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OPHTHALMOLOGY 


ORAL  HISTORY  SERIES 


A  Link  With  Our  Past 


An  Interview  with 


Harold  Glendon  Scheie,  MD 


OPHTHALMOLOGY 


ORAL  HISTORY  SERIES 


A  Link  With  Our  Past 


Harold  Glendon  Scheie,  MD 
c.1970 


Harold  Glendon  Scheie,  MD 


Ophthalmic  Surgery 
and  the  Scheie  Eye  Institute 


An  Interview  Conducted  by 
Sally  Smith  Hughes,  PhD, 

1988 

With  Introductions  by 
Daniel  M.  Albert,  MD 
William  C.  Frayer,  MD 


The  Foundation  of  the  American  Academy  of  Ophthalmology,  San  Francisco 
Regional  Oral  History  Office,  University  of  California  at  Berkeley 


It  is  recommended  that  this  oral  history  be  cited  as  follows: 

Harold  Glendon  ScheieT  MDT  Ophthalmology  Oral  History  Series,  A  Link  With  Our  Past,  an  oral  history 
conducted  in  1988  by  Sally  Smith  Hughes,  Regional  Oral  History  Office,  University  of  California,  Berkeley  in 
cooperation  with  The  Foundation  of  the  American  Academy  of  Ophthalmology. 

Copyright  ©  1989  by  The  Foundation  of  the  American  Academy  of  Ophthalmology  and  the  Regents  of  the  University 
of  California.  All  rights  reserved.  All  uses  of  this  manuscript  are  covered  by  a  legal  agreement  between  Harold  G. 
Scheie,  MD  and  The  Foundation  of  the  American  Academy  of  Ophthalmology  and  the  University  of  California,  dated 
January  30,  1988.  All  literary  rights  in  the  manuscript,  including  the  right  to  publish,  are  reserved  to  The  Foundation  of 
the  American  Academy  of  Ophthalmology  and  The  Bancroft  Library  of  the  University  of  California  at  Berkeley.  No 
part  may  be  reproduced,  quoted,  or  transmitted  in  any  form  without  the  written  permission  from  the  Executive  Vice 
Chairman  of  The  Foundation  of  the  American  Academy  of  Ophthalmology  or  the  Director  of  The  Bancroft  Library  of 
the  University  of  California  at  Berkeley.  Requests  for  permission  to  quote  for  publication  should  include  identification 
of  the  specific  passages  to  be  quoted,  anticipated  use  of  the  passages,  and  identification  of  the  user.  The  legal 
agreement  with  Harold  G.  Scheie,  MD,  requires  that  he  be  notified  of  the  request  and  allowed  thirty  days  in  which  to 
respond. 

Cover  &  Title  Page  Design:  Romaniello  Design 
Printed  in  the  United  States 


The  Foundation  of  the  American 

Academy  of  Ophthalmology 

655  Beach  St. 

P.O.  Box  6988 

San  Francisco,  CA  94101-6988 


Regional  Oral  History  Office 
The  Bancroft  Library 
University  of  California 
Berkeley,  CA  94720 


CATALOG  CARD 


SCHEIE,  Harold  Glendon  born  1903  Ophthalmic  surgeon 

Harold  Glendon  Scheie,  MD:  Ophthalmic  Surgery  and  the  Scheie  Eye  Institute, 
1989,  xxvi,  321pp. 

Ophthalmology  Oral  History  Series 

The  Foundation  of  the  American  Academy  of  Ophthalmology  and 

The  University  of  California  at  Berkeley. 

Norwegian  homesteader  family  background;  undergraduate  and  medical 
education,  University  of  Minnesota;  internship  and  residency,  University  of 
Pennsylvania  Hospital;  Doctor  of  Medical  Science  degree,  University  of 
Pennsylvania;  faculty  member,  department  of  ophthalmology  University  of 
Pennsylvania,  1940-1975;  private  practice  with  Francis  Heed  Adler; 
ophthalmologist,  US  Army  Medical  Corps,  China-Burma-India  theatre  and 
Crile  Army  Hospital  Eye  Center,  Cleveland,  Ohio;  faculty  member,  Graduate 
School  of  Medicine,  University  of  Pennsylvania,  1946-1964;  chairman, 
department  of  ophthalmology,  University  of  Pennsylvania;  chief  of 
ophthalmology  services,  Philadelphia  Veterans  Administration  Hospital, 
Children's  Hospital  of  Philadelphia,  Philadelphia  General  Hospital;  Central 
Office  Chief  Consultant  in  Ophthalmology,  Veterans  Administration;  design, 
construction,  and  funding  of  Scheie  Eye  Institute;  history  of  glaucoma  and 
cataract  surgery;  contributions  to  glaucoma  and  cataract  surgery;  research  in 
medical  ophthalmology;  medical  student  and  resident  teaching;  medical 
organization  memberships;  honors;  acquaintance  with  Noel  Coward,  Stewart 
Duke-Elder,  Patrick  J.  Hurley,  Elias  Potter  Lyon,  Louis  Mountbatten,  Soon 
sisters,  and  others. 

Introductions  by  Daniel  M.  Albert,  MD,  and  William  C.  Frayer,  MD 
Interviewed  1988  by  Sally  Smith  Hughes,  PhD 
ISBN  0-926866-02-8 


VI 


OPHTHALMOLOGY  ORAL  HISTORY  SERIES 

Dohrmann  Kaspar  Pischel,  MD  1988 

PhiUips  Thygeson,  MD  1988 

Harold  Glendon  Scheie,  MD  1989 

Thomas  David  Duane,  MD  1989 

Paul  Boeder,  PhD  In  Progress 

David  Glendenning  Cogan,  MD  In  Progress 

Alfred  E.  Maumenee,  MD  In  Progress 

Dupont  Guerry,  III,  MD  In  Progress 


The  Foundation  of  the  American  Academy  of  Ophthalmology 
San  Francisco,  California 

Oral  Histories  Committee  Members  &  Staff: 

Susan  E.  Cronenwett 
Jill  Hartle 
Patricia  I.  Meagher 
David  J.  Noonan 
Arnall  Patz,  MD 
Erica  E.  Perez 
Wiliam  H.  Spencer,  MD 
Stanley  M.  Truhlsen,  MD 


Regional  Oral  History  Office,  The  Bancroft  Library 
University  of  California  at  Berkeley 

Project  Staff: 

Willa  K  Baum 
Sally  S.  Hughes,  PhD 
Sophia  Hayes 
Shannon  Page 


VII 


DONOR  REGISTRY 


The  oral  history  of  Harold  Glendon  Scheie,  MD  has  been  made  possible 
through  the  generosity  of  the  following  contributors: 

Melvin  G.  Alper,  MD 
Chevy  Chase,  Maryland 

B.  John  Ashley,  Jr.,  MD 
Topeka,  Kansas 

Randall  W.  Bell,  MD 
Wayne,  Pennsylvania 

Saul  Bresalier,  MD 
Pennsauken,  New  Jersey 

Todd  A.  Brockman,  MD 
Tulsa,  Oklahoma 

Alexander  J.  Brucker,  MD 
Villanova,  Pennsylvania 

J.  Douglas  Cameron,  MD 
Minneapolis,  Minnesota 

James  H.  Demming,  MD 
Daytona  Beach,  Florida 

David  L.  Edwards,  Jr.,  MD 
Tulsa,  Oklahoma 

Madeleine  Q.Ewing,  MD 
Philadelphia,  Pennsylvania 

William  C.  Prayer,  MD 
Philadelphia,  Pennsylvania 

Peter  G.  Gross,  MD 

Bala  Cynwyd,  Pennsylvania 

Thomas  F.  Hogan,  Jr. 
San  Antonio,  Texas 

Richard  B.  Kent,  MD 
Berwyn,  Pennsylvania 


viii 

David  M.  Kozart,  MD 
Philadelphia,  Pennsylvania 

Michael  Lamensdorf,  MD 
Sarasota,  Florida 

Alan  Laties,  MD 
Philadelphia,  Pennsylvania 

Sze  Kong  Luke,  MD 
Ontario,  Canada 

Hugo  E.  Martinez  Roig,  MD 
Rio  Piedras,  Puerto  Rico 

Ophthalmic  Club  of  Philadelphia 
Philadelphia,  Pennsylvania 

Presbyterian  Medical  Center  of  Philadelphia 
Philadelphia,  Pennsylvania 

Scheie  Eye  Institute 
Philadelphia,  Pennsylvania 

Harold  G.  Scheie,  MD 
Philadelphia,  Pennsylvania 

Cody  L.  Smith,  MD 
El  Cajon,  California 

Judson  P.  Smith,  MD 
Ft  Worth,  Texas 

David  B.  Soil,  MD 
Philadelphia,  Pennsylvania 

University  of  Pennsylvania  Alumni  Association 
Philadelphia,  Pennsylvania 

University  of  Pennsylvania  School  of  Medicine 
Philadelphia,  Pennsylvania 

Neil  S.  Williams,  MD 
Beaufort,  South  Carolina 


Harold  Glendon  Scheie,  MD 


CONTENTS 


PREFACE xiv 

INTRODUCTION  by  Daniel  M.  Albert,  MD     xvi 

INTRODUCTION  by  William  C.  Frayer,  MD xviii 

INTERVIEW  HISTORY  by  SaUyS.  Hughes,  PhD     xx 

Oral  History  Process xxi 

BIOGRAPHICAL  INFORMATION     xxv 

I.  FAMILY  BACKGROUND  AND  EARLY  EDUCATION 1 

Grandparents     2 

Childhood 2 

High  School      7 

Undergraduate,  University  of  Minnesota,  1927-1931 11 

Elias  Potter  Lyon      14 

II.  MEDICAL  EDUCATION  AND  EARLY  CAREER 19 

University  of  Minnesota  Medical  School,  1931-1935 19 

Faculty     21 

Jobs 24 

Internship,  University  of  Pennsylvania  Hospital, 

Julyl,  1935 -June  30, 1937     27 

Assistant  Medical  Officer     31 

Thomas  B.  Holloway 32 

Residency,  University  of  Pennsylvania, 

July  1, 1937-June  30, 1940 33 

Alexander  Garrison  Fewell     35 

Francis  Heed  Adler 37 

The  Basic  Science  Course  in  Ophthalmology, 

Graduate  School  of  Medicine 39 

The  Department  of  Ophthalmology 40 

The  Poison  Gas  Project 41 

Prostigmin  in  Myasthenia  Gravis 42 

Julius  H.  Comroe,  Jr. 44 

Medical  Innovations 45 

The  Tonic  Pupil 48 

Doctor  of  Medical  Science  in  Ophthalmology 51 

Private  Practice  With  Dr.  Adler 53 

Physiology  of  the  Aqueous  Humor 59 

The  Sulfonamides  in  Ophthalmology 60 


III.  OPHTHALMOLOGIST,  U.S.  ARMY  MEDICAL  CORPS,  1942-1946    .  66 

Formation  of  the  20th  General  Hospital     66 

Camp  Claiborne,  Louisiana     69 

Camp  Anza,  California 71 

Ledo,  India    75 

The  Layout,  Work,  and  Personnel  of  the  Hospital  Unit      ....  78 

Willy  Winstead     88 

The  Chinese  Troops 91 

Scrub  Typhus 92 

Angioid  Streaks  of  the  Retina     95 

Louis  Mountbatten 99 

Patrick  J.  Hurley 105 

Joseph  Warren  Stilwell 107 

The  Soong  Sisters 108 

Stewart  Duke-Elder     109 

Noel  Coward     112 

The  Heaolhunter      113 

The  Wartime  Experience 116 

Returning  from  India 118 

Injection  of  Oxygen  into  Tenon's  Capsule 119 

Crile  Army  Hospital  Eye  Center,  Cleveland,  Ohio 120 

The  Staff     121 

Fever  Therapy     124 

Penicillin  and  Sulfa  Drugs 124 

Commanding  General,  31st  Hospital  Center  Headquarters   ....  125 

IV.  UNIVERSITY  OF  PENNSYLVANIA    129 

The  Immediate  Postwar  Period 129 

More  on  Francis  Heed  Adler 130 

Instructor,  Graduate  School  of  Medicine     132 

Chairman,  Department  of  Ophthalmology     134 

Retinal  Detachment  Work 135 

Radiation  of  the  Cornea     137 

Adrenocorticotropic  Hormone  and  Cortisone    138 

Retinal  Changes  Associated  with  Hypertension 

and  Arteriosclerosis     141 

Local  Anesthetic  Agents     142 

Visual  Field  Defects  in  Exophthalmos 144 

Retrolental  Fibroplasia 144 

Conditions  Associated  with  Pigmentary  Glaucoma 146 

Chief  of  Ophthalmology  Service  and  Consultant,  Veterans 

Administration  Hospital,  Philadelphia  1953-1975      147 

Wills  Eye  Hospital 149 

Chief  of  Ophthalmology  Service  and  Consultant, 

the  Children's  Hospital  of  Philadelphia,  1960-1972 152 

Chief  of  Ophthalmology  Service, 

Philadelphia  General  Hospital,  1960-1975 154 

Other  Consultantships 155 

The  Philadelphia  Home  for  Incurables-Inglis  House     158 

Central  Office,  Chief  Consultant  in  Ophthalmology, 

Veterans  Administration,  Washington,  D.C.,  1951-1959     ....  159 


Chairman,  Department  of  Ophthalmology,  University  of 

Pennsylvania  School  of  Medicine,  1960-1975    162 

Renovating  the  Department 163 

Staff 166 

New  Equipment     167 

The  Resident  Training  Program 169 

Other  Departmental  Improvements      171 

The  Medical  Students'  Curriculum  in  Ophthalmology   ....  172 

The  Resident  Training  Program      176 

Presbyterian  Hospital     178 

Selecting  the  Site  for  the  Scheie  Eye  Institute 178 

Grand  Rounds  and  Teaching  Conferences     182 

Teaching  Surgery 185 

Patient  Care     187 

Books 190 

Hyphema 193 

Hurler's  Syndrome 194 

Rubeola  Retinopathy     198 

Surgery 199 

Routine 201 

Sutures 204 

The  Scheie  Eye  Institute     207 

Design 209 

Research     215 

Affiliations     217 

Glaucoma 218 

Historical  Background 219 

Instrumentation     222 

Twentieth  Century  Contributions 224 

Types  of  Glaucoma 227 

The  Neurovascular  and  Gonioscopic  Concepts 228 

Goniotomy      231 

The  Academy  Symposium  on  Glaucoma,  1948    234 

Goniopuncture     236 

The  Scheie  Procedure     240 

Pseudoglaucoma    242 

Induced  Ocular  Hypertension 243 

Peripheral  Iridectomy     245 

Gonioscopy  in  Tumor  Diagnosis 246 

Tonography 247 

Angle-width  and  Pigmentation  Grading  by  Gonioscopy    .  .  .  250 

Cyclodiathermy 250 

Sources  of  Error  in  Perimetry 252 

The  Miotic  Resistant  Pupil     252 

Glaucoma  and  Iris  Atrophy     253 

OralGlycerol 254 

Iris  Nevus  and  Glaucoma     255 

Pigment  Dispersion  Syndrome     256 

Operating  for  Glaucoma 258 

Cataracts 260 

Extracapsular  versus  Intracapsular  Extractions 261 


Xll 

Phacoemulsification     262 

Intraocular  Lenses     263 

Cataract  Ripening     265 

Cataract  Aspiration 266 

Criteria  for  Operating  for  Cataract     269 

Steps  in  Operating  for  Cataract 270 

Anesthesia      272 

Postoperative  Care 273 

Cryoextraction     275 

Alpha-chymotrypsin     275 

Miotic  Agents  and  Anesthesia 277 

Procedures  for  Cataract  Extraction     279 

Rubella  Cataracts 287 

The  Light  Coagulator  and  the  Laser     291 

Membership  in  Medical  Organizations 293 

Academia  Ophthalmologica  Internationalis 294 

American  Academy  of  Ophthalmology  and  Otolaryngology     .  294 

American  Association  of  Ophthalmology     295 

American  Board  of  Ophthalmology     295 

American  College  of  Surgeons 297 

Section  on  Ophthalmology,  AMA 300 

American  Ophthalmological  Society 301 

College  of  Physicians  of  Philadelphia 303 

Editorial  Work 304 

Miscellaneous 308 

Retirement     309 

The  Hotel  Fire,  Norway,  September  1986 310 

Controversies  in  Ophthalmology 313 

Subspecialization  in  Ophthalmology      314 

Thomas  D.  Duane 315 

Governmental  Intervention  in  Medicine      316 

Disseminating  Information  in  Ophthalmology 316 

Writing  Papers     317 

Movies  and  Videotapes 318 

LifeStyle     319 

Major  Advances  in  Ophthalmology  and  the 

Basic  Sciences     319 

Dr.  Scheie's  Greatest  Contribution      320 

APPENDICES 

Curriculum  Vitae 325 

Bibliography      333 

INTERVIEWER  BIOGRAPHY 342 

INDEX  .  343 


Xlll 


XIV 


PREFACE 

Ophthalmology  Oral  History  Series 

American  ophthalmology  has  undergone  striking  changes  since  World  War  II, 
not  only  in  terms  of  basic  science,  diagnosis,  and  therapy,  but  also  in  terms  of 
its  internal  organization  and  relationship  with  the  rest  of  medicine  and  with 
the  federal  and  state  governments.  Aware  of  the  need  to  document  these 
changes,  the  Foundation  of  the  American  Academy  of  Ophthalmology  sought  a 
means  to  preserve  the  memories,  experiences,  and  insights  of  individuals  who 
had  lived  through  them. 

The  result  was  the  inauguration  in  1986  of  the  Ophthalmology  Oral  History 
Series,  an  ongoing  series  of  in-depth  interviews  with  senior  ophthalmologists 
and  others  who  have  made  significant  contributions  to  the  specialty.  Aside 
from  providing  enjoyment  and  inspiration,  the  series'  intent  is  to  preserve  a 
fund  of  historical  information  which  might  otherwise  be  lost  and  to  give 
ophthalmologists  a  sense  of  their  discipline's  heritage. 

In  January  1986,  an  Oral  Histories  Committee,  consisting  of  William  H. 
Spencer,  MD,  (chairman),  Stanley  M.  Truhlsen,  MD,  Susan  E.  Cronenwett, 
Patricia  I.  Meagher,  and  David  J.  Noonan,  was  formed  to  facilitate  collection  of 
the  oral  histories.  A  selection  subcommittee,  with  an  anonymous  membership 
of  three  senior  ophthalmologists,  was  appointed  to  select  individuals  to  be 
interviewed  from  nominations  by  the  Foundation  Board  of  Trustees  and  the 
Academy  Board  of  Directors. 

In  selecting  individuals  to  be  interviewed,  the  subcommittee  considers  the 
individual's  age,  prominence  in  and  contributions  to  ophthalmology,  and 
ability  and  motivation  to  participate  in  the  project.  As  the  series  expands,  an 
effort  will  be  made  to  select  interviewees  from  different  areas  of  the  country 
and  with  different  subspecialty  interests.  Regional  subcommittees  provide 
information  concerning  the  local  ophthalmologists  to  be  interviewed  and  assist 
in  fund  raising  for  the  oral  history  series. 

Production  of  the  oral  histories  is  carried  out  by  the  Regional  Oral  History 
Office  of  the  University  of  California  at  Berkeley.  Sally  Smith  Hughes,  PhD,  a 
medical  historian  with  the  Regional  Oral  History  Office,  conducts  the 
research,  interviewing,  and  editing,  and  collaborates  with  Foundation 
personnel  in  final  production  of  the  oral  history  volumes.  Willa  K.  Baum, 
director  of  the  Regional  Oral  History  Office,  serves  as  consultant.  For  over 
thirty  years  the  Regional  Oral  History  Office  has  conducted  interviews  with 


XV 

West  Coast  leaders  in  all  walks  of  life  and  is  pleased  to  have  the  opportunity 
to  expand  nationally  to  document  the  history  of  American  ophthalmology. 

An  oral  history  memoir  is  a  recorded  and  transcribed  series  of  interviews 
designed  to  preserve  the  recollections,  knowledge,  and  reactions  of  a  person 
who  has  played  a  significant  role  in  or  observed  important  events.  It 
represents  an  important  way  to  preserve  information  and  opinions  that  the 
narrator  alone  is  able  to  provide.  The  transcriptions  are  edited,  reviewed  by 
the  narrator,  retyped,  indexed,  and  bound  with  photographs  and  illustrative 
material,  and  placed  in  appropriate  research  libraries. 

The  finished  product  is  both  a  record  of  a  conversation  and  a  primary  research 
source.  It  should  not  be  regarded  as  having  the  polish  and  finality  of  a 
published  book.  It  is  not  intended  to  present  the  final,  verified,  and  complete 
account  of  events.  Rather,  it  reflects  the  narrator's  view,  sometimes  recounted 
with  partisanship  and  passion,  sometimes  with  impartiality  and  objectivity, 
but  always  vivid,  immediate,  and  irreplaceable. 

Oral  history  in  one  sense  is  an  informal  art,  one  that  relies  on  the  give  and 
take  between  two  individuals  holding  a  directed  conversation.  Thus  the 
reader  should  not  expect  a  studied,  impersonal,  and  invariably  exhaustive 
discourse  in  the  pages  that  follow.  Instead,  good  oral  history  offers  a  view  of 
the  narrator  and  his  opinions  up  close,  expressed  with  the  immediacy,  appeal, 
and  occasional  errors  of  everyday  speech. 

The  interviews,  which  are  entirely  supported  by  private  contributions,  are 
meant  for  a  wide  audience.  Although  the  focus  is  ophthalmology,  the  goal  is  to 
produce  documents  of  broad  historical  interest  through  full,  referenced, 
multidimensional  biographies. 

Indexed  and  bound  transcripts  of  the  interviews  are  available  to  readers  at  the 
Foundation  of  the  American  Academy  of  Ophthalmology,  the  Bancroft  Library, 
the  National  Library  of  Medicine,  and  other  medical  and  manuscript  libraries. 
The  interview  tapes  and  supplementary  material  relevant  to  each  interview 
are  on  deposit  at  the  Foundation.  Oral  history  volumes  may  be  ordered  from 
the  Foundation. 


Sally  Smith  Hughes,  PhD  William  H.  Spencer,  MD 

Interviewer-Editor  Chairman 

Regional  Oral  History  Office  Oral  Histories  Committee 

University  of  California,  Berkeley  The  Foundation  of  the 

American  Academy  of 
Ophthalmology 

March  1988 


XVI 


INTRODUCTION 
Daniel  M.  Albert,  MD 


I  first  met  Dr.  Harold  Scheie  thirty  years  ago  when  I  was  a  medical  student  at 
the  University  of  Pennsylvania.  In  the  ensuing  years  he  was  my  teacher,  role 
model,  chief,  advisor,  and  friend.  During  this  time  my  admiration  and 
affection  for  him  have  continuously  grown. 

The  oral  history  that  follows  covers  in  detail  his  monumental  contributions  to 
ophthalmology  and  recounts  the  progressive  milestones  of  his  life.  In  this 
brief  introduction  I  would  like  to  share  some  of  my  own  insights  into  the 
personal  character  of  the  man.  His  energy  and  forcefulness  sometime  obscure 
the  fact  that  he  is  a  planner,  always  well  aware  of  his  goals.  He  is  at  once  a 
cautious  person  avoiding  unnecessary  risks  or  confrontations,  and  an 
individual  of  courage  willing  to  take  chances. 

Dr.  Scheie  is  a  man  of  great  pride  and,  although  proud  of  his  midwestern, 
frontier  origins,  is  anxious  that  none  of  the  rough  edges  remain  or  show.  He  is 
an  intensely  loyal  individual  who  cares  about  his  friends.  He  follows  the 
Protestant  work  ethic  to  the  extreme.  Although  seemingly  impatient  and 
intolerant  of  mistakes,  he  has  a  persistence  that  in  my  experience  is  unique. 
He  does  not  give  up  on  an  objective  or  goal  despite  what  has  sometimes  been 
years  of  adversity  or  negative  results. 

He  is  a  shrewd  judge  of  individuals,  a  "quick  study,"  able  to  access  with 
remarkable  rapidity  the  strengths  and  weaknesses  of  those  about  him.  Most 
impressively  of  all,  he  is  able  to  appraise  what  really  counts  to  a  person  and 
relate  to  those  needs,  desires,  and  goals. 

In  1972  when  the  Scheie  Eye  Institute  opened,  I  wrote  an  introduction  to  a 
collection  of  selected  papers  by  Dr.  Scheie,  published  to  commemorate  that 
event.  I  came  then  to  the  following  conclusion  in  attempting  to  give  the  key  to 
Dr.  Scheie's  character,  a  conclusion  which  I  still  believe: 

Perhaps  the  secret  lies  in  the  prairies  ofBrookings  County,  South 
Dakota,  and  in  Plaza,  North  Dakota,  and  in  Warren,  Minnesota, 
where  he  grew  up.  For  he  is  a  link  between  the  Old  Frontier,  the  days 
of  the  doctors  on  horseback  and  the  rugged  individualist,  and 
government  medicine  of  the  1970s. 

When  Frederick  Jackson  Turner  came  to  the  end  of  his  long  study  of 
the  influence  of  the  American  Frontier  on  American  character,  he 
attempted  to  define  the  dominant  human  characteristic  produced  by 


xvii 


frontier  living  and,  in  the  process,  drew  a  word  portrait  of  Harold  G. 
Scheie.  He  defined  frontier  characteristics  as  "that  coarseness  and 
strength  combined  with  acuteness  and  inquisitiueness;  that  practical, 
inventive  turn  of  mind,  quick  to  find  expedience;  that  masterful  grasp 
of  material  things,  lacking  in  the  artistic  but  powerful  to  affect  other 
ends;  that  restless  nervous  energy;  that  dominant  individualism, 
working  for  good...  with  buoyancy  and  exuberance  which  comes  from 
freedom.. .these  are  the  traits  of  the  frontier  or  traits  called  out 
elsewhere  because  of  the  existence  of  the  frontier."* 


*    Hedges  TR,  Prayer  WC,  Albert  DM:  Harold  G.  Scheie:  A  Biographic  Sketch  and  Selected  Papers.  On  the 
occasion  of  the  dedication  of  the  Scheie  Eye  Institute,  1972. 


XV111 


INTRODUCTION 
William  C.  Frayer,  MD 


Harold  Scheie  once  told  me  that  as  a  boy  he  was  always  up  before  anyone  else, 
running  out  to  the  fields,  often  to  sit  on  a  fence  and  dream  of  the  future  and  of 
what  he  wanted  to  make  of  it.  The  reality  of  farm  life  in  those  days  left  little 
time  for  dreaming,  however,  and  young  Harold  had  to  spend  most  of  his  time 
helping  with  the  daily  chores  or  studying.  Habits  of  hard  work  formed  during 
those  years  were  the  substance  from  which  his  dreams  have  been  built. 

I  first  met  him  forty  years  ago,  after  those  hard  years  were  over.  He  had 
completed  his  training,  had  served  in  the  army  and  had  begun  his 
distinguished  academic  career  at  the  University  of  Pennsylvania  under  the 
guidance  of  Dr.  Francis  Heed  Adler.  I  was  applying  for  a  residency  and  an 
interview  was  a  part  of  the  process. 

I  found  Dr.  Scheie  working  with  some  of  the  residents  in  a  laboratory  in  the 
basement  of  the  medical  school.  He  graciously  took  a  few  minutes  to  talk  to 
me  in  the  hallway  outside.  I  have  a  vivid  memory  of  that  brief  encounter.  He 
turned  his  attention  completely  to  me  for  those  few  minutes,  a  trait  I  saw  later 
many  times  when  he  was  talking  with  patients.  His  questions  were  searching 
but  essentially  kind.  Like  everyone  else  meeting  him  for  the  first  time,  I  was 
impressed.  Naturally,  I  was  thrilled  when  I  received  the  appointment  as  a 
first  year  resident.  It  was  the  beginning  of  a  long  and  gratifying  association 
with  this  remarkable  man. 

In  the  early  years  I  soon  began  to  respect  and  admire  his  ability  as  a  teacher, 
not  so  much  in  the  classroom,  but  at  the  bedside.  We  made  ward  rounds  with 
him  early  every  morning.  We  were  expected  to  be  there  on  time  and  to  know 
everything  about  our  patients.  His  probing  questions  were  sometimes 
embarrassing  but  always  made  us  think.  He  captured  our  interest  and  helped 
us  to  learn.  Just  as  he  disciplined  himself  to  look  deeply  at  the  problem,  so  he 
taught  us  to  discipline  ourselves. 

He  was  also  a  superb  clinician.  His  approach  to  patients  was  direct  and 
unerring.  He  wasted  no  time  on  irrelevant  questions  but  went  right  to  the 
heart  of  the  problem.  He  was  greatly  concerned  with  efficiency  and  designed 
his  examining  rooms  and  his  operating  schedule  to  make  the  most  of  every 
minute.  His  ability  to  work  quickly  coupled  with  his  prodigious  energy 
brought  him,  in  time,  a  very  large  practice. 


XIX 


Watching  him  practice  was  the  way  to  a  better  understanding  of  the  man.  He 
saw  many  patients  during  the  course  of  a  day  and  seemingly  was  able  to 
concentrate  all  of  his  attention  on  each  one.  Patients  always  felt  that  he  was 
interested  only  in  their  problem  and  came  away  feeling  much  better,  even 
though  he  may  have  only  reassured  them.  For  those  who  were  really  in 
trouble,  he  gave  more  than  his  share.  No  effort  was  too  great  if  it  meant 
saving  an  eye  or  helping  a  patient  through  a  difficult  or  painful  ordeal. 
Patients  of  all  kinds  received  the  same  attention. 

Harold  Scheie  was  a  widely  respected  consultant.  Many  times  each  day  he 
was  called  upon  to  resolve  complex  problems  sent  to  him  by  other  physicians. 
I  thought  he  was  especially  adept  in  handling  this  portion  of  his  practice. 
Whenever  I  asked  him  for  an  opinion,  he  always  made  sure  that  the  patient 
returned  to  me.  These  patients  all  came  back  singing  his  praises  and  mine. 
He  managed  to  do  this  even  when  he  thought  I  was  dead  wrong! 

And  now  he  has  seen  his  life's  dream  fulfilled.  He  has  created  an  eye  institute 
dedicated  to  patient  care,  education,  and  research.  His  own  integrity,  energy, 
and  steadfast  determination  have  made  it  possible.  He  can  be  very  proud  of 
what  he  has  accomplished. 

April,  1989 


XX 


INTERVIEW  HISTORY 

Sally  S.  Hughes,  PhD 


This  oral  history  of  Harold  Glendon  Scheie  is  the  third  in  a  projected  series 
with  prominent  individuals  in  American  ophthalmology.  The  Foundation  of 
the  American  Academy  of  Ophthalmology,  sponsor  of  the  series,  chose  Dr. 
Scheie  because  of  his  many  contributions  to  ophthalmology,  ophthalmic 
teaching,  ophthalmic  research,  and  ophthalmic  surgery  and  his  role  as  founder 
and  former  director  of  the  Scheie  Eye  Institute  at  the  University  of 
Pennsylvania. 

In  the  interviews  Dr.  Scheie  tells  of  his  modest  beginnings  in  the  harsh 
country  of  the  Dakotas  and  northern  Minnesota.  Life  on  this  frontier- 
including  eight  years  homesteading  on  an  Indian  reservation-doubtless 
fostered  the  force  of  character,  independence,  and  respect  for  hard  work  by 
which  he  is  distinguished.  His  family's  straitened  circumstances,  compounded 
by  the  depression  which  crippled  agricultural  areas  of  the  midwest  a  few  years 
before  the  market  crash  of  1929,  placed  the  responsibility  of  obtaining  a  higher 
education  and  professional  career  squarely  on  young  Harold's  shoulders.  He 
describes  his  undergraduate  and  medical  education  at  the  University  of 
Minnesota,  the  various  jobs  he  held  to  support  himself  and  assist  his  sisters, 
and  his  association  with  Dean  Elias  Potter  of  the  medical  school,  who 
persuaded  his  protege  to  apply  to  medical  school. 

The  interviews  go  on  to  relate  the  launching  of  his  medical  career  in  1935  as 
one  of  only  two  out-of-state  interns  at  the  University  of  Pennsylvania  Hospital, 
his  reasons  for  specializing  in  ophthalmology,  and  his  complex  relationship 
with  Francis  Heed  Adler,  first  as  a  resident  and  later  as  university  colleague 
and  partner  in  Dr.  Adler's  private  practice. 

