing the recti 
muscles of the eye precisely as now practiced, some twenty 
years since in Baltimore. Soon after, he repeated it unsuc- 
cessfully, in Philadelphia, in several cases, and was induced to 
abandon it by the unfavorable opinions expressed on the 
operation by Dr. Physick. He, however, inculcated the propri- 
ety of the operation on his class many years since, and Dr. A. 
E. Hosack of New York, then one of his pupils, distinctly 
recollects Dr. Gibson's expressions of confidence that the opera- 
tion would ultimately succeed. 

Dr. Gibson himself in the sixth edition of his "Insti- 
tutes of Surgery ,^^ published in 1841, describes in detail 
the operations which he performed in 1818, and also 
adds that on the advice of Dr. Physick he wae led to 
abandon these experiments. His reference to the sub- 
ject will be found on page 375 of his work. 

Dr. Harry Friedenwald, of Baltimore, in his "Early 
History ,^^ etc., quotes Dr. Gibson^s remarks in full. 

Gibson's scissors for operation of absorption of 


William Gibson,^* then professor of surgery, Univer- 
sity of Pennsylvania, in 1821, described an instrument 

23. Philadelphia Medical Examiner, iv, 119. 

24. Phila. Jour. Med. and Phys. Sci., 1821, ill, 192. 


for "cutting to pieces the crystalline lens in all cases of 
cataract/' It was a pair of scissors, thus described : 

So delicate as hardly to exceed, in size, the iris knife of Sir 
William Adams, and at the same time, so strong and sharp as 
to cut, with ease, the most solid and compact lens and cap- 
sule, without injuring, in the slightest degree, any part of the 
eye. These scissors are formed on the principle of Mr. Willas- 
ton's scissors, used for common purposes — with the edge so 
constructed as to operate like a knife. On this account, the 
instrument perforates the coats of the eye with the utmost 
facility, and when introduced, the blades can be opened to a 
certain extent so as to cut the lens to pieces without bruis- 
ing it or any other part — the necessary effect of scissors, as 
they are usually made. This instrument possesses anotlier 
advantage — the lens is supported in its natural situation dur- 
ing the operation, by having one blade behind, and the otheij 
before it, so that it may be cut to pieces, in situ, and its 
remains afterwards forced, by the shut blades, into the an- 
terior chamber, for dissolution. 

At the time Dr. Gibson suggested this instrument, 
"dissolution^^ of cataract had become a popular method 
of operating through the influence of Saunders and 
Adams, of London, and the scissors were offered as a 
substitute for needles, the use of which was frequently 
attended by dislocation of the lens into the vitreous 


Dr. Gibson^s originality was further illustrated by 
another method which he adopted for the absorption of 
cataract.^^ His operation was described by Dr. J. 
Revere, of Baltimore, in a letter dated March 2, 1819. 
It consisted in passing "a common sewing needle, slight- 
ly curved and armed with a single thread of silk 


25. New England Journal of Medicine and Surgery, 1818, viii, 


through the sclera about two lines from the cornea, 
through the opaque lens and sclera of the opposite side 
at a point corresponding to the one at which it was 
introduced, the pupil having been previously dilated 
with belladonna. "The silk being drawn through and 
the ends cut off, a single thread was thus left passing 
through the ball of the eye and acting on the diseased 
lens in the manner of a seton." Dr. Gibson had oper- 
ated in this manner on two cases. "No reaction or acci- 
dent intervened, and at the end of ten days, in both 
cases, the diseased lens had disappeared." The silk 
was then withdraw^n and in a few days the vision was 
restored. In a third case*" in which this operation was 
performed "it failed in consequence of the iris being 
wounded^' and the thread was withdrawn at an early 
period because of inflammation. The wound of the 
iris was attributed to not using belladonna. 

Horner's operation for ectropion of the lower 


Dr. Horner, like many others, devised a very ingen- 
ious operation for ectropion of the lower lid which he de- 
scribed in the American Journal of the Medical Sciences, 
18»37, vol. xxi, p. 105. It deserves to be remembered 
as an original and effective method of correcting this 
deformity. Dr. Horner had performed it as follows: 
"An incision, two inches in length and down to the 
bone, was made parallel with and at the inferior margin 
of the orbicularis muscle. The whole thickness of the 
eyelid was then dissected up from the adjoining bones. 
From about the middle of that incision started another, 
of an inch in length, downward toward the angle of 
the jaw. From the termination of the latter another 


incision of the same length was directed toward the root 
of the nose. The two last incisions consequently de- 
fined an angle of integuments, which, being dissected 
up as far as its base, was then turned into the b^in- 
ning of the first incision. The following diagram will 
illustrate the operation. 

"The angle A, Figure 1, taken from the cheek was 
inserted into the lower eyelid, as seen in Figure 3, and 
a pin fised at b and another at c, so as to keep the parts 
in place. An almost immediate correction of the de- 
formity ensued." 

The ordinary dressings were applied over the eye and 
recovery was rapid. 


Dr. George C. Blackman, a prominent surgeon of 
New York, again illustrated the resourcefulness of our 
American surgeons by devising a method of operating 
for blepharospasm, which, in a modified form, has since 


hi^en widely practiced. His ease was recorded in the 
New York Lancet, 1842, vol. i, p. 410. The operation 
wag used as a last resort after every remedy which 
scH^med applicable had been unsuccessfully tried. Dr. 
iilackman's description is as follows: 

After cxplaininfT to the patient the nature of the operation 
which I thought likely to raise (open) the eyelid, she readUy 
fonsented to its {)erformanee. With the assistance of Prof. 
Willard Parker and Dr. Hall, I divided the musculi orhicu- 
Itnitt ftnifn'hrtirum in tin* following manner: The patient was 
>tMitei| on a low Htool before the window; Professor P. then 
P<U8(m1 h Hinootli ivory handle beneath the lid, in order to pro- 
tei-t the eyeball, whilst with a straight, narrow tenotome, a 
puncture wan made near the outer margin of the lid, and mid- 
^w»\ between the outer and the inner angle. The knife was 
p)i88t)tl on towards the superciliary ridge, when, turning the 
>'»lgti ttusanU the muscle* and by gently pressing during the 
i»*t ot withdrawing, its tllH»rs were easily divided. The muscle 
'>»Mh i\\ file inner and outer edge of the eye I divided in the 
»*Mne nuinne)\ in every instance leaving the conjunctiva entire. 
lMj»i4Mal\ our )\atieni r«>marked that she could raise the lid so 
•»!» »leiul> lo \li!inn^uish objjivts acros^s the street. Professor 
V \\w\\ du^^v^iexl \\\M ihe divis^ion of the lower portion of the 
^u\»!.vU> uM^hi lY^heve ihc euti\^)\)on of the lower lid. This I 
nUmvUx* \\\ iW m^uuev Wunv iu^niii>iKNl. and much to our 
^.m^i.\v Uvvu, kUc ewuv^i-viow hm^^vslMi^K disappeared. , . . 

\ \^y\\\ \\w \\M^\\\ v5hv«,s \\V,iv>^ iv^IVwv^ the dirision of the 
i^\u>»>U' u^ \^s.' ',.vv\v\ ^„l. Ax >^^\:V^WNNr l>*rkter K<ixHiiiiieiided, I 
^'Un' ^;i,; U;iiv .U'v,S'i V,v. ',Vi^ \^-^ ^,'>* ixi$;!«$s aa easv and 
^ ^\<>'N«,UA^. u';i.^,\i,\ jVA :■..<,;».> \^j ,< wotvjrt^v xxi «W ««s«s of this 


account was published in the New York Medical Ga- 
zette, Jan. 19, 1842. His example was soon imitated 
by Dr. J. Mason Warren of Boston, Dr. George McCIel- 
lan and Dr. Miitter of Philadelphia and others. Dr. 
Horneii's method, which was reported in the American 
Journal of the Medical Sciences for 1837, was entirely 
different in its principles. 



Dr. Nathan E. Smith, the eminent Baltimore surgeon, 
early devised a knife for dividing strictures of the nasal 
duct. His instrument is figured in vol. iii, p. 161, of 
Norris and Oliver's System of Diseases of the Eye. The 
operation which he performed antedated Still ing's by 
many years, having been done as early as 1846 at least. 
Dr. Smith also used gold lachrymal canulse of his own 
device, which were an improvement on the old forms.^® 


Prof. L. A. Dugas, of Augusta, Ga., was an eminent 
surgeon of the South who also gave much attention to 
diseases of the eye. In 1840 he practiced an operation 
on the eye in certain conditions of corneal staphyloma, 
which has since met with much favor by experienced 
ophthalmologists. The operation was the abscission of 
the cornea, which he did "by passing a tenaculum 
through the cornea and excising it with the straight 
bistoury without touching the sclerotica.^^ Dr. Dugas 
seems to have used proper discrimination in his cases 
and preferred this method to the excision of the whole 

26. Norrls and Oliver's System, Hi, 157. 


eyeball. The deformity resulting from his operation 
was greatly diminished^ while the removal of the cornea 
was attended with no danger.-^ 


Dr. L. A. Dugas, of Augusta, 6a., published a paper 
in the Southern Medical and Surgical Journal for 1837 
on "Purulent Ophthalmia/' in which he related several 
cases, all of which were successfully treated by a solu- 
tion of chlorid of sodium as a wash, one-half ounce to a 
quart of water. 

If there were no medicinal properties in chlorid of 
sodium, it served the purpose of cleanliness at least, 
and it is possible that effectual cleanliness in purulent 
conjunctivitis is better than the indiscriminate use of 
some of the strong drugs which have, during later years, 
been so popular. 


As early as 1842 Dr. Isaac Parrish,^* of Philadelphia, 
recommended this drug in certain ophthalmic diseases, 
in doses of from two to six grains, three times a day. 
He believed it had potency in relieving inflammatory 
affections "involving the deep tunics of the eye.'' 

horner's muscle. 

In 1824 Dr. William E. Horner (1790-1853), of 
Philadelphia, who was an excellent anatomist and very 
painstaking and minute in his dissections, described^* 
a muscle which he believed to be separate from the or- 

27. ReeHC : Cooper's Surgical Dictionary, Supplement, 1842» 
p. 76. 

28. Medical Examiner, April 16, 1842. 

2t). Phlla. Jour, of Med. and Phys. Scl., 1824, vill, 70. 

DB. WILLIAM E. HORNCB (1790-1858). 


bicularis of the eyelids and which extended along the 
course of the lachrymal canals of the lids from the crest 
of the lachrymal bone to the lachrymal puncta. The 
article was entitled "Description of a Small Muscle of 
the Inner Commissure of the Eyelids." He said that a 
"compend of the foregoing description was published 
two years ago" (p. 72). The function of this muscle 
he believed to be to "apply the puncta lachrymalia to 
the ball of the eye." This muscle has from that time 
been called "Horner's muscle" in almost all of the ana- 
tomic descriptions of the eye, and has been regarded by 
physiologists as having the special function, noted by 
Dr. Horner himself, of facilitating the excretion of the 
tears. While it is a structure of small size, vet it de- 
serves the attention that it has received, and has a use- 
ful function in the "economy" of the eye. Horner will 
be remembered for many generations as its discoverer. 