Ironically,  the  horrors  of  World  War  II  provided  Dr.  Scheie  and  many  other 
young  military  physicians  and  surgeons  with  countless  opportunities  for 
professional  and  personal  growth.  He  tells  the  engrossing  story  of  his  taxing 
responsibilities  as  the  only  ophthalmologist  assigned  to  Ledo,  India,  at  one  end 
of  the  Ledo  Road,  which  figured  prominently  in  the  military  campaign  in  the 
China-Burma-India  theatre.  At  his  most  expansive  on  this  stage  of  his  life, 
Dr.  Scheie  entertains  the  reader  with  stories  of  patients  ranging  from  a 
Burmese  headhunter  to  Lord  Louis  Mountbatten,  Supreme  Allied  Commander 
of  the  CBI  theatre  and  cousin  of  Queen  Elizabeth. 

But  these  were  the  highlights  of  his  wartime  assignment.  The  reality  was 
providing  eye  care  for  thousands  of  American  and  Chinese  troops,  the  latter 


XXI 


riddled  with  trachoma  and  syphilis.  It  was  this  day-to-day  experience  of  a 
wide  range  of  medical  and  surgical  problems,  and  the  administrative  skills 
and  efficiency  requirements  he  developed  to  cope  with  them,  which  were  to 
serve  him  so  well  when  he  resumed  his  medical  career  at  home. 

The  interviews  describe  the  postwar  expansion  of  the  department  of 
ophthalmology  at  Penn  and  Dr.  Scheie's  intense  involvement  with  the  funding, 
design,  and  construction  of  the  Scheie  Eye  Institute,  where  he  served  as  its 
forceful  and  energetic  director  from  1972  until  his  mandatory  retirement  in 
1975.  In  addition  to  his  administrative  responsibilities,  Dr.  Scheie  maintained 
a  crushing  surgical  schedule,  improved  procedures  for  glaucoma  and  cataract 
surgery,  conducted  research  on  diverse  medical  aspects  of  ophthalmology, 
formulated  and  engaged  in  medical  student  and  resident  teaching,  and,  above 
all,  cared  for  patients-lots  and  lots  of  patients. 

How  did  he  handle  these  diverse  and  demanding  responsibilities?  Dr.  Scheie 
has  a  simple  answer:  "...I  have  always  worked  like  the  dickens  and  tried  to 
take  good  care  of  my  patients."  He  understates  his  dedication  to  patients. 
They  always  came  first,  regardless  of  who  they  were.  A  resident  of  South 
Philly  got  the  same  careful,  personal  treatment  as  a  member  of  the  city's  social 
elite. 

Yet  this  benevolence  was  combined  with  a  perfectionism  which  drove  him  to 
require  the  best  of  his  associates  and  even  more  of  himself.  The  tension  in  the 
operating  room  must  have  been  considerable:  "I  tried  to  keep  everybody  on 
their  toes,  because  when  I  was  in  the  operating  room,  it  was  serious.  I  couldn't 
stand  a  bad  result." 

As  the  reader  may  suspect,  Dr.  Scheie's  retirement  did  not  mean  withdrawal 
from  active  life.  Until  this  month,  he  continued  at  eighty  to  go  daily  to  his 
office,  where  he  planned  the  funding  strategies  of  the  institute  which  not  only 
bears  his  name  but  also  the  mark  of  one  who  has  always  striven  for  the  best. 


Oral  History  Process 

In  preparation  for  the  oral  history,  short  interviews  were  taped  in  person  or  by 
telephone  with  nine  friends  and  colleagues  selected  by  Dr.  Scheie:  Daniel  M. 
Albert,  MD,  Madeleine  Q.  Ewing,  MD,  William  C.  Frayer,  MD,  John  R.  Jones, 
Mrs.  A.  Evans  Kephart,  H.L.  Harry  Pepper,  Eric  G.  Scheie,  Cletus 
Schwegman,  MD,  and  George  S.  Tyner,  MD.  These  interviews  were 
invaluable  for  they  produced  information  and  insights  lacking  in  written 
sources.  Nine  interviews  of  varying  lengths  were  recorded  with  Dr.  Scheie 
between  January  27  and  June  15, 1988.  Interviews  one,  eight,  and  nine  were 
conducted  in  Dr.  Scheie's  imposing  office  at  the  Scheie  Eye  Institute.  The 
room  reflects  two  contrasting  aspects  of  this  complex  man:  The  efficiency 
expert  par  excellence,  epitomized  in  an  elaborate  panel  of  switch  buttons  for 
the  institute's  signal  system,  and  the  sentimentalist  who  treasures  mementos 
from  his  patients,  awards  from  his  colleagues,  and  photographs  and  artwork 
from  his  friends  and  benefactors. 


XX11 


Interviews  two  and  three  were  taped  in  the  Scheies'  modern  condominium  on 
the  Jersey  shore  overlooking  the  ocean.  Advantage  was  taken  of  the  Scheie's 
annual  visit  to  San  Francisco  to  see  their  son  Eric  to  record  sessions  four 
through  seven  at  the  Academy  headquarters  on  Beach  Street. 

Hesitant  at  first,  Dr.  Scheie  quickly  warmed  to  the  interview  process, 
responding  carefully  and  completely.  Particularly  remarkable  was  his 
memory  for  details  of  his  research,  which  ranged  widely  over  medical  and 
surgical  aspects  of  ophthalmology  and  resulted  in  the  publication  of 
approximately  230  papers  and  several  books.  The  Scheie  procedure  (which  Dr. 
Scheie  and  his  staff  always  called  peripheral  iridectomy  with  scleral  cautery), 
the  Scheie  syndrome,  the  Scheie  test,  and  other  contributions  are  discussed, 
with  fullest  coverage  given  to  his  work  in  glaucoma  and  cataract  surgery,  the 
principal  basis  for  his  reputation  in  ophthalmic  surgery. 

Each  interviewing  session  was  followed  by  a  social  occasion,  usually  at  a 
seafood  restaurant,  graciously  hosted  by  Dr.  Scheie  and  his  supportive  wife 
Polly.  On  the  first  occasion,  the  privileged  guest  was  kept  on  her  toes  by  the 
host's  detailed  demonstration  of  the  niceties  of  lobster  dissection.  The  trick, 
one  quickly  learned,  was  to  find  time  to  eat  the  delicacy  and  also  respond 
appropriately  to  Dr.  Scheie's  witty  banter  and  to  the  chain  of  friends 
presenting  themselves  at  his  table. 

Transcriptions  of  the  interviews  were  edited  and  sent  to  Dr.  Scheie  who,  with 
his  prodigious  dedication  to  the  task  at  hand  and  despite  deteriorating  health, 
revised  them  painstakingly.  He  then  asked  Mrs.  Charlotte  Beurer,  his 
devoted  secretary  of  over  thirty  years,  to  retype  the  transcript-three  times,  the 
rumor  goes.  The  product  is  considerably  changed  stylistically  but  differs  little 
in  content  from  the  original.  (A  former  secretary,  after  being  put  through  a 
similar  ordeal,  was  overheard  to  bemoan:  "Dr.  Scheie,  I  think  you  would  try  to 
revise  Shakespeare!")  When  Dr.  Scheie  had  finished  reviewing  the  entire 
manuscript,  we  met  in  San  Francisco  to  clarify  a  few  points  and  to  celebrate 
with  Mrs.  Scheie  and  the  Academy  staff  over  another  dinner. 

With  Dr.  Scheie's  ready  agreement,  Drs.  Daniel  Albert  and  William  Frayer 
were  asked  as  close  personal  and  professional  friends  to  write  introductions 
portraying  Dr.  Scheie  as  an  ophthalmologist  and  a  personality. 

The  oral  history  records  the  life  and  opinions  of  a  man  of  diverse  facets: 

—  a  man  of  humble  origins  who  came  to  associate  with  the  rich,  the  famous, 
and  the  powerful, 

—  an  individualist  who  ran  his  practice,  his  department,  and  his  institute 
according  to  his  own  personal  high  standards, 

—  a  perfectionist  who  universally  demands  the  best,  especially  of  himself, 

—  a  teacher  noted  for  his  clear  explanations  and  breadth  of  knowledge,  whose 
demands  for  total  commitment  could  terrorize  the  incompletely  committed, 

—  a  researcher  who  ranged  broadly  over  his  beloved  specialty  of  ophthal 
mology,  who  refuses  to  think  of  himself  as  a  subspecialist  in  anything, 
despite  an  international  reputation  in  glaucoma  and  cataract  surgery, 


XX111 


a  frontier  spirit  who  takes  immense  pride  in  building,  without  government 
money,  the  ten-million  dollar  Scheie  Eye  Institute, 

and  above  and  beyond  all  else,  a  physician  who  loves  caring  for  patients, 
and  whose  patients  love  him,  not  only  for  his  unquestioned  medical  and 
surgical  skills,  but  because  he  cares  for  them  as  individuals,  regardless  of 
their  status  in  life. 

June,  1989 


XXIV 


XXV 


Regional  Oral  History  Office 
University  of  California 
Berkeley,  California 


The  Foundation  of  the  American 
Academy  of  Ophthalmology 
San  Francisco,  California 


OPHTHALMOLOGY    ORAL   HISTORY    SERIES 
BIOGRAPHICAL   INFORMATION 

(Please  write  clearly,  don't  type.  Use  black  ink.) 
Your  full  name  -  ^f^. 


Date  of  birth 


Father's  full  name  -rJ   -,-,  ^, 


-T^r**t*^  -  tfA-TVT**  ft  <*P i  y<"-h  &  Death  dates  /  f"7  V- 

Mother's  full  name  /•  f-g^^  ~ ^K^O^\  ^$*t^*.**n 

^  *          /) 
Occupation. 

Spouse's  full 


Where  did  you  grow  up? 
Present  community 

Education _ 

(Undergraduate,  Medical' Softool,  Internship,  Residency) 
of- 


ff^^L-   T 
" • 


Occupation(s) 
Areas  of  expertise 


Birth  &  Death  dates 


Children's  full  name 


Other  interests  or  activities  ICJL+ -&++*> 


Active  in  which  medical  organ  iz  at  ions 


Other  organizations 


Dr.  Scheie  being  interviewed  by 
Dr.  Hughes  at  his  office, 
Scheie  Eye  Institute, 
Philadelphia  Pennsylvania,  1988 

[photo  by  William  C.  Nyberg] 


I.    FAMILY  BACKGROUND  AND  EARLY 
EDUCATION 

[INTERVIEW  1:   JANUARY  28,  1988]    ## 


Grandparents 


Hughes:     Dr.  Scheie,  please  tell  me  about  your  grandparents  on  both  sides  of 
the  family,  where  they  came  from  and  what  they  did  for  a  living. 

Scheie:       My  maternal  grandfather  was  born  in  Kinton,  Dorchester  County, 
England  in  1846  and  came  to  Trempealeau,  Wisconsin  with  his 
parents  at  eight  years  of  age.  Later  he  was,  like  most  people  at  that 
time,  involved  in  farming.  He  lived  in  several  places  and  in  1910 
moved  to  Canada  to  homestead  and  remained  there  until  he  became 
ill  and  returned  to  Warren,  Minnesota.  I  don't  know  where  he  lived 
in  Canada.  In  fact,  I  never  knew  my  grandfather  until  about  a  year 
before  his  death  in  1921,  when  he  came  to  live  with  our  family.  I 
was  probably  in  the  eighth  grade  when  he  arrived. 

Hughes:     What  was  his  name? 

Scheie:       His  name  was  James  Ware.  He  was  a  tall,  nice-looking  man  with 
white  hair  and  was  age  seventy-five  when  he  died. 

Hughes:     And  your  grandmother? 

Scheie:       I  never  knew  my  grandmother.  She  married  James  Ware  in  1881 
and  she  died,  I  understand,  of  tuberculosis  in  1898  when  she  was 
thirty-five  years  of  age.  They  had  three  boys  and  two  girls.  The 
oldest  was  my  mother,  who  was  sixteen  years  old  when  her  mother 
died,  and  the  youngest  child,  her  sister  Myrtle,  was  three  years  of 


##    This  symbol  indicates  that  a  tape  or  a  segment  of  a  tape  has  begun  or  ended. 


age.  My  mother  brought  up  her  siblings,  and  Myrtle  was  still  with 
her  after  the  marriage  of  my  parents.  I  remember  that  she  was  a 
part  of  our  family  life  until  I  was  about  age  ten,  when  she  married 
Earl  C.  Clauson. 

Hughes:     How  much  older  was  she  than  Myrtle? 

Scheie:       Thirteen  years, 
[interruption] 

Hughes:     And  your  father's  side  of  the  family  ? 

Scheie:       They  came  from  Norway  in,  I  think,  1853  from  the  Eiken  area.  I 
visited  the  area  in  1986  and  found  that  my  family  had  owned  an 
area  of  farmland  along  a  fjord  on  which  the  family  had  lived.  I  don't 
know  for  sure  how  many  generations  but  probably  since  the  late 
1700s.  I  was  shown  an  area  of  land  that  passed  into  other  hands  in 
about  1890  and  is  now  occupied  by  a  village  called  Skeie. 

Hughes:     Spelled  the  same  as  your  name? 

Scheie:       No,  apparently  the  spelling  of  my  name  was  modified  along  the  way 
because  the  name  of  the  village  and  the  names  on  the  gravestones 
and  of  some  of  the  relatives  that  I  visited  while  I  was  there  were 
named  Skeie.  It  should  be  pronounced  "shay-uh". 


Childhood 


Scheie:  My  grandparents  came  to  the  Iowa-South  Dakota  area  where  I  have 
numerous  relatives  whom  I've  never  met  and  at  this  point  I  suspect 
I  never  will. 

Hughes:     Do  you  know  approximately  when  they  arrived? 

Scheie:       Yes,  they  left  Norway  in  1863.  My  grandfather,  Lars  Olson  Scheie, 
was  twenty-three  and  his  brother,  Simon  Olson  Scheie,  was  twenty 
years  old  when  they  came  to  this  country.  In  Norway,  the  oldest  son 
inherited  the  property  at  the  death  of  his  parents,  and  the  others 
were  left  out.  So  these  two  young  men,  and  both  came  with  brides, 
settled  in  the  Iowa  area.  Those  were  pioneer  days.  Buffalo  were 
roaming  the  countryside. 

Hughes:     Had  they  been  farming  before  they  arrived  in  this  country? 

Scheie:       Yes,  the  property  along  the  fjord  (now  the  village  of  Skeie)  was 

agricultural.  My  father,  Lars  Tobias  Scheie,  was  born  in  1878,  and 
he  married,  of  course,  my  mother,  Ella  Mae  Ware  Scheie.  They  had 
four  children. 


Hughes:     Do  you  know  how  they  met? 

Scheie:       I  don't  know  that.  I  am  sure  it  was  a  neighbor  situation. 

I  was  born  in  1909  and  was  three  when  they  moved  to  North 
Dakota  on  a  homestead  fifty  miles  west  of  Minot,  North  Dakota.  It 
was  an  Indian  reservation  that  had  been  opened  up  for 
homesteading. 

Hughes:     Had  they  gone  for  the  land?  Was  that  the  impetus? 

Scheie:       Yes,  my  father  was  first  generation,  and  in  a  pioneer  country  funds 
are  difficult  to  accumulate.  So  he  took  his  young  family  up  to  the 
North  Dakota  area  where  the  Berthhold  Indian  Reservation  had 
opened  up  and  where  we  lived  for  the  six  years  that  it  took  to  own 
the  land.  After  developing  it  and  living  on  it  for  six  years,  the  land 
was  ours. 

Hughes:     Was  the  six  years  a  stipulation  of  the  Homestead  Act? 

Scheie:       Yes,  and  that  was  a  great  opportunity  for  my  father.  When  we  went 
up  there  the  Indians  had  just  been  asked  to  leave  that  part  of  the 
reservation  and  it  was  turned  over  to  the  settlers. 

Hughes:     Do  you  remember  the  tribe? 

Scheie:       Yes,  the  Mandan  tribe,  [interruption]  The  area  was  very  primitive 
because  only  the  Indians  had  lived  there  and  the  homesteaders  had 
to  create  their  own  way  of  life.  I  was  only  three  but  my  recollection 
is  of  living  in  a  sod  house  for  a  time,  probably  a  year  or  two.  I've 
heard,  "Yes,"  and  I've  heard,  "No."  The  Fischer  family,  who  were 
close  friends  of  our  family  in  the  Brookings,  South  Dakota  area 
where  I  was  born,  followed  my  parents  and  took  claim  to  their 
homestead  about  three  miles  from  our  own.  Mrs.  Fischer  wrote  a 
book  describing  her  experiences  for  her  family  and  friends.  It  was 
never  published. 

This  is  a  photograph  of  a  sod  building  on  the  Fischer  farm.  The 
homesteader  would  excavate  an  area  in  the  ground  about  two  or 
three  feet  deep  and  then  use  sod  as  we  use  cement  tiles  or  bricks 
today  to  create  the  upper  walls.  As  soon  as  lumber  was  available, 
they  built  regular  wooden-frame  houses  and  barns. 

Hughes:     Tell  me  please  what  your  father  did. 

Scheie:       My  father  was  a  farmer.  There  were  almost  no  schools  in  this 

pioneer  area  when  he  was  growing  up.  My  father,  therefore,  had  a 
limited  education  of  only  a  very  few  years. 

When  we  moved  to  North  Dakota,  there  were  no  schools.  My 
brother,  John  Scheie,  who  was  three  years  older  than  I,  could  not  go 


to  school  for  the  first  year  that  we  lived  on  our  homestead.  When  a 
school  was  built,  probably  four  or  five  miles  from  our  farm,  it  was  a 
country  school  for  all  grades  with  one  teacher  for  all  grades,  truly  a 
one-room  school  of  the  type  we  read  about. 


Esther,  John 
and 

Harold  Scheie, 
c.  1912 


Hughes:     How  many  students  do  you  suppose  there  were? 

Scheie:       Ten  or  twelve,  but  it  was  a  school. 

When  my  brother  started,  I  guess  I  was  four  years  old,  thereabouts. 
I  was,  of  course,  to  stay  home  because  I  was  considered  to  be  too 
young  for  school,  but  I  settled  that  by  running  away  to  school.  So  I 
was  allowed  to  attend. 

Hughes:     Did  you  make  that  round  trip,  eight  miles,  every  day? 

Scheie:       Yes,  and  on  foot.  Our  parents  were  very  busy  and  they  could  not 
take  us  to  school.  We  had  a  horse  and  buggy;  no  car,  of  course.  In 
winter  we  would  stay  at  the  school  with  the  teacher  much  of  the 
time.  Blizzards  on  the  prairie  were  a  great  hazard,  as  were  prairie 
fires.  Our  parents  and  others  would  provide  food. 

Hughes:     You  mean  you  actually  lived  with  the  teacher? 

Scheie:       During  the  blizzard  months,  yes,  we  just  stayed  at  the  school.  I 
vaguely  recall  that  our  parents  would  come  and  take  us  home  for 
weekends. 


At  any  rate,  when  I  was  supposed  to  start  school  should  have  been 
a  year  later.  It  turned  out  I'd  had  practically  one  year  of  school  by 
following  my  brother,  and  I  was  soon  advanced  into  second  grade 
with  my  brother,  which  was  not  particularly  good  for  him  as  he  was 
three  years  older.  That  continued  until  we  graduated  together  from 
high  school  in  1926,  having  one  less  year  of  school  than  I  should 
have  had.  We  had  moved  to  Minnesota  by  then.  I  finished  high 
school  quite  young,  and  this  proved  to  be  fortunate  because  at  that 
time  along  came  the  Depression  and  I  was  forced  to  delay  college  for 
one  more  year. 

Hughes:     Do  you  think  that  drew  you  and  your  brother  closer  together? 

Scheie:       Well,  my  brother  was  never  a  rugged  individual  and  tended  to  be 
shy.  He  was  right  on  schedule  in  school,  but  I  was  quite  athletic 
and  into  many  activities.  I  don't  think  this  helped  him.  He  handled 
it,  but  even  at  that  time  I  was  sensitive  to  the  fact  that  it  might  be 
awkward  for  him. 

Hughes:     What  did  he  do  later  in  life? 

Scheie:       He  had  his  own  little  store  and  meat  market.  He  was  very 

mechanical  and  very  good  in  electronics.  I  think  he  built  the  first 
radio  in  our  little  town,  homemade  out  of  bits  and  pieces.  I 
remember  listening  to  radio  KDKA  when  I  was  eleven  years  old,  a 
station  in  Pittsburgh  that  came  in  well  on  his  little  radio. 

My  father  was  also  a  farm  and  livestock  auctioneer.  He  went  to 
Chicago  to  take  a  course  for  a  year.  He  was  a  very  bright  person. 
When  we  moved  to  Minnesota  in  1919,  it  was  because  he  had  an 
opportunity  to  become  the  regional  livestock  and  farm  auctioneer, 
which  he  enjoyed.  He  did  well  at  this  but  later  again  acquired  a 
farm  after  some  of  the  ravages  of  the  Depression.  But  the  move 
was  made,  I  am  sure,  because  he  had  been  able  to  go  to  an 
auctioneering  school  in  Chicago. 

Hughes:     That  was  the  move  to  Warren,  Minnesota? 

Scheie:       That  was  the  move  to  Warren,  which  is  sixty  miles  from  the 

Canadian  border  and  about  fifteen  miles  from  the  North  Dakota 
border  in  the  Red  River  Valley,  as  they  call  it. 

Hughes:     Tell  me  a  little  about  family  life,  discipline,  religion,  and  politics. 

Scheie:       We  were  brought  up  as  Methodists,  and  I  think  possibly  our  strict 
attendance  turned  me  off  a  little  bit.  I  am  not  the  most  religious 
person  in  the  world. 

Hughes:     Were  your  parents? 


Scheie:       My  dad,  yes  and  no.  He  went  to  church  regularly,  but  he  was  not 
quite  as  wrapped  up  in  it  as  my  mother,  who  was  a  good  Methodist 
and  a  member  of  the  Women's  Christian  Temperance  Union.  We 
had  loving  discipline,  but  our  parents  expected  something  of  us.  We 
always  had  errands  to  do,  and  we  were  kept  in  line. 

Hughes:     Were  they  interested  in  polities'? 

Scheie:       My  mother  really  wasn't  interested  in  politics.  My  father  was 
always  on  the  liberal  side.  He  was  a  Democrat,  but  I  am  a 
registered  nonpartisan. 

Hughes:     You  were  well  into  grammar  school  when  you  moved  to  Warren1? 

Scheie:       I  was  in  the  fifth  grade. 

Hughes:     When  did  your  sporting  activities  begin1? 

Scheie:       They  started  in  upper  grade  school,  probably  in  the  seventh  or 
eighth  grade.  We  began  to  have  junior  teams. 

I  was  one  of  a  few  boys  who  organized  a  boy  scout  troop.  I  was  in 
the  little  founding  group,  and  some  of  my  good  friends  in  Warren 
knew  that  if  we  had  an  organized  effort,  we  could  use  the 
gymnasium.  The  high  school  gymnasium  was  off  limits  ordinarily 
to  grade  students,  and  it  was  fairly  carefully  controlled.  So  we 
organized  a  boy  scout  troop,  still  in  existence.  One  of  our  favorite 
teachers  headed  it  up,  and  we  gained  permission  to  use  the 
gymnasium  where  we  could  play  basketball.  In  the  town  of  Warren 
at  that  time,  which  is  now  a  little  over  one  hundred  years  old,  there 
were  no  tennis  courts  and  certainly  there  was  no  golf  course  or 
swimming  pool. 

Hughes:     What  was  the  population1? 

Scheie:       It  was  about  one  thousand.  There  are  probably  not  many  more 

today.  It  is  agricultural  country  and  farming  has  had  its  limitations 
recently.  The  small  farm  has  largely  been  abandoned  for  large 
farms  with  combines.  It  now  takes  two  or  three  hundred  thousand 
dollars  worth  of  machinery  to  operate  a  farm. 

Our  home,  which  was  a  rather  nice  one,  was  the  last  house  on  the 
street  at  the  edge  of  town.  Near  our  home  was  a  pasture  owned  by 
a  farmer  who  was  very  kind.  My  father  arranged  with  him  for  us  to 
use  an  area  of  that  farm  where  I  laid  out  a  baseball  diamond  with 
the  help  of  my  playmates,  so  we  sort  of  ran  an  athletic  field  for  the 
city.  Not  formal,  but  the  boys  would  gather  there  on  a  Saturday  or 
after  school,  that  sort  of  thing.  There  was  literally  nothing  for 
children  in  the  way  of  recreation  in  Warren.  As  a  result,  we  had  to 
be  self-sufficient. 


Captain  [with  ball]  of  high  school  basketball  team 


High  School 


Hughes:     In  high  school,  did  you  begin  to  develop  interests  in  certain  subjects? 
Scheie:       I  don't  think  I  ever  took  a  book  home  to  study  until  I  went  to  college. 
Hughes:     Is  that  because  it  came  so  easily? 

Scheie:       Well,  somehow  I  lucked  out  with  good  grades.  Any  studying  I  did 
was  in  assembly.  The  last  couple  of  years  of  high  school,  I  had  so 
many  activities  that  I  was  excused  from  study  hour  in  the 
afternoons. 

Hughes:     Do  you  feel  that  you  got  a  pretty  good  foundation  ? 

Scheie:       I  think  so.  It  certainly  has  served  me  well.  I  have  always  liked  to 
read.  I  took  library  books  home  to  read  at  night.  We  had  a  good 
school  system  in  Warren.  It  was  a  Scandinavian  community  and 
they  were  very  diligent  and  progressive  people. 

Hughes:     Were  there  any  teachers  that  you  formed  a  bond  with? 

Scheie:       I  guess  the  principal  of  the  school,  Mrs.  Leora  Cassidy.  I  was 

always  very  close  to  her.  She  later  became  an  assistant  dean  of 
women  at  the  University  of  Minnesota.  She  was  a  lovely  lady. 

Hughes:     When  did  you  make  the  decision  that  you  wanted  to  go  on  to  the 
university? 


Scheie:       Oh,  I  always  knew  I  wanted  to,  but  finances  were  a  concern.  My 
dad  never  became  affluent.  I  started  working  at  one  thing  or 
another  when  I  was  eleven  years  old. 

There  was  a  brick  factory  in  town  which  operated  during  the 
summer  when  labor  was  scarce.  Jobs  were  available  that  even  an 
eleven-year-old  could  do.  We  had  peculiar  clay  that  made  good 
bricks.  The  clay  would  come  through  a  mixing  machine  and  was 
poured  into  molds.  The  molds  in  turn  would  be  emptied  onto  trays 
that  we  called  palettes.  The  palettes  would  get  placed  onto 
block-long  racks  where  they  would  be  air  dried.  Later,  younger 
children,  like  myself,  would  be  paid  so  much  for  every  hundred 
bricks  that  we  turned  so  they  could  dry  on  all  sides. 

Years  later  when  I  was  in  high  school,  I  had  the  prize  job  called 
wheeling.  Those  air-dried  or  so-called  green  bricks  were  taken  on  a 
special  wheelbarrow  out  to  the  kiln,  and  that  took  a  pretty  good 
physical  specimen  to  do  it.  The  pay  was  good  but  it  was  hard  work. 
At  the  kiln  the  bricks,  weighing  seven  pounds  apiece,  were  tossed 
by  hand  in  groups  of  four  to  a  setter  who  placed  them  to  build  the 
kiln.  It  was  fun  in  its  own  way. 

The  last  five  or  six  years  while  in  school,  I  was  given  a  part-time 
job.  The  barber,  who  became  a  good  friend  of  mine,  was  named 
Frank  Stuempke.  He  was  a  fine,  religious  man.  I  would,  after 
school,  clean  the  shop  and  do  other  chores  after  the  shop  had  closed 
in  the  late  afternoon.  He  paid  me  three  dollars  a  week,  bought  a 
shoeshine  stand  for  me,  and  gave  me  permission  to  keep  my 
earnings  from  it,  which  helped  a  great  deal. 

Most  of  the  farms  and  many  buildings  in  town  did  not  have  running 
water.  Again  these  were  sort  of  pioneer  days,  even  in  Warren. 
Customers  would  come  into  the  barbershop  where  a  bath  was 
available.  On  Saturdays,  when  I  was  free,  I  would  clean  the 
bathtub  and  provide  clean  towels  for  the  next  patron.  On  Saturday 
night  when  the  farmers  usually  came  to  town,  I  would  have  my 
shoeshine  stand  out  on  the  street.  We  kept  busy,  both  inside  and 
out.  The  farmers  seemed  to  like  stopping  for  a  shoeshine  and  a 
chat,  particularly  as  I  began  to  be  involved  in  high  school  athletics. 

Hughes:     Were  you  even  at  that  young  age  saving  money  with  the  idea  of 
attending  the  university1? 

Scheie:       Yes,  and  that  is  a  sad  story.  The  year  I  finished  high  school  in  1926 
both  banks  failed.  The  Depression  arrived  at  the  midwest  rural 
areas  three  or  four  years  before  places  like  New  York  City  were 
affected  and  stockbrokers  were  jumping  from  skyscraper  windows, 
as  you  know. 

In  Warren,  anyone  who  had  savings  in  the  banks  lost  them.  My 
father  and  I  lost  all  of  our  savings,  which  was  a  terrible  setback.  Of 


Hughes: 


Scheie: 


Hughes: 


Scheie: 


course,  he  had  his  auctioneering  but  the  hard  times  greatly  affected 
that  also.  At  about  that  time,  he  moved  to  a  farm  where  my 
parents  lived  until  their  deaths  in  1962. 

I  remember  vividly  the  morning  the  banks  closed.  I  think  I  was  on 
my  way  to  school  when  I  saw  a  few  people  standing  in  front  of  the 
bank.  Upon  joining  them,  I  learned  that  the  bank  had  failed  and 
would  never  open.  All  of  my  savings  for  college  were  lost,  about 
three  thousand  dollars. 

You  asked  about  school.  I  received  the  American  Legion  Medal 
given  for  athletic  and  scholarship  ability,  which  was  given  to  one 
graduating  senior  each  year. 

There  was  a  teacher,  Miss  Roberts,  who  was  unpopular  with  most  of 
the  students.  The  following  anecdote  was  published  in  our  little 
town's  newspaper,  The  Warren  Sheaf.  I  am  still  a  subscriber,  which 
shows  how  sentimental  I  am. 

Miss  Roberts  asked  me  in  class  one  day  what  Milton  saw  as  he 
looked  across  the  lake  in  the  poem,  "While  Gazing  Across  Lake 
Geneva."  I  with  a  straight  face  said,  "Miss  Roberts,  he  saw  the 
opposite  shore."  She  was  furious  and  sent  me  not  to  Mrs.  Leora 
Cassidy  but  to  the  superintendent  of  the  school,  Gamelius 
Holmquist.  He  was  a  very  stern  old  Swede  but  very  capable  though 
quite  humorless,  at  least  in  the  opinion  of  the  students, 
[interruption]  He  wanted  me  to  be  expelled  from  school.  Mrs. 
Cassidy  intervened  and  talked  him  out  of  it.  Years  later,  when  Mrs. 
Cassidy  was  assistant  dean  of  women  at  the  University  of 
Minnesota— I  think  I  was  in  medical  school  at  the  time— she  told  me 
that  she  had  always  despised  that  teacher. 

Is  there  anything  more  that  you  care  to  say  about  family  or  your 
upbringing1? 

Well,  when  we  were  on  the  farm,  even  when  we  were  youngsters, 
we  would  help  our  mother  and  father  in  every  way  we  could.  We 
learned  early  to  milk  cows,  and  we  learned  to  pull  mustard  weeds 
out  of  the  fields.  It  was  very  rocky  soil  and  we  would  help  our 
father  move  stones  off  the  fields  so  they  wouldn't  hit  his  plow.  We 
would  help  feed  the  cattle  and  bring  the  cattle  in  from  the  pastures, 
and  so  on.  We  were  busy  as  kids,  and  it  was  good  for  us. 

Dr.  [Daniel  M.]  Albert  likened  your  philosophy  of  life  to  the  frontier 
spirit.  * 

Well,  to  live  to  be  age  ten  or  eleven  on  an  Indian  reservation  was 
pioneer  living.  I  saw  my  first  electric  light  turned  on  in  a  hotel  in 


Harold  G.  Scheie:  A  Biographical  Sketch  and  Selected  Papers.  Compiled  by  TR  Hedges,  WC 
Frayer  and  DM  Albert  on  the  occasion  of  the  dedication  of  the  Scheie  Eye  Institute,  October  1972. 
Philadelphia:  WB  Saundcrs  Co,  26. 