Isaac Hays, in his American edition of Lawrence on 
"Diseases of the Eye," of 1854, p. 669, and Dr. Henry 
D. Noyes, of New York, in the American Journal of the 
Medical Sciences, 1872, vol. Ixvii, p. 355, both described 
the case of Eev. Mr. Goodrich, who had deficiency of 
sight, which he called "near sighted," because he was 
obliged to approach nearer to objects to see them than 
most persons. This mtin had noticed that in looking at 
lines, or branches of trees, or the rigging of a ship, that 
those objects having a vertical direction were more dis- 
tinct than those having a horizontal direction. In 1828 
he consulted a skilled optician, Mr. John McAllister, of 


Philadelphia. After studying the case and making 
tests, McAllister had a glass ground, "plane on one side 
and to a section of a cylinder on the other." This cor- 
rected the irregular refraction and the vision was much 
improved. Mr. Goodrich later became chaplain of the 
New York State Lunatic Asylum at Utica, and Dr. 
Noyes came into possession of the glasses. Dr. Noyes 
says: "They were given to me in a piece of writing 
paper on which, iji the owner's handwriting, was in- 
scribed the following memorandum : ^Number 7, 
French number, cylinder cone, got of McAllister, May, 
1828.' " 

Dr. Noyes stated that they were plano-concave cylin- 
ders of seven inches' focus, with axes horizontal, and 
were mounted in a spectacle frame with oval rims. It 
is believed that these were the first of the kind made 
in this country, and, according to Dr. Noyes, "they have 
become historical." 


It is said that Dr. J. C. Warren was the first to de- 
scribe a case of accidental dislocation of the crystalline 
lens.^^ He also called the attention of the profession to 
"rheumatic inflammation of the eye, now universally 
recognized, but then little was known of its diagnosis.'^*^ 


It is very interesting in this connection to note that 
perhaps the first case on record of so-called "inverted^^ 
vision was reported by Dr. John D. Godman, of Phila- 
delphia, in 1827.*'*^ His article is headed, "Note of an 

30. New England Med. Jour., 1811. 

31. Reese's Supplement to Cooper's Surgical Dictionary, p, 75. 

32. American Journal of the Medical Sciences, 1827, i, 183. 


Interesting Fact Connected with the Physiology of 
Vision," which he reports as follows : 

The following instance communicated to me by Reuben 
Peale, Esq., the uncle of the young man, is the only one with 
which we are at present acquainted, where the inversion of 
objects on the retina was productive of inaccuracy of judg- 
ment as to position, notwithstanding all the other senses were 
in their ordinary condition, and the individual had Arrived at 
the age of 7 years. 

When his father, who was a distinguished artist, began to 
give him lessons in drawing, he was very much surprised to 
find that whatever object he attempted to delineate, he uni- 
formly inverted. If ordered to make a drawing of a candle and 
candlestick set before him, he invariably drew it with the 
base represented in the air and the flame downwards. If it 
was a chair or table he was set to copy, the same result was 
the consequence; the feet were represented in the air, and 
the upper part of the object, whatever it might be, was turned 
to the ground. His father, perplexed at what he considered 
the perverseness of the boy, threatened, and even did punish 
him for his supposed folly. When questioned on the subject 
the youth stated that he drew the objects exactly as he saw 
them, and as his drawings were in other respects quite accu- 
rate, there was no reason to doubt his statement. Whenever 
an object was inverted previous to his drawing it, the draw- 
ing was made to represent it in its proper position, showing, 
that the sensations he received from the eye were exactly 
correspondent with the inverted pictures formed on the retina. 
This condition of his vision was observed to continue for more 
than a year, when his case gradually ceased to attract atten- 
tion, which was when he was about 8 years old. Since that 
time he has imperceptibly acquired the haoit of seeing things 
in their actual position. 


This visual defect received attention in this country 
long before the publication of George Wilson's book in 


Edinburgh in 1855. As early as 1840^* Dr. Isaac Hays 
reports the case of a young woman who was unable to 
distinguish certain colors. Supplementing this report, 
he discusses the subject quite fully, and gives references 
to the literature from the time of Dalton, in 1794, to 
the time of the writing of this article. He believed the 
imperfection to be a very curious one, and finds that it 
occurs in persons whose vision is natural and who can 
see minute objects, often with perfect distinctness. He 
also found it to be hereditary, "or, at least, to prevail in 
certain families.'^ The various theories which had been 
previously put forward, he thought, did not explain the 
phenomenon. He believed the condition to be incurable. 
The subject was again taken up by Dr. Pliny Earle, 
of Philadelphia, in 1845.^* Dr. Earle's article is a 
most learned one and treats of : 

1. Cases heretofore unpublished. 

2. Peculiarities heretofore observed: (a) the inability to 
distinguish colors is hereditary; (b) when thus entailed it 
sometimes overleaps one generation or more; (c) males are 
more frequently affected than females. 

3. Peculiarities heretofore unnoticed: (a) the power of 
accurately distinguishing colors varies at different times in the 
same individual; (b) the inability to distinguish colors is not 
infrequently connected with, or accompanied by a defective 
power of discriminating between musical notes. 

He concludes by referring to "the several theories 
promulgated by different authors as explanatory of the 
inability to distinguish colors,^' and said that "they may 
be resolved into two classes : first, those which place the 
cause of the defect in the apparatus of vision, and, 
second, those which suppose it to be in the organ of 

33. Am. Jour. Med. Sol., 1840, xxvi, 277. 

34. Am. Jour. Med. Sci., N. S., ix, 346. 


perception," adding that "we are disposed to give pref- 
erence to the latter, but we have nothing on the subject 
to add to the excellent treatise of Dr. Hays." Probably 
up to the time of these papers nothing more enlightening 
had been written on the subject. 


In 1849^^ the late Prof. Chester Dewey, of Rochester, 
N. Y., published a brief but interesting paper entitled, 
"On an Unnoticed Kind of Abnormal Vision." Ex- 
pressing himself according to the knowledge of that 
time, he said that there were two well-known kinds of 
abnormal vision in eyes not diseased, "the far sighted 
and the near sighted." He then adds : 

There is a kind of abnormal vision, different from either of 
these, which is not farsighted or nearsighted, but in which small 
near objects, or larger distant objects, are not seen with distinct- 
ness. This imperfection occurs in children and young persons and 
is remedied by convex spectacles which are suited to the eyes 
of persons from 65 to 70 years of age. The younger eyes re- 
quire the older glasses and with advancing years less con/vex 
glasses are required. At the age of 45, or more, this kind of 
abnormal visicn becomes much diminished. As the young use 
glasses of the farsighted, this kind may be called neo-macropia. 
It is evident that convex glasses produce that change in the 
rays of light which fits such eyes to see distinctly small and 
large objects at varying distances. This fact proves that 
there is no defect in the adjusting power of the eyes. The 
cause, then, is to be sought in the structure of the eye. 

• Professor Dewey said this "abnormal vision" had not 
attracted attention, for he had found but one allusion 
to it in authors on optics, although it was relatively 
common. In New England and New York more than 
fifty instances had come to his knowledge. A child of 

35. American Journal of Science and Arts, 1849, viii, 443. 


15 was enabled for the first time to see distinctly by 
using his grandfather's glasses. A young man of 18 
required glasses of ten-inch focus. Poor progress of 
children in study occurred because they were not able 
to see distinctly, and this defect had not been sus- 
pected. "Knowledge of this subject will make spec- 
tacles a still greater benefit to our race.'' 



The mechanism of the adjustment of vision to dif- 
ferent distances has always been an interesting problem, 
and it was one to receive scholarly attention in this 
country in 1813 by Dr. David Hosack (1769-1835), 
who was one of our most celebrated physicians. Pre- 
vious to his time, Descartes had expressed the opinion 
that accommodation of the eye was effected by the ac- 
tion of the ciliary processes on the crystalline lens in 
such a way as to make it more or less convex; Kepler, 
Zinn and Porterfield, that it was done by the lens being 
moved nearer to the cornea; La Chariere, Brisseau, 
Perault, by being moved nearer to the retina; while 
others held that the change was made by variations in 
the size of the pupil. 

Thomas Young had endeavored to prove that the ad- 
justment was produced by a change of the curvature of 
the crystalline lens through muscle-tissue existing in it. 
Mr. Young's paper was published in the Philosophical 
Transactions of London in 1793. In 1794 Dr. Hosack 
followed up the discussion by a paper in the same trans- 
actions for that year, in whicli he took issue with all 
opinions previously expressed. In April, 1813, he to- 


published his paper in the American Medical and 
Philosophical Register, New York, under the title, "Ob- 
servations on Vision." It is an extended experimental 
study in which he endeavors to prove that the change 
of focus of the eye is effected by the action of the exter- 
nal recti muscles, and to disprove all the theories fhat 
had been presented up to that time. His paper con- 
cludes with the following summary : 

I have thus endeavored, first, to point out the limited action 
of the iris, and of consequence, the insufficiency of this action 
for explaining vision. Secondly, to prove that the lens pos- 
sesses no power of changing its form to the different distances 
of objects. Thirdly, that to see objects at different distances, 
corresponding changes of distance should be produced between 
the retina and the anterior part of the eye, as also in the re-^ 
fracting powers of the. media through which the rays of light 
are to pass. And fourthly, that the combined action of the 
external muscles is not only capable of producing these effects, 
but that from their situation and structure they are also pecu- 
liarly adapted to produce them. 


MORTON^ 1831. 

A discussion on this subject was again renewed in 
this country by Dr. H. Morton, of New York City, in 
1831, in a paper, "On the Adaptive Powers of the 
Eye.^^^^ This was a laborious effort to invalidate all the 
experiments and conclusions before advanced, and every 
available argument was used to show that the focal 
adjustment of the eye was produced by the action of the 
iris in dilating and contracting the pupil : 

The iris, by its contraction and dilatation, admits the requis- 
ite number of visual rays to pass through that portion of the 

36. Am. Jour. Med. Sci., 1831, ix, 51. 


crystalline lens which will cause them to reach the retina at 
their proper foci, while at the same time it excludes in the 
most effectual manner all unnecessary light, and all collateral 
or direct rays. 