10 


Minot,  North  Dakota,  when  we  were  moving  to  Minnesota.  I  can 
remember  my  father  showing  me  how  to  turn  the  light  switch  and  I 
was  just  amazed.  In  fact,  much  of  my  studying  was  done,  not  quite 
like  Lincoln  with  a  candle,  but  with  a  kerosene  lamp.  A  tremendous 
event  in  our  home  was  when  we  finally  acquired  one  of  those 
mantle  gasoline  lamps.  You  know  the  kind  which  with  a  tank  of  gas 
you  pump  up  to  force  the  gas  vapor  to  the  mantle.  It  gave  a 
beautiful  white  light. 


Harold 
and  his 
prize  pig 


Hughes:     Did  you  have  running  water1? 

Scheie:       We  had  no  running  water  when  we  first  arrived  in  Warren.  I  think 
I  was  in  high  school  athletics  before  I  ever  had  a  shower  bath. 
These  were  very  primitive  days.  One  of  our  chores  was  carrying 
water  for  cooking  and  drinking.  Another  was  having  the  coal 
buckets  constantly  filled  for  heating  and  cooking.  My  mother  had 
no  washing  machine;  no  such  thing  existed.  She  baked  her  own 
bread;  she  sewed  our  clothes;  canned  vegetables  and  fruit, 
especially  for  winter.  We  salted  down  pork  and  we  canned  beef. 
There  were  no  refrigerators.  Instead,  our  cool  cellar  or  the  well  was 
used. 

I  told  you  [off  tape]  about  my  father  going  to  the  barn  and  being 
guided  during  heavy  blizzards  by  a  wire  strung  from  the  house  to 
the  barn,  from  which  his  lantern  was  hung.  Becoming  lost  on  the 
prairie  during  a  snowstorm  was  always  a  danger.  My  brother  and  I 
also  did  much  of  the  gardening,  even  in  Warren,  raising  vegetables 
of  various  types,  including  potatoes. 

Hughes:     Do  you  think  this  upbringing  had  something  to  do  with  your 
strength  of  purpose  in  later  life1? 


11 


Scheie:       Yes,  you  learned  that  there  were  things  in  life  other  than  play.  In 
fact,  in  those  days,  I  remember  that  playing  time  was  a  treat. 

[Interview  2:  January  30, 1988] 

Hughes:     You  didn't  speak  very  much  about  the  personalities  of  your  parents, 
and  I'm  wondering  if  strength  of  purpose  was  a  family  characteristic. 

Scheie:       Well,  both  of  my  parents  were  prodigious  workers.  I  have  told  you 
some  of  the  things  that  my  mother  did.  My  father  was  up  at 
daybreak.  When  you  go  into  a  pioneer  land  where  there  is  nothing 
but  grass  and  sod  and  you  have  to  build  your  own  home— you  did  not 
hire  a  carpenter-dig  a  well,  when  that  sort  of  life  persists  for  six 
years  or  more,  a  great  deal  of  determination  and  character  is  a 
necessity.  The  entire  family  had  to  chip  in  to  help  overburdened 
parents. 

I  am  a  morning  person,  yet  my  brother,  same  environment,  was  a 
night  person.  He  did  not  like  to  go  to  bed  at  night  and  he  disliked 
getting  up  in  the  morning.  On  the  other  hand,  I  was  usually  up  at 
daybreak-  my  parents  could  not  sleep  late,  even  on  Sundays,  until  I 
was  older,  [laughter] 

Hughes:     What  did  you  do  when  you  got  up? 

Scheie:       Well,  probably  reading,  waiting  for  breakfast.  As  a  growing  boy,  I 
was  known  as  "Hungry  Hank." 

My  parents  were  so  diligent,  their  work  so  organized,  that  they 
were  great  examples.  Of  course,  I  think  there  is  [also]  something  to 
physiological  makeup,  [interruption] 


Undergraduate,  University  of  Minnesota,  1927-1931 

Hughes:     Did  you  ever  consider  going  anywhere  other  than  the  University  of 
Minnesota? 

Scheie:       Yes,  I  did.  A  friend  of  mine,  who  had  been  a  high  school  teammate 
in  football  and  basketball,  had  been  given  an  athletic  scholarship  to 
South  Dakota  State  University  in  Brookings.  Through  him  I  was 
invited  to  consider  an  athletic  scholarship,  which  I  declined  because 
I  preferred  to  go  to  the  University  of  Minnesota  for  the  best  possible 
education  rather  than  devote  much  of  my  time  to  athletics.  Yet 
through  happenstance  I  did  participate  in  big-time  athletics. 

Hughes:     Did  you  know  what  you  were  interested  in  when  you  started  college? 

Scheie:       No,  I  did  not.  By  the  way,  I  had  been  out  of  school  for  a  year 
because  of  lack  of  money. 


12 


Hughes:     What  did  you  do? 

Scheie:       During  the  year  I  stayed  out,  although  I  have  never  bragged  about 
it  to  my  surgical  patients,  I  became  the  village  butcher.  A  Swedish 
butcher  by  the  name  of  Gordhammer  hired  me  to  work  in  his  shop. 
After  a  month  or  two  of  working  for  him  as  a  combined  counter  boy, 
delivery  boy,  and  assistant  butcher,  his  regular  butcher  left.  I  was 
then  assigned  the  job.  In  addition  to  my  duties  in  the  shop,  I  had 
the  duty  of  going  out  to  the  farms  and  killing  the  cattle  or  pigs, 
cleaning  them,  and  bringing  them  back  to  the  meat  market  where 
the  proprietor  himself  would  cut  them  into  sections  and  ready  them 
for  counter  work. 

In  this  little  town  the  meat  that  we  supplied  did  not  come  from 
Hormel,  Armour,  or  some  other  company.  It  was  butchered  locally 
by  us  and  obtained  at  relatively  low  prices  from  farmers  who  badly 
needed  the  money. 

Hughes:     Did  you  accumulate  enough  money  for  college  from  that  job? 

Scheie:       Well,  by  that  time  I  had  helped  my  parents  a  bit  and  my  memory  is 
that  I  was  determined  to  enter  the  University  of  Minnesota  the 
next  year,  regardless.  I  think  I  had  something  like  thirty-five 
dollars  in  my  pocket,  and  I  hitchhiked  down  to  Minneapolis,  a 
330-mile  trip.  A  typical  little  farmer  boy,  I  arrived  in  Minneapolis 
in  the  pitch  dark,  about  eleven  or  twelve  o'clock  at  night,  not 
knowing  where  the  university  was  nor  how  to  find  it.  I  asked  a 
policeman  who  pointed  out  a  trolley,  which  I  did  not  know  how  to 
board.  Then  once  on  it,  I  didn't  know  where  to  get  off  and  was  too 
embarrassed  to  ask  the  conductor.  So  I  went  about  as  far  as  I  dared 
and  then  simply  got  off.  I  found  a  rooming  house,  which  fortunately 
was  in  the  university  area,  and  obtained  a  room  for  the  night. 

The  next  day  I  found  a  part-time  job  as  a  strikebreaker  in  a  center 
city  moving  picture  theatre.  All  of  the  ushers  were  on  strike,  for 
issues  I  never  learned.  At  any  rate,  I  was  given  a  job  and  what  we 
called  a  monkey  suit,  a  formal  uniform.  Although  a  green  country 
boy  in  his  first  big  city  day,  I  was  assigned  the  main  floor,  center 
aisle.  They  taught  me  some  hand  signals  because  ushers  were  not 
supposed  to  talk  to  each  other.  This  was  difficult  because  we  were 
all  green  replacements.  I  was  quite  upset  during  two  afternoon 
performances.  The  theater  had  to  be  emptied  on  two  occasions 
because  the  strikers  came  in  and  exploded  stink  bombs.  They  were 
something  comparable  to  tear  gas.  The  gas  not  only  irritated  your 
eyes  but  it  smelled  terrible.  Fortunately,  this  never  happened  again. 

I  kept  this  job  for  a  few  weeks  until  I  found  something  better  near 
the  campus.  Ushering  was  quite  interesting  for  me,  however.  It 
was  part  of  the  old  Finkelstein  and  Reuben  theater  chain.  In 
addition  to  movies,  they  always  had  burlesque  or  some  stage  show. 


13 

I  remember  Al  Jolson  came  in  as  a  soloist.  He  did  that  for  a  couple 
of  weeks.  Various  national  pop  stars  came  in  too.  So  this  was  my 
introduction  to  Minneapolis. 

Hughes:     What  happened  when  you  found  your  way  to  campus'? 

Scheie:       The  first  thing  I  had  to  do,  I  learned,  was  take  entrance  exams, 

because  two  levels  of  education  were  offered.  Some  students  could 
attend  the  university,  but  others  had  to  go  to  junior-level  two-year 
schools.  I  apparently  did  all  right  and  was  admitted  to  the 
university.  After  that  I  started  looking  for  part-time  campus  jobs. 

Hughes:     What  did  you  eventually  major  in? 

Scheie:       Well,  I  took  general  courses  the  first  two  years,  basic  courses  like 
math  and  history.  By  the  time  I  decided  to  go  into  premedical,  I 
had  practically  a  major  in  history.  I  also  took  considerable 
chemistry.  I  didn't  think  that  I  could  ever  afford,  nor  was  I  bright 
enough,  to  go  through  medical  school.  So  I  didn't  hitch  my  wagon  to 
a  star.  I  also  became  involved  in  athletics,  mostly  by  accident. 

We  had  two  onerous  obligations,  at  least  to  me,  that  were  required 
during  the  first  two  years  of  college.  Minnesota  was  one  of  the 
ROTC  [Reserve  Officer  Training  Corps]  land-grant  colleges  where 
ROTC  and  physical  education  were  required,  each  three  hours  a 
week  for  two  years.  When  you  are  working  and  going  to  school,  that 
is  quite  demanding.  For  somebody  who  had  been  quite  athletic  in 
high  school  basketball,  football  and  baseball,  having  to  do 
calisthenics  was,  in  my  opinion,  demeaning. 

However,  it  worked  out  well  for  me.  The  University  of  Minnesota 
had  a  new  varsity  basketball  coach,  Dave  McMillan,  who  had 
played  for  the  original  New  York  Celtics,  and  an  associate  coach, 
Wilbur  Penfield.  They  both  came  into  big  ten  athletics  from  Coeur 
d'Alene,  Idaho,  where  they  had  coached  basketball,  one  an  assistant 
and  the  other  the  head  coach.  It  was  their  first  year  at  Minneapolis 
and  they  were  looking  for  walk-ons  or  anybody  to  help  their  team. 
So  they  came  to  our  phys  ed  class  looking  for  recruits  for  their  team. 
They  listed  our  class  alphabetically  to  form  basketball  teams  for  a 
tournament,  instead  of  calisthenics.  It  was  a  round-robin  affair. 

It  happened  that  I  was  teamed  with  Harry  Schoening,  who  was 
later  a  star  on  our  Minnesota  varsity.  Our  team  won  the 
tournament  and  playing  with  him  made  me  look  good.  So  both  of  us 
were  invited  to  join  the  freshman  squad.  I  had  no  idea  of  playing 
varsity  athletics  when  I  came  to  the  University  of  Minnesota. 
However,  my  decision  to  play  freshman  basketball  was  an 
opportunity  to  avoid  gym  class  from  which  we  were  to  be  excused. 
It  also  opened  doors  on  campus  for  me. 

I  was  never  given  an  athletic  scholarship  and  I  never  asked  for  one. 
I  felt  that  such  a  commitment  might  interfere  with  schoolwork.  I 


14 


did  play  basketball  on  the  freshman  team  and  continued  with  the 
varsity  into  my  junior  year,  when  I  developed  nearly  fatal  lobar 
pneumonia. 

Traveling  with  the  squad  I  had  my  first  train  ride,  to  play  at  the 
University  of  Illinois.  I  saw  most  of  the  other  campuses  of  the  big 
ten  and  over  the  years  met  many  people,  especially  on  campus  and 
in  Minneapolis,  that  otherwise  would  have  been  impossible.  These 
contacts  also  led  to  job  openings  such  as  at  the  Faculty  Campus 
Club. 


Elias  Potter  Lyon 


Scheie:       During  medical  school,  I  had  two  jobs  that  were  very  important  to 
me.  During  the  fall  of  my  third  year  of  college,  I  was  invited  to  live 
with  the  dean  of  the  medical  school,  Elias  Potter  Lyon. 

Hughes:     How  did  that  come  about1? 

Scheie:       I  was  waiting  tables  at  the  Campus  Club.  The  manager  knew  Dean 
Lyon  very  well.  The  dean  already  had  a  young  man,  Roger  Loucks, 
living  at  his  home.  They  usually  had  two  students,  which  I  didn't 
know  at  the  time.  He  was  working  for  his  Ph.D.  degree  in 
psychology.  Over  the  years  he  became  an  outstanding  researcher  in 
his  field  and  chairman  of  the  department  at  the  University  of 
Washington,  as  well  as  famous  in  the  world  of  psychology. 

## 

The  dean  had  called  the  Campus  Club  manager  and  said,  "Do  you 
have  a  student  who  will  work  with  Roger  Loucks  and  give  him  a 
hand  putting  up  storm  windows?"  So  I  did  that.  I  think  it  took  us  a 
couple  of  weekends  in  our  spare  time.  At  the  end  of  that  time,  of 
course,  Roger  and  the  dean  had  learned  something  about  me. 

The  dean  was  a  great  humanist.  He  and  his  wife  had  no  children  of 
their  own  which  is  why  they  liked  to  have  a  couple  of  students  with 
them.  We  lived  in  the  basement,  and  a  room  in  the  attic  provided  a 
very  nice  area  for  studying.  Well,  Roger  seemed  to  like  me  and 
agreed  with  the  dean  to  invite  me  as  the  second  student.  I  moved 
in  and  this  proved  to  be  just  a  wonderful  experience. 

Hughes:     Were  you  taken  into  their  lives'? 

Scheie:       Oh,  yes.  We  did  not  eat  with  them  but  they  would  occasionally 
include  us  in  a  party  with  faculty  members.  One  of  the  things  I 
enjoyed  a  great  deal  was  driving  them  in  their  car  to  the  theater  in 
downtown  Minneapolis,  which  they  attended  quite  regularly.  That 
was  rewarding  and  educational  as  well. 


15 


One  thing  led  to  another  and  finally  late  in  my  junior  year,  I 
decided  to  make  a  try  for  medical  school.  My  grades  had  been  fairly 
good. 

Hughes:     Did  Dr.  Lyon  encourage  you1? 

Scheie:       Not  at  this  point.  But  his  support  and  his  enthusiasm  obviously 

made  me  think  about  medical  school.  By  the  fall  of  my  third  year  in 
college,  I  talked  seriously  with  him  about  it,  and  he  was  all  for 
trying  whatever  I  wanted.  He  said  I  would  have  to  complete  certain 
required  courses.  Among  them  were  reading  requirements  in 
language.  I  had  had  quite  a  bit  of  Spanish,  but  that  wasn't  one  of 
the  required  languages.  So  on  my  own  I  studied  French  grammar 
to  qualify  for  medical  school,  rather  than  take  courses,  because  I 
was  overloaded  that  last  year. 

Hughes:     You  were  taking  mainly  science  courses? 

Scheie:       Yes,  there  was  quantitative  chemistry  that  I  had  not  taken. 

Fortunately,  I  had  taken  adequate  zoology  and  enough  math.  There 
were  some  odds  and  ends,  but  to  pack  them  all  into  one  year  was 
difficult.  I  surmounted  French  by  taking  a  reading  test,  which  I 
was  able  to  pass,  and  also  satisfied  the  medical  aptitude  test. 

I  began  to  take  the  other  required  courses.  What  with  outside  jobs 
and  an  overload  of  courses,  I  became  so  run  down  that  I  developed 
lobar  pneumonia  and  nearly  died.  In  those  days  there  was  no 
treatment,  only  support.  I  was  in  an  oxygen  tent  and  unconscious 
for  about  a  week. 

Hughes:     What  could  be  done  for  pneumonia  in  those  days? 

Scheie:       Go  to  bed  and  wait  for  the  so-called  crisis  which  would  occur  after 
about  seven  days.  I  became  extremely  ill  and  out  of  it.  When  I 
regained  consciousness  at  the  end  of  the  week,  my  mother  and 
father  were  sitting  in  the  room.  I  knew  then  that  I  had  been  very  ill 
because  only  a  very  serious  problem  could  get  my  dad  to  come  to  the 
big  city.  I  had  been  taking  a  course  in  bacteriology  at  that  time  and 
assisted  at  an  autopsy  on  a  man  who  had  died  of  pneumonia.  I  was 
run  down  enough,  I  think,  with  all  of  the  things  that  I  was  doing 
that  I  was  predisposed. 

My  physician,  Hobart  Reimann,  was  the  chairman  of  the 
department  of  medicine  at  the  medical  school.  His  specialty  was 
infectious  disease  and  bacteriology.  He  had  come  in  from  China 
where  he  was  one  of  the  Rockefeller  people  who  taught  and  did 
research  at  the  Peking  Union  Medical  College.  Years  later  he  came 
to  Philadelphia  to  be  chairman  of  the  department  at  Jefferson 
Medical  College. 


16 

Shortly  after  I  was  admitted  to  the  university  hospital  student 
section,  Dr.  Reimann  came  in,  examined  me,  and  took  a  sample  of 
my  saliva  for  culture  and  injection  into  mice.  I  am  not  sure  that  his 
psychology  was  very  good-he  was  so  scientific-because  he  came  in 
very  proudly  about  thirty-six  hours  later  with  a  tray  holding  several 
dead  mice  lying  on  their  backs  with  their  feet  sticking  up  in  the  air. 
He  triumphantly  said,  "Look,  I  recovered  your  organism.  It's  type 
III  [pneumococcus]."  Well,  that  I  didn't  need  because  I  knew  there 
was  no  treatment  for  this  type.  Therapeutic  serum  was  available 
for  the  other  two  types.  Possibly  seeing  the  dead  mice  on  the  tray 
knocked  me  out,  but  they  were  the  last  thing  I  remembered  for  a 
week.  It  is  now  quite  humorous  to  think  of  all  those  dead  mice  and 
their  ominous  suggestion. 

Dr.  Reimann  became  one  of  my  very  favorite  teachers  in  the 
medical  school  and  a  supportive  friend.  He  always  had  a  dry  and 
ready  humor  that  enlivened  his  conferences  and  lectures. 

I  was  a  premed  student  when  the  pneumonia  occurred,  and  later 
when  I  was  taking  clinical  medicine  as  a  junior  and  a  senior  in 
medical  school,  Dr.  Reimann  seemed  to  enjoy  seeing  me  in  his 
classes  but  he  always  gave  me  a  difficult  time.  For  example,  we 
used  to  bring  patients  that  Dr.  Reimann  had  selected  into  the 
amphitheater  where  someone  would  be  called  upon  to  present  the 
clinical  findings  and  discuss  the  patient.  On  one  occasion  I  was 
presenting  a  patient  and  happened  to  say  that  I  did  a  urine  on  a 
patient.  Dr.  Reimann  was  a  very  precise  person  but  also  had  a 
great  sense  of  humor.  He  walked  over  to  the  patient,  pulled  the 
covers  down,  asked  the  patient  to  turn  over,  and  he  said,  "I 
wondered  if  the  patient  became  wet."  [laughter] 

Another  time  when  we  were  making  rounds  one  morning-there 
were  probably  half  a  dozen  or  a  dozen  medical  students  with  Dr. 
Reimann-we  came  to  a  patient  with  pneumonia.  He  asked  me  to 
examine  the  patient's  chest.  It  was  a  great  opening  for  Dr. 
Reimann  since  he  had  treated  my  pneumonia.  I  was  listening  to 
the  chest  with  the  stethoscope  while  he  was  talking  to  my  fellow 
students  and  telling  them  about  the  patient  and  the  type  of 
pneumonia.  A  fellow  student  asked  about  the  percentage  of 
empyema  with  this  type  of  pneumonia.  Dr.  Reimann,  without 
smiling,  said  "Ask  Scheie,  he's  the  pneumonia  specialist  around 
here."  I  had  no  idea  what  it  was  but  I  acted  very  self-important  and 
didn't  look  up.  He  tapped  me  on  the  shoulder.  I  listened  to  the 
question  again  and,  acting  as  important  as  I  could,  I  think  I  said, 
"Six  percent,  Dr.  Reimann,"  and  then,  without  smiling,  went  back 
listening  to  my  patient.  There  was  quiet  for  a  matter  of  seconds, 
after  which  he  tapped  me  on  the  shoulder  again,  and  said,  "Scheie, 
you  are  a  liar.  It's  twelve  percent."  He  was  great  fun  as  a  teacher. 

Hughes:     Was  there  anybody  else  memorable  on  the  faculty  in  your 
undergraduate  years? 


17 


Scheie:       I  had  a  Spanish  teacher,  Mr.  Juan  LeForte,  who  didn't  like  me  but 
who  impressed  me  and  I  enjoyed  him.  He  had  no  time  for  athletes. 
I  had  good  grades  in  his  course,  but  he  gave  me  a  bad  time  in  class. 

Another  was  our  sergeant  in  ROTC  who  was  a  typical  old-time 
army  sergeant,  and  I  got  a  big  kick  out  of  him.  If  you  asked  Eric, 
my  son,  who  Sergeant  Ken  Strider  was,  he  would  know  because  of 
some  of  the  tales  I  have  told  about  him.  Sergeant  Strider  was  like  a 
typical  marine  sergeant,  only  he  had  to  deal  with  students. 


II.  MEDICAL  EDUCATION  AND  EARLY 
CAREER 


University  of  Minnesota  Medical  School,  1931-1935 

Hughes:     Was  it  the  discussion  with  Dean  Lyon  that  convinced  you  that  you 
wanted  to  go  to  medical  school? 

Scheie:       Yes,  it  helped.  I  was  considering  dentistry  and  also  coaching 

because  of  my  athletic  background.  I  knew  that  coaching  would  be 
neither  as  expensive  nor  as  difficult  as  studying  dentistry.  Yet 
dentistry  really  did  not  appeal  to  me,  except  that  it  would  be  doing 
something  for  people.  I  read  Sinclair  Lewis's  Arrowsmith  at  about 
that  time,  a  book  that  also  helped  to  crystallize  my  decision. 

Hughes:     Who  else  helped  with  the  decision  ? 

Scheie:       I  talked  it  over  with  the  dean  of  student  affairs,  Edward  E. 

Nicholson,  who  was  well  known  and  well  liked.  This  was  when  I 
was  making  up  my  mind,  but  he  advised  me  against  it.  He  said, 
"You  don't  have  enough  money.  You  can't  possibly  meet  the 
demands  of  the  medical  school  curriculum."  I  guess  I  resented  his 
advice,  so  I  decided  to  go  ahead. 

Hughes:     How  did  your  parents  feel  about  your  going  to  medical  school? 

Scheie:       By  that  time,  I  had  really  sort  of  outgrown  that  part  of  my 

background.  They  had  always  seemed  pleased  with  anything  that  I 
accomplished.  My  father,  however,  had  not  wanted  me  to  go  to 
college. 

Hughes:     What  did  he  want  you  to  do? 


20 


Scheie:       Be  a  farmer.  He  worried  that  I  might  become  another  big-city  bum. 
My  mother  was  in  favor,  however.  In  spite  of  having  very  little 
money,  she  chipped  in  a  few  dollars  here  and  there  to  help  me 
during  my  first  two  years  in  college. 

Hughes:     Were  you  still  sending  money  to  them  when  you  were  at  the 
university? 

Scheie:       Here  and  there  I  did. 

Hughes:     I  heard  you  helped  a  sister  through  nursing  school. 

Scheie:       Yes,  and  another  through  two  years  of  college.  I  had  several 

part-time  jobs  by  that  time.  This  was  when  I  was  in  medical  school. 
Tuition  was  modest.  I  think  Mrs.  Leora  Cassidy  helped  with  my 
younger  sister,  Ethel.  My  sister  Esther  finished  nursing  school, 
worked  in  Minneapolis  for  a  year  or  two,  and  then  went  to  Oregon 
where  she  met  her  husband,  Charles  Temple,  a  very  fine  person. 
He  is  still  living;  she  died  in  1986.  Ethel  was  quite  a  bit  like  me. 
She  was  very  active  and  interested  in  many  things.  She  was  doing 
very  well  in  the  school  of  journalism  but  after  two  years  she 
married  and  left  college,  [interruption] 

Dr.  Owen  Wangensteen,  the  famous  surgeon,  did  a  biographical 
book  containing  a  series  of  chapters  written  by  different  people.* 
He  had  trained  Christiaan  Barnard  as  a  resident,  who  later  did  the 
first  heart  transplant.  He  also  trained  the  famous  heart  surgeon  at 
Stanford. 

Hughes:     Dr.  [Norman  EJ  Shumway? 

Scheie:       Yes.  As  a  senior,  I  took  my  final  oral  exam  in  surgery  from  Dr. 

Wangensteen.  At  the  end  of  the  examination,  he  asked  me  what  I 
was  going  to  do.  I  told  him  that  I  had  an  opportunity  to  go  to  the 
University  of  Pennsylvania.  This  was  a  two-year  internship,  while 
most  of  them  were  one  year  in  those  days.  He  questioned  the 
advisability  of  spending  that  much  time  and  suggested  that  I 
consider  a  one-year  internship  and  then  a  fellowship  or  residency. 
His  own  residents  usually  followed  their  internship  with  basic 
science  work  for  a  year  or  two  before  taking  their  clinical  residency. 
I  replied  that  this  opportunity  had  come  along  and  that  Dean  Lyon 
thought  it  was  a  good  idea.  In  his  clipped  speech,  he  said,  "Harold, 
remember:  Time  wasted  can  never  be  regained." 

Hughes:     Why  did  the  University  of  Pennsylvania  have  a  two-year  internship? 


Wangenstcn,  OH  cd.  Elias  Potter  Lyon:  Minnesota's  Leader  in  Medical  Education.  St.  Louis: 
Warren  H.  Green,  Inc.,  1981 


21 


Scheie:       Well,  they  were  the  oldest  medical  school  in  the  country;  they  were 
established.  They  were  trying  to  turn  out  very  fine  physicians, 
which  they  did. 

Hughes:     In  the  two-year  internship  did  you  rotate  through  more  services  or 
stay  longer  in  a  few? 

Scheie:       With  the  two-year  rotating  internship,  I  served  on  practically  every 
service  in  the  hospital-neurology,  neurosurgery,  various  specialties 
of  medicine  and  surgery,  dermatology,  radiology,  obstetrics,  and 
pediatrics.  Each  service,  sometimes  combining  two  or  even  three 
specialties,  was  of  three-months  duration.  This  broad  exposure  has 
been  invaluable  to  me  as  a  specialist.  I  do  not  think  it  was  wasted. 

Hughes:     Was  the  idea  to  turn  out  well-rounded  physicians? 

Scheie:       Yes.  Well-rounded  people,  giving  them  a  broad  background. 

Faculty 

Hughes:     Well,  before  we  leave  Minnesota,  were  there  outstanding  people  on 
the  faculty  that  should  be  mentioned?  It  was  the  early  to 
mid-thirties  that  you  were  there. 

Scheie:       Yes,  we  had  an  outstanding  faculty  of  excellent  teachers.  An 
anatomist  by  the  name  of  Clarence  M.  Jackson  was  very  fine. 
Another  basic  scientist  in  anatomy  and  embryology,  Richard 
Scammon,  was  a  brilliant  teacher.  He  later  succeeded  Dean  Lyon 
as  dean.  Andrew  Theodore  Rasmussen,  a  neuroanatomist,  was  a 
brilliant  teacher.  One  of  his  sons,  Waldemer,  was  a  classmate  of 
mine.  Another  son,  Theodore,  was  a  year  ahead  of  us  in  medical 
school.  Both  were  brilliant.  Theodore  became  head  of  neurosurgery 
at  McGill  University  in  Canada,  succeeding  the  famous  Wilder 
Penfield. 

Hughes:     What  was  the  reputation  of  the  medical  school  in  those  days? 

Scheie:       I  believe  it  had  a  good  reputation.  Many  of  the  clinical  and 
basic-science  faculty  were  full  time,  and  visiting  staff  were 
excellent.  I  think  Minnesota  was  a  leading  institution  in  having 
full-time  faculty.  This  had  been  an  increasing  trend,  although 
criticized  by  some. 

Hughes:     Why  wouldn't  it  be  good? 

Scheie:       Well,  with  salaries  and  tenure,  incentive  might  be  diminished.  If 

they  are  especially  interested  in  the  basic-science  aspects,  they  may 
not  want  to  see  patients;  they  would  rather  be  in  the  laboratories. 
There  are  many  other  aspects. 


22 


Hughes:     Was  it  a  research-oriented  school? 

Scheie:       Oh,  yes,  and  it  still  is.  It  is  outstanding  in  many  fields.  It  has 
become  one  of  the  major  transplant  centers  in  the  country. 
Wangensteen,  Dean  Lyon,  and  others  had  always  urged  clinicians  to 
team  with  basic  scientists.  Minnesota  has  leaders  in  most  clinical 
fields,  including  radiology,  internal  medicine,  obstetrics, 
ophthalmology,  pediatrics,  and  others,  as  well  as  in  the  basic 
sciences. 

Hughes:     Were  medical  students  encouraged  to  consider  a  career  in  research! 

Scheie:       Oh,  yes.  We  didn't  have  government  support,  such  as  now,  so  the 
school  couldn't  hire  large  numbers  of  research  people,  but  faculty 
encouragement  was  there.  Some  of  the  state  universities  are 
fortunate,  however,  in  having  fairly  generous  support  from  the  state 
budgets. 

Hughes:     I  read  that  Dean  Lyon  had  some  bearing  on  the  standing  of  the 
medical  school. 

Scheie:       I  think  he  brought  it  into  the  truly  modern  era.  He  was  unique  in 
that  he  was  the  first-possibly  more  have  come  later-to  be  named 
dean  of  a  major  medical  school  with  only  a  Ph.D.  degree. 

Hughes:     A  Ph.D.  in  what? 

Scheie:       Physiology.  He  worked  for  years  with  a  famous  researcher,  Jacques 
Loeb,  at  the  University  of  Chicago,  and  then  at  St.  Louis  University 
in  Missouri.  From  there  he  went  to  Minnesota  in  1913.  I  think  it 
was  understood  when  he  came  that,  although  he  was  a  physiologist, 
he  would  be  named  dean.  I  do  not  know  all  of  the  details  as  to  how 
or  why  that  was  done.  He  recruited  many  of  the  faculty  who  were 
there  when  I  was  in  medical  school.  He  had  great  vision  and  laid 
the  foundations  for  a  modern  medical  school— clinical  and  scientific. 

After  Wangensteen  had  finished  medical  school  and  trained  in 
surgery-he  had  a  Ph.D.  degree  in  physiology  also-he  was  sent  by 
Dean  Lyon  for  a  year  or  two  for  postgraduate  work  and  exposure  to 
European  medicine.  He  studied  in  Germany,  Austria,  and  places 
like  that.  When  he  came  back,  he  was  appointed  the  first  full-time 
chairman  of  the  department  of  surgery  and  was  only  thirty-two 
years  of  age.*  Dean  Lyon  nearly  lost  his  job  for  doing  that  because 
traditionally  the  chief  of  surgery  had  always  been  a  clinical  surgeon 
from  downtown.  But  more  than  that,  to  bring  in  such  a  young 
academician  for  the  job  was  almost  unheard  of. 


GrayJ.  The  University  of  Minnesota,  1851-1951.  Minneapolis:  University  of  Minnesota  Press, 
1951;  501-10.  Wangensteen  OH,  ed.  Elias  Potter  Lyon:  Minnesota's  Leader  in  Medical 
Education;  30-1. 


23 


Subsequently,  Wangensteen  became  very  famous  while  developing 
one  of  the  country's  outstanding  surgical  departments. 
Wangensteen,  I  understand,  has  trained  more  professors  of  surgery 
for  medical  schools  than  any  surgeon  in  our  country's  history.  He 
was  an  intense,  hard-driving,  dedicated  man.  He  was  a  very 
brilliant  individual  who  never  spared  himself. 

Hughes:     He  was  the  only  full-time  chairman  at  that  time? 

Scheie:       Well  no,  there  were  others. 