The next conspicuous study of the accommodation of 
the eye was made by William C. Wallace, of New York, 
already referred to. By his numerous dissections of the 
eye and his minute study of the ciliary body, both in 
man and animals, beginning in 1835, he came to the 
conclusion that the adjustment of vision to different 
distances was accomplished by the action of the ciliary 
muscle and by the "erection^' of the ciliary processes in 
such a way as to change the position of the crystalline 
lens farther from or nearer to the retina. I will quote 
him in full: 

We have, then, the ligament by which the ciliary body is 
attached to the sclerotica; the outer ciliary muscle to contract 
the vessels returning from the ciliary processes; the ciliary 
processes, which are attached by the filaments of Ammon to 
the ciliary zone and crystalline capsule, to become erect and 
draw forward the crystalline body; and the inner ciliary mus- 
cle, aided by the elasticity of the membrane of the vitreous 
humor, to draw it backwards. 

The functions of the various parts of the ciliary body are 
evident from: 1, Its entire absence when there is another in- 
strument for adjustment; 2, its structure; 3, there is no 
other arrangement by which adjustment can be explained, or 
by which we can account for the sudden occurrence of near 
and far-sightedness. 

If, when the eye is adjusted to a remote object, we direct 
it by the external muscles to one which is near, an indistinct 
image of the latter is formed on the retina; the impression is 
communicated to the sensorium by the optic nerve; a reflex 
affection of the third, from which the ciliary nerves in part 


proceed, causes the ciliary muscle to contract, the processes to 
become erect, and the crystalline body to be drawn forward 
until a distinct image of the object is formed on the retina. 

The following facts show that the eye, in a perfectly passive 
state, is adjusted for the discernment of distant objects: 1, 
An effort is necessary to look at near objects without fatigue; 
2, as age advances, the ability to see near objects becomes 
lessened, while distant objects can be seen as plainly as ever; 
and, 3, when under the relaxing power of belladonna, the eye 
loses the power of seeing near objects distinctly. 
• By the graduating power of the ciliary processes and ciliary 
muscles, together with the elasticity of the membranes of the 
vitreous body, the crystalline may be drawn not only back- 
wards and forwards, but its inclination may be changed so as 
to throw the image on another part of the retina. As the 
upper and outer portion of the ciliary body is the broadest, 
that margin of the crystalline will advance the furthest, and 
thus facilitate the vision of near objects with both eyes at the 
same time." 

Had Wallace accompanied his otherwise intelligent 
experiments with a study of the catoptric images from 
the surfaces of the lens and noted their curvature- 
changes, he would undoubtedly have anticipated von 
Helmholtz by many years and arrived at the correct 
mechanism of accommodation, which does consist in the 
action of the ciliary muscle on the crystalline lens, but 
to change its surface curvatures, and not to change its 


While ophthalmology, both from the scientific and 
practical standpoints, has been simultaneously advanced 
by the numerous discoveries and greatly increased 

37. The Accommodation of the Eye to Distances, 1850, p. 23. 


knowledge in general siirgerv, yet I will take the time to 
refer to but two American contributions which were 
made previous to 1850, and which have proved to be so 
advantageous in o})hthalmic surgery and in its advance- 
ment. ]\Iv first reference is to 


I need not discuss the value of animal ligatures in 
certain operations on the eye and its appendages. All 
will agree that it is very great. The credit of suggest- 
ing and demonstrating the advantages of such ligatures 
in surgical practice belongs to an American surgeon, 
Dr. Phillip Syng Physick, of Philadelphia. The story 
of Dr. Physick's adoption of the use of animal ligatures 
is best told hv Dr. Frederick P. Henrv*^® as follows: 

In the Eclectic RcjH'rtoni, 181(), vol. vi, p. 389, there is a 
letter from Dr. Physick, in which he speaks of the delay in 
the healing of wounds because of the ligatures in use. He 
says: "Several years ago, recollecting how completely leather 
straps, spread with adhesive plaster and applied over wounds, 
for the purpose of keeping their sides in contact, were dis- 
solved by the lluids discharged from the wound, it occurred 
to me that ligatures might be made of leather, or of some 
other animal substance, with which the sides of a blood ves- 
sel could be comi)rossod for a sufficient time to prevent hemor- 
rhage, and that such ligatures would be dissolved after a few 
days and would bo evacuated with the discharge from the 
cavity of the wound." He requested Dr. Dorsey to try such a 
ligature on a horse, and the result justified his anticipations. 
The letter goes on to say that, acting on Dr. Physick's sugges- 
tion. Dr. Hartshornc had used ligatures made of parchment on 
some of the arteries, after an amputation of the thigh, and 

they were found dissolved at the first dressing. Dr. Dorsey, 
.1 — • — ■ — — » 

38. Standard History of the Medical l*rofession of Philadelphia, 
1897, p. 436. 


with Dr. Physick's assistance, used French kid ligatures with 
success in several cases. He experimented with different sub- 
stances to ascertain which would withstand the solvent power 
of the pus for the longest time, by applying the material over 
the surfaces of ulcers. Buckskin and kid dissolved first, then 
parchment, lastly the catgut. Fearing that the leather might 
dissolve too soon in tying large vessels, he intended to re- 
quest Dr. Dorsey to use leather impregnated with the varnish 
used in making elastic catheters. In his letter he makes the 
suggestion that perhaps tendon would be found more durable 
than any of the materials above mentioned. 

Further historical details are given in the American 
Medical Recorder, 1819, vol. ii, p. 488, and the Philadel- 
phia Journal of the Medical and Physical Sciences, 1821, 
vol. ii, p. 4. 


The other contribution, and undoubtedly the most 
important to surgery, is general anesthesia. This, too, 
is emphatically of American origin. The history has 
been so often told that I need only refer to a few facts 
in- connection with it at this time. The first man to 
use sulphuric ether as an anesthetic was Dr. Crawford 
W. Long of Jefferson, Jackson County, Ga., in March, 
1842. He had graduated from the University of Penn- 
sylvania in 1839, and had spent one year after this in 
a New York Hospital. His use of ether was the out- 
come of the knowledge of effects derived from its in- 
halation as a matter of amusement. His experiments, 
which were prosecuted in a perfectly scientific manner, 
demonstrated that the operations which he performed 
under its influence were done without pain or disagree- 
able reaction to the patient. His first operation was 
performed on March 30, 1842, and consisted in the re- 
moval of a small cystic tumor of the jaw. His second 


operation was on the same patient on June 6, 1842, for 
the removal of another small tumor. His third case was 
that of a negro boy who had a disease of a toe which 
rendered its amputation necessary, and the operation 
was done on July 3, 1842. Dr. Long continued to use 
sulphuric ether anesthesia in surgical operations, but, 
unfortunately, he does not seem to have realized what a 
vast benefit this discovery would prove, and, being a 
modest country practitioner, he did not publish his ex- 
perience until 1849.^® In 1852 he read a paper on the 
subject before the Georgia Medical Society, in which he 
again detailed his experience with ether as an anesthetic. 
His claims to priority of the discoveiy were publicly ad- 
mitted by Dr. Charles T. Jackson in 1861 in the Boston 
Medical and Surgical Journal of April 11, that year. 

Another claimant for the early administration of sul- 
phuric ether as an anesthetic, according to Professor 
Lyman in his work on "Anesthesia/^ (p. 6) was the late 
Dr. W. E. Clark, of Chicago, 111., who, while a student 
in Dr. E. M. Moore's office, Eoch«ster, N. Y., in the 
winter of 1842, administered ether to a young woman 
for the extraction of a diseased tooth, which was done 
with the patient in an unconscious state. Dr. Moore 
believed, however, that the unconsciousness was hyster- 
ical, and advised his pupil to make no more experi- 
ments in that direction, and the advice was unfortu- 
nately followed. 

It remained for Dr. W. T. G. Morton, later, to redis- 
cover the anesthetic properties of sulphuric ether and to 
bring the agent to the attention of the public in the 
form of a proprietary preparation which he named 

30. Southern Medical Surgical Journal, December, 1849. 

DB. W. T. C, MOKTON <1819 1898). 



"letheon;" and, so far as the professional world is con- 
cerned, sulphuric ether anesthesia had its real birth in 
the Massachusetts General Hospital on Oct. 16, 1846, 
at the hands of its originator, Dr. W. T. 6. Morton, 
and under the knife of that progressive and distinguished 
Boston surgeon. Dr. John Collins Warren. As is well 
known, the news of this demonstration of sulphuric ether 
anesthesia spread rapidly throughout the world. It led 
Sir James Y. Simpson to use chloroform anesthesia at 
Edinburgh the following year, and from that time till 
now general anesthesia has been a priceless boon and a 
most powerful factor in that surgical advancement in 
which ophthalmology has taken a proportionate share. 
The extent of the progress which it has furthered can not 
be measured or even imagined. I need not undertake to 
picture any of the benefits which operative and experi- 
mental ophthalmology has derived from it. It will suf- 
fice to say that America would have glorified herself in 
ophthalmology as well as in general surgery had this 
been her onlv contribution. 



The imperfect review which I have now given of the 
ophthalmology of America from 1800 to 1850, of its 
institutions, of the men who were most alive to its 
interests, of the surgeons who incidentally made it a 
part of their teachings and practice, and of its litera- 
ture and contributions, shows what growth can be ob- 
tained, what developments can be made, what last- 
ing foundations can be laid in the midst of an en- 
vironment whose professional standards averaged low, 
whose professional life in a new country was a struggle 
for bread; whose professional sentiments were opposed to 
specialism, looking upon it as disgraceful, and in which 
a certain amount of apathy toward ophthalmology was 
always present. 

Isaac Hays and his co-workers had, notwithstanding 
all these hindrances, supplied foreign and original liter- 
ature which, at the opening of the s econd half of t he 
ninet eenth centur y, impressed the American profession 
with the value and respectability of this special science, 
and the special institutional activities had demonstrated 
its public as well as private needs and benefits. More 
and more had a few of our physicians and surgeons in 
our large cities been extending their practices into this 
special field. James Edward Cornell, Mark Stephenson, 


George Wilkes, Freeman J. Bumstead, Henry B. Sands 
and David L. Eogers, of New York; George Hayward, 
Eobert W. Hooper, Francis P. Sprague, John H. Dix 
and George A. Bethune, of Boston; Adinell Hewson, 
Samuel D. Gross, William Hunt, Edward Hartshorne, 
A. D. Hall, Thomas G. Morton, Henry H. Smith, John 
Neill, D. Hays Agnew and E. J. Levis, of Philadelphia ; 
Aaron Friedenwald and Nathan E. Smith, of Balti- 
more; J. S. Hildreth and Moses Gunn, of Chicago; 
Simon Pollak, William Dickinson, John T. Hodgen, 
Paul F. Eve and Charles A. Pope, of St. Louis; Eob- 
ert A. Kinloch, of Charleston; Julius F. Miner, of 
Buffalo, and Alden March, of Albany, and probably 
many others whom I do not recall, had been greatly 
skilled in it, if not foremost in its practice, and their 
prestige had so dignified it that it needed only the 
slightest reaction from abroad to establish it as an 
exclusive department of medicine here. This reaction 
was imminent, and this specialism was soon to be an ac- 
complished fact 



The first American, I believe, to set himself to ex- 
clusively special study in Europe was Dr. Henry W. 
Williams (1821-1895), of Boston. He had begun his 
medical studies at Harvard in 1844, but it appears that 
before graduating he went to Europe, where he spent 
three years, returning in 1849. In the same year he 
received his M.D. degree from Harvard. While in 
p]urope he took a systematic course in ophthalmolog}' 
at the then famous clinics of Sichel and Desmarres. of 
Paris, also following the services at Vienna of Frederich 
Jaeger and Rosas, and at London of Dalr}'mple, Law- 
rence, Dixon. Critchett and Bowman. It was too earlv 
to studv with von Graefe, von Helmholtz and Donders, 
for they were just entering on their life work. On his 
return to Boston, he was appointed one of the district 
physicians of the Boston Dispensary, and in 1850 wa4 
made its first ophthalmic surgeon. In the same year 
he organized a class of Harvard medical students for 
instruction in diseases of the eye, in which he was great- 
ly aided by his lifelong friend. Dr. Charles E. Bucking- 
ham, who for several years jilaced at his disposal a very 
abundant and excellent clinical material at the "Old 
Citv Institution" in South Boston. In 1864 Dr. Wil- 
liams was made ophthalmic surgeon to the City Hos- 
pital, a i)osition which he held for many years. In 



1869 he was made lecturer on ophthalmology, and in 
1871 professor of ophthalmolog}^ in Harvard Medical 
College. It is said that his teaching was lucid and 
practical, and was always admirably suited to the just 
requirements of the particular class of hearers, whether 
physicians or students, to whom it was addressed. 

Through the long succession of ophthalmic internes 
and externes under him at the City Hospital, and the 
many classes of students taught by him at the medical 
college, also through the numerous editions of his books, 
which were bought and studied by physicians, he ex- 
erted a continuing and far-reaching influence. 

As an ophthalmologist. Dr. Williams won favorable 
recognition from the first years of his practice as a physi- 
cian in 1850. He was identified with this specialty 
from the beginning of a professional career which ex- 
tended through forty-six years, and, although a special- 
ist of high rank, he never gave up his interest in general 
medicine or in subjects of public interest. 

Throughout the whole of his professional life Dr. Wil- 
liams showed himself at once conservative and inde- 
pendent. A careful observer of the work of others, he 
possessed in a high degree the faculty of discrimination 
in respect to the relative merits of teachers and the 
value of their particular methods. Learning from all, 
he owed no partisan allegiance to any single master or 

The method of Daviel, as perfected by Beer, was, 
with unimportant variations, practiced by all the great 
masters of the art with a deftness and finish which have 
never been rivaled. Influenced by such examples, it 
was only natural that he should adopt extraction in 


preference to the brilliant but uncertain operation of 
reclination then in vogue in this country. In the per- 
formance of extraction he was unexcelled, and it is char- 
acteristic of the man that he never departed very widely 
from the method which he had learned to practice so 
well and which he believed to be, on the whole, the most 
satisfactory in its results. He adhered to the classical 
tiap incision long after the peripheral linear section of 
von Graefe had been generally adopted, and steadfastly 
withstood the tidal wave of opinion in favor of iridec- 
tomy as an integral part of the operation. He was one 
of the first, if not the first, among ophthalmic surgeons 
to advocate and employ etherization as a general prac- 
tice in cataract extraction. 

He was a man of large stature and strong character, 
and was a conspicuous figure on all medical occasions. 
He was a frequent and forcible, but persuasive, speaker 
and an excellent presiding oflBcer. He was sturdy and 
honest in suppressing quackery, and in a thousand ways 
left his mark on his times and on his community.*** 


Elkanah Williams (1822-1888) began his profes- 
sional life a little later. He graduated from the Uni- 
versity of Louisville in 1850. After engaging in general 
practice for a short time, he went abroad in 1852, with 
the avowed purpose of studying ophthalmology. He 
followed the same teachers as had Henry W. Williams 
at Vienna, Berlin, Paris and London. He was a young 
man of intelligence and ambition, and he fitted himself 
for ophthalmologic practice as completely as possible. 

40. From biographical slcetcli by Dr. John Green, Trans. Am. Oph. 
Soc, 1896, vii, 479. 

DR. ELKANAH WILLIAMS (1822-1888). 


While in Europe the newly invented ophthalmoscope 
was the source of much experiment and discussion. He 
acquired a knowledge of its use in its modified form and 
was probably the first to bring an instrument to this 
country and to teach his American colleagues its won- 
derful revelations. It is said that he was also the first 
to demonstrate its use to London ophthalmologists at 
Moorfields in 1854.*^ They had previously hesitated to 
employ it, fearing that the strong light which was re- 
flected by it into the eye would injure the retina. To 
illustrate the sentiment then existing in London I will 
quote from Mr. James Dixon, who was then one of the 
most prominent ophthalmologists in England, and who 
was one of the surgeons to the Moorfields Eye Hospital. 
In 1853 he said :*- ^^If the praise bestowed on this in- 
strument (the ophthalmoscope of Coccius) be allowed 
to go forth to the professional public without strong 
cautions and limitations, such dangerous results appear 
to me likely to ensue that I feel it a duty to offer a 
few remarks on the subject for the consideration of your 
readers." The practitioner in using the ophthalmoscope 
"may bring about the very condition (amaurosis) that 
he is hoping to avert.'^ Later he also said*^ that he 
retained "a very strong opinion as to the mischief likely 
to result from the abuse of the reflecting ophthalmo- 
scope if it is indiscriminately resorted to by inex- 
perienced persons for investigating cases hastily classed 
as incipient amaurosis.'' 

Dr. Williams,** in an article on the ophthalmoscope, 

41. London Medical Times and Gazette, vol. ix, p. 30, 1854. 

42. The London Medical Times and Gazette, vol. yii, 1853, p. 379. 

43. Ibid., vol. ix, 1854, p. 7. 

44. The London Medical Times and Gazette, vol. ix, 1854, p. 30. 


contributed in 1854, modestly referred to his use of the 
instrument in the Moorfields (Royal London Ophthal- 
mic) Hospital, where he probably demonstrated its 
harmlessness, as well as benefits, with convincing effect. 
He said : *^As examples are always more interesting and 
instructive than general descriptions, I will give a short 
account of some cases which I have had occasion, within 
the last few weeks, to observe at the London Ophthalmic 
Hospital in the presence of Mr. Dixon and Mr. Bowman, 
who had themselves seen some of the alterations which 
it is my object now to describe. It is with great pleas- 
ure that I take this opportunity of thanking the eminent 
surgeons of the institution for the kind permission they 
have granted me of attending their extensive and inter- 
esting practice, and especially of continuing those ob- 
servations with the ophthalmoscope which I had com- 
menced at Paris with Dr. Anagnostakis, the ingenious 
inventor of the ophthalmoscope which I use." Then 
follows a description of the cases in which he had used 
this instrument and of the appearances which they pre- 

On his return to Cincinnati, in 1855, Dr. Williams at 
once established an eve clinic in connection with one of 
the hospitals, which met with success. In 1860 Miami 
Medical College, which was organized in 1852, created 
a chair of ophthalmology, and Dr. Williams was elected 
professor to it. This was the first time in America that 
a medical college had thus recognized this specialty. 

Dr. Williams was a lucid and impressive teacher, and 
was greatly beloved by both physicians and students. 
For a number of years he had editorial charge of the 
Cincinnati Lancet and Observer, and contributed nu- 


merous articles and reports on ophthalmologic subjects 
to its columns. In 1885 he wrote the section on dis- 
eases and injuries of the eye for Ashurst's International 
Enclycopedia of Surgery, 1884, vol. v, pp. 169-288. It 
was concise and comprehensive; in fact, it was a com- 
plete manual on the subject and embodied the results of 
his own observations and experience of many years' dura- 
tion. As a teacher, practitioner and operator he had 
few equals. 


These two men, Henrv W. Williams, of the East, and 
Elkanah Williams, of the West, inspired by the examples 
of their famous European teachers and believing in the 
dignity and value of specialism, dared to assert them-, 
selves in opposition to an organized and inbred senti- 
ment against it. By their professional loyalty and up- 
rightness, by their devotion to the interests of general 
medicine, bv their enthusiasm and consistent ao^orres- 
siveness, by their learning and their skill, and by their 
kindly and commanding personality, they won the battle 
for the exclusive practice of ophthalmology. 

With the examples and labors of these two men, and 
with the growing interest in ophthalmology that had 
already developed, the impulse became irresistible and 
the time seemed to have arrived for men to build anew 
on the foundations which a half century had made 
secure. Other young men began to repair to the large 
eye clinics of Europe, and they continued to bring back 
to this country the enthusiasm of the great masters and 
a greatly enlarged view of ophthalmology. 



While this interest was deepening and widening in 
this country, great changes were also taking place 
abroad. In 1851 von Helmholtz published his invention 
of the ophthalmoscope; in 1854 von Graefe established 
his Archives; in 1857 Streatfield began the publication 
of the Royal London Ophthalmic Hospital Reports; in 
1857 von Graefe startled the world by the announce- 
ment of a surgical remedy for glaucoma; in 1857 to 
1859 Bonders recorded in von Graefe's Archives his 
marvelous researches in the refraction and accommoda- 
tion of the eye and their anomalies. • 

During the ^50s the important accessions to the spe- 
cial literature were Dr. H. W. Williams' translation, in 
1850, of Dr. SichePs work on "Spectacles,'^ and new 
editions of English treatises on the eye and its diseases. 
In 1853 Lindsay and Blakiston, of Philadelphia, issued 
"A Treatise on Operative Ophthalmic Surgery,'' by H. 
Hayes Walton, F.K.C.S.E., of London, England, edited 
by S. Littell, M.D., of Philadelphia. It was the first 
American, from the first London edition, in an octavo 
volume of 599 pages, illustrated by 169 engravings. As 
indicated by the title, the range of the work was limited 
to operative ophthalmic surgery, and within that range 
it was a valuable contribution to our science. It was 
the first work on the eye to contain a chapter on general 
anesthesia in this department of surgical practice. The 

DK. ADINELL HEWSON (1B28-1889). 


author preferred chloroform to sulphuric ether or any 
other agent in producing the anesthesia. He believed 
that it might be administered to ^^pereons of all ages, 
from a few weeks or months old to extreme age" He 
further stated that "it is scarcely possible to overrate the 
value of a discovery which tranquilizcs the mind of the 
patient by banishing the anticipation of pain, deadens 
the sensibility, and prevents the reality of suffering; 
while to the operator it brings the inestimable advantage 
of quieting the struggles of children, or of irresolute 
adults, which are so apt to frustrate all the care, fore- 
sight and dexterity that the most assiduous application 
to practical surgery can command." 