Another  thing  that  Dean  Lyon  did  that  caused  a  great  deal  of 
turmoil  was  described  in  a  book,  The  Doctors  Mayo,  and  two 
others.*  The  Mayo  Clinic,  as  you  may  know,  had  been  criticized  for 
being  only  a  private  clinic.  I  gather  that  it  offered  very  real 
competition  for  practicing  doctors,  particularly  in  Minneapolis,  St. 
Paul,  and  the  entire  state  of  Minnesota.  The  Mayo  Clinic  name  was 
often  in  the  newspapers,  which  today  is  commonplace  among 
hospitals  and,  unfortunately,  even  for  individual  physicians. 

At  any  rate,  Dean  Lyon  helped  to  develop  an  affiliation  agreement 
between  the  Mayo  Clinic  and  our  medical  school,  thus  helping  the 
clinic  to  develop  a  research  program  and  the  opportunity  for  fellows 
to  earn  postgraduate  degrees  from  the  University  of  Minnesota. 
Today  they  have  a  well  known  and  excellent  research  section.  The 
agreement  which  Dean  Lyon  helped  to  culminate  proved  to  be 
beneficial  to  both  the  University  of  Minnesota  and  the  Mayo  Clinic. 
They  now  even  have  their  own  Mayo  Clinic  medical  school  and  I 
believe  the  arrangement  with  the  university  has  been  terminated. 

J.C.  Litzenberg,  I  believe,  was  a  part-time  and  outstanding  chief  of 
obstetrics  at  that  point.  Irvine  McQuarrie  in  pediatrics  was  also 
outstanding.  He  became  world  famous  for  his  work  with  fluid 
balance  as  it  pertained  to  epilepsy  and  he  was  also  a  great  teacher. 
He  revealed  his  humanity  to  our  class  in  a  vivid  lesson  during  a 
lecture  one  day.  Our  lectures  were  held  before  ninety  to  one 
hundred  students  in  a  large  amphitheater. 

On  this  particular  occasion  he  had  just  started  his  lecture  when  a 
rather  odd-looking,  servant-type  woman,  probably  Swedish, 
nervously  hurried  into  the  room  to  hand  him  some  papers.  She 
even  walked  with  a  funny  gait.  The  class  audibly  snickered  at  her. 
McQuarrie  indignantly  stopped  his  lecture,  waited  for  her  to  leave 
the  room,  and  said  he  was  ashamed  that  we  laughed  at  this  woman. 
"I  want  you  to  know  that  she  is  the  maid  who  cares  for  my  office 
and  adjoining  quarters.  She  saw  these  papers,  thought  that  I'd 
forgotten  them  and  might  need  them  for  this  lecture.  She  was  nice 


Clapesattlc,  H.  The  Doctors  Mayo.  New  York:  Pocket  Books,  4th  ed,  1968.  Gray,J.  The 
University  of  Minnesota,  1851-1951;  176-80.  Wangensteen,  OH,  ed.  Elias  Potter  Lyon: 
Minnesota's  Leader  in  Medical  Education;  33-7. 


24 


enough  to  come  trudging  all  the  way  down  here  to  give  them  to  me. 
I  want  this  class  to  know  that  she  always  does  her  best  and  that  I 
have  great  respect  for  her.  I  doubt  that  I  will  be  able  to  say  the 
same  for  even  ten  percent  of  this  class  after  you  are  out  in  practice." 
It  was  a  good  lesson  in  decency  and  most  of  the  class  was  left 
feeling  very  ashamed. 

Hughes:     Did  you  do  any  research  as  a  medical  student? 

Scheie:       As  a  medical  student  I  was  much  too  busy  making  financial  ends 

meet.  I  had  difficulty  keeping  up  with  my  laboratory  work  because 
I  was  forced  to  miss  numerous  lab  sessions.  I  could  do  some  of  my 
studying  while  on  duty  on  certain  of  my  jobs,  which  I  was  fortunate 
to  have. 

Jobs 

Hughes:     What  sort  of  jobs  did  you  do? 

Scheie:       I  worked  as  an  optician  during  medical  school  years.  In  addition  to 
being  paid,  it  helped  to  stimulate  my  interest  in  ophthalmology. 
The  job  required  two  to  three  hours  a  day  in  the  student  health 
service  where  I  dispensed  glasses.  We  had  a  large  student  health 
service  where  ophthalmologists  did  eye  examinations.  The 
ophthalmologist  in  charge  was  Dr.  E.  Wilbur  Rucker.  He  later 
became  chief  of  ophthalmology  at  the  Mayo  Clinic  and  president  of 
the  American  Ophthalmological  Society.  He  was  very  well  known  in 
this  country  and  abroad  as  a  result  of  his  work  in 
neuro-ophthalmology.  He  was  a  lovely  man  and  we  developed  a 
lifelong  friendship.  I  had  a  letter  from  him  recently.  He  is  now 
retired  but  has  health  problems. 

## 

I  was  hired  and  trained  as  an  optician  by  the  Benson  Optical 
Company  when  I  was  a  freshman  medical  student,  a  job  that  I  held 
until  I  graduated.  The  Benson  Company  was  run  by  John  Benson, 
the  founder.  It  was  a  one-man  shop  in  the  Medical  Arts  Building  in 
downtown  Minneapolis.  Now  it  is  nationwide  and  one  of  the  largest 
in  this  country.  In  fact,  they  have  a  little  branch  office  in  our  eye 
institute.  The  Benson  Company  refers  to  me  as  their  "dropout 
optician." 

Then  I  had  my  job  as  night  manager  of  the  large  Northrup 
Auditorium  Parking  Garage  where  the  Minneapolis  Symphony  was 
conducted  by  Eugene  Ormandy.  I  also  helped  Suzie  the  cook  in  the 
kitchen  of  the  University  of  Minnesota  Hospital.  I  received  my 
meals  there.  It  was  directly  across  the  street  from  the  dean's  home. 
All  of  this  created  problems  with  attendance  at  assigned 
laboratories.  However,  I  was  able  to  pass  the  demanding 


25 

comprehensive  written  examinations  with  good  grades  and  satisfy 
academic  requirements.  In  fact,  I  graduated  either  tenth  or  twelfth 
in  my  class  and  even  made  Alpha  Omega  Alpha,  of  which  I  was  very 
proud. 

My  freshman  year  was  really  difficult.  They  didn't  coddle  the 
students  in  those  days  and  we  had  heavy  schedules.  Out  of  the  155 
admitted  to  my  class  only  105  graduated,  and  the  comprehensive 
examinations  were  what  knocked  them  out.  [interruption]  I  know 
it  sounds  like  the  old,  "When  I  was  your  age,  I  had  to  break  the  ice 
in  the  wash  basin  every  morning  and  walk  two  miles  to  school" 
routine,  but  what  I  say  is  true.  The  work  load  that  I  carried  to  be 
able  to  attend  medical  school  most  students  today  would  consider 
impossible.  Including  school  work  and  study,  to  which  I  devoted 
forty  to  fifty  hours  a  week,  I  averaged  over  forty  hours  of  work 
outside  of  medical  school.  My  sisters  needed  some  assistance 
during  that  time  and  I  felt  fortunate  to  have  the  outside  jobs.  In 
fact,  it  was  both  a  challenge  and  an  economic  necessity. 

Anatomy  was  a  problem.  I  just  couldn't  put  in  the  long  hours  of 
dissection  that  were  called  for.  The  course  lasted  for  at  least  six 
months  of  our  freshman  year.  By  that  time  I  had  become  a  member 
of  a  medical  fraternity  (Phi  Rho  Sigma)  at  Dean  Lyon's  urging.  He 
had  been  a  member  sometime  previously  and  was  elected  national 
president  during  my  senior  year.  The  dues  fortunately  were  modest 
and  I  did  not  have  to  live  at  the  fraternity  house  since  I  was  living 
at  the  dean's  house.  One  of  my  fraternity  brothers,  whose  name 
was  Stopelstad  (I  forget  his  first  name),  also  was  having  some 
problems.  Some  shortcuts  had  to  be  taken.  To  make  up  for  lack  of 
time,  my  lab  partner  and  I  smuggled  out  the  leg  and  thigh  of  our 
cadaver  so  that  we  could  dissect  at  night.  We  kept  it  covered  in  the 
dean's  basement  in  a  formaldehyde  footbath  and,  we  thought,  safe 
from  prying  eyes. 

Alas,  our  disguise  was  not  a  success.  Mrs.  Lyon  had  an  exceedingly 
nice,  neat,  black  cleaning  person  who  came  to  help  her  every  week. 
Unfortunately  for  us  she  was  a  bit  too  careful  one  day  about  how 
she  tidied  our  basement.  When  I  arrived  home  that  evening,  I  was 
met  by  a  serious  confrontation  about  what  we  had  done.  The  dean 
pointed  out  quite  fairly  that  not  only  was  it  in  defiance  of  the 
university  rules,  but  it  was  also  an  action  of  disrespect  to  the 
human  body.  We  explained  the  limited  time  that  I  had  and  my 
missed  anatomy  sessions.  Both  the  dean  and  Mrs.  Lyon  were  kind 
and  understanding.  Their  judgment,  however,  was  that  we  were 
free  to  go  ahead  with  our  work  as  quickly  as  possible  and  then 
return  the  leg  as  carefully  and  secretly  as  we  had  taken  in  out.  My 
punishment  was  that  the  maid  was  not  to  clean  the  basement  in  the 
future.  It  was  my  job  from  that  time  for  the  next  three  years. 
However,  never  again  did  she  discover  part  of  a  corpse.* 


Wangenstcen  OH,  cd.  Elias  Potter  Lyon:  Minnesota's  Leader  in  Medical  Education;  215. 


26 


Hughes:     Did  the  fact  that  you  missed  some  laboratory  work  make  any 
difference  later  on? 

Scheie:       I  don't  think  so.  Probably  I  concentrated  more  while  in  the 
laboratory.  One  always  had  in  mind  those  comprehensive 
examinations.  I  can't  see  that  it  made  much  difference. 

Hughes:     Were  you  thinking  about  your  area  of  specialization  yet? 

Scheie:       Not  seriously.  The  reason  I  did  so  at  all  was  because  of  the 

optician's  job  and  the  fact  that  I  took  electives  and  spent  some  time 
in  the  ophthalmology  department  to  help  me  with  my  optician  work. 

The  chairman  and  professor  was  Dr.  Frank  Birch,  who  was  very 
kind  to  me.  Minnesota  alumni  are  raising  money  now  to  establish  a 
professorship  in  his  honor.  I  also  took  some  ophthalmology 
electives  later.  He  allowed  me  to  come  into  the  operating  room  and 
on  occasion  to  assist.  This  was  something  that  did  not  happen  in 
those  days  in  eye  surgery.  However,  if  you  were  allowed  to  hold  a 
hand-held  operating  lamp,  it  was  considered  to  be  part  of  the 
operation  and  I  was  allowed  to  do  that.  Of  course,  it  stimulated  my 
interest. 

Wilbur  Rucker  reminded  me  in  his  recent  letter  about  one  of  the 
reasons  I  became  interested  in  ophthalmology.  Glasses  have  to  be 
centered  accurately.  I  told  this  story  at  a  meeting  of  the  American 
Ophthalmological  Society  the  year  I  was  asked  to  present  him  as 
president  of  the  society.  The  story  involves  a  dentist  who  also 
worked  in  the  student  health  service  and  who  was  examined  for 
glasses  by  Wilbur  and  sent  to  me  to  fill  his  prescription.  The  man, 
Dr.  [Erling]  Hansen,  not  only  had  a  large  nose  but  it  had  been 
broken  and  was  deviated  from  the  midline.  Also  he  was  very 
farsighted.  Well,  putting  the  two  problems  together,  the  deviation 
and  his  farsightedness,  unless  a  correction  was  made  a  prism  would 
be  induced  and  eyestrain  or  double  vision  would  result.  An 
experienced  optician  would  have  managed  this  correctly. 
Measurements  should  be  made  from  the  center  of  the  nose  to  the 
center  of  each  eye.  Ordinarily  we  measure  the  pupillary  distance 
between  the  two  eyes,  which  was  where  I  made  a  mistake.  It  took 
about  three  different  refractions  by  frustrated  Dr.  Rucker  and  three 
different  incorrect  pairs  of  glasses  by  me  until  the  equally 
frustrated  dentist  was  happy.  Dr.  Rucker,  of  course,  discovered  that 
they  were  not  being  centered  properly,  [laughter] 

In  spite  of  such  incidents,  we  became  very  good  friends.  Dr.  Rucker 
is  now  over  eighty  years  of  age  and  I  am  approaching  that.  He  has 
never  forgotten  Dr.  Hansen,  nor  have  I.  Dr.  Hansen,  with  a  broken 
nose,  was  my  first  real  lesson  into  the  intricacies  of  opticianry. 
Episodes  such  as  this  stimulated  me  to  take  courses  in  refraction 


27 


with  the  residents  in  ophthalmology  at  the  university  hospital  and 
in  turn  to  be  permitted  in  Dr.  Birch's  operating  room. 

Hughes:     You  were  allowed  to  take  courses  for  residents  as  a  medical  student? 

Scheie:  Yes,  we  could  take  electives  and  mine  were  in  ophthalmology.  I 
thought,  "Gee  whiz,  I  would  like  to  know  more  about  what  I  am 
doing." 

Hughes:  Was  ophthalmology  a  part  of  the  standard  medical  curriculum  at 
Minnesota? 

Scheie:  We  had  a  few  lectures,  which  did  not  interest  most  students.  Dr. 
Birch  was  not  a  stimulating  lecturer  although  he  was  a  very  fine 
surgeon  and  a  dedicated  ophthalmologist. 

Hughes:     What  was  his  particular  interest? 

Scheie:       Surgery. 

Hughes:     Not  any  particular  type? 

Scheie:       He  did  general  ophthalmology  but  had  a  very  large  eye  surgical 

practice.  Ophthalmology  did  not  become  subspecialized  until  quite 
recently  and  has  possibly  gone  too  far  in  that  direction.* 


Internship,  University  of  Pennsylvania  Hospital, 
July  1,  1935  -  June  30,  1937 

Hughes:     Dr.  Scheie,  would  you  tell  me  please  how  you  came  to  be  an  intern  at 
the  University  of  Pennsylvania? 

Scheie:       Yes,  in  1934,  with  letters  of  recommendation  from  a  couple  of  my 
professors  at  Minnesota  and  from  Dean  Lyon,  I  took  a  trip  to  the 
East-I  had  never  been  out  of  the  Midwest-in  search  of  possible 
sites  for  internship.  The  dean  had  given  the  money  to  me  for  the 
trip  in  return  for  driving  him  and  his  wife  to  Cleveland,  Ohio, 
where  the  American  Medical  Association  was  meeting.  So  I  left 
them  and  their  car  there  and  went  on  my  journey.  I  went  to 
Philadelphia  first  and  stayed  there  so  long  that  I  never  did  get  to 
Boston  because  I  had  to  return  to  Cleveland  to  again  join  the  dean 
and  his  wife.  In  Philadelphia,  I  had  letters  to  Jefferson  Medical 
College,  to  the  University  of  Pennsylvania,  and  to  the  Philadelphia 
General  Hospital. 

My  first  appointment  was  with  Dean  William  Pepper  of  the  famous 
Pepper  family  that  has  played  a  major  part  in  the  history  of  the 


See  below,  for  a  discussion  of  subspecialization  in  ophthalmology. 


28 


University  of  Pennsylvania.  A  very  famous  statue  of  Provost 
Pepper  stands  beside  Houston  Hall.  Well,  the  dean  of  the 
University  of  Pennsylvania  Medical  School  was  an  absolutely 
lovable  man  whom  I  will  never  forget.  Some  members  of  the  Pepper 
family  I  still  see  as  patients  and  friends.  The  dean  and  I  chatted 
about  the  university  and  other  internships  in  town  for  which  I 
might  apply. 

Philadelphia  General  Hospital  was  a  large  old  but  prestigious  city 
hospital  where  the  interns  were  given  great  responsibility.  Of 
course,  for  a  young  man  just  finishing  medical  school  that  was  very 
attractive.  It  was  number  one  on  my  list,  really.  Dean  Pepper  told 
me  that  applicants  were  required  to  be  in  Philadelphia  later  in  the 
year  to  take  the  written  and  oral  examinations  as  well  as  to  be 
interviewed.  I  would  have  to  return  to  Philadelphia  for  this. 
Jefferson  Medical  College  also  did  not  interview  as  early  as  my 
visit.  I  saw  the  dean  there  but  it  was  a  meeting  rather  than  an 
interview. 

The  oldest  hospital  in  the  United  States  is  Pennsylvania  Hospital, 
located  in  Philadelphia  at  Eighth  and  Spruce  Streets.  I  told  Dean 
Pepper  that  it  sounded  interesting  and  asked  if  it  was  a  good 
hospital  and  a  good  place  to  intern.  He  looked  up  and  rather 
whimsically  asked,  "Did  your  ancestors  come  over  on  the 
Mayflower!"  When  I  said,  "No,"  which  he  obviously  knew,  he  stated 
that  it  would  just  be  a  waste  of  time  to  apply.  As  an  aside,  they  now 
have  interns  and  residents  of  all  races,  creeds,  sexes,  and  color.  I 
was  not  upset  because  I  have  never  had  strong  feelings  about  status 
because  of  my  own  background.  In  fact,  I  was  very  amused  when 
about  two  years  ago  in  a  lead  article  in  Newsweek  discussing 
minorities,  Norwegians  were  referred  to  as  one  of  the  minority 
groups.  Well,  that  was  really  the  extent  of  my  interview.  For 
economy's  sake,  I  stayed  at  the  Phi  Rho  Sigma  fraternity  house  for 
three  nights. 

Dean  Pepper  was  a  very  genuine  and  friendly  man.  It  was  he  who 
brought  up  the  University  of  Pennsylvania  as  a  possible  place  to 
intern.  I  replied,  "Well,  the  internship  is  two  years,  and  I 
understand  the  interns  are  very  closely  supervised  by  staff.  They 
are  not  given  the  degree  of  responsibility  that  they  are  at 
Philadelphia  General."  Imagine  talking  to  the  dean  like  this! 
However,  I  think  I  probably  made  a  friend  by  my  frankness. 

Later,  during  my  senior  year,  I  had  just  about  determined  to  go  to 
Cincinnati  General  Hospital  where  no  interview  was  required.  It 
had  an  excellent  reputation  and  was  nearly  as  sought  after  as 
Philadelphia  General.  I  also  considered  an  internship  in  Seattle  at 
King's  County  Hospital.  Although  I  was  devoted  to  the  University 
of  Minnesota,  I  did  want  exposure  to  medical  practice  in  another 
part  of  the  country. 


29 


I  had  given  up  consideration  of  Philadelphia  and  was  about  to  write 
a  letter  to  accept  the  internship  in  Cincinnati,  when  a  letter  arrived 
from  Dean  Pepper  to  Dean  Lyon  and  our  local  intern  selection 
committee.  Dean  Lyon  showed  the  letter  to  me  in  which  Dean 
Pepper  said,  "Tell  Scheie  I  liked  his  looks,  [laughter]  If  he  wants  to 
come  to  Penn  to  intern,  we  would  like  to  have  him."  At  that  time,  I 
didn't  realize  how  nicely  I  was  being  treated  because,  although  they 
accepted  fourteen  interns  each  year  for  their  two-year  internship, 
only  three  were  from  other  medical  schools.  The  purpose  of  taking 
graduates  from  other  schools  was  to  compare  their  education  and 
work  with  that  of  the  Penn  graduates.  Actually,  I  did  not  learn  that 
until  later. 


Intern 


Hughes:     Was  it  typical  in  those  days  for  a  hospital  affiliated  with  a  university 
to  take  on  mainly  their  own  graduates'? 

Scheie:       It  was  true  at  Penn  but  whether  it  was  general,  I  don't  know. 

The  internship  at  Penn  was  very  sought  after,  and  their  eleven 
interns  each  year  were  nearly  always  in  the  top  twenty-five  in  a 
class.  It  gave  the  outsiders,  like  myself,  a  feeling  of  some  stress. 
We  were  made  to  feel  at  home,  however,  and  I  had  a  great  two  years 
of  internship. 

Hughes:     Were  you  aware  of  any  difference  in  your  training'? 


30 


Scheie:       Not  really.  I  think  medical  education  was  and  still  is  fairly  uniform. 
What  one  learns  is  up  to  the  individual.  The  University  of 
Pennsylvania  dwelt  more  on  detail,  probably,  with  meticulous 
records  and  staff  men  who  made  detailed  and  meticulous  rounds. 
We  had  the  same  chief  of  service  for  three  months  at  a  time  and 
probably  felt  more  pressures  than  interns  did  at  Minnesota. 

Hughes:  Philadelphia  medicine  has  a  reputation  for  being  conservative.  Did 
you  notice  that  it  was  more  conservative  than  what  you  were  used  to 
at  Minnesota? 

Scheie:       It  depended  upon  the  hospital.  I  learned  very  early  that  the  young 
men  did  not  have  as  much  responsibility  at  the  University  of 
Pennsylvania  Hospital  [HUP]  as  they  did,  say,  at  Philadelphia 
General.  This  was  a  big  city  teaching  hospital  which  delegated  a 
great  deal  of  patient  care  with  less  intense  staff  supervision.  At  the 
Hospital  of  the  University  of  Pennsylvania  we  had  wonderful  chiefs 
who  were  in  constant  attendance.  They  were  very  capable, 
dedicated  and  academically  oriented,  as  well  as  quite  demanding. 

Hughes:     Tell  me  what  the  two-year  internship  entailed. 

Scheie:       Well,  the  volume  of  patients  for  each  of  those  services  at  that  time 
was  less  than  it  would  be  today.  We  would  assist  the  staff  in  their 
clinics  and  also  help  care  for  inpatients.  There  was  no  particular 
relationship  among  the  services  except  for  freely  used 
consultations.  But  we  did,  before  we  were  through,  cover 
practically  every  service  in  the  hospital  for  three  months  at  a  time 
and  it  was  a  great  educational  experience.  Ophthalmology  is  much 
broader  than  is  generally  realized.  I  do  not  believe  a  day  passed  in 
my  subsequent  practice  that  I  did  not  utilize  some  of  the  general 
knowledge  that  I  acquired  as  an  intern. 

Hughes:     So  the  two  years  were  very  much  worthwhile? 

Scheie:       Oh,  yes.  Now  we  are  slighting  internships  and  I  believe  it  is  wrong. 
Today  the  student  is  almost  required  to  decide  upon  his  specialty 
while  still  in  medical  school.  For  example,  if  he  decides  upon 
internal  medicine,  he  is  immediately  taken  into  an  equivalent  of  a 
medical  residency.  In  ophthalmology  there  is  no  significant 
exposure  to  other  branches  of  medicine,  except  a  one-year 
internship,  usually  in  medicine  or  neurology,  before  starting  the 
residency. 

Hughes:     Were  you  being  paid  as  an  intern? 

Scheie:       Nothing. 

Hughes:     Did  you  live  at  the  hospital? 


31 


Scheie:       Yes,  we  lived  in  the  hospital  and  I  am  not  even  sure  they  bought  our 
uniforms.  We  did  get  room,  board,  and  laundry.  A  superintendent 
of  the  hospital  and  a  chief  medical  officer  were  responsible  for 
running  the  hospital.  The  chief  medical  officer,  a  wonderful  person 
by  the  name  of  Larry  [C.]  Hatch,  a  Jefferson  Medical  School 
graduate,  was  in  charge  of  interns  and  residents. 

I  will  never  forget  my  arrival  in  Philadelphia  on  the  30th  of  June, 
1935.  I  had  ridden  a  Greyhound  bus  from  Minneapolis  for  two  days 
and  three  nights.  I  couldn't  afford  a  train  and  flying  was  not 
commonplace  in  those  days.  The  bus  station  in  Philadelphia  was 
dirty  and  grimy.  I  was  also  dirty,  unshaven,  and  exhausted.  We 
had  even  had  an  accident  a  few  miles  east  of  Fort  Wayne,  Indiana. 
The  bus  had  careened  off  the  road,  sheered  off  a  telephone  pole,  and 
caved  in  its  front.  We  had  to  wait  a  few  hours  for  another.  The 
remainder  of  the  trip  was  uneventful.  I  didn't  have  much  baggage, 
and  I  remember  walking  from  the  Greyhound  station  near  30th  and 
Market  Streets  to  the  hospital  at  34th  and  Spruce  Street, 
half-a-dozen  blocks. 

At  the  hospital,  I  went  to  the  reception  desk,  dirty,  unshaven  and 
all.  I  was  told  that  all  new  interns  starting  service  the  next  day 
must  report  to  Dr.  Hatch,  the  chief  medical  officer,  before  they  were 
assigned  a  room.  So  dirty  and  unshaven,  I  had  to  go  in  to  see  Dr. 
Hatch.  He  had  a  dry  sense  of  humor.  I  was  a  little  taken  aback 
when  I  met  him,  but  I  liked  his  approach  to  life.  I'll  come  to  the 
point  of  that  in  a  little  while.  I  told  him  who  I  was  as  I  came  in,  of 
course.  He  took  one  look  at  me,  asked  me  to  spell  my  name, 
checked  it  on  the  list,  had  another  look  and  said,  "Thank  God!  I 
thought  you  might  have  been  a  Hindu."  [laughter]  We  became  good 
friends.  After  not  too  many  years,  he  became  the  physician  for  the 
Goodyear  Rubber  Company.  After  many  years  with  them,  he 
retired  to  Phoenix  and  is  now  deceased. 

Assistant  Medical  Officer 

Scheie:       Dr.  Hatch  showed  his  friendship  for  me  when  after  six  months  he 
accorded  me  a  great  and  supportive  favor.  He  had  two  assistant 
medical  officers,  and  they  had  always  been  interns  in  their  second 
year.  He  realized  that  I  had  little  money.  To  get  spending  money,  I 
had  given  blood  for  occasional  transfusions  and  was  paid  $150  or 
thereabouts.  This,  plus  the  additional  help  that  was  about  to  be 
forthcoming,  enabled  me  to  go  home  on  vacation  between  my  first 
and  second  year. 

At  Christmas  one  of  the  second-year  interns  who  was  Dr.  Hatch's 
assistant  medical  officer  dropped  out.  So  for  the  first  time  we  had  a 
first-year  intern  in  that  position  when  he  invited  me  and  I  was 
pleased  to  accept.  For  that  I  was  given  fifty  dollars  a  month,  which  I 
felt  was  a  big  income.  I  held  this  position  through  the  second  year 


32 


of  my  eye  residency.  Our  monetary  needs  as  interns  were  small 
because  we  lived  in  the  hospital  and  were  on  twenty-four  hour  duty. 
None  of  this  eight  to  five  o'clock. 

Hughes:     You  mean  day  after  day? 

Scheie:       Day  after  day.  Very  few  interns  were  married,  maybe  two  or  three. 
It  was  very  demanding.  In  addition,  as  assistant  chief  medical 
officer  I  was  on  call  every  other  night  and  every  other  weekend. 
Among  the  duties  was  caring  for  sick  nurses,  fellow  interns,  or 
employees,  unless  a  senior  physician  was  needed.  Obviously  if 
someone  was  ill  and  had  a  serious  situation,  he  became  a  regular 
patient.  Dr.  Hatch  was  responsible  ultimately  for  seeing  that 
everything  was  going  well. 

We  would  also  decide  which  patients  were  admitted  from  the 
emergency  room  or  receiving  ward.  Then  we  were  affected  by 
occasional  staff  politics.  To  whom  were  we  going  to  refer  this 
patient  with  an  acute  appendix  who  came  in  off  the  street?  We 
could,  with  a  wrong  decision,  be  in  a  little  trouble  with  chiefs  of 
service.  It  was  good  to  be  introduced  at  that  time  to  some  of  the 
realities  of  staff  relationships. 

In  addition  to  the  pay  [as  assistant  chief  medical  officer],  a  little 
prestige  was  involved  as  another  reward.  The  job  also  added 
valuable  clinical  experience,  which  was  great.  The  contacts  you 
made  around  the  hospital  were  invaluable. 

Thomas  B.  Holloway 

Hughes:     Thomas  Holloway,  who  was  the  third  chairman  of  the  department  of 
ophthalmology,  died  of  lung  cancer  in  1936.  You  were  still  an  intern. 

Scheie:       Dr.  Holloway  was  chairman  of  the  department  and  its  professor.  He 
proved  to  be  someone  whom  I  very  much  liked  and  respected.  He 
had  a  dry  wit,  but  few  realized  that  he  had  a  great  sense  of  humor. 
I  was  one  of  the  few  on  the  house  staff  who  did.  Everybody  held 
him  in  great  awe  because  of  his  personality  and  stern  front.  He  was 
rather  imperious-probably  a  poor  word-and  he  was  dignified. 

At  that  time  the  eye  doctors  would  come  to  the  hospital  during  the 
afternoon  to  do  their  surgery  and  see  clinic  patients  and  their  own 
inpatients.  The  inpatient  service  was  not  terribly  large.  Dr. 
Holloway  himself  came  in  at  about  two  in  the  afternoon.  Since  I 
was  covering  three  services,  I  wasn't  on  the  spot  waiting  for  him  on 
the  first  day  of  service  and  I  arrived  a  little  late.  He  had  preceded 
me.  The  chief  nurse,  whom  I  had  met  earlier  in  the  day,  introduced 
me  to  Dr.  Holloway.  I  had  tried  to  meet  the  chiefs  of  my  three 
services  during  the  morning,  but  Dr.  Holloway  was  always  in  his 
downtown  private  office  seeing  patients  until  noon. 


33 


He  was  in  the  dark  examining  room  looking  at  a  student  nurse's 
eye.  She  had  choroiditis,  an  inflammation  in  the  back  of  her  right 
eye.  The  chief  nurse  brought  me  into  the  room  and  introduced  me. 
We  shook  hands  and  he,  ignoring  my  tardiness,  told  me  how  happy 
he  was  to  have  me  on  the  service.  Then  he  pointed  toward  the 
student  nurse  whose  eye  he  had  been  examining.  I  had  already 
noticed  that  she  was  very  pretty,  and  he  said,  "Would  you  like  to 
look  at  her?"  Without  hesitation  I  replied,  "Dr.  Holloway,  would  I!" 
[laughter]  He  thought  that  was  great!  So  we  hit  it  off  from  the  start. 

I  came  to  know  that  nurse  quite  well  over  the  years  because  she 
later  became  a  staff  nurse  and  in  1943  was  assigned  to  our  hospital 
unit  in  India  during  World  War  II.  Of  some  interest.  Shortly  before 
I  retired,  the  choroiditis  in  her  right  eye  recurred  and  she  flew  to 
Philadelphia  from  Texas,  where  she  is  now  living,  to  be  seen  by  me 
in  consultation.  Quite  amazing-my  first  patient  seen  at  Perm  in 
July  1935  and  nearly  my  last  in  1987. 


Residency,  University  of  Pennsylvania, 
July  1,  1937-June  30,  1940. 

Dr.  Holloway  soon  learned  that  I  had  an  interest  in  ophthalmology 
and  with  my  permission  tentatively  arranged  for  me  to  have  a 
residency  in  ophthalmology  in  a  department  that  he  and  many 
others  thought  was  number  one  in  the  country. 


He  had  urged  me  to  let  him  write  a  letter  to  Columbia  Presbyterian 
Eye  Institute  in  New  York  City,  whose  chief  was  the  famous  and 
skilled  surgeon,  Dr.  John  Wheeler.  I  went  over  for  an  interview,  but 
since  I  had  not  yet  firmly  decided  to  specialize  in  ophthalmology,  no 
firm  promises  were  made  by  either  of  us  at  that  time. 

I  was  interviewed  later  and  tentatively  accepted  for  that  residency, 
I  am  sure  because  of  Dr.  Holloway.  Very  shortly  though,  after  I 
finished  my  three  months  on  his  service,  he  developed  cancer  of  the 
lung,  which  was  treated  by  x-ray.  He  was  only  fifty-two  years  of 
age.  He  became  very  depressed  and  even  insisted  that  his  face  be 
covered  so  that  no  one  would  recognize  him  when  taken  on  a  litter 
to  or  from  treatments.  He  requested  that  an  autopsy  be  done  at  his 
home  and  he  also  arranged  for  a  funeral  service  to  be  held  there 
with  only  a  few  old  friends  invited.  Whiskey  and  cocktails  were  to 
be  served  for  the  occasion.  Dr.  Holloway  died  near  the  end  of  my 
first  year  of  internship  in  1936.  A  sad,  premature  end  for  a  very 
dedicated  and  fine  man. 

Hughes:     What  is  he  known  for  in  ophthalmology? 