In 1854 another edition of the great work of Law- 
rence was republished here, much enlarged and im- 
proved by Dr. Hays. His notes were numerous and 

The next year, 1855, Dr. Adinell Hewson brought out 
a new American edition of William Mackenzie's encv- 
clopedic "Practical Treatise on Diseases of the Eye." 
His additions, too, were numerous and valuable. Thev 
included new suggestions, as well as recent observations, 
and for the first time, in an American book, he de- 
scribed the ophthalmoscope by adding a special chapter 
devoted to it. This instrument had been entirely ignored 
in the English edition. 

In 1856 there was another, the second American, 
edition of T. Wharton Jones' "Principles and Practice 
of -Ophthalmic Medicine and Surgery" (Philadelphia 
Lea and Blanchard, 1856). This time it was edited by 
Dr. Edward Hartshorne instead of by Dr. Hays. Dr. 
Hartshorne was a distinguished practitioner of Philadel- 


phia and was prominent there in ophthalmic circles. His 
notes added materially to the value of the book. 

The '60s became more prolific than ever before, at 
least of foreign literature on the eye, and its influence 
on America was deeper and more lasting. In 1864 the 
classic work of Bonders on ^Tlefraction and Accommo- 
dation" was put into English, and in 1866 and 1867 
that of von Helmholtz on "Physiological Optics'' was 
issued both in German and in French. Immediately 
after these publications J. Soelberg Wells, of London, 
wrote his extended "Treatise on Diseases of the Eye," 
accepting and incorporating the conclusions of Bonders 
and von Helmholtz, together with the operative proce- 
dures of von Graefe in glaucoma and cataract. Wells' 
work epitomized, also, the new experiences and conclu- 
sions of his English confreres, Critchett, Bowman and 
others. In fact, it was the reflection of all that was 
new in ophthalmology, and at the same time embodied 
the verities 6i the old. It was published in London in 
1868 and in this country in 1869. E. Jaeger, in 1869, 
also published that inimitable "Atlas," representing the 
normal and pathologic fundus of the eye, the descrip- 
tive text being in German. It was followed the next 
year by a French edition, by de Wecker, of Paris. 

Another work of great erudition and merit was thai 
of Stellwag von Carrion. It was issued in German in 

1867 and was at once translated into English by Brs. 
Roosa, Bull and Hackley of New York and published in 

1868 by William Wood & Co., New York. In the mean- 
time translations of foreign ophthalmologic articles were 
published in the Boston, New York and other journals, 
either in full or in abstract, by Hasket Berby, Henry D. 
Noyes and others. 



Dr. H. W. Williams in 1862 published his "Practical 
Guide to the Study of Diseases of the Eye/^ a 12mo of 
351 pages. This was the fourth original work on dis- 
eases of the eye written by an American, and in its 
clearness and conciseness, and yet completeness, has 
never been excelled. Eepresenting, as it did, the oph- 
thalmology of that time, the publication of DondersT 
work in 1864 made it necessary to give it an early re- 
vision. It passed through several editions, the last of 
which was issued in 1886, and to-day, even, is a model 
of medical authorship. In 1865 Dr. Williams was the 
successful competitor for the Boylston prize, the subject 
being "Eecent Advances in Ophthalmic Science.'^ This 
was published in uniform style with his "Practical 
Guide,'^ making a 12mo of 178 pages. The substance 
of this essay was afterwards incorporated into his "Prac- 
tical Guide," but in itself alone it was an important ad- 
dition to the ophthalmic literature of that time. 


^ Soon after the discovery of the ophthalmoscope much 
interest was shown in this instrument in this country, 
and numerous articles were written describing it and its 
uses. Among the earliest of those who wrote on the 
subject were George A. Bethune, of Boston ;*^ John H. 
Dix, of Boston:**^ Adinell Hewson, of Philadelphia;*^ 
Montrose A. Pallen, then of New York,*^ and L. Turn- 
bull, of Philadelphia.*'^ 

45. Boston Med. ^nd Surg. Jour., 1854, vol. li. 

46. Boston Med. and Surg. Jour, for 1855, 1856 and 1858. 

47. Am. Ed. of Mackenzie, 1855. 

48. Trans. Am. Med. Assn., 1858. 

49. Phila. Med. and Surg. Reporter. 1859. 



Two original articles which were especially notable, 
both by the Williainses^ were published during the early 
part of this formative period. One was by Henry W. 
Williams "On the Treatment of Iritis Without Mer- 
cury/' in 1856. It was a memorable essay, and is said 
to have inaugurated a radical reform in the therapeu- 
tics of that disease. Dr. Williams demonstrated by the 
study of sixty-four cases that this class of cases would 
recover by the systematic use of a strong solution of 
atropia, the only internal remedies administered being 
iodid of potassium, colchicum and iron. 

The other paper was by Elkanah Williams "On the 
Obliteration of the Lachrymal Sac by the Actual Cau- 
tery.'^ It was first presented in Cincinnati in 1856 
{Cincinnati Lancet and Observer, 1856), and again be- 
fore the International Congress of Ophthalmology in 


During the same period two new institutions devoted 
to the charitable relief of the poor afflicted with diseases 
of the eye were added to those previously founded. 

The first was the New York Ophthalmic Hospital, 
which was incorporated April 21, 1852, and was opened 
on May 25 of the same year. The board of directors 
was made up of prominent citizens of New York City, 
and Hon. C. S. Woodhull was its first president. The 
first surgeons were Dr. David L. Kogers and Dr. Mark 
Stephenson, both of New York. It had a humble be- 
ginning like other institutions of the kind, and" the 

50 Congress Perlodique Internationale d'OphthalmoIogie, 2e ses- 
sion, 1862. Compte-rendu, Paris, 1863, p. 137. 

DR. EDWARD L, HOLMES (1828-1900). 


purpose of its organization was said to be to accommo- 
date the poor in districts then farther up town in that 
city. Its first location was at No. 6 Stuyvesant Street, 
between Second and Third Avenues. According to its 
first report, four hundred and forty-four patients were 
treated from May 25, 1852, to Jan. 1, 1853. From that 
time it had a steady and healthful growth. In 1865 
the surgical staff was constituted of Drs. John P. Gar- 
rish, Marcus P. Stephenson, William F. Holcomb, 
Ebenezer McFarland, Giovinni Ceccarini and John M. 
Carnochan, with Drs. David L. Rogers, Alfred C. Post 
and Frank H. Hamilton, consultants. Almost from 
the outset clinical instruction on diseases of the eye was 
given to students, and in 1865, the report states that 
"over six hundred students have availed themselves of 
these advantages/' 

In 1867 the homeopaths in some way secured posses- 
sion of the management, and since then it has been 
served by homeopathic practitioners. To-day it is es- 
timated that about 15,000 patients, including eye, ear, 
nose and throat cases, are treated there annually. 

The other institution was that most active and benef- 
icent one of Chicago, known to-day as the Illinois Char- 
itable Eye and Ear Infirmary. 

In the month of May, 1858, a number of physicians, 
under the leadership of Dr. Edward L. Holmes, met 
some benevolently disposed citizens of Chicago and 
founded the Chicago Charitable Eye and Ear Infirmary, 
electing a board of trustees and making Dr. Edward L. 
Holmes surgeon. Its first location was in a single room 
at the northeast corner of Michigan and North Clark 
Streets. It remained there until 1862, when it was re- 


moved to No. 28 North Clark Street. In 1864 Walter 
L. Newberry, president of the institution, donated for 
a term of ten years the lease of a lot of land, on which 
was erected a large two-story frame building. In 1865 
this building was raised and a brick basement con- 
structed under it. In 1871 the State of Illinois, after 
some preliminary legal proceedings, received it into the 
circle of state institutions by a special act, when the 
name of the institution was changed by the substitution 
of the word "Illinois'^ for "Chicago.'' On Oct. 9, 1871, 
fire swept away the old infirmary. The state at once 
made provisions for carrying on the work of the institu- 
tion, and as soon as possible erected the present building, 
which was completed in 1874. The number of patients 
of all kinds admitted to the infirmary for treatment for 
the biennial period ending June 30, 1902 (the last re- 
port at hand), was 21,395, making a total at that time 
of 182,904 admitted since the opening of the institution 
by the state in 1874. 

Among the active surgeons have been Edward L. 
Holmes, Edwin Powell, F. C. Hotz, S. J. Jones and 


Early in the '60s a movement was made to establish 
an ophthalmologic journal. This deserved to be a last- 
ing success, but it was not. There had never been an 
ophthalmologic journal in this country, ophthalmologic 
papers having been heretofore published in the general 
medical journals and in the transactions of the state 
societies and of the American Medical Association. Dr. 
Julius Homberger, who had been a pupil of von Graefe 
and Sichel, had just settled in New York to practice 


ophthalmology. The time seemed to him auspicious for 
establishing a special journal. In 1862, therefore, he 
undertook to do so, under the name. The American Jour- 
nal of Ophthalmology, The first prospectus announced 
that it would be a quarterly with forty-eight pages to 
each number. The first number was issued in July, 
1862. Six numbers were published between that date 
and May, 1863 and constituted the first volume. The 
second volume was begun in January, 1864, but the en- 
terprise was apparently discontinued with the second 
number of this volume, in April of that year. It con- 
tained but few original articles and these were mostly 
written by the editor. The bulk of the contents was 
made up of translations of articles by von Graefe and 
other German writers. The pages were closely printed 
and the articles represented some of the best German 


In point of time the next movement to create a means 
of interchange of thought and experience on the part 
of the few Americans who were engaging themselves 
wholly or in part in ophthalmic study and practice was 
instigated by two enterprising young men, Dr. Henry D. 
Noyes, of New York, and Dr. Hasket Derby, of Boston, 
who had then just entered on careers of specialism. They 
were materially aided and encouraged by Dr. Freeman J. 
Bumstead, a prominent and influential general as well 
as ophthalmic surgeon of New York. In response to 
several verbal invitations, a conference was held at the 
ofl&ce of Dr. Noyes, 278 Fourth Avenue, New York, on 
Jan. 9, 1864. The purposes of the conference were 
stated to be "to consult on the best mode of promoting 


the interests of ophthalmolog}' in this country." Drs. 
H. B. Sands, H. Althof, J. H. Hinton, F. J. Bumstead, 
D. B. St. John Roosa, W. F. Holcomb, H. D. Noyes, all 
of New York, and Hasket Derby, of Boston, were pres- 
ent. The project of founding a journal of ophthalmol- 
ogy was discusseil, but it was voted down.*^^ A resolution, 
however, presented by Dr. Bumstead, was passed, au- 
thorizing the appointment of a committee "to invite 
ophthalmic surgeons from the whole country to assemble 
in New York at the time of the meeting of the Ameri- 
can Medical Association." Drs. Bumstead, Noyes and 
Derby were appointed such committee. Pursuant to a 
call of this committee, a meeting was held at the New 
York Eye Infirmary, Second Avenue and Thirteenth 
Streets, on June 7, 1864. Eighteen gentlemen were 
present. Dr. Bumstead called the meeting to order, 
and Dr. Edward Delafield was elected chairman and Dr. 
H. D. Noyes secretary. A constitution and by-laws 
were adopted. 

At the meeting held the next day papers were read 

51. Since the above was put In type I have received the fol- 
lowing note from Dr. Hasket Derby, of Boston, whicli is self ex- 
planatory. It will serve to indicate the opposition that was felt 
toward Dr. Homberger and his journal, and the actuating desire 
of the pioneer ophthalmologists to neutralize his influence and to 
advance ophthalmology on scientific and unselfish lines. Dr. Derby 
says : "The^ actual founder of the society was Dr. Julius Homberger, 
as I used laughingly to assert, to Dr. Noyes' great indignation. 
About 1862, a peripatetic German adventurcfr of this name came 
to New York to engage in ophthalmic practice', and started a maga- 
zine of ophthalmology. After a few numbers this probably fell 
stillborn, but while it lasted it disgusted reputable ophthalmologists, 
and the meeting called by Dr. Noyes, after consultation with me, 
was really to concert measures for the establishment of a magazine 
that should be respectable. Eight of us came together at Ur, 
Noyes' office in Fourth Avenue, and after well weighing the matter, 
decided that a society would be a better thing to found than a 
magazine. So we issued a call for a meeting and held it (the 
first) June 7, 1864. Thus we originated. Whatever became of 
Homberger I have no means of knowing. The Germans have a 
word, 'verschoUen,' which probably applies to him." 



and discussed and certain other business was transacted. 
The organization was completed and named The Amer- 
ican Ophthalmological Society. Dr. Edward Delafield 
was elected president, Dr. Henry D. Noyes recording 
secretary, and Dr. Herman Althof corresponding secre- 
tary. As an indication as to who the principal ophthal- 
mic surgeons were in 1864 I will here record those who 
were present and who were made charter members, and 
also those who were not present but who were elected to 
membership: Present, Drs. Edward Delafield, F. J. 
Bumstead, John Hinton, Francis Simrock, Herman Alt- 
hof, W. F. Holcomb, D. B. St. John Roosa, William F. 
Carmalt, William Stimpson, Henry B. Sands, Henry 
D. Noyes, of New York; John H. Dix, B. Joy Jeffries, 
Hasket Derby, Francis P. Sprague, of Boston; Ezra 
Dyer, of Philadelphia, and C. A. Robertson, of Pough- 
keepsie. Others elected to active membership were Drs. 
Abram Du Bois, of New York; Henry W. Williams, 
Gustavus Hay, of Boston ; J. F. Noyes, of Detroit, J. S. 
Hildreth, of Chicago; Adinell Hewson, William Hunt 
and Thomas G. Morton, of Philadelphia. The follow- 
ing were elected honorary members : Drs. Edward Rey- 
nolds, Robert W. Hooper, George A. Bethune, John 
Jeffries, of Boston; George Wilkes, of New York, and 
Isaac Hayes, of Philadelphia. 

Dr. John H. Dix was the first to read a paper before 
the newly organized society. It had a double subject; 
one part was the report of a case of "Peculiar Trans- 
parent Neoplastic Formation in the Anterior Chamber 
of the Eye,^* and the other was "On the Effects of Cal- 
abar Bean on Paralysis of Accommodation Following 


Thus was founded the first ophthalmological society 
in America, if not in the world. Thus began the united 
scientific labors of American ophthalmic surgeons, and 
such was the personnel of its first membership. 'The 
transactions of the society from 1864 to 1906 record 
the essential results of the study and practice of these 
and subsequent members, and in a great measure repre- 
sent the progress of ophthalmology in this country dur- 
ing the last forty years. 


In 1864 the New York (City) Ophthalmological So- 
ciety was organized, with Dr. Cornelius R. Agnew its 
first president. It has continued in successful operation 
to the present time. 

On Feb. 1, 1870, a similar organization was started 
in Philadelphia, the Philadelphia Ophthalmological So- 
^i^'ty, with Dr. Isaac Hays president and Dr. Edward 
Hartshorne vice-president. Dr. S. D. Eisley, of Phila- 
^'tilphia^ in a private letter to me, says: 

Ali<> names of many eminent men, some of whom are still 

"^nijr, appear again and again in the records of the scientific 

|»J'oct»e(ling8 and in their discussions of the private business of 

"" society. Monthly meetings with full attendance were held 

»*'** the llrat year, and most of the second. Then the attend- 

**»><•« rapidly fell off, the leading ophthalmologists' names being 

**"Ht»iit from the list of those present, only general surgeons, 

Ike I^vis, Morton and others, all of whom did eye surgery 

i» c'-onjuuetion with their general surgery, being habitually 

l»»'«««nt. The society finally died a natural death after many 

viciHBituduH, the last meeting having been held at Dr. Straw- 

Inidgo'B house, April 6, 1875. 




It was apparent from the discussion at the first meet- 
ing; held for the purpose of organizing the American 
Ophthalmological Society, that an ophthalmologic jour- 
nal was regarded a desideratum, and yet it was not 
deemed best to undertake the publishing of one at that 
time. Perhaps the experience of Dr. Homberger was 
a warning against it. Soon, however, a distinguished 
and energetic Heidelberg professor. Dr. Herman Knapp, 
came to this country and took up his residence in New 
York. This was in 1868. In the following year he 
established his Archives. This journal had a vigorous 
beginning and gave assurance of perpetuity. With the 
realization of such perpetuity, with the maintenance of 
' its high and scientific ideals and standards, it has proved 
to be a most powerful engine of ophthalmologic progress 
in this country. 


At this period also medical college after medical col- 
lege was estabiiehiag special lectureships and professor- 
ships of ophthalmology. 

Institutions for diseases of the eye were still being 
organized. The Ophthalmic and Aural Institute was 

founded by Herman Knapp in 1868; the Brooklyn Eye 
and Bar Hospital by Arthur Matthewson, late of the 
United States Army, and Homer C. Newton, late of 
the United States Navy, assisted by Cornelius R. Ag- 
new, in 1868; the Manhattan Eye and Ear Hospital 
by Cornelius R. Agnew in 1869. 


The first of these to which I wish to call attention i^ 
the "needle-knife" of Dr. Hays for the operation for 


cataract "by solution or absorption ."'* Not only did this 
instrument admirably serve the purpose for which it 
was designed by Dr. Haye, but it is still an excellent 
knife for discission of "after-cataract." Dr. Haya de- 
scribed it, in 1855, as having a total length of six-tenths 

ofaninch "from point to bead," with a perfectly straight 
cutting edge four-tenths of an inch long. The back was 
also straight to near the point "where it was truncated 
so as to make the point stronger, but at the same time 

leaving it very acute." This truncated portion of the 
back was made to cut. The rest was rounded and the 
shank was so constructed as to fill the incision and pre- 


vent the escape of aqueous humor. It is doubtful if any 
discission "needle-knife" or "knife-needle" has since 
been devised that was better than this. 

Previous to and for some time after this period "ex- 
traction of cataract was an infrequent procedure, con- 
fined *o the hands of a few skilful men. Comminution 
and depression were the common operations."*^^ 


At about the same time Dr. R. J. Levis, a Philadel- 
phia surgeon skilled in ophthalmic surgery, devised a 
wire loop with which to facilitate the exit of the lens 
in cataract extraction. This has proved to be of great 
service in certain cases. 


In 1860 Dr. S. Weir Mitchell made some interesting 
experiments which showed that the administration of 
saccharine substances to frogs produced cataract in 
them.*^* The experiments consisted in injecting "syrup" 
subcutaneously, the effect being, among other things, to 
produce a peculiar variety of cataract "due to mechan- 
ical disturbances of the form and relative position and 
contents of the component tubes of the lens." 


Dr. Ezra Dyer, a careful student of Donders and an 
astute observer, read a memorable paper before the 
American Ophthalmological Society in 1865 entitled 
"Asthenopia in Connection with Hypermetropia."*^*^ He 
believed that the cause of asthenopia in these cases was 

53. S. D. Gross : "Century of Surgery," Am. Jour. Med. Scl., 
1876, Ixxi, 478. 

54. Am. Jour. Med. Sci., 1860, xxxix, 106. 

55. Trans. Am. Oph. Soc, 186i5, p. 28. 


a loss of tone of the ciliary muscle. The treatment, 
therefore, consisted in increasing the tone or strengthen- 
ing the ciliary muscle by systematic reading exercises, 
or what he termed, "gymnastic exercises^^ of the accom- 
modating muscle. In addition to the lack of "tone" 
he believed that there was some disturbance of the rela- 
tive accommodation, together with a "want of mental 
energy, the patient having lost confidence in his power 
to use the eye." He first changed the relation of the ac- 
commodation to the angle of convergence of the axes of 
the eyes by glasses. To the emmetrope he gave + 1-^5 
or + 1.00. In a myope of 4.00 D. he simply corrected 
the myopia. In the higher grades of myopia he carried 
the far point to ten or fifteen inches with the proper 
concave glass. Glasses having thus been ordered in ac- 
cordance with the given refractive condition of the eyes, 
the patient was directed to read clear type of medium 
size for three to fifteen minutes in the morning. If no 
pain followed, the reading was continued a minute 
longer at noon and increased another minute at evening. 
This was done entirely by daylight. If pain followed 
the first reading until the time of the second, the patient 
should not mind it, but read a minute less than he had 
done in the morning and a minute less at night, if it 
still continued. In this way a point was to be found 
when he could read a certain number of minutes without 
pain and then the time increased a minute each day, or 
faster if prudent, until the patient could read thirty or 
forty minutes three times a day. Then other uses of 
the eyes than for reading were carefully substituted. 
When sixty to seventy minutes were reached the glasses, 
except in the myopic class, were gradually dispensed 


with, the surgeon being guided by the nature and course 
of the case. Dr. Dyer added: One minute increase a 
day seems a small matter, but if a person begins with 
an increase of time of reading one minute, three times 
a day, at the end of a month he will be reading an 
hour and a half a day. Dr. Dyer^s gymnastic treatment 
of asthenopia at that time was based on an experience 
with forty cases, in thirty-eight of which the results were 
"highly satisfactory.^^ 


Dr., Haeket Derby, of Boston, was probably the jBrst 
to urge the importance of using steady and uniform ar- 
tificial light on test letters in examinations for ame- 
tropia. He directed the attention of the profession to 
this in a paper read in ISee.**® His statement was as 
follows : 

Let the letters used as a test be placed in a room from 
which daylight is excluded, and let them be illuminated by a 
steady flame, uniform in intensity of illuminating power, and 
placed always at the same distance from the letters. 