34 


Scheie: 


Hughes: 
Scheie: 

Hughes: 
Scheie: 


He  was  a  good  teacher  and  had  a  particular  interest  in  ophthalmic 
pathology  and  perimetry.  He  was  skilled  at  ophthalmoscopy,  which 
he  emphasized.  He  dictated  long  notes  that  the  intern  usually  took. 
Unfortunately,  my  handwriting  was  never  very  good. 

The  record  system  at  the  Hospital  of  the  University  of  Pennsylvania 
was  antiquated.  We  did  not  have  individual  records  in  our 
outpatient  department.  They  were  kept  in  a  bound  notebook,  which 
was  unsatisfactory.  I  was  accustomed  to  a  central  record  room  at 
the  University  of  Minnesota  Hospital.  There,  records  were 
delivered  to  clinic  or  patient  floors  through  air  chutes  from  a 
separate  and  modern  record  room. 

I  became  acquainted  with  Penn's  pathetic  record  system  shortly 
after  reporting  to  Dr.  Eugene  P.  Pendergrass,  who  was  chairman 
and  professor  of  the  very  distinguished  department  of 
roentgenology.  Radiation  therapy  and  surgery  were  just  about  the 
only  treatments  for  cancer  at  that  time.  Patients  were  referred  to 
x-ray  for  therapy  from  every  department  in  the  hospital.  Each 
department  had  its  own  record  folder  and  many  of  these  patients 
had  been  seen  and  even  treated  by  several  different  departments. 

When  I  arrived,  one  such  patient  had  just  been  readmitted  and  Dr. 
Pendergrass  asked  me  to  obtain  the  previous  records  for  him.  I 
said,  "Surely,  but  will  you  direct  me  to  the  record  room?"  He 
replied,  "The  hospital  does  not  have  a  central  record  room.  Each 
department  has  its  own.  I  do  know  that  she  has  been  on  surgery,  on 
gynecology,  and  possibly  others.  Also,  the  records  from  one 
department  may  inform  you  what  other  services  she  has  been  on." 
Before  long,  I  had  learned  that  she  had  been  to  about  a  half-dozen 
different  services,  including  gynecology,  medicine,  surgery,  nose  and 
throat,  and  others.  I  spent  most  of  my  first  half-day-the  hospital 
was  two  blocks  long-running  from  one  service  to  another  for 
records.  I  might  add  that  the  outpatient  records  were  not  with  the 
hospital  records  for  each  department.  It  was  absolutely  chaotic.  I 
wondered  what  sort  of  a  place  I  was  in.  Well,  before  long  they  had  a 
central  record  room. 

It  is  interesting  that  Dr.  Holloway  encouraged  you  to  go  elsewhere  in 
ophthalmology. 

There  was  no  residency  program  at  Penn.  I  think  in  all  fairness  he 
probably  realized  that  his  staff  was  too  small  and  that  his  private 
practice  might  interfere. 

Did  you  ever  have  any  regrets  about  not  going  to  Columbia? 

No,  not  really. 

I  have  often  been  asked  why  I  went  into  ophthalmology.  As  I 
worked  with  patients  on  the  various  services,  I  observed  that  there 


35 

were  three  areas  where  the  patients  were  most  pleased  and 
grateful.  These  were  also  fields  where  you  could  do  something 
concrete  for  them.  One  was  ophthalmology;  everybody  seemed  very 
happy.  They  left  the  hospital  looking  forward  to  a  new  life.  In 
those  days  the  patient  had  to  wait  for  cataracts  to  be  complete 
(ripe),  so  they  were  often  nearly  blind  before  they  were  operated. 

Another  service  with  happy  patients  was  obstetrics.  I  loved  the 
atmosphere.  Again,  a  service  that  gives  new  life.  The  patients  were 
so  grateful  and  happy,  and,  of  course,  they  did  all  of  the  work. 
When  there  is  an  emergency  in  obstetrics,  believe  me,  it  is  an 
emergency.  The  service  might  seem  dull  to  many  doctors  but  it  was 
exciting  for  me. 

The  third  area  was  general  surgery.  When  you  make  a  diagnosis 
you  can  usually  do  something  about  it.  There  are,  of  course, 
patients  who  are  terminal  and  hopeless  and  there  are  other 
disappointments,  but  most  conditions  can  be  surmounted.  So 
eventually  it  boiled  down  to  a  choice  from  those  three  services  and  I 
settled  on  ophthalmology. 

Alexander  Garrison  Fewell 

Scheie:       Now  coming  back  to  another  part  of  the  story:  Dr.  Holloway  had 
died  and  two  people  were  being  seriously  considered  for  the  job  as 
chairman-Dr.  Francis  Heed  Adler  and  Dr.  Alexander  Garrison 
Fewell.  Each  of  them  badly  wanted  it.  The  famous  Dr.  George  de 
Schweinitz  had  trained  Dr.  Fewell  and  had  used  him  as  his 
right-hand  man,  much  as  happened  with  Dr.  Madeleine  Ewing 
training  and  working  with  me. 

Dr.  Fewell  was  one  of  my  very  favorite  people  and  a  key  staff  person 
under  Dr.  Holloway.  Not  long  after  I  arrived  at  Penn,  he  and  Dr. 
Alfred  Cowan  took  me  to  see  my  first  major  league  baseball  game, 
in  which  Babe  Ruth,  Lou  Gehrig,  Jimmy  Fox  and  Lefty  Grove  were 
playing.  It  was  exciting  for  me,  being  my  first  major-league  game, 
and  especially  to  see  the  Yankees.  Babe  Ruth  was  becoming  a 
legend  in  this  country  at  that  time.  I  think  Dr.  Fewell  contacted  Dr. 
Holloway  the  day  before.  Dr.  Holloway's  schedule  was  to  come  in  at 
two  o'clock  and  he  liked  to  have  his  intern  with  him.  I  would  not 
have  dared  to  ask  but  they  were  able  to  wangle  permission. 
Fortunately  Dr.  Holloway  was  a  great  baseball  fan  and,  I 
understand,  had  played  baseball  in  college.  We  had  a  great 
afternoon.  That  was  one  of  my  early  contacts  with  Dr.  Fewell. 

After  Dr.  Holloway's  death,  Dr.  Fewell  felt  that  he  might  be  given 
the  job  as  chairman  of  the  department  of  ophthalmology  at  Penn. 
He  had  even  made  tentative  plans  for  the  future  of  the  department 
and  had  suggested  that  I  might  like  to  be  his  resident.  Dr.  Francis 
Heed  Adler  was  appointed  as  the  chief  instead. 

Hughes:     But  Dr.  Fewell  did  serve  for  a  brief  period,  did  he  not? 


36 


Scheie:       Yes,  as  acting  chairman  for  some  months.  Dr.  Adler  was  an 

outstanding  member  of  the  staff  at  Wills  Eye  Hospital.  That  was 
where  he  did  his  clinical  work  and  was  one  of  their  chiefs. 
Obviously  I  came  to  know  Dr.  Fewell  well  because  of  the  months 
that  he  was  acting  chairman.  Dr.  Adler,  however,  was  finally 
appointed,  but  before  I  could  commit  myself  to  Dr.  John  Wheeler  at 
Columbia  Presbyterian  Eye  Institute. 

The  institute  had  been  built  because  Dr.  Wheeler  had  operated  on 
the  King  of  Siam,  and  the  king  had  given  him  a  large  sum  of  money 
toward  the  building  fund.  Wheeler  was  a  very  skilled  surgeon  and 
a  great  leader.  I  had  gone  to  New  York  to  watch  him  operate.  He 
was  also  a  very  nice  person.  A  little  of  an  autocrat  probably,  but  you 
don't  know  until  you  work  with  someone.  Later  I  became  a  damn 
autocrat,  [laughter] 

Hughes:     You  were  in  good  company. 

Scheie:       Yes.  However,  as  an  intern  I  was  in  no  position  to  be  an  autocrat, 
believe  me. 

Dr.  Fewell,  when  he  realized  that  he  would  not  be  selected,  was 
very  disappointed.  Shortly,  Dr.  Adler,  very  progressive,  wanted  to 
start  a  residency.  He  had  learned  that  I  was  interested  in 
ophthalmology.  At  any  rate,  he  asked  me  if  I  would  stay  on  and 
become  his  first  resident.  I  felt  sad  for  Dr.  Fewell,  and  because  he 
had  asked  me  to  be  his  own  resident,  I  felt  compelled  to  speak  to 
him  about  Dr.  Adler's  invitation. 

Dr.  Fewell's  response  gave  me  another  reason  to  respect  and  admire 
him  so  greatly.  When  I  told  him  about  my  dilemma  of  staying  with 
Dr.  Adler  or  going  to  New  York,  he  said,  "There  is  no  doubt  that 
Columbia  has  one  of  the  outstanding  residencies  in  the  country  and 
there  has  never  been  one  here  at  Penn.  But  if  you  go  to  New  York, 
it  is  big  and  it  will  be  like  going  from  a  small  town  to  the  big  city. 
You  are  apt  to  end  up  after  you  finish  your  residency  just  a  small 
frog  in  a  big  pond.  If  you  stay  in  Philadelphia,  it  is  very  likely  that 
you  will  be  a  big  frog."  And  more  to  the  point,  he  said,  "Dr.  Adler  is 
a  fine  person.  He  is  truly  accomplished  in  research  and  in  the 
scientific  side  of  ophthalmology,  as  well  as  a  good  clinician.  They 
made  a  great  selection  when  they  appointed  him  as  chairman,  and 
if  I  were  you,  I  would  stay  here  with  Dr.  Adler." 

Hughes:     Dr.  Scheie,  considering  the  history  of  ophthalmology  at  the 
University  of  Pennsylvania  with  people  of  the  stature  of  de 
Schweinitz  and  Adler,  why  do  you  suppose  that  it  took  them  so  long 
to  create  a  residency1? 

Scheie:       I  can't  answer  except  to  say  that  the  staff  was  small.  Dr.  Holloway 
was  interested  in  teaching;  he  could  have  done  it.  However,  few 
residencies  existed  in  1937.  Don't  forget  that  the  people  who 


Hughes: 


37 


started  the  department  in  1874  had  trained  in  Europe,  as  many 
physicians  were  doing.  One  prestigious  professor  trained  a  few 
underlings,  and  some  had  courses  for  Americans.  I'm  sure  that 
carried  over  from  William  F.  Norris  to  George  de  Schweinitz  and 
even  to  Dr.  Holloway. 

Dr.  de  Schweinitz  was  a  very  austere,  dignified,  sophisticated 
gentleman,  an  excellent  speaker,  and  someone  who  stood  for 
everything  that  was  good  in  medicine.  But  he  was  his  own  man. 
Holloway's  stance  was  similar  because  he  had  worked  under  de 
Schweinitz  and  was  his  successor.  My  intern  class  (1935)  was  the 
last  to  be  exposed  to  Dr.  de  Schweinitz.  He  lectured  to  our  group  on 
medical  ophthalmology  using  some  of  his  famous  slides  of  fundus 
drawings.  I,  while  on  the  eye  service,  saw  some  patients  with  him 
and  Dr.  Fewell. 

I  made  rounds  in  some  German  hospitals  just  after  World  War  II. 
It  was  a  little  depressing  and  even  somewhat  frightening  to  observe 
their  rounds.  The  staff  would  line  up  and  when  the  chief  would 
come  in  they  would  click  their  heels.  Even  the  patients  were 
required  to  get  out  of  bed  and  stand  at  attention  near  the  end  of 
their  bed  while  the  chief  was  in  attendance.  The  young  men 
learned  by  observing.  I  think  some  of  that  probably  influenced 
Norris  and  de  Schweinitz.  The  system  certainly  in  its  own  way 
seemed  to  work. 

A  residency  adds  a  great  many  responsibilities  to  the  life  of  a  chief 
and  requires  a  dedicated  staff  as  well.  The  residency  programs  of 
the  twenties  and  thirties  were  not  as  they  are  today.  There  was  less 
teaching  and  more  self-education.  Today  the  departments  are 
usually  diversified  and  have  clinical  specialists,  different  types  of 
basic  scientists,  research  facilities,  and  carefully  prepared  teaching 
programs. 

Francis  Heed  Adler 

Dr.  Adler,  when  he  was  appointed  chairman,  was  only  forty-two 
years  of  age. 


Scheie:       Yes,  he  was  young. 

Hughes:     I  believe  his  previous  appointment  had  been  instructor,  which  meant 
that  he  was  promoted  from  instructor  to  professor  and  chairman  of 
the  department  in  one  step. 

Scheie:       His  instructorship  was  in  the  department  of  pharmacology.  I  think 
he  did  little  or  no  teaching.  But  he  worked  in  the  medical  school, 
the  laboratory  side,  with  a  very  famous  research  worker,  Dr.  Alfred 
Newton  Richards,  who  was  of  Nobel  Prize  stature.  Dr.  Richards 
had  most  every  other  honor  there  is  in  the  field  of  pharmacology 
and  physiology.  He  was  the  first  man  to  intubate  with  a  microtube 


38 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


into  the  glomerulus  of  the  kidney.  He  had  chemists  with  him  who 
helped  him  by  utilizing  their  microchemistry  techniques  to  analyze 
minute  amounts  of  fluid.  For  the  first  time  we  began  to  know 
something  about  how  the  kidney  worked.  This  was  a  fantastic 
accomplishment.  That  is  where  Dr.  Adler  possibly  received  his 
original  stimulus  for  research,  and  he  applied  the  techniques  to 
ophthalmology. 

His  work  doing  microchemical  studies  on  vitreous  and  aqueous  gave 
him  a  well-deserved  reputation.  He  wrote  his  first  book  on 
physiology  of  the  eye-I  believe  the  first  ever-which  was  so  well 
done  that  a  resident  or  practicing  ophthalmologist  could  read  and 
understand  it.*  He  was  an  excellent  writer,  a  beautiful  speaker, 
and  an  outstanding  teacher.  His  book  of  physiology  became  the 
standard  around  the  world.  What  with  being  named  chairman  at 
forty  two  years  of  age  with  its  many  responsibilities  and  having  a 
busy  private  practice,  he  had  little  time  to  work  in  the  laboratory. 

My  first  papers  on  urea  with  Dr.  Adler  and  even  the  sulfonamide 
papers  stem  indirectly  from  Dr.  Adler 's  work  with  Dr.  Richards.  We 
had  a  laboratory  available  and  did  the  work  on  urea  with  Dr. 
Eleanor  Moore,  who  was  a  fine  chemist  with  a  Ph.D.  degree.  Dr. 
Adler's  position  as  chief  at  Wills  had  been  equivalent  to  professorial 
status,  and  he  was  qualified  indeed  to  be  named  chairman  of  the 
department  of  ophthalmology  and  professor  at  Penn. 

Why  was  he  chosen  over  Fewell? 

For  the  reasons  I  have  already  given.  He  was  very  academic,  wrote 
well,  had  a  background  of  research,  and  was  an  excellent  teacher 
and  clinician.  He  could  take  complicated  scientific  work  and  bring 
it  to  the  level  of  his  staff  and  residents.  His  textbook  of  physiology 
was  excellent.  He  could  take  articles  and  rework  them  full  of  his 
own  ideas,  as  well  as  make  them  understandable.  Certainly  he  was 
very  stimulating  to  me,  future  residents,  and  staff. 

What  about  his  sense  of  ethics? 

Oh,  fine.  He  was  a  very  ethical  man.  Were  he  here  today  he  would 
be  infuriated  by  some  of  our  entrepreneur  ophthalmologists.  I 
think  he  heavily  influenced  me  because  I  feel  that  I  am  one  of  the 
crotchety  people  in  the  country  regarding  ethics. 

We've  spoken  of  the  residency  program  that  he  set  up.  Tell  me  what 
it  actually  consisted  of. 

That  is  a  difficult  one.  He  had  only  a  small  staff  that  was 
interested  in  teaching.  It  was  really  a  preceptorship  rather  than  a 
residency,  a  situation  which  I  later  helped  to  correct.  During  the 


Adler,  FH.  Clinical  Physiology  of  the  Eye.  New  York:  The  Macmillan  Company,  1933. 


39 

second  year  of  my  residency,  I  realized  that  there  was  very  little  by 
way  of  academic  teaching.  Dr.  Adler  would  have  an  excellent 
teaching  conference  and  grand  rounds  one  day  a  week.  Dr.  Wilfred 
Eyles  Fry  would  give  an  occasional  pathology  conference,  and  we 
always  had  staff  attendants  in  our  clinics. 

During  my  second  year,  Dr.  Benjamin  F.  Souders  came  on  as  the 
first-year  resident.  He  was  very  bright  and  an  able  person  and  very 
dedicated.  But  he  and  I  both  realized  that  we  needed  more  didactic 
teaching,  such  as  bacteriology  as  it  applied  to  the  eye,  optics, 
chemistry  and  anatomy. 

The  Basic  Science  Course  in  Ophthalmology, 
Graduate  School  of  Medicine 

Scheie:       Fortunately,  the  Graduate  School  of  Medicine  at  Penn  gave  a  basic 
science  course  in  ophthalmology.  The  Graduate  School  was  a 
branch  of  Penn  Medical  School  and  under  its  own  dean.  His  office 
was  located  in  the  medical  school  administration  building,  but  most 
of  the  teaching  was  done  at  the  Graduate  Hospital  located  in  center 
city  about  twenty  blocks  away.  Dr.  Souders  and  I  went  to  Dr.  Adler 
and  asked  if  he  could  arrange  for  us  to  attend  some  of  the  lectures 
in  a  way  so  as  not  to  neglect  our  university  residency  duties.  We 
would  pick  the  lectures  to  fit  into  the  residency  schedule.  Dr.  Adler 
arranged  for  this,  and  later  in  our  residency  we  were  also  permitted 
to  prepare  a  thesis.  Should  this  be  approved,  we  could  be  granted  a 
doctor  of  science  degree. 

Hughes:     You  were  getting  at  the  graduate  school  the  optics  and  bacteriology 
and  basic  courses  you  thought  were  necessary  for  ophthalmology1? 

Scheie:       Yes,  we  were  getting  those  in  addition  to  the  residency  at  Penn.  It 
worked  out  very  nicely.  We  did  take  individual  classes  here  and 
there  for  a  couple  of  years  when  we  could  fit  them  into  our 
residency  schedule.  The  program  added  a  great  deal  to  the 
residency  program  and  it  was  continued  for  many  years. 

Hughes:     Who  was  on  the  staff  in  ophthalmology  at  the  Graduate  School  of 
Medicine? 

Scheie:       Well,  they  had  a  rather  large  staff.  Dr.  Edmund  B.  Spaeth  was 
chairman.  He  was  very  active  and  always  had  a  big  surgical 
practice.  Years  later  he  was  succeeded  by  Dr.  Irving  H.  Leopold,  a 
brilliant  scholar,  lecturer,  and  researcher.  Each  of  these  chairmen 
had  staff  members  with  training  and  special  interest  in  ophthalmic 
basic  sciences.  Dr.  Martin  Luther  Kaufman  taught  optics  and  Dr. 
Luther  Peter  taught  extraocular  muscles. 

Hughes:     Were  these  men  in  private  practice? 


40 


Scheie:       Yes,  they  were  practically  all  in  private  practice.  Dr.  Fry,  who  was 
on  Dr.  Adler's  staff,  but  not  an  intimate  of  Dr.  Adler,  taught 
pathology  in  the  Graduate  School.  Also  he  would  teach  us  as  part  of 
our  program.  He  was  another  very  fine  and  capable  person. 

The  Department  of  Ophthalmology 

Hughes:     Well,  let's  turn  to  the  physical  improvements  in  the  department  that 
Dr.  Adler  made  soon  after  his  appointment. 

Scheie:       The  clinic  at  that  time  was  in  an  almost  windowless,  fortresslike 
building  which  we  referred  to  as  the  "Black  Hole  of  Calcutta."  It 
was  apart  from  the  hospital,  literally  in  the  backyard,  and  it  was 
miserably  hot  in  the  summer.  We  needed  the  dark  rooms  but  this 
building  was  utterly  inadequate.  Air  conditioning  was,  of  course, 
unheard  of  and  the  space  was  inadequate.  I  have  forgotten  the  year 
but  Dr.  Adler  was  able  to  get  some  money  from  the  John  Frederick 
Lewis  family,  who  were  his  very  close  friends. 

Hughes:     Was  that  the  $50,000  donation? 

Scheie:       I  don't  know  the  amount  of  money  but  it  was  probably  much  more 
because  it  provided  a  large  segment  of  a  floor  in  the  new  D.  Hayes 
Agnes  Building,  giving  us  lovely  new  wards,  private  patient  rooms, 
and  an  operating  room.  Clinic  space  remained  inadequate  until  a 
few  years  later. 

Again,  I  can  not  recall  the  year,  but  we  were  given  a  new  clinic  area 
on  the  third  floor  of  the  new  Thomas  Gates  Building.  It  was  built 
largely  by  private  funds  and  in  honor  of  a  former  president  of  the 
University  of  Pennsylvania.  Dr.  Adler  helped  lay  out  the  plans  for 
the  eye  clinic  in  that  building.  I  do  remember  that  Dr.  Adler  and  I 
both  contributed  to  the  building  fund.  The  area  was  a  great 
improvement,  with  air  conditioning  and  other  amenities.  It  was 
later  remodeled  when  I  was  appointed  chairman  in  1960. 

U.S.  Senator  from  Pennsylvania  Joseph  Grundy,  a  patient  of  mine, 
donated  $75,000  to  rebuild  that  wing  and  to  provide  rooms  for  more 
residents  and  staff  and  for  my  own  private  practice.  We  gradually 
outgrew  this  space  as  our  program  expanded.  It  became  totally 
inadequate.  For  example  we  were  getting  into  laser  therapy  and 
had  raised  money  for  the  equipment  but  had  no  place  to  install  it. 
It  was  sitting  in  the  corridor  along  with  other  equipment. 

Hughes:     Was  ophthalmology  in  a  worse  situation  than  other  specialties? 
Scheie:       I  think  so.  We  felt  a  bit  like  neglected  orphans. 

Hughes:     Was  there  any  special  relationship  between  ophthalmology  and  the 
department  of  surgery? 


41 


Scheie:       None  except  a  very  friendly  one. 
Hughes:     You  were  totally  independent1? 

Scheie:       Ophthalmology  became  an  independent  department  at  the 

University  of  Pennsylvania  in  1873  when  Dr.  William  F.  Norris  was 
named  chairman,  and  it  always  remained  independent  of  all  other 
departments. 

Hughes:     What  about  associates  of  Dr.  Adler's  in  those  early  days'?  What 
about  Dr.  Irving  H.  Leopold1? 

Scheie:       Well,  he  became  a  resident  [1940-43]  the  year  after  I  finished  my 
residency.  He  started  working  with  me  on  research  projects.  My 
original  work  on  sulfa  drugs  was  in  progress  and  he  assisted  me 
while  doing  his  residency  until  I  went  on  active  military  duty  in 
1942. 

During  the  two  years  between  my  going  into  the  army  and  finishing 
my  residency,  I  helped  Dr.  Adler  in  his  private  practice  as  his 
assistant  three  or  four  mornings  a  week  until  about  twelve  o'clock. 
Then  I  would  go  out  to  the  university  hospital  in  the  afternoon 
where  I  usually  helped  the  residents  in  the  clinic  and  did  some 
research.  For  practical  purposes,  I  was  a  full-time  member  of  the 
department  of  ophthalmology;  I  rarely  saw  my  own  private 
patients.  In  fact,  I  wasn't  looking  for  a  practice  at  that  point.  As 
the  first  full-time  person  in  the  history  of  the  department,  I  was 
paid  the  vast  sum  of  $200  a  month.  The  residents  were  paid 
nothing. 

The  Poison  Gas  Project 

Scheie:       Coming  back  to  Leopold,  he  was  still  in  his  residency  at  the  time  of 
Pearl  Harbor,  [interruption]  It  was  probably  as  early  as  1940  that 
the  U.S.  Army  research  department  proposed  and  organized  a 
collaborative  study  to  investigate  the  mechanisms  and  treatment  of 
mustard  gas  injuries  of  the  eyes.  Johns  Hopkins,  Columbia, 
Harvard,  and  Pennsylvania  were  to  participate.  As  chairman  of  the 
department,  Dr.  Adler  was  named  director  of  the  investigation  at 
Penn.  I  was  expected  to  do  much  of  the  work  under  his  supervision 
and  was  asked  to  help  draw  up  the  protocol  and  the  proposals  for 
our  part  of  the  overall  project  with  Dr.  Adler. 

An  army  reserve  hospital,  the  20th  General  Hospital  Unit,  had  been 
organized  shortly  before  Pearl  Harbor.  I  had  had  college  ROTC 
[Reserve  Officer  Training  Corps],  as  well  as  in  medical  school,  and 
had  received  my  commission  as  first  lieutenant  on  graduation  from 
medical  school,  and  I  had  retained  my  commission  since  that  time. 
The  army,  anticipating  a  possible  war,  had  organized  reserve  units, 


42 

such  as  the  20th  General  Hospital.  Dr.  [Isidor  Schwaner]  Ravdin 
invited  me  to  join  the  unit  as  chief  of  ophthalmology. 

I  now  found  myself  caught  in  a  dilemma  because  I  was  exempt  from 
military  service  as  assistant  director  of  the  mustard  gas  project,  to 
which  I  had  a  feeling  of  loyalty  and  responsibility,  as  I  did  to  Dr. 
Adler.  Should  I  remain  with  the  research  project  that  I  had  helped 
to  plan  or  should  I  go  into  the  army?  I  had  been  involved  with  the 
army  reserve  since  1927  and  had  been  a  commissioned  officer  since 
1935,  which  made  me  feel  that  if  I  were  not  called  to  active  duty, 
nobody  should  be.  Dr.  Ravdin  at  that  time  was  a  lieutenant  colonel 
in  the  reserve  unit  and  was  the  organizer  and  commanding  officer, 
and  he  had  wanted  to  have  me  in  the  unit. 

So  after  a  great  deal  of  thought  and  discussion  with  Dr.  Adler,  I 
finally  resigned  from  the  mustard  gas  project  with  some  misgivings. 
I  continued  my  work  with  Dr.  Adler  until  the  unit  was  activated  on 
May  15,  1942.  Dr.  Leopold  was  appointed  to  my  spot,  a  big  step  for 
a  young  man  still  in  his  residency.  He  was  very  able,  bright,  and  a 
diligent  worker,  as  his  outstanding  career  has  shown. 

Prostigmin  in  Myasthenia  Gravis 

Hughes:      The  first  paper  you  ever  published  was  at  the  end  of  your  internship, 
1937?* 

Scheie:       Yes,  it  was.  George  Gammon  and  I  did  the  work  while  I  was  an 
intern  on  the  neurology  service. 

Hughes:     That  explains  your  co-author,  George  Gammon,  who  was  head  of 
that  service,  is  that  not  right? 

Scheie:       Yes. 

Hughes:     This  research,  then,  had  no  connection  with  ophthalmology? 

Scheie:       Except  that  eye  and  facial  muscles  are  very  commonly  involved. 

Did  you  see  the  pictures  of  the  measurements  showing  the  response 
to  prostigmin? 

Hughes:     What  Dr.  Scheie  is  referring  to  is  a  series  of  photographs  of  a  woman 
with  myasthenia  gravis. 

Scheie:       They  show  quite  dramatically  her  facial  muscles  recovering  after  an 
injection  of  prostigmin.  The  method  graphically  measuring  her 
recovery  was  mine.  Our  paper  was  done  almost  simultaneously 


Gammon,  GD,  Scheie,  HG.  Use  of  prostigmin  as  a  diagnostic  test  of  myasthenia  gravis.  JAMA 
1937; 109;  413-14. 


43 


with  a  paper  on  the  same  subject  by  Dr.  H.R.  Viets  of  Boston.*  He 
was  a  very  well-known  neurologist.  Both  papers  advocated  using 
prostigmin  as  a  diagnostic  test. 

Hughes:     Tell  me  how  the  project  originated. 

Scheie:       It  occurred  to  us  while  studying  this  patient  that  prostigmin  might 
be  effective  and  even  diagnostic.  The  idea  of  having  her  purse  her 
lips  around  the  tube  to  blow  up  a  mercury  manometer  gave  us  an 
objective  test  to  measure  the  effect  of  prostigmin.  Who  thought  of 
using  the  prostigmin?  I  am  quite  sure  it  was  Dr.  Gammon. 

Hughes:     That  was  the  first  time  that  prostigmin  had  been  advocated  as  a 
diagnostic  test? 

Scheie:       There  would  have  been  no  question  except  for  Viets'  work,  which 
was  published  unbeknown  to  us  while  ours  was  in  progress.  Who 
did  the  work  first?  What  date?  I  don't  know,  but  Viets  is  generally 
given  credit  because  of  prior  publication. 

Hughes:     Is  prostigmin  still  used  as  a  diagnostic  test  for  myasthenia  gravis? 

Scheie:       I  believe  so.  It  is  also  employed  for  treatment.  Neither  Viets  nor 

we  knew  of  the  others'  work.  We  published  in  the  AMA  journal  and 
at  that  time  there  was  a  long  waiting  list  for  publication. 

Hughes:     Dr.  Scheie,  why  don't  you  describe  exactly  how  the  test  works.  In 
normal  individuals  and  in  some  muscular  diseases  prostigmin 
causes  muscle  twitching? 

Scheie:       I  can  assure  you  that  it  does  in  normal  people  and  in  patients  with 
other  muscular  diseases  than  myasthenia  gravis.  A  couple  of 
friends  and  I  injected  prostigmin  into  ourselves  and  can  vouch  for 
the  fact  that  it  can  cause  muscle  twitching  in  healthy  people. 

Hughes:     Yes,  you  know  from  experience.  But  it  does  not  cause  muscle 
twitching  in  myasthenia  gravis  and  therefore  can  be  used  as  a 
diagnostic  test? 

Scheie:       Yes.  I  am  not  sure  it  was  known  at  that  time,  but  it  permitted  the 
utilization  of  choline,  the  effector  substances  that  stimulate  muscle 
fibers  to  contract.  In  other  words,  they  become  effective  and  muscle 
function  is  restored  until  the  effect  of  the  prostigmin  wears  off. 

Hughes:     I  don't  think  you  got  into  mechanism  in  this  paper. 

Scheie:       No,  I'm  not  sure  that  the  exact  mechanism  was  known,  but  it  was 
projected  that  after  you  gave  a  patient  prostigmin,  then  the  normal 


Viets,  HU,  Schwab,  RS.  Prostigmin  in  the  diagnosis  of  myasthenia  gravis.  N  Engl  J  Med  1935; 
213:1280-3. 


44 


choline  substances  could  become  effective  again.  I  will  have  to  get 
out,  now  that  my  curiosity  is  stimulated,  a  neurology  book  from  the 
library.  Perhaps  the  neurologists  can  be  more  specific.  Frankly,  I 
don't  even  know  what  they  use  for  treatment  today.  If  I  recall 
correctly,  the  effectiveness  of  prostigmin  eventually  diminished  in 
treated  patients.  The  physiology  was  closely  related  to  work  that  I 
did  with  tonic  pupils  (Adie's  syndrome).  The  iris  sphincter  muscles 
were  hypersensitive  to  the  cholines. 

Hughes:     When  you  first  came  into  ophthalmology  in  the  thirties,  were 
surgical  gloves  being  used  in  operations? 

Scheie:       No.  The  operative  field  was  considered  clean.  In  retrospect,  it  was 
amazing  how  few  infections  occurred.  It  is  almost  unbelievable  to 
me.  I  was  one  of  the  first  to  use  gloves  in  ophthalmology  at  Penn. 

Hughes:     When  did  you  do  that? 

Scheie:       I  would  not  swear  to  the  date  but  it  was  before  World  War  II.  Being 
a  resident,  I  followed  the  lead  of  Dr.  Adler  and  his  staff.  The  gloves 
at  that  time  were  not  the  delicate,  thin  ones  of  today.  Of  course, 
later  we  would  not  think  of  operating  without  gloves. 

Hughes:     Was  there  a  higher  incidence  of  infection  with  bare- hand  surgery? 

Scheie:       As  a  matter  of  fact,  I  don't  remember  infections  in  those  days  but  of 
course,  hospitals  weren't  as  contaminated  as  they  are  today.  We 
didn't  have  staph  [staphylococci]  lingering  around.  I  was  one  of  the 
first  at  the  university  hospital  to  consistently  wear  rubber  gloves 
and  to  scrub  for  ten  minutes.  The  older  surgeons  would  come  in, 
wash  their  hands,  and  that  was  about  it. 

Julius  H.  Comroe,  Jr. 

Scheie:       An  interesting,  dramatic  series  of  events  pertaining  to 

ophthalmology  and  the  sulfonamide  story  occurred  during  the  first 
week  of  my  internship.  A  patient  had  been  admitted  to  the  eye 
service  with  a  nasty  eye  infection  which  proved  to  be  gonorrheal 
ophthalmia.  The  story  actually  began  in  the  receiving  ward  on 
June  30,  1936,  when  Dr.  Julius  Comroe  on  the  last  day  of  his 
internship  saw  an  outpatient  with  an  infected  eye  and  had  asked 
him  to  return  for  follow  up,  which  he  did  the  next  day.  His  eye 
looked  so  badly  infected  that  he  was  admitted  to  the  hospital  on  our 
eye  ward.  Smears  and  microscopy  established  the  diagnosis  of 
gonorrheal  ophthalmia.  The  patient  was  promptly  isolated  because 
the  condition  was  very  contagious.  In  those  days  no  adequate 
therapy  was  available  and  this  type  of  infection  often  destroyed  the 
eye. 

A  day  later,  Dr.  Holloway  received  a  telephone  call  from  Julius 
Comroe  who  was  vacationing  in  Chicago.  Both  of  his  eyes  were 


45 

giving  him  trouble  and  he  had  seen  an  ophthalmologist  who  told 
him  that  he  had  conjunctivitis.  He  was  very  worried  and  wanted  to 
come  back  to  Philadelphia  to  see  Dr.  Holloway. 

## 

When  he  arrived  the  following  day,  Dr.  Holloway  saw  him.  It  was 
obvious  that  he  had  severe  purulent  conjunctivitis.  Smears  were 
made  for  laboratory  examination  which  demonstrated  gonococci  as 
the  cause.  It  seemed  obvious  that  he  had  caught  it  from  his  patient 
in  the  receiving  ward  and  whom  we  now  had  in  the  hospital. 
Unfortunately,  antibiotics,  sulfonamides,  and  any  adequate  or 
specific  treatment  were  not  available  at  that  time.  All  that  could  be 
done  were  frequent  irrigations  with  boric  acid  or  physiological 
saline  solutions  and  one  percent  silver  nitrate  applied  daily  with  a 
cotton  applicator.  The  silver  nitrate  hurt  like  the  devil  but  it  was 
thought  to  be  effective  by  causing  so  much  irritation  that  the 
epithelial  cells  would  slough  off  carrying  the  gonococci  with  them.  I 
was  never  sure  that  it  just  didn't  make  things  even  worse. 

Dr.  Comroe's  eyes  were  very  tender  and  touching  them  caused 
extreme  pain.  He  was  a  very  highly  keyed  person  and  the  nurses 
could  not  manage  the  painful  irrigations.  As  a  result,  it  fell  to  me  to 
administer  them.  For  about  six  weeks,  every  two  hours, 
twenty-four  hours  a  day,  I  irrigated  his  eyes.  It  was  extremely 
difficult  for  both  of  us  and  I  think  he  considered  me  a  bit  heartless. 
Not  personally,  I  hope.  I  have  always  been  fond  of  Julius  and  recall 
his  experience  as  an  unfortunate  example  of  the  frustrations  of  the 
pre-sulfonamide  and  pre-antibiotic  eras.  In  a  few  days  he  lost  one 
eye  and  the  other  was  still  badly  infected.  We  were  not  sure  that  it 
could  be  saved.  It  was  a  dreadful  ordeal  for  everyone.  There  was 
no  letup  in  the  irrigation  during  his  hospitalization  nor  for  Dr. 
Holloway  who  applied  the  daily  agonizing  silver  nitrate.  Ultimately 
the  left  eye  did  recover  with  normal  vision. 

Medical  Innovations 

Scheie:       Now,  the  continuing  drama  of  the  chemotherapy-antibiotic  story:  I 
was  on  the  Pepper  Medical  Ward  as  an  intern  in  the  spring  of  1936, 
about  a  year  after  Julius  Comroe's  tragedy  when  sulfonamides  first 
became  available  in  this  country.  Prontosil  was  introduced  from 
England  and  was  at  first  regarded  with  great  skepticism.  It  was 
first  used  at  HUP  on  two  of  my  patients  in  the  Pepper  Ward,  a 
medical  teaching  ward.  One  patient  had  rheumatoid  arthritis  and 
was  running  a  fever.  The  other  had  erysipelas,  which  is  an  acute 
streptococcus  infection  that  can  be  fatal.  Nobody  even  now  knows 
the  precise  cause  of  rheumatoid  arthritis. 

Several  of  the  senior  physicians  on  the  staff,  including  Dr.  Eugene 
Pendergrass  who  was  chief  of  radiology,  attended  the  special 
conference  this  particular  morning.  The  wonder  drug  had  become 


46 


available  and  patients  were  being  screened  for  its  use.  The 
substance  had  been  idly  resting  in  somebody's  laboratory  in 
Germany  for  probably  twenty  or  thirty  years.  Dr.  Alfred  Stengel, 
chairman  of  medicine,  was  there  and  Dr.  O.  H.  Perry  Pepper, 
brother  of  Dean  William  Pepper.  I  think  Dr.  Richard  Kern,  an 
internist  at  Penn,  and  some  medical  residents  were  involved.  I  was 
serving  part  of  my  medical  rotation.  They  gave  the  drug  prontosil 
to  both  patients  but  debated  using  x-ray  therapy  for  the  patient 
with  erysipelas,  a  condition  that  was  very  unpredictable.  The 
patient  could  recover  in  twenty-four  to  forty-eight  hours  or  could  die 
in  that  time. 

Well,  the  next  morning  the  erysipelas  patient  was  practically  well 
but  then  the  question  was  raised  as  to  whether  or  not  the  new  drug 
was  responsible.  The  condition  of  the  patient  with  rheumatoid 
arthritis  was  unchanged.  So  that  was  the  introduction  of 
sulfonamide  therapy  to  the  university  hospital.  If  Julius  Comroe 
had  come  in  only  one  year  later,  he  would  probably  have  been  well 
in  twenty-four  hours.  That  is  the  irony. 

Well,  in  talking  about  the  treatment  of  infections  before  sulfonamide 
and  the  antibiotics,  you  mentioned  silver  nitrate  and  irrigation. 
What  other  methods  were  tried  in  eye  infections'? 

Argyrol,  which  made  Albert  D.  Barnes-now  Barnes-Hind 
Pharmaceutical*-wealthy,  was  used  for  sinus  and  ear  infections 
and  for  treating  gonorrhea  and  other  conditions.  Today  it  is 
realized  that  it  probably  did  little  good,  but  at  least  it  did  little 
harm.  With  prolonged  used  of  argyrol  the  conjunctiva  might  be 
stained  black.  It  in  general  was  comparable  to  many  of  the 
nonprescription  eye  drops  in  use  today.  There  was  some  reason  for 
using  argyrol;  it  did  contain  silver.  Ultimately,  sulfonamides  proved 
to  be  of  great  value.  Previously,  the  only  treatment  for  a  patient 
with  pneumonia  was  oxygen,  fluids,  and  supportive  nursing  care. 

I  am  so  fortunate;  I  feel  that  I  have  lived  in  the  golden  age  of 
medicine.  The  sulfa  drugs  laid  the  groundwork  and  stimulated 
interest  that  may  have  helped  to  pave  the  way  for  antibiotic 
therapy,  which  has  even  more  so  revolutionized  the  treatment  and 
prevention  of  a  great  many  types  of  infection.  The  prognosis  for 
surgery  also  has  been  changed  in  many  ways  with  the  advent  of 
antibiotics.  New  developments  in  anesthesia  are  another  change. 
Before  World  War  II,  interns  and  nurses  gave  much  of  the 
anesthesia. 


Hughes:     What  was  monitored? 


Hughes: 


Scheie: 


Interviews  with  Han-y  William  Hind  of  Barnes-Hind  Pharmaceutical  are  scheduled  to  be 
undertaken  by  the  Regional  Oral  History  Office  late  in  1990. 


47 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Scheie:       The  patient's  pulse,  pupils,  and  blood  pressure.  If  the  patient's 

pupils  began  to  dilate  under  our  anesthesia,  we  reduced  the  flow  of 
anesthetic  in  a  hurry.  There  really  was  no  one  to  run  to  for  help, 
because  there  were  so  few  or  no  anesthetists. 

[By  World  War  II]  the  number  of  medical  anesthetists  was 
increasing.  There  was  a  Dr.  Ivan  Taylor  and  a  Dr.  Philip  Gleason. 
Gleason  was  with  our  army  unit  in  India.  He  may  have  come  back 
to  HUP  for  a  year  or  so  after  the  war. 

Did  you  have  problems  with  wound  gaping  at  the  University  of 
Pennsylvania  Hospital  when  you  weren't  using  sutures? 

Oh,  yes.  The  patient  would  be  kept  in  bed  with  sandbags  beside  his 
head  and  both  eyes  covered.  The  head  was  immobilized  by  the 
sandbags  for  at  least  a  week.  Dressings  were  done  by  candlelight  to 
prevent  the  patient  from  squeezing  his  lids. 

What  kind  of  problems  did  you  run  into? 

Oh,  all  sorts.  Older  patients  could  become  irrational  from  patching 
both  eyes.  Late  hemorrhages  could  occur  because  the  wound  might, 
give  way,  rupturing  vessels.  Very  high  astigmatic  errors  often 
occurred  because  of  poor  wound  apposition.  Vitreous  might  even 
extrude  and,  of  course,  iris  prolapse  was  common. 

Hughes:     Plus  it  wasn't  very  good  for  the  patient  to  be  immobile. 

Scheie:       Well,  you  immobilize  an  eighty-year-old  patient  and  he  could 
develop  pneumonia,  blood-vessel  occlusions  of  the  heart  or 
extremities  or  gastric  distention  from  lying  flat,  causing  nausea  and 
vomiting  with  wound  disruption. 

Hughes:     You  thought  long  and  hard  before  you  operated,  I  suppose. 

Scheie:       Oh,  you  certainly  did.  It  was  a  much  more  serious  consideration 
than  it  is  now.  I  remember  the  patients  very  well,  lying  flat  in  bed 
with  sandbag  and  both  eyes  covered  for  about  a  week  and  all  of  the 
accompanying  problems.  The  finest  sutures  available  to  us  during 
World  War  II  were  four  aught. 

Hughes:     It  was  just  that  the  technology  wasn't  available? 

Scheie:       The  principles  of  wound  closure  were  there  but  the  instrumentation 
was  not  available.  It  was  just  that  simple. 

Hughes:     It  must  have  been  a  real  problem  in  a  military  situation  where  you 
really  didn't  want  to  have  a  patient  down  and  out  for  long  periods. 

Scheie:       We  could  only  do  the  best  we  were  able.  We  did  no  intraocular 

surgery,  such  as  senile  cataracts,  overseas.  Surgery  usually  was  for 


48 


perforating  wounds  of  the  eye,  many  of  which  were  associated  with 
intraocular  foreign  bodies.  If  the  wound  was  large,  as  from  a  bullet 
or  a  large  grenade  fragment,  the  damage  was  often  so  severe  that 
repair  was  not  possible. 

Hughes:     The  cataract  cases  were  sent  home? 

Scheie:       Well,  we  saw  few  senile  cataracts  and  we  would  not  have  operated 
these.  Traumatic  cataracts  in  the  younger  patient  usually  had  to  be 
removed  and  that  became  an  area  of  great  interest  for  me.* 

After  two  and  a  half  years  in  India,  I  was  reassigned  to  an  army 
hospital  in  Cleveland.  We  had  a  large  number  of  soldiers,  some  five 
hundred  in  the  hospital,  who  had  traumatic  ocular  injuries.  They 
had  a  mixture  of  plastic  and  ocular  problems. 

I  remember  Dr.  [A.D.]  Ruedemann,  a  well-known  ophthalmologist 
in  this  country,  who  was  our  civilian  consultant  in  Cleveland  at  the 
Crile  Army  Hospital,  a  designated  Army  Eye  Center.  He  could 
hardly  believe  that  one  could  enter  an  eye  with  a  #19  needle  and 
completely  suck  out  a  cataract.  Traumatic  cataracts  are  usually 
operated  to  restore  vision,  but  also  if  not  removed  they  can  be 
irritating  or  even  cause  increased  pressure  and  loss  of  an  eye. 
Aspiration  was  a  simple  and  safe  method  that  wasn't  being  utilized 
at  that  time. 

Hughes:     Have  you  worked  with  Ethicon  to  develop  some  of  the 
instrumentation  ? 

Scheie:       Yes,  in  a  consultative  capacity.  Their  representatives  would  come  to 
my  operating  room  to  observe  and  discuss  mutual  problems.  I  have 
always  felt  very  close  to  Ethicon;  it  has  contributed  so  much  to  eye 
surgery. 

The  Tonic  Pupil 

Hughes:     Let's  turn  to  the  Scheie  test.   You  published  two  papers  in  1940  on 
Adie's  syndrome  or  the  tonic  pupil.  **  Tell  me  how  you  first  became 
interested  in  the  problem. 

Scheie:       [Consulting  paper]  Because  of  the  patient  whose  eye  is  shown  in 
the  first  paper.  I  was  a  resident  at  the  time.  The  paper  was 
published  in  1940  but  the  material  was  submitted  as  my  thesis  for 
a  doctor  of  medical  science  degree.***  I  saw  the  first  patient  in 


** 


See  the  section  on  cataract  aspiration. 

Scheie,  HG.  Site  of  disturbance  in  Adie's  syndrome.  Arch  Ophthalmol  1940;  24:225-37.  Scheie, 
HG,  Adler,  FH.  The  site  of  the  disturbance  in  the  tonic  pupil.  Trans  Amer  Ophthalmol  Soc,  76th 
ann  meeting,  1940;  183-92. 

*  Dr.  Scheie  received  a  doctor  of  medical  science  degree  from  the  University  of  Pennsylvania  in 
1940. 


49 


Hughes: 
Scheie: 

Hughes: 
Scheie: 

Hughes: 

Scheie: 

Hughes: 

Scheie: 


1938.  She  was  on  the  ear,  nose,  and  throat  service  at  HUP  and 
their  staff  was  concerned  that  she  might  have  neurological 
complications  from  mastoiditis.  I  was  asked  to  see  her  in 
consultation  because  they  had  noticed  that  the  right  pupil  was 
larger  than  the  left  and  reacted  poorly. 

My  service  on  neurology  and  the  work  with  prostigmin  in 
myasthenia  gravis  had  made  me  aware  of  disturbances  in  the 
neuroeffector  mechanisms,  so  I  began  to  try  to  explain  why  this 
pupil  reacted  so  poorly.  The  normal  pupil  constricts  promptly  to 
light  and  accommodation  and  dilates  promptly  when  the  stimulus  is 
removed. 

This  lady  had  me  very  puzzled.  I  had  never  heard  of  Adie's 
syndrome  at  that  time.  Her  right  pupil  constricted  very  poorly  and 
extremely  slowly  and  through  small  amplitude  to  light  and  to 
accommodation.  The  amplitude  was  greater  with  the  latter.  I 
found  that  when  she  maintained  convergence  for  some  time,  the 
pupil  came  down  nearly  to  the  size  of  the  normal  pupil.  The  left 
pupil  reacted  normally.  The  right  also  dilated  very  slowly,  taking 
two  or  three  minutes,  and  it  was  best  observed  with  a  slit-lamp 
microscope.  Adie's  pupils  often  move  so  slowly  that  they  may  be 
mistaken  for  a  paralytic  pupil. 

Which  is  the  same  as  the  tonic  pupil? 

No,  the  paralytic  pupil  is  just  permanently  dilated  and  will  not 
constrict. 

Oh,  I  see;  Adie's  syndrome  could  be  confused  with  another  condition. 

Yes,  because  patellar  reflexes  can  be  depressed  or  absent,  central 
nervous  system  syphilis  can  be  mistakenly  diagnosed  and, 
unfortunately,  has  even  mistakenly  been  treated. 

Oh,  yes,  and  there  is  a  special  name  for  that  type  of  pupil. 
Yes,  Argyll-Robertson. 

That's  it.  You  wanted  to  distinguish  the  two  because  of  the  different 
significance? 

Yes.  The  Adie's  type  of  pupil  can  be  small  but  even  then  usually  not 
as  small  as  the  Argyll-Robertson  syphilitic  pupil.  The  Adie's  pupil 
is  usually  unilateral  while  the  Argyll-Robertson  is  usually  bilateral. 


Hughes:     What  was  Dr.  Adler's  role,  if  any,  in  this  work  on  Adie's? 

Scheie:       He  encouraged  my  interest.  His  name  was  on  the  paper  because  I 
presented  it  at  a  meeting  of  the  American  Ophthalmological  Society 


50 


and  he  was  nice  enough  to  be  my  sponsor.  The  society  required  that 
his  name  be  listed  as  the  senior  author. 

Hughes:     What  did  you  establish? 

Scheie:       Well,  I  did  a  great  deal  of  work  on  animals  which  was  documented 
in  the  thesis  but  not  in  the  AOS  paper.  I  operated  on  the  orbits  of 
many  animals,  manipulating  the  ciliary  nerves  by  dividing  them 
pre-  and  postganglionically  and  also  crushing  some.  If  you  cut  the 
nerves  supplying  the  pupil  or  before  they  reach  the  ganglion,  no 
sensitivity  to  the  choline-effector  substances  resulted. 

In  this  study,  I  used  mecholyl.  If  the  nerve  was  divided  or  even 
partially  divided  peripheral  to  the  ganglion,  a  weak  solution  of 
mecholyl  would  cause  the  pupil  to  constrict,  but  it  had  no  effect  on 
the  normal  pupil.  It  seemed  probable  that  the  cause  of  Adie's 
syndrome,  which  had  never  been  known,  was  a  partial  denervation 
of  the  ciliary  nerves. 

Hughes:     And  that  proved  to  be  correct? 

Scheie:       And  that  proved  to  be  correct,  and  so  far  the  theory  has  not  been 
challenged.  We  still  use  the  test  on  an  occasional  eye  that  we 
suspect  of  being  Adie's  but  cannot  prove. 

Hughes:     Do  ophthalmologists  in  general  use  the  Scheie  test? 

Scheie:       Well,  I  think  those  who  are  doing  neuro-ophthalmology  use  it.  Dr. 
Frank  Walsh,  who  was  our  greatest  authority  in 
neuro-ophthalmology,  thought  it  was  great.  He  even  called  it  the 
Scheie  test. 

Hughes:     Why  is  Adie's  pupil  usually  only  in  one  eye? 

Scheie:       I  cannot  explain  this  but  it  is  very  rare  to  see  it  bilaterally. 

However,  I  have  had  at  least  one  such  patient.  Nobody  knows  what 
causes  the  denervation. 

If  you  use  strong  enough  solutions  of  mecholyl  (five  percent  and 
above)  normal  pupils  will  constrict.  I  was  very  careful  to  do  a  great 
many  tests  to  find  the  strength  solution  that  did  not  affect  the 
normal  pupil  but  would  affect  sensitized  pupils.  Many  patients 
were  tested.  Many  cats  were  operated  and  mecholyl  tests  done  and 
it  was  found  that  two-and-a-half  percent  mecholyl  constricted  the 
postganglion-denervated  pupil  in  animals,  as  it  had  in  humans  with 
Adie's  syndrome.  The  first  patient  with  Adie's  syndrome  was  seen 
in  follow-up  by  Dr.  Alan  M.  Laties  and  me.  We  did  a  joint  paper 


51 


repeating  her  studies,  and  her  findings  were  unchanged.* 
[interruption] 

Doctor  of  Medical  Science  in  Ophthalmology 

Hughes:     You  used  the  work  on  Adie's  syndrome  for  your  thesis  for  the  degree 
of  doctor  of  medical  science  in  ophthalmology.  Were  there  other 
institutions  that  offered  that  degree?  Was  it  a  common  degree  in 
ophthalmology  ? 

Scheie:       Well,  all  specialties  involved  in  the  Graduate  School  of  Medicine 
[awarded]  a  degree.  The  doctor  of  science  degree  is  not  an 
uncommon  one. 

Hughes:     Yes,  but  what  I'm  really  asking,  was  it  an  uncommon  degree  in 
ophthalmology  at  that  time? 

Scheie:       No.  I  can't  quote  figures.  I  am  sure  that  at  least  some  of  the  people 
who  took  the  basic  science  course  for  a  year  and  then  produced  a 
satisfactory  thesis  profited  both  from  the  course  and  from  using  the 
thesis  requirement  as  a  stimulus  for  further  learning.  Many  would 
come  to  Penn's  graduate  school  course  in  ophthalmology  from  other 
residency  programs  for  eight  or  nine  months  and  then  return  to 
their  residency.  It  would  give  a  background  in  the  basic  sciences  of 
their  specialty  that  was  otherwise  unobtainable.  That  is  why  I 
asked  Dr.  Adler's  permission  to  attend  the  course. 

I  know  that  I  was  not  only  the  first  resident  at  Penn  but  also  the 
first  to  receive  the  doctor  of  science  degree  [in  ophthalmology] 
although  several  others  did  so  later,  including  Dr.  Irving  Leopold. 
The  Mayo  Clinic  has  had  a  similar  program  made  possible  by  their 
affiliation  with  the  Graduate  School  of  the  University  of  Minnesota. 
It  did  stimulate  the  resident,  who  otherwise  might  not  be  in  the 
laboratory  at  all,  to  produce  a  piece  of  work  worthy  of  a  degree.  But 
with  the  degree  as  a  reward  it  added  motivation  for  such  an  effort. 

When  I  succeeded  Dr.  Adler  I  required  attendance  in  the  graduate 
school  basic  science  course  as  part  of  our  residency  program.  After 
Dr.  Edmund  B.  Spaeth  retired  a  few  years  after  World  War  II,  Dr. 
Leopold  was  named  head  of  the  Section  on  Ophthalmology  of  the 
Graduate  School  of  Medicine.  Dr.  Julius  Comroe  was  then  dean 
and  head  of  the  graduate  school.  In  1963,  when  Dr.  Leopold  was 
appointed  chairman  of  the  department  of  ophthalmology  at  New 
York  Hospital  and  Medical  School,  I  was  asked  to  succeed  him  in 
the  Graduate  School  at  Penn.  Comroe  was  the  dean  and  I  served 
under  him  for  only  a  short  time  when  he  was  succeeded  by  Dr.  Paul 
Nemir. 


Scheie,  HG,  Latics,  AM.  Adie's  syndrome:  Duration  of  methacholine  sensitivity.  Arch 
Ophthalmol  1965;  74:458. 


52 


Hughes:     According  to  your  curriculum  vitae,  you  became  professor  and 
chairman,  department  of  ophthalmology,  Division  of  Graduate 
Medicine,  in  1964. 

Scheie:       I  said  '63,  so  I  wasn't  too  far  off. 

Hughes:     Before  that,  it  was  called  the  Graduate  School  of  Medicine  and  then 
it  became  the  Division  of  Graduate  Medicine.  Is  there  any 
significance  to  that  name  change1?  Was  there  a  reorganization1? 

Scheie:       Somewhere  along  the  line,  the  graduate  school  itself  was 

terminated  and  merged  with  the  medical  school.  Postgraduate 
degrees  were  no  longer  given.  When  the  change  was  made,  I 
reorganized  and  shortened  the  basic  science  course  in 
ophthalmology  to  about  three  months  and  all  first  year  residents 
attended  full  time.  Then  they  began  the  clinical  residency. 

Hughes:     But  by  then  it  was  an  absolute  requirement  to  take  the  basic  science 
course? 

Scheie:       Only  for  my  people. 
Hughes:     Yes,  that  is  what  I  mean. 

Scheie:       Well,  I  wanted  them  to  have  the  basic  science  course  because  of  my 
own  experience  of  coming  into  a  specialty  residency  knowing  little 
about  very  highly  specialized  basic  science  subjects. 

Hughes:     Yes,  you  made  that  requirement  because  when  you  started  your 
residency  you  had  to  ask  Dr.  Adler  if  you  could  do  it. 

Scheie:       That's  right,  but  now  in  addition  our  department  was  giving  the 
course,  and  the  relationship  was  changed  since  I  was  head  of  both 
the  department  and  the  course.  I  felt  that  our  residents  should 
have  no  responsibilities  during  the  first  three  months  except  to 
acquire  a  basic  science  background.  It  was  a  full-time,  highly 
concentrated  course.  But  I  also  added  something  for  our  residents 
that  they  did  not  particularly  like.  I  said,  "I  think  it  is  worth  your 
while  to  have  this  course,  but  we  must  have  year-round  clinical 
service  for  the  hospital,  so  it  will  be  necessary  for  you  to  stay  three 
extra  months."  This  was  possibly  a  little  unfair,  but  the  course  was 
intensive  with  outstanding  teachers  from  all  over  the  country  and  it 
demanded  full-time  participation.  For  example,  for  chemistry  of  the 
eye,  Dr.  John  Harris  came  from  the  University  of  Minnesota  where 
he  was  chairman  of  the  department  of  ophthalmology.  From  the 
University  of  Michigan,  it  was  Dr.  Harold  Falls  to  teach  genetics, 
and  Dr.  Paul  Boeder  [from  the  University  of  lowal  taught  optics.* 


See  the  forthcoming  interview  in  this  series  with  Dr.  Boeder. 


53 


Several  other  distinguished  teachers  from  other  places  also 
participated  in  the  course. 

Hughes:     Well,  getting  back  to  your  thesis,  were  you  required  to  defend  it 
orally? 

Scheie:       Yes,  before  a  knowledgeable  faculty  committee.  The  candidate  was 
questioned  orally  by  the  committee. 

Hughes:     Do  you  remember  who  was  on  it? 

Scheie:       No,  I  have  forgotten  that  by  now.  Comroe  might  have  been  on  it 
because  it  was  a  little  down  his  alley-pharmacology. 

Hughes:     Do  you  remember  having  any  trouble? 

Scheie:       No,  the  work  was  basically  solid.  Our  knowledge  of  neurohumoral 
mechanisms  and  effector  substances  was  only  beginning  to  be 
accumulated  at  that  time.  My  own  interest  had  been  stimulated  by 
the  patient  with  myasthenia  gravis. 

Private  Practice  With  Dr.  Adler* 

Hughes:     I  am  ready  to  move  on  to  private  practice  with  Dr.  Adler.  Does  that 
suit  you? 

Scheie:       Surely. 

Hughes:     I  presume  you  began  in  August,  1940.  Wouldn't  it  have  been  right 
after  the  conclusion  of  your  residency? 

Scheie:       Let  me  think  for  a  minute. 

I  finished  my  residency  on  June  30,  1940,  and  then  took  a  summer 
job  as  physician  at  a  boys'  camp,  and  so  I  really  started  with  Dr. 
Adler  in  September. 

Camp  experience  involved  a  calamity.  A  boy  at  the  camp  had  an 
earache,  and  I  took  him  as  an  outpatient  to  Packer  Hospital,  which 
was  near  the  camp.  A  day  or  so  later  he  became  quite  ill.  I  called 
his  parents  and  said  that  I  had  had  him  seen  by  specialists  but  was 
worried  about  him.  I  asked  if  they  would  mind  if  I  sent  him  down 
to  Philadelphia.  He  was  from  Argentina  and  his  family  had  a 
temporary  apartment  on  the  Main  Line  in  the  suburbs  of 
Philadelphia.  It  became  a  horror  story  because  he  eventually  died 
of  meningitis  secondary  to  a  mastoid  infection. 

By  the  way  I  had  another  experience  while  working  as  chief  medical 
officer  at  HUP  that  I  love  to  recite.  I  had  continued  as  Dr.  Hatch's 
assistant  chief  medical  officer  through  the  first  two  years  of  my 


Parts  of  a  later  discussion  of  Dr.  Adler  have  been  added  here. 


54 


residency  because  of  my  need  for  money.  Like  my  internship,  the 
residency  paid  no  salary.  During  the  month  of  August  between  the 
first  and  second  year  of  my  residency,  Dr.  Hatch  was  on  vacation 
and  I  was  substituting  as  chief  medical  officer  when  a  crisis 
occurred  during  a  polio  epidemic  for  which  there  was  no  specific 
treatment.  The  hospital,  however,  did  have  a  respirator.  I  received 
a  call  from  Williamsport,  Pennsylvania,  telling  me  that  they  had  a 
child  with  polio  who  was  becoming  progressively  worse  and 
developing  breathing  difficulties.  Our  respirator  wasn't  occupied  at 
the  time,  so  as  chief  medical  officer  I  agreed  to  accept  the  child  as 
an  emergency. 

I  was  not  aware  that  the  mayor  of  Philadelphia  and  its  board  of 
health  had  issued  a  directive  that  they  must  give  approval  before 
bringing  any  polio  patient  to  Philadelphia.  At  any  rate,  the  child 
was  flown  to  Philadelphia  in  a  local  plane  and  admitted  to  HUP. 
The  superintendent's  assistant,  Miss  Elizabeth  Berrang,  like  me 
was  a  substitute  covering  for  the  vacationing  superintendent,  Miss 
Mary  Virginia  Stevenson.  Mayor  Samuel  of  Philadelphia  had  his 
own  plane  in  which  he  had  a  great  public  relations  interest.  I 
suspect  that  he  was  especially  concerned  because  as  mayor  he 
wanted  the  publicity  which  would  have  come  from  using  his  plane 
as  an  ambulance.  As  a  consequence,  when  he  learned-probably 
from  the  radio  news-of  the  story  of  our  child,  he  personally  called 
and  raised  the  roof. 

The  next  afternoon,  the  Evening  Public  Ledger  ran  a  story  about 
the  boy.  Unfortunately,  I  do  not  have  the  newspaper  clipping  which 
I  was  probably  too  frightened  to  keep.  A  subheadline  on  the  front 
page  read,  "Dr.  Harold  Scheie  Subject  to  One  Year's  Imprisonment 
and  an  $800  Fine."  [laughter]  There  we  were,  a  substitute  chief 
medical  officer  and  a  substitute  superintendent.  There  we  were 
holding  the  bag-and  all  due  to  me.  However,  nothing  came  of  the 
charge,  no  doubt  because  of  the  intervention  of  influential  members 
of  the  board  of  the  university  hospital. 

Hughes:     Did  the  university  authorities  have  anything  to  say  to  you? 
[interruption] 

Scheie:       As  I  recall,  no.  I  am  sure  they  felt  that  it  was  only  a  spectacular 
move  on  the  mayor's  part. 

Hughes:    As  you  mentioned,  in  1940  you  joined  Dr.  Adler  in  private  practice  in 
Philadelphia.  Where  exactly  was  the  practice? 

Scheie:       Dr.  Adler  owned  the  building  where  he  practiced.  It  had  been  his 
father's  office.  It  was  a  residential  building  where,  I  think,  his 
father  Dr.  Louis  Adler  had  practiced.  The  office  was  lovely  and  was 
located  at  313  South  17th  Street. 


55 


Patients  were  met  by  a  receptionist  on  the  first  floor.  There  was  no 
elevator,  so  the  patients  had  to  walk  up  a  flight  of  stairs  to  Dr. 
Adler's  office,  which  was  in  a  big  suite  at  the  rear  of  the  building. 
There  was  another  private  reception  area  at  the  front  of  the 
building  that  became  my  office  after  World  War  II.  Another 
adjacent  smaller  room  I  used  for  a  waiting  room.  The  two  areas,  Dr. 
Adler's  in  the  back  and  mine  in  the  front,  were  separated  by  a  small 
flight  of  steps.  I  was  always  impressed  by  the  large,  mounted 
moose  head  hanging  over  the  fireplace  in  his  office. 

Hughes:     That  he  had  shot1? 

Scheie:       I  believe  not  because  he  was  not  a  hunter. 

Hughes:     What  was  the  division  of  labor?  What  was  he  doing  and  what  were 
you  doing? 

Scheie:       From  September,  1940  to  May  15,  1942,  when  I  went  into  the  army, 
I  really  did  what  technicians  would  do  today.  His  patients  would 
stop  at  the  reception  desk  on  the  first  floor  and  be  ushered  in  to  see 
me  in  an  office  adjacent  to  the  reception  area.  I  would  take  the 
patient's  history  and  record  the  vision  and  neutralize  the  glasses.  I 
routinely  measured  the  muscle  balance  and  took  keratometer 
readings.  Refractions  were  done  when  indicated  but  were  always 
checked  by  Dr.  Adler. 