Dr. Hasket Derby, in 1868, was also the first to pro- 
test against the use of mydriatics in glaucoma.^"^ He 
cited two cases in which acute glaucoma had super- 
vened on the use of atropia. He concluded that "so 
important in glaucoma are the early ophthalmoscopic 
symptoms . . . and so frequently does it become 
desirable to dilate the pupil in order to satisfactorily 
determine their existence, that any facts tending to show 

56. Trans. Am. Oph. Soc, 1866r, p. 116. 
• 57. i Trans, Am. Oph. Soc, 1868, p. 35. 

DR. FRBEMAN"'J: BDMaTBAD (1828-1879). 



the impropriety of the use of mydriatics would have a 
most important practical bearing/^ 


Dr. F. J. Bumstead and Dr. Hasket Derby were the 
first in this country to follow Donders in the determina- 
tion and correction of astigmatism. Dr. Bumstead re- 
ported one case with suggestions in 1863.^^ In the same 
year Dr. Derby reported four cases, the first of which 
was examined by him in Boston in May, 1862. He had 
glasses ground in Berlin for them.^^ 

Dr. Derby had been studying ophthalmology in Europe 
under the great masters, Arlt, Jaeger, Von Graefe and 
Donders from 1859 to 1862. During the latter part of 
this period he was in Utrecht with Donders, who was 
then working out the great problem of astigmatism and 
its correction with cylindrical glasses. He, with his 
companion at that time. Dyer, thus had the rare privilege 
of acquiring at first hand the essential principles of as- 
tigmatism and its correction from the one who scientif- 
ically established them. Being, therefore, one of the first 
disciples of the immortal founder of a new science, and 
being conscious of the verity and practicability of his 
teachings, he returned to this country to promulgate and 
apply them. In this most difficult and important field 
of refraction work he was an American pioneer. 


Another original contribution which is worthy of notice 
was made by Dr. C. E. Agnew on the operative correction 
of divergent strasbismus. His paper will be found in the 

58. Am. Med. Times, 1863, vii, 203. 

59. Ibid., p. 277. 


Transactions of the American Ophthalmological Society 
for 1866, p. 31, entitled "A Method for Operating for 
Divergent Squint/' 

Dr. Agnew described his method in substance as fol- 

The patient being put under the influence of a general anes- 
thetic, the eye is exposed by an eye speculum and the cornea 
is drawn as much as possible toward the outer canthus by an 
assistant grasping the tissues over the tendon of the external 
rectus muscle with a pair of fixation forceps. The operator 
then makes a horizontal opening of the conjunctiva over the 
external rectus muscle with scissors, midway between its bor- 
ders and extending from a point one line distant from the cor- 
nea inward as far as the semilunar fold, thus exposing the 
muscle without difficulty and without the occurrence of much 
bleeding. After having found the insertion of a muscle, a stra- 
bismus hook with an eye in its free extremity and armed with 
a waxed silk thread is passed beneath it, from below upward 
keeping the hook in close contact with the sclera, and carried 
sufficiently far back to include every straggling band or theca 
which is to be advanced. The uplifted mass is then tied close 
to its scleral implantation. The next step is to divide the 
attachment of the external muscle freely through a horizontal 
wound in the conjunctiva. The operator now holds the liga- 
ture, which is tied to the external rectus muscle, firmly in one 
hand, and with scissors severs the insertion of the muscle and 
gently breaks up any bands of connective tissue which may 
attach it to the sclera. Having satisfied himself that there are 
no adhesions which may obstruct the advancement of the mus- 
cle, he now catches the scleral edge of the cut tendon of the 
external rectus muscle, draws the cornea toward the inner 
canthus, and while he holds up the muscle on the stretch, the 
retentive sutures are placed. For this purpose two delicate, 
short and sharp-curved needles are armed with fine, well-waxed 
silk and adapted to a needle-holder. 

The author's method of placing this suture is, in his own 
words, as follows: "Having measured the extent to which the 
eyeball must be adducted in order to correct the divergence, 


the sutures should be passed through the muscle and its theca 
as far from its cut end as may be necessa-ry. The muscle 
should be drawn well out and kept on the stretch, so that the 
sutures may be passed through it as deeply as possible behind 
the caruncle, to secure a firm hold, and to leave a somewhat 
longer mass between the perforations made by the sutures and 
the ligature on its cut end than the original divergence meas- 
ured. The course of the sutures should be perpendicular to the 
plane of the muscle, one passing through near its upper mar- 
gin and the other near its lower. After the sutures have been 
placed in the muscle the end included in the ligature should be 
cut off, care being taken to leave enough to prevent their 
tearing out. The amount cut should nearly equal the degree 
of divergence to be corrected, allowance being made for shrink- 
age which has followed the detachment of the muscle from the 
sclera. The next step is to carry the sutures beneath the con- 
junctiva above and below the cornea. It is better to place the 
upper suture first. This also requires the curved needle. The 
point aimed at in carrying the needle along the sclera, beneath 
the conjunctiva, should be about a line above the cornea and 
over the center of the line of implantation of the superior rec- 
tus muscle, and there the suture should emerge. Before tying 
the upper, the lower suture should be brought out at a corre- 
sponding point over the inferior rectus insertion. While the 
operator is cautiously tying the sutures his assistant should, 
catching hold of the insertion of the external rectus, carry the 
cornea toward the internal canthus as much as possible and 
thus efi'ect what may be considered the real intention of the 
operator, namely, to adduct the eye strongly, and thus place 
the end of the shortened internal rectus in coaptation with the 
sclera at the natural line of sclerotic implantation. The exer- 
cise of a little care will cause the muscle to spread out and be 
hidden beneath the horizontal pillars of the wound through 
which the retentive sutures have been carried, thus insuring a 
consolidation of the wounded parts intervening between the 
cornea and the caruncle in the ultimate result. 

This operation has been followed by ophthalmic sur- 
geons and has proved most satisfactory. 



In 1867®® Dr. Agnew also devised an ingenious aud 
safe method for removing a thickened capsule or other 
pupillary obstruction, which was as follows : 

The pupil having been dilated by atropin, the operator 
passes a stop needle through the cornea about one line from 
the nasal border and transfixes the membraniform obstruction. 
Then while holding this steady, he makes an opening in the 
cornea about one-half line from the temporal border with a 
knife or a broad needle. Through this opening a sharp hook 
is introduced, and its point entered in the opening made in 
the membrane by the stop needle. If possible, the hook is now 
to be rotated and the membrane rolled up around it, and 
brought out of the anterior chamber. If it can not be drawn 
out, it should be torn. 

The patient is then kept in bed two or three days 
with the eye bandaged. The great advantage of the stop 
needle is that it prevents traction on the ciliary body. 


Dr. H. W. Williams, of Boston, was undoubtedly the 
jBrst to suggest suturing the corneal wound after cataract 
extraction. His first reference to the subject was made 
in 1866.®^ He again described his method in the last 
edition of his work on "Diseases of the Eye" (Edition of 
1886, p. 292), where he says : 

The use of a suture to bring together the edges of the cor- 
neal wound was proposed by me about twenty years since. 
Extensive further trial has proved the value of this expedient 
in many cases, whatever method of operation is employed; as 
also the perfect tolerance by the cornea of the exceedingly 
minute suture. 

60. See Stellwag. Am. Editions, 1868, p. 544, and 1873, p. 645. 

61. Trans. Am. Oph. Soc., 1866, p. 45. 


By holding the edges of the wound in contact the suture 
promotes immediate union, and tends to lessen the danger of 
hernia of the iris, loss of vitreous and suppuration of the 
wound; while, by securing early restoration of the anterior 
and posterior chambers, it removes the iris from contact with 
the cornea, or with portions of lens substance or capsule, thus 
preventing synechia, or inflammation of the ciliary body. In 
my judgment, the suture deserves attention as a means of 
gaining quicker and better results in any mode of extraction. 

The needle I use is one-fourth of an inch long, and has a 
flattened point with cutting edges. The needle -holder should 
not be fastened with a spring catch, but must be held with 
the fingers, so that the needle may be instantly released, with- 
out jar, at the proper moment. Only a single strand of the 
finest silk, scarcely larger than a filament from a cocoon, is 
used for the suture. One edge of the flap is taken hold of with 
a fine-toothed forceps, and held, while the needle is passed 
through it close to its border ; the needle may be pulled through 
at this side before the opposite edge is seized and penetrated 
at a corresponding point. The slight contusion of a small 
point of the cornea by the forceps, or the continued presence 
of the suture, does no apparent harm. The silk may be left 
in situ till it comes away, or may be removed in a few days 
after the healing is consolidated, too much haste in this re- 
spect being avoided. 


Dr. Williams in 18G7^^ also proposed a modification 
of probes for the lachrymal passages. The modification 
consisted in having bulbous extremities of the sizes of 
Bowman^s series^ and which are slender for one-third 
of the distance from the bulb to the flat disc at their 
middle. He directed that they should be made of al- 
loyed silver so that they might have an elastic flexibility 

62. Trans. Am. Oph. Soc, 1867, p. 30. 


without being liable to bend on themselves in encounter- 
ing obstructions, as would be the case were the silver too 


At about the same period®^ Dr. John Green, of St. 
Louis, suggested substituting for the rigid styles of sil- 
ver in the treatment of lachrymal obstructione those 
made of leaden wire : 

The wire should be of the purest and softest lead, and drawn 
to sizes ranging from one to two millimeters in diameter. 
The styles are easily cut with a penknife, and the ends are 
carefully rounded and smoothed by scraping. They are made 
perfectly straight, as they are more easily introduced in this 
form, and the upper end is bent over into a hooked form by 
means of forceps after it has been placed in position. 

Since Dr. Green suggested these styles many surgeons 
have used them with satisfaction. 


The publication of the test letters of Dr. Snellen, of 

Utrecht, Holland, in 1862, marks the beginning of the 

systematic testing of the acuteness of vision in clinical 

work. The principle of Snellen consisted in using 

^^lock'^ letters whose height subtends a visual angle of 

five minutes at given distances, and in recording the 

vision in accordance with the formula, V = — , V rep- 


resenting the acuteness of vision, d the distance at 
which the letters are viewed, and D the distance at 
which the smallest size of letter correctly named is rec- 
ognized by an average normal eye. The first American to 

63. Trans. Am. Oph. Soc, 1868, v. 31. 


appreciate the value of Snellen's principle and to intro- 
duce into this country test letters based upon it was the 
late Dr. Ezra Dyer, in 1862, even several months before 
the publication of Snellen's standard test-types. After 
a prolonged period of study in Europe, the last few 
months of which were passed in Utrecht, Dyer, in 1862, 
entered on the practice of ophthalmology in Philadel- 
phia. His letters, which were of different patterns 
placed in juxtaposition, were printed on a sheet for 
private use and distribution among his American col- 
leagues. The credit due to him is for his prompt recog- 
nition of the importance of Snellen's invention and for 
making it known in this country in advance of its gen- 
eral promulgation in Europe.^** 

Soon after the publication of Donders' studies on re- 
fraction and accommodation Dr. Green, of St. Louis, 
became one of his pupils. He at once gave especial at- 
tention to the detection and measurement of astigma- 
tism, his first paper being published in Holland in 1866 
and again in the United States in 1867.^^ His paper 
in the English language was entitled "On the Detection 
and Measurement of Astigmatism," in which, after giv- 
ing the definition of the term and a historical sketch of 
the subject, he proceeded to explain the methods of de- 
termining its presence, suggesting the use of new forms 
of charts made up of radiating lines or radiating rows 
of dots, designed in different forms and varying in num- 
bers. He suggested also certain improvements in the 
test types of Snellen which had both a mathematical 
and practical interest. In a later article the same 

64. From report of Dr. John Green, of St. Louis, Trans. Am. 
Ophthalmological Society, 1903, vol. x, p. 190. 

65. Am. Jour. Med. Sci., 1867, liii, 117. 


year"^® he wrote another paper on "Astigmatism Consid- 
ered in Its Relation to Defective Vision, Asthenopia and 
Progressive Myopia." After the contribution of Bon- 
ders this, so far as it went, was one of the most im- 
portant on the subject of astigmatism, and especially in 
its causal relations to myopia. The article can not be 
easily summarized, but should be read in full. 

Dr. Green's invaluable teachings in regard to the de- 
tection and correction of ametropia, beginning in 1867, 
have had great weight and they have permeated the 
whole ophthalmologic profession, and its members, many 
of them unconscious of their authorship, are determin- 
ing and treating astigmatism in accordance with them, 

fray's astigmatic letters. 

Soon after the ingenious charts of Dr. Green were 
presented to the public Dr. 0. M. Pray, of Brooklyn, 
suggested a form of test-type for astigmatism, in which 
the letters were made of lines running in different direc- 
tions.^'' These astigmatic letters met with great favor 
on the part of ophthalmologists for a long time. I fear 
they are not used as much to-day as they should be. 


Early in the '60s attempts were made by Dr. H. D. 
Noyes, of New York, and Dr. Liebreich, of Berlin, to 
photograph the fundus of the eye, but they were unsuc- 
cessful. In 1864 Dr. A. M. Eosebrugh, of Toronto, Can- 
ada, made another attempt with partial success. He 
devised a special form of ophthalmoscope with a camera 


66. Am. Jour. Med. Sci., 1867, liv, 82. 

67. Knapp's Arch. Oph. and Otol., 1869, i, 17. 


attached, and after a long series of experiments, assisted 
by our Toronto colleague. Dr. Eeeve, he succeeded in 
obtaining a "photograph of the eye of a cat, showing 
very clearly the nerve entrance and the larger branches 

of the vessels of the retina."** At the time of describ- 
ing his instrument and method he had not attempted 
to photograph the fundus of the human eye. This pio- 
neer effort, although not perfectly successful, demon- 
strated the scientific enterprise of this distinguished oph- 
thalmologist, and it was the forerunner of the successful 
results which have been obtained in the last few years. 

The above are a few of the more important American 
contributions that have been made to ophthalmology 
during its transition stage in this country from 1850 to 
1870. They forcibly indicate the energy, intelligence, 
resourcefulness and progressiveness of our ophthalmolo- 
gists of that period. While there were no momentous 
discoveries or startling revelations, there was a growing 
literature of genuinely scientific and practical value. 
There were many new experiences and new investiga- 
tions which tended either to confirm or to disprove the 
conclusions and views which other students and practi- 
tioners had advanced. Such instrumental devices as 
were made were of value, and both the surgical and 
medical therapeutics were more or less improved. Clin- 
ical facilities were increased by the readjustment of the 
old institutions and the creation of new ones, and the 
provisions of lectureships and professorships in our 
medical schools promoted the ophthalmologic movement. 
The organizing zeal and enterprise of our medical men 
in founding the American Ophthalmological Society 

68. Oph. Rev., London, 1864-5, i, 119. 


and the ophthalmological societies of New York City 
and Philadelphia^ together with the American Medical 
Association, established a "forum" for the freer inter- 
change of personal experiences, observations and con- 
clusions and for the fostering of those fraternal and 
ethical sentiments so conducive to united effort and 
scientific uplift. And, finally, Dr. Knapp came to this 
country, adopted it as his own, enriched it by his learn- 
ing, gave encouragement by his enthusiasm, and in the 
face of adverse prospects, supplied it with a journal 
of ophthalmology, which became for years the principal 
channel for transmitting to the profession the fruits 
of the best labors and the most intricate studies of those 
cultivating this branch of medical science. 



Developed to such definite proportions, erected on the 
firm foundations of three-fourths of a century's labor, 
built up of such forces as were at first nascent, and later 
active, in the men whom I have mentioned, and sus- 
tained by such activities as were going on in schools, in 
clinics, in organizations and in journalism, ophthalmol- 
ogy in America in 1870 had become an established spe- 
cialty. It had reached a development which no influ- 
ence could then retard, and an assurance of permanency 
and progress which could not be doubted. It had not 
only kept pace with the progress of general surgery and 
the development of other specialties, and, for the most 
part, had also shared in their improvements, but through 
the discovery of general and local anesthesia, the inven- 
tion of the ophthalmoscope, and the increased knowl- 
edge of refraction and physiologic optics, it had excelled 
them all in precision of diagnosis and in definiteness 
and certainty of therapeutics. Moreover, it had opened 
up a field of study and practice of greatly expanded 
boundaries, as compared to former times, and with an 
intensely fascinating attraction. 

The ophthalmologic ranks have since been gradually 
enlarged until now there are twenty-five hundred to 
three thousand members in America, basing the esti- 
mate on the membership of the Section on Ophthalmol- 
ogy of the American Medical Association. No Ameri- 


can medical school is without its didactic and clinical 
teachers in ophthalmology. Besides the general hos- 
pitals with ophthalmologic departments, there are at 
least thirty-five special hospitals in this country. The 
older eye institutions have grown to immense propor- 
tions and, aside from their clinical advantages, are pro- 
viding special facilities and opportunities for pathologic 
study and investigation. They are also engaging in 
experimental therapeutics which promise results of great 
value. Their equipment, in short, of ophthalmologic 
experts, of instrumental and laboratory appliances put 
them on a high plane of modem excellence. 

American ophthalmology, with its small army of prac- 
titioners, workers and contributors, has already devel- 
oped a literature too voluminous to be analyzed or even 
specified on this occasion. The transactions of the Amer- 
ican Ophthalmoligacl Society (1864) ; the ophthalmo- 
logical section of the American Medical Association 
(made a distinct organization in 1878, in my own city, 
Buffalo, through the efforts of Eugene Smith, of Detroit, 
and X. C. Scott, of Cleveland) ; the American Academy 
of Ophthalmology and Oto-Laryngology (1895) and the 
local ophthalmological organizations or sections of or- 
ganizations in New York City, Philadelphia, Boston, 
Chicago, Buffalo, Detroit, Denver and other cities; 
Knapp's Archives (1869) ; Alfs American Journal of 
Ophthalmology (1884) ; the Ophthalmic Record, 
founded by Savage (1891), now under the management 
of Wood and Woodruff; the Annals of Ophthalmology 
(1892), issued under the editorial supervision, at first 
of James P. Parker, then of Wood and Wiirdemann, 
and now of W. T. Shoemaker and C. W. Parker; and 


Wurdemann's OphthcUmology (1904), are great store- 
houses of American as well as foreign contributions of 
varying but, in the aggregate, of immense scientific and 
practical value. The history of ophthalmologic progress 
since 1870 is, in fact, written in these volumes. 

Auxiliary to these records have been those excellent 
summaries of current ophthalmologic progress, first so 
ably made by Hays and continued by Jackson in the 
American Journal of Medical Sciences, and afterward 
similarly presented by Noyes and Bull in the New York 
Medical Journal, by Thomson, Gould, Oliver, Posey and 
others in Sajous' Annual by Hansell, Clark, Eeber, Pyle 
and others in Saunders' Year-Booh, by Wood in the 
Practical Medicine Series volumes, and by Jackson and 
de Schweinitz in their Year-Book. 

Besides this form of literature there have been the 
treatises, systems, text-books and manuals on diseases 
of the eye, together with monographs and essays on spe- 
cial subjects, beginning with the great work of Noyes, 
in 1890, which was an outgrowth of a former treatise 
published by him in 1881, and ending with those of the 
last year or two, the authors of which are so well known 
as to need no mention. Some of these works, according 
to the purpose for which they have been written, are 
not excelled in correctness of style, evidence of learning, 
or comprehensiveness of matter, by similar works in any 

Supplementary to all of this there has been the inval- 
uable indexes of all ophthalmologic, as well as other 
medical literature, found in the Index Catalog of the 
Surgeon-GeneraPs library and in the Index Medicus. 



In my endeavor to describe the origin of our early eye 
institutions ; to call specific attention to those who have 
been foremost in keeping alive and advancing ophthal- 
mology in this country and in developing it into an or- 
ganized entity of enduring vitality, of scientific value 
and of honored recognition; and to trace its literature 
and most important contributions, from 1800 to 1870, 
I find that the material has been suflBciently abundant, 
important and interesting to warrant me in changing 
the scope of this paper as originally planned, and to 
bring it to a close at this point. I also justify myself 
in this change by the fact that it has already attained 
such proportions that the limitations of time and space 
forbid me to proceed further, although the records 
deepen in interest, at least to me, the nearer they ap- 
proach the professional lives and environments of to-day. 

Taking into consideration the educational and profes- 
sional conditions incident to a new and democratic 
country, it seems to me that American ophthalmology 
has had a development fully commensurate with its op- 
portunities and resources. It has been fostered by men 
of character, intelligence and skill, and has suffered 
comparatively little from the blighting influences of 
charlatanism. If viewed properly, it has a past of which 
all of us may feel proud. This is especially true of its 
institutional, scientific and literars' contributions dur- 
ing the period beginning with 18t0. 


As to its future, there is every reason to believe that, 
with the new intellectual and scientific life that has been 
infused into it; with the inexhaustible clinical and 
pathologic resources at command; with the stimulation 
to research work which such an organization as the Sec- 
tion of Ophthalmology of the American Medical Asso- 
ciation gives; and with a literature of such high excel- 
lence dominating professional thought and action, the 
outlook is resplendent with bright prospects and allur- 
ing promises. There can be no turning backward. The 
movement must be onward and upward. And when 
sufficient endowment of schools, teachers and labora- 
tories is provided to meet the needs of research teachers 
and students, and of experimental pathology, etiology 
and therapeutics, American ophthalmology will lead and 
not follow. May not such provision soon come as the 
crowning recognition by this rich and prosperous coun- 
try, of a pressing physical, intellectual and scientific 
need ihat can not otherwise be satisfied.