I  enjoy  telling  anecdotes  relating  to  my  experience  of  being  low  man 
on  the  totem  pole.  I  will  not  mention  the  name  of  the  patient,  a 
lady  from  an  old  family  dating  to  the  Revolutionary  War,  a 
grand-dame  type  who  was  unwillingly  brought  in  to  see  me.  She 
was  obviously  very  annoyed  that  she  had  to  stop  to  see  Dr.  Adler's 
assistant  on  the  first  floor.  I  began  to  take  her  history,  not  much 
more  than  the  minimum  that  would  be  done  in  an  ophthalmologist's 
office.  Of  course,  she  was  asked  if  she  had  diabetes,  high  blood 
pressure,  how  her  general  health  was,  and  what  were  her  eye 
problems,  past  and  present.  Soon  she  reached  the  bursting  point, 
not  the  breaking  point.  She  asked  how  I  spelled  my  name  and  I 
told  her.  Looking  at  me  she  said,  "Pretty  soon  you'll  be  asking  me  if 
I'm  an  immigrant,  too."  [laughter] 

Another  episode  was  stimulated  by  a  cartoon  in  The  New  Yorker 
which  I  had  seen  on  this  particular  morning  just  before  the  patient 
arrived.  She  was  new  to  the  office,  from  the  Wilmington  area,  and 
at  even  half  a  glance  was  a  wealthy  dowager  type  who  was  not 
happy  about  seeing  an  assistant.  I  asked  her  to  be  seated. 
Although  showing  her  annoyance,  she  submitted  to  having  her 
history  and  her  vision  taken.  I  next  followed  office  routine  which 
included  a  keratometer  reading.  The  instrument  was  mounted  on  a 
table  and  resembled  a  spyglass.  I  was  seated  at  one  end  of  the 
instrument  and  she  on  the  other.  The  instrument  had  a  very  bright 


56 


Hughes: 
Scheie: 


light  that  added  to  her  annoyance.  As  I  turned  it  on  to  measure  her 
right  eye,  she  flinched  and  forcibly  squeezed  the  eye  shut.  I  couldn't 
resist,  having  just  seen  the  cartoon  a  few  minutes  before  in  my 
office  waiting  room,  asking  her,  "Madam,  was  that  a  twitch  or  was 
it  the  old  come-on?"  To  extricate  myself-I  knew  I  was  in  trouble—  I 
immediately  went  to  the  waiting  room,  picked  up  the  magazine  and 
showed  her  the  cartoon  with  a  lady  before  the  same  instrument 
squeezing  her  eye  shut  and  the  young  ophthalmologist  asking  the 
same  question.  At  that  point,  she  forgave  me,  at  least  partially,  and 
she  did  smile,  [laughter] 

When  I  returned  to  the  office  after  World  War  II,  the  first  lady 
happened  to  see  me  in  the  corridor  downstairs  after  she  had  seen 
Dr.  Adler.  She  said,  "I'm  so  happy  to  see  you  because  I  have  been 
concerned  all  this  time  and  I  want  to  apologize  for  the  way  I  acted." 
Those  are  only  two  of  many  office  experiences.  Obviously  I  very 
early  learned  the  meaning  of  humility,  as  well  as  a  great  deal  of 
ophthalmology,  while  working  as  an  assistant  in  Dr.  Adler's  office. 
It  was  invaluable  as  a  personal  and  professional  experience. 

How  was  surgery  arranged  between  you  and  Dr.  Adler? 

Before  World  War  II  he  did  all  of  the  private  surgery.  The  patient 
who  came  in  on  a  free  clinic  basis  would  be  operated  by  one  of  the 
residents  or  by  me  unless  it  was  their  only  eye.  We  were  never 
allowed  to  operate  on  private  patients  or  patients  who  had  only  one 
eye. 


This  was  a  rule  that  I  also  adopted  during  my  own  years  as  chief.  I 
always  took  the  responsibility  for  operating  my  own  patients.  On 
the  clinic  service  the  residents  and  even  the  young  ophthalmologists 
who  had  finished  their  residency  were  not  allowed  to  operate  a 
patient's  only  eye.  Not  all  of  the  young  men  were  in  agreement. 

Hughes:     How  long  did  your  arrangement  with  Dr.  Adler  last? 

Scheie:       I  was  a  salaried  employee  in  Dr.  Adler's  office  for  two  years  before 
World  War  II  until  my  call  to  active  military  duty  on  May  15,  1942. 
I  would  see  an  occasional  private  patient,  but  only  an  emergency  if 
Dr.  Adler  was  too  busy,  or  occasionally  one  of  my  own  through  some 
personal  contact. 

Hughes:     You  mentioned  that  Dr.  Adler  didn't  come  in  to  the  university  every 
day. 

Scheie:       Well,  he  would  come  in  to  operate  and  he  would  see  the  inpatients 
on  a  daily  basis.  In  the  days  before  the  war  he  usually  came  into 
the  hospital  five  days  a  week,  but  I  would  see  the  inpatients  on 
weekends  unless  there  were  serious  problems.  Later  on  in  my 


57 


association  with  him  when  he  operated  little,  he  came  in  much  less 
but  always  twice  a  week  to  teach  and  to  see  that  all  was  well.  He 
[eventually]  turned  over  a  great  deal  of  his  surgery  to  me, 
particularly  the  last  years  before  his  retirement.  I  don't  think  he 
ever  really  enjoyed  operating. 

Hughes:     Tell  me  how  his  Thursday  conferences  went1? 

Scheie:       All  of  the  residents  and  some  of  the  staff,  which  was  slowly 

growing,  always  attended.  We  would  have  interesting  patients 
brought  in  from  the  clinics  or  the  staff  would  even  bring  an 
occasional  interesting  patient  from  their  private  offices.  The 
patients  would  be  examined  in  our  clinic  and  discussion  would  be 
held  in  our  library.  Then  following  patient  discussions,  Dr.  Adler 
often  gave  an  informative  lecture,  usually  on  physiology  or 
extraocular  muscles. 

Hughes:     [George  SJ  Tyner  told  me  that  Dr.  Adler  was  remarkable  in  his 

ability  to  come  up  with  a  history  of  whatever  was  under  discussion.* 

Scheie:       He  was  very  good  at  that  and  utilizing  our  library  to  find  pertinent 
articles.  Our  eye  library  was  quite  complete.  At  times  he  would 
have  the  appropriate  literature  prepared  in  advance  for  the 
conference. 

Hughes:     So  an  historical  review  was  expected  in  the  presentation? 

Scheie:       No,  not  necessarily  an  historical  review,  but  wherever  there  was 

doubt  or  something  interesting,  he  would  himself,  or  with  help,  find 
the  book  or  books  that  amplified  the  subject.  He  would  present  the 
highlights  of  that  article  or  chapter  or  whatever  it  might  be  and 
discuss  it.  He  was  very  good  at  that. 

Hughes:     Did  he  have  a  format  in  mind  for  a  presentation? 

Scheie:       It  would  be  a  brief  presentation  of  a  case,  a  summary  of  the 

problem,  and  the  patient's  findings.  Then  it  would  be  discussed. 
He  was  very  good  at  improvising  discussions  and  leading  into 
various  facets  related  to  the  condition.  Hence  the  library.  These 
conferences  were  excellent;  they  were  outstanding. 

Hughes:     From  what  Dr.  Tyner  told  me,  Dr.  Adler  knew  German  and  French. 

Scheie:       He  knew  German  particularly  well. 

Hughes:     To  know  German  was  still  important  for  an  ophthalmologist? 

Scheie:       My  goodness,  when  I  started  in  ophthalmology  much  of  the 

pertinent  literature  and  many  textbooks  were  in  German  and  I  was 


Telephone  conversation,  January  26,  1988. 


58 


terribly  handicapped  because  I  did  not  read  them.  I  had  had  some 
French  and  quite  a  bit  of  Spanish  but  literally  no  German. 

Hughes:     What  was  Dr.  Adler's  style  with  his  patients'? 

Scheie:       Very  gracious,  somewhat  formal.  He  was  nice  to  his  patients  and 
enjoyed  them  and  they  adored  him.  I  honestly  think  that  his 
interest  and  enjoyment  of  medicine  was  more  academic  and 
intellectual  than  in  the  more  mundane  world  of  dealing  with  a  cross 
section  of  the  American  public. 

Hughes:     Which  was  more  your  orientation,  was  it  not1? 

Scheie:       I  greatly  enjoyed  my  patients  and  practice,  there  is  no  doubt  of  that. 

Dr.  Adler's  background  was  that  of  intellectual  Philadelphia.  He 
had  the  finest  of  educations  with  almost  a  princely  background  of 
culture.  He  was  an  excellent  musician  and  owned  a  prized 
Guarnerius  violin.  He  even  played  with  a  chamber  orchestra  on 
occasion.  A  quartet  of  those  musicians  was  very  close  friends  and 
would  frequently  come  to  his  home  where  they  played  together  for 
recreation.  That  was  one  of  his  favorite  pastimes.  He  also  enjoyed 
higher  mathematics. 

Hughes:     Would  it  be  fair  to  say  that  he  was  more  interested  in  the  theoretical 
aspects  and  you  were  more  interested  in  the  practical  challenges'? 

Scheie:       Yes,  I  am  sure  that's  right.  That  is  a  reasonable  way  to  put  it. 

Hughes:     How  did  you  get  along? 

Scheie:       Very  well.  We  were  close  friends. 

Hughes:     In  1940  you  became  an  instructor  in  the  department  of 
ophthalmology.  Was  that  at  Dr.  Adler's  invitation1? 

Scheie:       Yes,  as  you  know,  I  was  his  first  resident  and  he  was  very  good  and 
considerate  of  me.  He  knew  that  I  had  no  source  of  income  and 
would  welcome  remaining  in  the  department  where  I  was  almost  a 
fixture.  There  was  neither  university  nor  government  money 
available  to  support  the  department.  He  therefore  gave  me  $200  a 
month  to  be  his  part-time  assistant  in  private  practice  and  to  help 
in  the  department.  I  was  in  his  office  five  half-mornings  a  week. 

Hughes:     That  was  your  sole  source  of  income'? 

Scheie:       That's  correct.  When  not  in  his  office,  I  helped  the  residents  and 
worked  in  the  laboratory  on  some  pet  projects.  I  also  assisted  him 
with  his  surgery  and  in  caring  for  his  patients  in  the  hospital. 


59 


Physiology  of  the  Aqueous  Humor 

Hughes:     I  believe  that  it  was  at  this  time  that  you  became  interested  in  the 
physiology  of  the  aqueous.  Is  that  right1? 

Scheie:       Yes,  it  was  really  Dr.  Adler's  interest.  He  had  written  a  paper  on 

the  microchemistry  of  aqueous  while  in  Dr.  Richards'  laboratory  and 
had  found  that  urea  did  not  diffuse  into  the  eye  at  the  same  level  as 
glucose.  He  was  curious  as  to  whether  aqueous  was  a  dialysate  or  a 
secretion,  and  these  studies  were  undertaken  because  of  Dr.  Adler's 
interest. 

Hughes:     Wasn't  this  part  of  the  controversy  about  the  formation  of  the 
aqueous,  whether  it  was  a  dialysate  or  a  secretion? 

Scheie:       Yes. 

Hughes:     So  that  was  ultimately  what  you  were  trying  to  achieve  through  this 
experimentation  ? 

Scheie:       Yes,  some  proof  as  to  that. 

Hughes:     It  was  to  these  experiments  that  you  applied  the  microchemical 

techniques  that  Dr.  Adler  had  learned.  The  paper  with  Dr.  Eleanor 
Moore  was  published  in  1942,  "Chemical  equilibrium  between  blood 
and  aqueous  humor."* 

Scheie:       That  is  the  same  work.  Dr.  Moore  did  the  chemical  analyses.  She 
was  an  academic  research  chemist  engaged  by  Dr.  Adler.  Her 
salary  and  the  project  were  provided  by  a  grant  from  the  John  and 
Mary  R.  Markle  Foundation. 

Hughes:     Do  you  remember  that  particular  piece  of  research  ? 

Scheie:       I  remember  going  over  to  operate  on  cats  and  to  tie  off  their  ureters, 
taking  aqueous  from  anterior  chambers,  and  taking  blood 
specimens.  Dr.  Moore,  however,  did  the  vital  chemical  analysis. 

Hughes:     From  what  I  understand,  you  were  trying  to  determine  the  urea 
content.  If  it  were  the  same  in  the  blood  and  in  the  aqueous  that 
would  indicate  that  it  was  not  secreted.  Is  that  not  true? 

Scheie:       That's  right. 

Hughes:     The  indications  were  that  it  was  secreted. 

Scheie:       We  thought. 


Moore,  E,  Scheie,  HG,  Adler,  FH.  Chemical  equilibrium  between  blood  and  aqueous  humor.  Arch 
Ophthalmol  1942;  317-29. 


60 


Hughes:     When  did  it  become  clear  that  aqueous  was  a  secretion? 

Scheie:  Oh,  I  think  that  went  on  as  a  debate  for  several  years.  [Stewart] 
Duke-Elder  and  his  group  in  England  were  working  on  the  same 
project.  Actually,  I  was  out  of  it  very  shortly. 

Hughes:     The  other  paper  on  the  aqueous,  "Physiology  of  aqueous  in 

completely  iridectomized  eyes,"*  was  published  the  following  year,  in 
1943.  Your  name  comes  first,  then  Eleanor  Moore's,  and  then  Dr. 
Adler's. 

Scheie:       Yes,  I  don't  know  that  we  proved  anything  much,  except  that  we 
ruled  out  the  iris  as  being  the  major  factor  in  the  production  of 
aqueous.  No  one  had  ever  studied  a  completely  iridectomized  eye, 
because  the  surgery  was  difficult. 

Hughes:     Secretion  by  the  iris  still  was  a  question? 

Scheie:       Yes,  and  that  is  the  one  thing  we  did,  I  think,  plus  the  technical 

accomplishment  of  removing  the  iris.  We  found  that  we  had  to  do  it 
in  stages.  If  hemorrhage  remains  in  an  eye  without  an  iris,  the 
blood  will  not  absorb.  Since  most  eyes  would  have  some  bleeding  at 
surgery,  I  would  remove  the  iris  in  three  or  four  stages.  Then  after 
the  last  operation  I  would  irrigate  with  blood  thinner 
(anticoagulants)  until  bleeding  stopped  to  avoid  leaving  blood  clots 
in  the  eye.  Blood  left  in  the  anterior  chamber  would  cause  the  eye 
to  deteriorate. 

Hughes:     Would  it  be  days  between  these  stages? 

Scheie:       Yes.  Probably  two  or  three  weeks  after  the  eye  had  recovered  from 
one  procedure,  we  would  do  another.  It  took  three  or  four  stages. 
The  study  also  demonstrated  that  blood  is  absorbed  from  the 
anterior  chamber  largely  by  the  iris. 

The  Sulfonamides  in  Ophthalmology 

Hughes:     The  other  thing  that  you  were  interested  in  at  this  period  was  the 
effectiveness  of  sulfonamides  in  ophthalmology. 

Scheie:       As  you  know,  the  first  sulfonamides  were  used  on  two  of  my 

patients  when  I  was  an  intern  at  HUP  in  1936.  This,  of  course, 
stimulated  a  great  interest  on  my  part.  One  of  my  first  papers 
reported  a  patient  who  became  blind  in  both  eyes  secondary  to  a 
bloodstream  infection  from  which  he  died.**He  was  an  upholsterer 


* 
** 


Arch  Ophthalmol  1943;  30:70-4. 

Reber  J,  Scheie  HG.  Bilateral  endophthalmitis  complicating  pneumococci  septicemia.  Arch 
Ophthalmol  1939;  21:731-4. 


61 

who  had  stepped  on  a  tack  that  apparently  carried  pneumococci, 
probably  from  another  worker's  mouth.  His  foot  became  infected, 
from  which  he  developed  phlebitis  that  went  on  to  a  subsequent 
pneumococcic  blood  infection,  associated  bilateral  endophthalmitis 
with  blindness  in  both  eyes,  and  death. 

I  began  to  wonder  if  an  intraocular  eye  infection,  metastatic  or  from 
a  perforating  injury,  could  be  treated  by  sulfonamides.  Would  they 
enter  the  eye  and  aqueous  humor  from  the  bloodstream,  and  which 
one  would  be  preferable?  Our  paper  demonstrated  that  all  of  the 
sulfonamides,  except  sulfathiasole  which  penetrated  only  to 
eighteen  percent  of  blood  level,  came  through  into  the  eye  nearly  to 
blood  level.  Sulfathiazole,  therefore,  would  probably  not  be  the 
drug  of  choice  to  treat  an  eye  infection. 

However,  we  carried  our  experiments  further  by  injecting  bacteria 
to  produce  an  endophthalmitis.  The  same  penetration  studies  were 
repeated  and  we  found  that  in  infected  eyes  sulfathiazole  came  into 
the  aqueous  humor  to  levels  equal  to  the  others.  So  if  you  had  an 
infected  eye,  it  probably  should  not  matter  too  much  which  you 
used.  But  for  prophylaxis  of  infection,  a  drug  that  did  not  enter  a 
normal  eye  should  be  less  desirable. 

Hughes:     You  wrote  a  paper  on  that  subject  too,  in  1941,  in  which  you  pointed 
out  that  sulfathiazole  did  not  penetrate  to  the  degree  that  the  other 
sulfonamides  did.* 

Scheie:       Right. 

Hughes:     You  also  wrote  a  paper  with  Leopold,  "Penetration  of  sulfathiazole 

into  the  eye.  "**  You  said  that  previously  you  had  reported  that  there 
was  a  low  concentration  of  sulfathiazole  in  the  aqueous,  and  the 
implication  was  that  its  clinical  use  was  inadvisable.  But  in  this 
paper  you  pointed  out  that  sulfathiazole  had  advantages  over  the 
other  sulfas  in  that  it  is  not  as  toxic  and  it  is  extremely  effective 
against  staphylococci  and  gonococci. 

Scheie:       Yes,  because  it  causes  less  damage  when  injected  into  the  vitreous. 

Hughes:     This  was  the  first  paper  in  which  you  were  actually  using  the 

microcrystalline  form  of  sulfathiazole,  which  I  guess  was  easier  to 
inject1? 

Scheie:       Yes,  with  the  actual  crystals  emulsified  and  powdered  into  very 
small  crystals. 

Hughes:     Was  it  easier  to  apply  to  the  eye? 


Scheie  HG,  Souders  IW.  Penetration  of  sulfanilamide  and  its  derivatives  into  aqueous  humor  of 
the  eye.  Arch  Ophthalmol  1941;  25:1025-31. 

**      Arch  Ophthalmol  1942;  27:997-1004. 


62 


Scheie:       Yes,  it  was  easier  to  inject. 

Hughes:     I  wouldn't  say  that  you  came  out  strongly  in  favor  of  it.  Your 
concluding  sentence  was:  "Its  use  against  ocular  infections  is 
probably  not  contra  indicated."  That's  caution!  [laughter]  Then 
there  is  a  paper  with  Leopold  in  1943,  "Studies  with  microcrystalline 
sulfathiazole.  "* 

Scheie:       That  paper  was  completed  after  I  had  gone  into  the  army,  but  we 
had  done  at  least  some  of  the  work  before.  At  that  time  Leopold 
completed  the  paper  and  carried  on  diffusion  studies  of  many 
different  substances,  especially  antibiotics. 

Hughes:     His  name  comes  first;  perhaps  he  wrote  it  because  you  were  away? 

Scheie:       Yes,  but  Leopold  did  have  the  idea  to  use  microcrystalline 
sulfathiazole.  His  name  was  on  one  of  the  other  papers. 

Hughes:     Yes,  but  I  think  yours  came  first. 

Scheie:       He  was  a  resident.  I  believe  that  Dr.  Benjamin  Souders  helped  me 
on  the  first  sulfa  paper. 

Hughes:     Yes,  he  did,  but  your  name  came  first  on  the  other  papers. 

Scheie:       Yes,  because  it  was  my  work,  helped  by  Souders  first  and  then 

Leopold.  Leopold  wrote  the  microcrystalline  article  on  data  that  we 
had  started  together,  but  using  the  microcrystalline  form  was  his 
idea.  He  has  done  and  written  extensively  about  diffusion  studies 
of  various  substances  into  the  eye  since  then. 

Hughes:     So  he  continued  along  that  line? 

Scheie:       Yes,  he  did.  He  became  well  known  for  it,  actually.  But  these  were 
pioneer  studies.  Dr.  John  C.  Bellows  of  Chicago,  who  had  a  Ph.D.  in 
chemistry  and  was  an  ophthalmologist,  was  doing  somewhat  the 
same  work  with  sulfonamides  that  we  were  doing. 

Hughes:     Well,  the  other  thing  that  you  pointed  out  in  this  last  paper  on  the 
sulfas  was  that  the  microcrystalline  forms  might  be  helpful  in 
clearing  purulent  dacryocystitis. 

Scheie:       Well,  that  is  a  tear-duct  infection. 

Hughes:     Yes.  Now  is  that  because  the  crystalline  form  would  penetrate  better? 


Arch  Ophthalmol  1943;  29:811-17. 


63 


Scheie:       I  think  probably  that  was  an  erroneous  conclusion.  It  would, 

however,  be  more  stable  and  remain  in  the  duct  longer  than  in  a 
solution  and  in  greater  concentration. 

Hughes:     Because  of  the  wording,  does  that  mean  that  you  hadn't  actually 
tried  it  against  dacryocystitis? 

Scheie:       At  this  point,  I  can't  tell  you. 


III.    OPHTHALMOLOGIST,  U.S.  ARMY 
MEDICAL  CORPS,  1942-1946 


Hughes:     Does  that  bring  us  up  to  World  War  II? 

Scheie:       I  think  so. 

Hughes:     Yes,  well,  let's  go  to  the  war  then. 

Scheie:       I  thought  we  were  getting  along  well;  now,  you're  suggesting  we  go 
to  war.  [laughter] 

Hughes:     Dr.  Cletus  Schwegman  was  very  helpful  in  giving  me  background  on 
the  war  experience.  We  talked  for  a  whole  hour  long  distance.  * 

Scheie:       He  is  a  very  nice  person  and  a  good  friend.  He  is  an  unusually 
considerate  and  very  skillful  general  surgeon.  He  has  been  very 
good  to  my  family  and  me,  as  well  as  to  some  of  my  employees  and 
their  families.  We  have  also  shared  patients.  Each  one  is  devoted 
to  him. 

Hughes:     Dr.  Schwegman  said  that  your  ability  was  already  recognized  before 
the  war  episode,  which,  of  course,  only  reinforced  your  reputation. 
What  aspect  of  what  you  had  already  done  had  people  noticed? 

Scheie:       I  don't  know  what  he  meant  unless  it  is  because  I  have  always 

worked  like  the  dickens  and  tried  to  take  good  care  of  my  patients. 
The  doctors  at  the  hospital  seemed  to  like  me.  I  had  been  known  to 
most  of  them  during  the  three-and-a-half  years  of  being  an  intern, 
resident,  and  assistant  chief  medical  officer. 


January  23,  1988. 


66 


That  [last]  job  served  as  a  fortunate  introduction  to  Perm  for  an 
unknown  from  Minnesota.  I  was  able  to  meet  and  work  with  a 
broad  spectrum  of  people  because  of  the  responsibilities  of  this 
position.  I  guess  that  is  what  he  meant.  I  became  known  around 
the  hospital. 

I  had  had  my  ophthalmology  residency  at  HUP  and  then  had  served 
two  years  as  Dr.  Adler's  assistant. 


Formation  of  the  20th  General  Hospital 

Hughes:     Tell  me  about  the  formation  of  the  20th  General  Hospital. 

Scheie:       Dr.  Ravdin— we  had  two  surgical  services  at  HUP— was  chief  of  one 
service.  He  was  one  of  the  early,  very  science-oriented  surgeons. 
He  was  also  very  patient  oriented.  We  were  both  morning  people 
and  in  the  army  were  the  first  two  people  up.  In  India  we  vied  to 
see  who  would  be  the  first  in  mess  hall  for  breakfast,  but  he 
probably  won. 

Dr.  Ravdin  could  appear  very  brusque  but  beneath  it  he  was  very 
sensitive  and  kind.  He  was  as  widely  respected  for  his  intellect  as 
for  his  surgery.  He  was  elected  president  of  the  American  College  of 
Surgeons  and  headed  many  other  medical  and  lay  organizations  as 
well.  He  trained  many  outstanding  surgeons,  some  of  whom 
became  heads  of  departments  in  other  schools. 

Hughes:     You  have  spoken  about  the  Mayflower  business  in  connection  with 
Pennsylvania  Hospital.  What  about  minorities  at  the  University  of 
Pennsylvania? 

Scheie:       From  my  point  of  view  the  University  of  Pennsylvania,  possibly 
because  of  the  nature  of  academia,  was  always  quite  liberal  and 
accommodated  minorities.  This  attitude  was  undoubtedly 
accelerated  by  people  like  Dr.  Ravdin. 

## 

He  graduated  from  Penn  Medical  School,  interned  and  trained  in 
surgery  there,  became  a  staff  member  and  eventually  chief  of 
surgery.  Later  in  his  career  he  became  vice-president  of  medical 
affairs,  the  school's  top  job.  I  realize  there  were  some  feelings  about 
religion,  but  certainly  he  deserved  the  position  and  surmounted  any 
such  problems  and  was  popular  throughout  the  school  and  in  the 
community. 

I  personally  believe  in  balance  and  I  sincerely  would  not  want  all 
Norwegians,  all  Irish,  or  all  of  any  one  group,  including  Quakers. 
In  my  opinion,  the  University  of  Pennsylvania  has  done  an 
excellent  job  with  bias  problems. 


67 


Hughes:     What  effect  does  that  have? 

Scheie:       Tolerance.  With  my  background  I  was  taught  that  a  German 

immigrant  was  as  good  as  a  Swedish  or  any  other.  Respect  was 
gained  by  performance.  If  someone  like  our  town  doctor  couldn't  live 
with  all  of  us  and  relate  to  everybody,  we  felt  there  was  something 
wrong  with  him.  The  minority  business  has  been  intolerable  for  me. 

Hughes:     Was  it  Dr.  Ravdiris  responsibility  to  form  the  20th  General  Hospital? 

Scheie:       The  Surgeon  General  had  asked  him  to  organize  a  unit  from  the 
University  of  Pennsylvania. 

Hughes:     He  was  a  reserve  officer? 

Scheie:       I  don't  think  so.  I  believe  he  was  asked  because  he  was  a  quality 
individual,  a  number-one  surgeon,  and  had  outstanding  ability. 

Hughes:     What  were  his  criteria  for  choosing  members  of  the  unit? 

Scheie:       He  selected  some  of  the  best  young  and  middle-aged  people  on  the 
hospital  staff.  It  was  just  that  simple. 

Julian  Johnson,  who  was  one  of  the  early  chest  surgeons  and  later 
one  of  the  best  chest  and  heart  surgeons  in  the  country,  was  one.  In 
fact,  such  surgery  was  in  its  infancy  at  that  point.  I  think  he  had 
had  some  training  under  the  famous  Elliott  C.  Cutler,  the  man  in 
Boston  who  was  a  leader  in  his  field.  Julian,  incidentally,  became 
head  of  cardiothoracic  surgery. 

Philip  Ayer  Marden  was  an  outstanding  nose  and  throat  staffman 
who  eventually  became  chief  of  the  department  at  Penn  following 
the  war.  Ravdin  also  took  one  of  the  finest  internists  at  the 
hospital,  Dr.  Thomas  Fitz-Hugh,  Jr.,  and  made  him  chief  of 
medicine.  Dr.  Herbert  Gaskill  was  our  chief  of  psychiatry,  who  after 
World  War  II  became  head  of  psychiatry  at  Colorado  Medical 
Center  in  Denver.  Dr.  Clarence  Swinehart  Livingood,  our 
dermatology  chief,  became  professor  and  chairman  of  dermatology 
at  the  University  of  Texas  in  Galveston  in  postwar  years.  He  was 
decorated  in  India  for  discovering  the  cause  and  cure  of  a  native 
skin  condition.  After  that  (he  is  now  semiretired)  he  was  chief  of 
dermatology  at  Henry  Ford  Hospital  in  Detroit  for  quite  a  few  years. 

Ravdin  also  included  an  excellent  peripheral  vascular  surgeon,  Dr. 
Norman  Eston  Freeman,  and  a  similarly  high  quality  orthopedic 
surgeon,  Dr.  Ernest  Brav.  They  were  all  key  staff  persons  in  their 
departments.  Dr.  Francis  C.  Wood  and  Dr.  Kendall  Adams  Elsom 
were  two  especially  able,  senior  internists.  Dr.  Wood  later 
succeeded  Dr.  Fitz-Hugh  as  our  chief  of  medicine  in  the  20th 
General  Hospital  and  became  professor  and  chairman  of  the 
department  of  medicine  at  Penn  after  the  war.  Dr.  Paul 


68 


Klingensmith  was  to  be  in  charge  of  triage.  All  admissions  were 
evaluated  by  him  and  sent  to  the  proper  services.  Who  else? 

Hughes:     Robert  Groff? 

Scheie:       Yes,  Robert  Groff,  head  of  neurosurgery.  So  you  see,  Ravdin  took 
along  quite  an  array  of  people  to  be  head  of  sections  and  then  filled 
in  with  some  of  the  younger  staff  people. 

Dr.  William  Fitts  was  one  of  the  younger  surgeons  who  later 
became  chairman  of  the  department  of  surgery  at  the  University  of 
Pennsylvania.  Right  off  the  top  of  my  head  that  is  the  end  of  my 
list.  There  were  other  young  men,  too  many  to  mention,  who  were 
headed  toward  bright  futures.  Many  fine  nurses  volunteered  and 
were  vital  to  the  unit.  You  have  probably  seen  that  big  photograph, 
the  panorama  of  our  unit. 

Arthur  Walker,  who  had  been  a  key  man  doing  research  with  Dr. 
Richards,  was  in  charge  of  all  of  our  records  and  was  our 
drillmaster  during  nine  months  of  training  camp.  He  pretended  to 
be  a  sergeant,  but  the  pretense  was  hardly  necessary,  [laughter] 
Finally,  we  had  two  chaplains. 

Hughes:     Of  different  faiths? 

Scheie:  Catholic  and  Episcopal,  now  both  deceased.  The  latter  was  first 
baseman  on  my  softball  team.  He  even  permitted  some  colorful 
words  during  the  height  of  the  game,  [laughter] 

The  Catholic  chaplain,  Father  Louis  Myer,  was  very  talented  and 
came  from  an  old  family  of  silversmiths  in  Philadelphia.  I  don't 
know  how  many  generations  they  go  back,  but  the  family  firm  was 
dissolved  only  within  the  last  few  years.  Father  Myer  was  a  great 
favorite  of  Cardinal  John  Krol,  our  recently  retired  local  cardinal. 
Following  the  war,  Father  Myer  built  a  new  parish  and  church  in 
the  Philadelphia  suburbs,  complete  with  a  nice  residence  and 
library.  To  show  that  my  being  nonsectarian  did  not  entirely 
exclude  me,  I  was  invited  to  a  large  reception  and  testimonial 
dinner  in  his  honor  at  which  I  was  seated  with  Cardinal  Krol  and 
him.  I  regarded  that  as  a  high  compliment. 

Hughes:     So  the  unit  was  formed,  and  then  what  happened? 

Scheie:       Well,  the  first  meeting  of  the  unit  was  called,  as  I  said,  the  evening 
of  Pearl  Harbor. 

Hughes:     Was  that  fortuitous? 

Scheie:       Oh,  no.  Ravdin  called  an  emergency  meeting  immediately  after 
news  of  the  attack.  The  names  of  the  chiefs  of  service  were 
announced  and  some  of  our  goals  outlined.  We  did  not  know  when 
we  would  be  activated  or  called  to  active  duty.  Following  Pearl 


69 


Hughes: 
Scheie: 


Harbor  we  had  an  occasional  meeting  but  nothing  very  definitive 
was  undertaken.  I  am  sure  Dr.  Ravdin  did  a  lot  of  planning  and 
work  behind  the  scenes.  Finally,  we  were  called  for  active  duty  on 
May  15, 1942.  On  that  date  we  left  on  a  special  train  from  the  30th 
Street  Station  in  Philadelphia.  The  university  family  turned  out  for 
our  departure. 

That  must  have  been  moving. 

Yes.  There  was  a  band  playing  and  some  tear-filled  eyes.  Once 
underway  it  took  us  two  days  to  reach  our  destination. 


Camp  Claiborne,  Louisiana 


Hughes:     Where  were  you  headed1? 

Scheie:       Camp  Claiborne,  Louisiana,  about  fifteen  miles  east  of  Alexandria. 
It  was  the  middle  of  May  and  hot  as  the  devil  and  we  were  wearing 
winter  uniforms.  Our  summer  uniforms  had  not  yet  been  issued,  so 
it  wasn't  a  very  pleasant  trip.  At  Camp  Claiborne  we  lived  in 
typical  military  barracks.  We  stayed  there  until  January,  1943. 

Hughes:     What  happened  at  Camp  Claiborne? 

Scheie:       Well,  believe  it  or  not,  we  were  trained  like  foot  soldiers,  including 
calisthenics,  close-order  drills,  long  hikes,  and  athletic  activities, 
like  softball. 

It  was  quite  boring  for  a  group  of  people  who  had  been  leading 
active,  professional  lives  to  adjust  to  this  environment.  The 
camp-partially  swampland-was  written  up  in  Life  magazine  as  the 
worst  training  camp  in  the  United  States. 

The  Surgeon  General  assigned  a  regular  army  officer  as  hospital 
commander,  Col.  Elias  Cooley.  After  Cooley's  arrival,  Ravdin 
remained  as  chief  of  surgery.  Colonel  Cooley  was  a  senior  officer 
who  retired  after  about  six  months  in  India,  when  Ravdin  was 
appointed  commanding  officer  and  later  promoted  to  brigadier 
general  while  we  were  still  overseas. 

Some  of  us  fortunately  were  needed  for  occasional  professional  work 
at  the  station  hospital.  I  have  a  copy  of  a  letter  written  to  Colonel 
Cooley  from  the  commanding  officer  of  the  Claiborne  station 
hospital  thanking  him  for  permitting  me  to  work  in  the  clinic.  They 
had  only  one  ophthalmologist  and  a  couple  of  optometrists.  The 
chief  of  ophthalmology,  Maj.  Paul  Black,  had  asked  if  our  unit  had 
anyone  who  could  be  assigned  to  help  him,  so  I  volunteered.  Even 
temporary  professional  duty  was  very  welcome  and  the  service  was 
very  active  for  a  station  hospital. 


70 


A  historic  event  occurred  while  I  was  working  there.  The  first  two 
airborne  divisions,  the  82nd  and  101st,  were  formed  at  Camp 
Claiborne  from  the  Pennsylvania  National  Guard's  28th  Division. 
Gen.  Matthew  Bunker  Ridgeway  was  one  of  my  patients  while  I 
was  there.  He  was  given  command  of,  I  believe,  the  82nd  Airborne 
Division.  Both  divisions  later  achieved  great  fame.  He  was  a  very 
superior  person  and  I  have  learned  that  in  the  army,  as  in  civilian 
life,  those  who  rise  to  the  top  ranks  are  much  like  the  persons  who 
rise  to  the  top  in  the  civilian  world.  They  have  met  competition  and 
surmounted  it  and  are  usually  superior  people. 

Over  the  years  I  have  acquired  great  respect  for  the  military.  The 
top  people  are  dedicated,  intelligent,  and  willing  to  give  their  lives 
when  needed.  They  have  to  be  bright  to  graduate  from  West  Point 
or  the  naval  or  air  force  academies  or  to  rise  from  the  ranks,  which 
a  great  many  of  them  did  during  World  War  II,  as  well  as  at  other 
times. 

Camp  Claiborne  was  said  to  be  the  only  training  camp  in  the 
United  States  where  you  could  stand  or  march  in  water  up  to  your 
belly  and  have  sand  blow  in  your  eyes.  But  that  is  the  way  it  was. 
Frogs,  my  God,  the  frogs!  I  have  a  story  about  a  frog  that  Dr. 
Livingood  did  not  quite  appreciate. 

In  Louisiana  near  our  camp  there  was  a  small-time  gambling  place 
in  a  village  named  Bunky.  We  therefore  named  Clarence  the 
"bunky  beaver"  because  of  his  occasional  attendance.  This  night 
Col.  Thomas  Cook,  who  was  head  of  our  oral  surgery  and  dental 
service,  and  I  went  to  the  movies  together.  We  knew  Clarence  had 
gone  to  Bunky  with  some  friends. 

Incidentally,  Dr.  Cook  later  became  chief  of  oral  surgery  at  the 
University  of  Miami  Medical  School.  We  had  a  long  association  at 
both  Penn  and  in  the  military  and  were  good  friends.  We  were 
together  at  Camp  Claiborne  and  later  in  India  with  the  20th 
General  Hospital  where  we  jointly  cared  for  numerous  facial 
trauma  patients.  In  1944  we  returned  to  the  United  States  at 
nearly  the  same  time  and  were  both  assigned  to  the  Crile  Army 
Hospital  in  Cleveland,  one  of  five  designated  army  eye  centers, 
where  we  worked  until  we  were  discharged. 

Back  to  our  evening  at  the  movies:  On  the  way  home  we  came  upon 
the  biggest  bullfrog  you  could  imagine.  Well,  you  have  never  seen 
frogs  like  those  in  swampy  Louisiana.  We  would  occasionally  go 
fishing  at  Lake  Charles,  which  was  about  fifty  miles  away,  when  we 
could  get  away  for  a  weekend.  The  frog  legs  served  in  the 
restaurants  of  that  small  town  were  delicious  and  as  large  as 
chicken  legs.  I  even  ordered  them  from  there  after  World  War  II, 
but  they  were  not  the  same. 

Well,  we  captured  this  large  and  very  active  bullfrog  with  some 
difficulty.  Now,  what  to  do  with  him?  We  finally  decided  that  he 


71 

would  be  a  good  bunkmate  for  Clarence  Livingood  who  would  be 
returning  later.  The  nights  down  there  were  rather  chilly  so 
blankets  were  tucked  in  nicely  at  the  sides  and  foot.  One  slid  in 
from  the  top  so  that  the  blankets  remained  in  place  and  the  bed 
stayed  warm.  We  slipped  this  bullfrog  under  the  blanket  as  near  to 
the  foot  as  possible.  Four  of  us  were  housed  in  each  bunkhouse  and 
we  were  able  to  tip  off  a  couple  of  his  roommates  to  include  them  in 
the  conspiracy.  As  a  result  they  were  waiting  for  Clarence  to  come 
home  and  for  the  show  to  start. 

As  we  had  anticipated  when  Clarence  slid  into  bed  and  his  bare  feet 
came  into  contact  with  the  cold  frog  they  both  (Clarence  and  the 
frog)  began  to  kick.  Obviously,  I  was  not  able  to  observe  the 
happenings  but  they  were  recited  to  me  in  much  detail  the  next 
morning  at  breakfast.  He  leaped  out  of  bed,  tore  the  covers  off,  and 
once  he  saw  the  frog,  the  show  continued.  It  would  not  have 
bothered  anyone  had  Clarence  left  it  alone.  Instead,  he  first  tried  to 
catch  it  with  his  bare  hands  but  was  unsuccessful.  So  he  took  the 
sheet  off  his  bed  and  finally  caught  the  frog.  His  roommates 
watching  this  were  hilarious.  Of  course,  all  had  been  sworn  to 
secrecy,  but  I  knew  that  I  would  be  a  suspect  as  the  perpetrator. 

All  of  us  eagerly  waited  for  him  to  come  to  the  mess  hall  for 
breakfast  but  pretended  to  be  very  busy  and  disinterested  when  he 
appeared.  He  said  nothing  for  a  few  minutes,  then  I  guess  he  said, 
"Some  damn  fool  put  a  frog  in  my  bed  last  night."  He  did  not  seem 
to  think  it  was  funny.  His  roommates  made  it  worse  by  saying  they 
saw  no  frog  in  the  room  at  all.  Eventually,  he  forgave  me  but  he 
never  did  find  it  humorous. 

Camp  Claiborne  was  near  enough  to  New  Orleans  and  Galveston 
that  we  could  spend  an  occasional  weekend  at  either  place.  Tom 
Cook  and  I  had  a  wonderful  weekend  in  the  latter  city.  It  meant  a 
change  from  our  rather  crude  camp  and  its  monotony.  The  climate 
and  terrain  of  Louisiana  and  the  hump-backed  Brahman  bulls 
raised  on  some  of  the  ranches  and  numerous  in  India  served  as 
excellent  preparation.  The  summer  weather  in  Louisiana  was  hot, 
humid  and  somewhat  like  India,  although  not  as  rugged  as  the 
monsoon. 


Camp  Anza,  California 

Hughes:     The  next  step  was  the  staging  area  in  southern  California? 

Scheie:       After  eight  months  we  were  taken  by  train  across  the  country  to 

California  to  our  staging  area  at  Camp  Anza,  about  five  miles  from 
Riverside.  We  were  the  first  units  to  pass  through  there  and  it  was 
not  yet  fully  prepared  for  troops.  Our  stay  was  for  about  a  week 
and  we  nearly  froze  to  death.  I  told  you  [off  tape]  about  sleeping  on 
the  floor  to  keep  warm.  They  had  no  blankets  for  us  nor  mattresses 


72 


for  the  beds.  Amenities  were  very  inadequate.  The  desert  in 
California  in  January  is  very  cold  at  night.  I  don't  think  I  have  ever 
been  as  cold  in  my  life,  even  growing  up  near  the  Canadian  border 
in  northern  Minnesota.  At  least  we  prepared  for  the  weather  there. 
Frank  [L.]  Newburger  [Jr.]  and  several  others  developed  severe 
colds;  he,  pneumonia.  It  was  a  question  as  to  whether  Newburger 
was  going  to  be  able  to  debark  with  us,  but  all  of  us  did  make  it  to 
the  boat.  We  took  a  night  train  with  all  lights  blacked  out  to  Long 
Beach,  California,  where  we  boarded  the  boat.  There  I  had  another 
adventure. 

When  we  boarded  the  boat,  we  had  to  give  our  name  and  serial 
number  and  pick  up  our  previously  made  bunk  assignments.  There 
were  more  than  ten  thousand  military  personnel  on  the  boat  so  an 
occasional  error  was  understandable.  When  I  reported,  my  name 
was  not  on  the  list  and  every  space  seemed  taken.  All  I  could  do 
was  wait  until  everybody  had  boarded  the  ship.  At  the  end  of  my 
wait,  I  was  asked  to  go  into  the  staging  office  where  the  army  troop 
commander  and  the  captain  of  the  ship  took  up  my  problem  and 
luckily  they  found  a  perfect  solution  for  me.  The  captains  had  been 
assigned  miserable  bunks  four  tiers  high  and  below  deck.  They 
would  have  to  slide  into  their  bunks  with  so  little  space  that  they 
could  not  sit  up. 

When  I  arrived  in  the  ship  captain's  office,  I  learned  that  the  only 
space  available  was,  believe  it  or  not,  with  three  colonels  in  a 
top-deck  stateroom.  One  was  a  full  colonel,  Colonel  Mullett,  who 
commanded  a  trucking  company.  The  other  two  were  his  deputy 
commanders,  Lt.  Col.  Chester  Asher  and  Lt.  Col.  Edwards.  Mullett 
was  regular  army.  Asher  and  Edwards  were  from  the  National 
Guard.  Colonel  Mullett  was  a  graduate  of  the  University  of 
Indiana,  where  he  participated  in  ROTC.  He  was  also  one  of  their 
good  football  players.  When  I  met  him  he  was  about  forty  years  of 
age  and  a  career  regular  army  officer. 

I  was  assigned  to  their  roomy  stateroom. 

## 

There  were  two  double  decker  beds  in  the  room  and  I  as  a  captain 
was  enjoying  the  comforts  accorded  to  colonels.  It  was  great  good 
luck  but  there  was  a  fly  in  the  ointment.  The  ship's  bakery  was 
directly  beneath  us  and  at  night  the  ovens  heated  the  floors  and  our 
room.  Although  we  had  two  portholes  which  would  have  helped  to 
keep  us  cool,  they  had  to  be  closed  when  the  ship  blacked  out  at 
night,  because  of  submarine  danger.  No  one  was  allowed  on  deck 
after  dark.  The  baking  was  done  at  night,  and  with  the  floor  almost 
painfully  hot  to  bare  feet,  the  stateroom  resembled  a  steam  bath. 

We  felt  lucky,  however,  when  we  saw  the  conditions  for  lesser  ranks 
below  deck.  Our  ship,  the  Monticello,  was  a  recently  captured 
Italian  liner  which  was  put  into  service  out  of  necessity  as  a  troop 


73 


transport  when  it  had  not  been  adequately  outfitted  for  that 
purpose.  Sometimes  sewage  would  overflow  into  the  lower  decks. 
Amenities  were  often  inadequate  and  nothing  could  be  done  about 
it  at  sea.  The  troops,  therefore,  had  an  unpleasant  trip.  So  in  spite 
of  the  heat,  we  were  very,  very  fortunate. 

Hughes:     How  many  units  were  there? 

Scheie:       There  were  seven  to  eight  thousand  army  troops  aboard,  including 
three  hospital  units,  the  trucking  unit,  and  others.  The  72nd 
Station  Hospital  was  an  affiliated  unit  from  USC  [University  of 
Southern  California],  and  the  field  hospital  was  from  Rhode  Island. 
We  held  some  medical  meetings  which  helped  to  keep  us  occupied. 
They  were  intended  to  anticipate  possible  military  medical 
problems,  even  though  we  did  not  know  our  specific  assignments 
until  shortly  before  we  arrived  in  India. 

For  a  couple  of  days  before  we  arrived  and  upon  leaving  each  port 
we  were  accompanied  by  submarine  chasers.  At  other  times,  we 
followed  a  zigzag  course  to  avoid  possible  submarine  torpedo 
attacks.  Our  course  was  below  Hawaii  and  our  first  stop  was 
Wellington,  New  Zealand.  Our  total  voyage  to  Bombay  took  forty 
days.  "Forty  days  and  forty  nights  Columbus  sailed  the  ocean." 

Hughes:  Wasn't  that  tough  on  somebody  with  your  energy  being  cooped  up  on 
the  ship  for  that  long? 

Scheie:       Well,  in  a  way  it  was  exciting  and  somehow  we  kept  occupied, 
possibly  anticipating  the  unknown. 

Hughes:     What  were  you  learning  in  the  medical  meetings? 

Scheie:  Oh,  we  covered  such  problems  as  management  of  tropical  diseases, 
the  treatment  of  various  types  of  battle  casualties,  and  others.  For 
example,  should  a  wound  be  debrided,  sutured,  or  no? 

Hughes:     The  meetings  were  helpful? 

Scheie:       Well,  they  did  keep  us  busy  and  they  were  informative. 

Hughes:     But  it  wasn't  necessarily  information  that  you  didn't  already  know? 

Scheie:       Yes  and  no,  but  they  served  as  a  review  and  they  helped  to  relieve 
boredom.  It  was  really  Ravdin's  enthusiasm  that  initiated  them 
and  it  was  he  who  organized  them.  He  was  a  very  active  and 
enthusiastic  person.  All  of  the  medical  units  participated  and 
speakers  were  utilized  from  each  unit  to  cover  various  subjects.  I 
talked  on  trachoma  at  least  once.  The  conferences  did  help  to 
relieve  the  tedium. 

The  citizens  of  Wellington  were  very  friendly  and  invited  us  into 
their  homes  and  almost  invariably  offered  us  beer.  Beer  seemed  to 


74 

be  the  national  drink  in  Australia  and  New  Zealand.  It  was  a 
beautiful  city  and  we  had  a  nice  two-day  visit.  We  sailed  the 
Tasmanian  Sea  between  Tasmania  and  Australia,  experiencing  a 
terribly  rough  ride,  even  on  a  big  ship. 

Hughes:     Were  you  seasick1? 

Scheie:       I  took  a  little  atropine  and  a  barbiturate  obtained  from  sick  bay 
about  once  a  day,  knowing  that  I  was  subject  to  airsickness.  We 
didn't  have  the  drugs  now  available,  such  as  dramamine,  to  prevent 
motion  sickness. 

Perth,  our  next  stop,  was  also  a  beautiful  city  with  lovely  lawns, 
with  bowling  on  the  green,  and  a  very  attractive  business  section. 
Australian  soldiers  were  just  returning  from  the  victorious  North 
African  campaign  and  were  being  replaced  by  American  and  British 
troops.  You  may  recall  that  they  had  helped  to  save  the  day  over 
there. 

Hughes:     This  was  [Field  Marshall  Erwin]  Rommel's  campaign1? 

Scheie:       Yes,  it  was  that  campaign. 

On  entering  Perth,  we  were  thrilled  to  see  the  beautiful  famous 
ships  that  had  evacuated  the  troops.  The  Queen  Elizabeth,  the 
Queen  Mary,  the  lie  de  France,  and  both  the  Queen  of  Bermuda  and 
its  companion  ship  were  at  anchor  and  alongside  each  other.  The 
scene  was  quite  breathtaking.  We  had  a  pleasant  time  in  Perth,  a 
time  when  American  popularity  was  at  its  height. 

Like  most  of  the  officers,  we  had  some  liquor  in  our  bedding  roll, 
but  it  was  stored  in  the  hold  of  the  ship  and  unavailable.  Liquor 
was  forbidden  aboard  ship,  but  some  of  the  officers  had  taken  some 
on  and  had  their  cocktail  hour  before  their  evening  meal. 

My  roommates  had  charged  me  with  the  responsibility  of  finding 
some  alcoholic  spirits  for  our  cabin,  saying,  "It's  your  job  to  bring 
some  aboard."  I  found  a  military  club  that  welcomed  Americans, 
where  I  bought  some  whiskey.  Then  I  had  the  problem  of  getting 
the  bottles  aboard  because  liquor  was  forbidden  and  there  were 
guards  at  each  side  of  the  gangplank.  To  solve  the  problem,  I 
bought  a  woven  bamboo  basket  at  a  market  and  then  found  a  fruit 
stand.  I  placed  the  bottles  at  the  bottom  and  covered  them  with 
fruit.  When  I  arrived  at  the  gangplank,  the  guards  looked  me  over 
and  I  asked,  "It's  okay  to  bring  this  fruit  aboard,  isn't  it?"  "Oh  yes, 
go  ahead,  captain."  Immediately  I  became  a  hero  and  permanent 
friend  of  my  roommates.  The  remainder  of  our  trip,  which  took  us 
to  Bombay,  was  even  more  convivial  as  a  result  of  my  fruit  basket. 

Later  in  India,  Colonel  Mullett  not  infrequently  stopped  by  my 
clinic  to  visit.  Colonel  Asher  became  a  patient  while  in  India  and 
later  in  Philadelphia.  His  family  had  a  successful  candy  company 
in  Philadelphia  which  he  took  over  after  World  War  II  and  which 


75 


his  son  now  runs.  He  continued  as  a  patient  of  mine  after  the  war 
because  of  recurrent  iritis,  and  we  remained  fairly  close  over  the 
years  until  his  death. 

I  have  always  enjoyed  children  so  after  the  war  I  developed  a  rather 
large  pediatric  ophthalmology  practice.  Possibly  that  is  the  reason 
I  feel  that  the  general  ophthalmologist  can  handle  most  of  the 
problems  of  pediatric  ophthalmology.  I  never  wore  a  white  jacket  in 
my  office  because  children  associate  them  with  their  pediatrician 
and  his  needles.  Instead,  I  courted  them  with  Asher  Candy 
Company's  lollipops,  which  I  ordered  by  the  case.  I  had  purchased 
them  from  the  Whitman  Candy  Company  until  they  stopped 
making  them.  For  help  I  called  Colonel  Asher  and  asked  if  he  could 
oblige  me,  and  until  this  day  his  company  supplies  them  for  our  eye 
institute.  Dr.  Madeleine  Ewing,  my  former  associate,  orders  Asher 
lollipops  for  her  own  practice. 


Ledo,  India 


Hughes:    A  long  tradition.  When  did  you  realize  that  your  destination  was 
India  ? 

Scheie:       Not  until  shortly  before  we  arrived,  possibly  a  day  or  so  out. 
Hughes:     Had  you  suspected? 

Scheie:       No,  but  my  [first]  wife  and  I  were  listening  to  a  concert  on  the  radio 
by  the  Philadelphia  Orchestra  on  December  7,  1941,  when  the 
music  was  interrupted  by  the  announcement  of  the  Pearl  Harbor 
bombing.  Of  course,  we  were  concerned  because  we  knew  that  if 
there  were  a  war,  I  would  very  probably  be  called.  I  am  sort  of  a 
map  buff  and  we  had  a  large  map  of  the  world  on  the  wall.  We 
scanned  this  to  speculate  where  I  might  be  sent.  Some  troops  were 
already  in  England,  North  Africa,  and  the  Philippines.  After  a 
short  time,  I  pointed  to  an  area  in  northeast  India  and  said,  "If  I 
were  to  have  my  choice,  I  would  prefer  I'd  be  sent  into  this  area  at 
the  junction  of  Nepal,  Tibet,  China,  India  and  Burma."  Oddly 
enough,  I  had  pointed  almost  to  the  exact  spot  to  which  I  was 
eventually  assigned.  It  was  an  amazing  coincidence. 

After  we  arrived  in  Bombay,  we  were  taken  by  train  to  our  final 
destination  at  Ledo,  India,  which  was  located  in  the  jungle  about 
eight  hundred  miles  northeast  of  Calcutta  and  about  twenty-five 
miles  from  the  Burma  border. 

Hughes:     By  train? 

Scheie:  We  went  by  train  but  had  to  cross  the  Brahmaputra  River  at  a  town 
named  Gauhati.  This  required  an  overnight  trip  by  boat  and  then  a 
transfer  to  another  train  of  different  gauge  to  Ledo,  where  our 


76 


jungle  hospital  was  being  built.  It  was  late  in  March  and  the 
monsoon  rains  were  just  beginning  when  we  arrived.  It  was  also 
quite  hilly  and  with  few  amenities  available  we  were  quite 
miserable,  but  living  conditions  rapidly  improved.  However,  we 
lived  and  worked  under  leaf  roofs  with  bamboo  walls  for  the  next 
two  and  one-half  years. 

On  arrival,  our  mail  caught  up  with  us  and  I  learned  that  my  son 
Harold  had  been  born  in  January.  Also,  my  birthday  was  at  hand. 
To  celebrate  I  invited  several  of  my  buddies  to  join  me  in  a  drink. 
To  our  dismay,  when  I  opened  my  bedroll  we  learned  that  the 
sailors,  who  had  had  access  to  the  ship's  hold,  had  removed  the 
liquor.  This  did  not  add  much  pleasure  to  our  arrival  and  I  have 
never  quite  forgiven  the  navy. 


With  his  bearer 


In  Ledo,  the  views  were  beautiful.  I  could  leave  my  bamboo  hut, 
look  to  the  north  and  see  the  beautiful  snow-capped  Himalayas  of 
Nepal.  Looking  to  the  south,  no  more  than  a  mile  away,  I  had  a 
view  of  the  jungle-covered  Naga  Hills  where  the  Naga  headhunters 
lived.  We  were  truly  in  jungle  country  with  wild  animals  such  as 
tigers,  leopards,  and  cobras  as  neighbors.  An  occasional  tiger  would 
go  through  our  hospital  area  at  night  leaving  tracks  to  be  seen  the 
following  morning.  Monkeys  were  commonplace  and  I  could  see  a 
hundred  or  more  monkeys  playing  by  a  stream  in  back  of  my  eye 
clinic. 

The  monsoons  started  in  late  March  or  early  April  and  gradually 
built  up  to  a  crescendo  by  June  and  continued  till  early  September. 
The  annual  rainfall  was  three  hundred  inches.  Small  streams  with 
little  water  might  become  one  hundred  yards  or  more  wide  before 


77 


the  monsoon  was  over.  Back  of  us  was  tea  country,  the  home  of 
Darjeeling  tea.  Some  of  us  came  to  know  several  of  the  tea  planters 
quite  well.  They  were  British  who  superintended  the  plantations, 
with  a  thousand  or  more  Indian  employees  on  each  plantation.  The 
area  provided  a  unique  experience. 

Hughes:     Well,  perhaps  you  should  explain  why  it  was  important  to  have  a 
hospital  at  Ledo. 

Scheie:       We  provided  medical  support  to  the  American  and  Chinese  troops 
under  Gen.  Joseph  W.  Stilwell,  whose  mission  was  to  build  a  road 
through  the  Himalayas  and  the  Hukwang  Valley  to  connect  with 
the  Burma  Road.  This  had  been  taken  by  the  Japanese.  You  may 
remember  that  Col.  Gordon  Seagrave  was  driven  from  Burma  when 
the  Japanese  invaded  China  and  later  Burma  after  Pearl  Harbor.  A 
dozen  or  more  divisions  of  Japanese  were  involved  and  had 
encountered  very  little  resistance  when  they  invaded  Burma. 

To  build  the  road  (called  the  Ledo  Road)  the  Japanese  had  to  be 
driven  back  and  the  engineers  protected  as  they  worked.  The  road 
began  at  Ledo  where  our  base  was  located  and  extended  into  Burma 
to  join  the  Burma  Road  south  of  Myitkyina  at  Bhamo  in 
mid-Burma.  The  dense  jungle  and  the  mountains  were  almost 
impassable  and  the  Japanese  troops  all  created  an  extremely 
difficult  situation.  Before  it  was  over,  at  least  200,000  Chinese 
troops,  some  Indian  troops,  and  our  own  combat  troops  (the  famous 
Merrill's  Marauders  and  our  combat  engineers)  succeeded  in 
driving  the  Japanese  back.  The  main  fighting  was  done  by  the 
Chinese  and  Merrill's  Marauders.  The  engineers  building  the  road 
provided  their  own  protection  from  Japanese  snipers  and  occasional 
patrols. 

The  mission  was  hazardous.  The  jungle  was  infested  with 
disease-diarrhea,  scrub  typhus,  and  malaria.  Malaria  was  a  major 
problem  because  of  the  heavy  rainfall  with  hordes  of  mosquitoes. 
Our  hospital  treated  over  ten  thousand  soldiers  with  malaria 
during  our  first  year  in  the  area.  Scrub  typhus  was  another  serious 
problem,  as  were  skin  problems.  We  also  cared  for  most  of  the 
serious  combat  injuries,  both  Chinese  and  American. 

Hughes:     What  was  done  as  a  prophylaxis  for  malaria? 

Scheie:       Atabrine,  but  it  only  suppressed  the  disease.  As  an  example,  I  had 
no  sign  of  the  disease  while  on  atabrine  in  India,  but  about  a  month 
after  I  returned  to  the  States,  having  stopped  the  atabrine,  I 
developed  the  condition. 

Hughes:     Does  atabrine  kill  one  of  the  phases  of  the  protozoan  ? 


78 


Scheie:  I  don't  know,  but  I  do  know  that  the  organisms  remain  latent  in  the 
body,  with  the  disease  breaking  out  a  month  or  so  after  stopping  the 
atabrine. 

Hughes:     Did  you  use  mosquito  netting1? 

Scheie:       We  were  required  to  sleep  under  mosquito  netting.  Rats  which 

lived  in  our  leaf  roofs  would  occasionally  fall  into  the  netting.  We 
also  used  it  as  protection  against  snakes.  There  were  many  snakes 
and  some  of  them  were  very  poisonous.  The  banded  krait  was  a 
very  lethal  snake.  We  also  would  bring  our  shoes  under  the 
mosquito  netting  because,  particularly  during  cooler  weather,  the 
warm  shoe  makes  a  nice  nest  for  a  snake  but  is  a  hazard  if  you  get 
up  during  the  night  and  slip  your  foot  into  it.  Our  bamboo  hut  was 
right  beside  a  swamplike  area  and  the  home  of  innumerable  frogs 
which  covered  our  floor  at  times. 

Hughes:     Did  you  enjoy  frog  legs  again? 

Scheie:       Not  in  India.  They  weren't  the  type  and  seemed  to  have  small  legs. 

Frank  Newburger,  my  roommate,  and  I  had  a  cage  of  mosquito 
netting  made  in  a  local  bazaar,  which  we  could  suspend  from  the 
ceiling.  It  was  large  enough  to  stand  and  sit  in  and  kept  us  free 
from  mosquitoes  and  frogs  while  we  read  or  chatted  in  the  evening. 
It  was  probably  about  ten  feet  square.  Leeches  were  a  nuisance 
and  might  drop  onto  our  backs  or  abdomens  while  we  were  shaving. 
You  usually  didn't  feel  them  bite  but  you  would  look  down  and  see 
them  filling  with  blood.  Then  it  was  a  problem  to  get  them  off.  You 
either  put  salt  on  them,  which  causes  them  to  drop  loose,  or  burn 
them  with  a  cigarette.  If  you  walked  through  a  grass  plot  a  leech 
could  attach  to  your  leg,  maybe  they'd  get  on  your  foot  and  crawl  up 
your  leg  and  you  would  not  know  it  until  later.  Imagine  what  they 
did  to  the  soldiers  out  in  the  jungle-some  of  them  were  elephant 
leeches  as  big  as  your  finger. 

The  Layout,  Work,  and  Personnel  of  the 
Hospital  Unit 

Hughes:     Describe,  please,  the  layout  of  the  hospital. 

Scheie:       Well,  we  had  two  hospitals,  one  for  Chinese  and  the  other  for 

Americans,  separated  by  a  low  area  which  was  swampy  during  the 
monsoon.  We  had  a  road  connecting  the  hospitals  so  that  we  had  no 
problem  going  from  one  to  another.  We  supported  two  hundred 
thousand  Chinese  soldiers  who  had  their  own  eating  habits  and 
other  customs  that  made  us  realize  that  we  must  have  a  separate 
Chinese  hospital.  Each  had  one  thousand  beds.  A  Chinese 
commanding  officer,  a  line  officer,  was  in  charge  of  the  Chinese 


79 

troops,  but  the  hospital  was  under  the  supervision  of  General 
Ravdin  and  his  staff.  The  medical,  nursing  and  technical 
personnel,  as  well  as  supplies  were  furnished  by  the  United  States. 

My  eye  clinic  was  located  between  the  hospitals.  I  was  kept  very 
busy  with  soldiers  needing  routine  care,  and  there  were  many 
trachoma  patients  needing  surgery,  some  in  an  advanced  stage  with 
severe  entropion  and  corneal  opacification.  About  sixty  percent  of 
the  Chinese  had  active  trachoma.  In  addition,  we  cared  for  most  of 
the  eye  casualties  incurred  by  the  Chinese  and  American  troops 
during  the  Burma  campaign. 

Hughes:     Did  the  Americans  get  trachoma  as  well? 
Scheie:       No,  and  that  was  a  matter  of  hygiene. 
Hughes:     Had  the  Chinese  brought  trachoma  from  China? 

Scheie:       Yes.  It  is  interesting  that  although  we  had  American  liaison  officers 
and  enlisted  personnel  living  with  Chinese  combat  troops  for 
months  at  a  time,  none  ever  developed  the  disease. 

## 

They  even  shared  quarters  with  the  Chinese.  I  was  always  on 
guard  against  spreading  trachoma  in  my  own  clinic.  There  was  no 
running  water  so  I  had  a  basin  of  alcohol  in  my  clinic  at  all  times. 
After  each  Chinese  patient,  I  would  dip  my  hands  for  a  few  seconds 
to  avoid  spreading  infections. 

Hughes:     How  did  you  treat  trachoma? 

Scheie:       Sulfa  drugs.  I  did  attempt  a  little  research  project  and  was  given 
permission  to  bring  infected  Chinese  patients  into  the  hospital  to 
evaluate  the  effectiveness  of  sulfa  drugs  in  treating  trachoma.  This 
led  me  to  correspond  with  Phillips  Thygeson,  who  had  vast 
experience  with  the  disease  and  had  cared  for  so  many  American 
Indians  with  trachoma.*  I  took  conjunctival  biopsies  before  and 
after  treatment,  as  well  as  frequent  conjunctival  smears.  When  the 
study  was  completed,  the  material  in  the  conjunctival  smears  along 
with  autopsy  material  from  scrub  typhus  patients  was  sent  back  to 
the  United  States  to  the  Armed  Forces  Institute  of  Pathology  for 
study.  Scrub  typhus  was  a  major  problem  and  had  a  high  mortality 
rate  in  the  China-Burma-India  theater. 

These  tissues  were  sent  back  by  messenger,  all  carefully  packed  and 
sealed  in  garbage  cans.  Shortly  after  they  arrived  in  the  States,  the 
messenger  went  into  a  club  for  refreshments,  leaving  the  material 


See  the  interview  in  this  series  with  Dr.  Thygeson. 


80 


outside.  A  garbage  truck  came  along  and  thinking  it  was  garbage, 
the  driver  emptied  the  can.  They  were  never  recovered  so  my 
trachoma  study  was  ruined. 

Capt.  Philip  A.  Marden  and  I  wanted  to  have  a  clinic  where  we 
could  see  Chinese  and  Americans  side  by  side.  This  caused 
considerable  discussion  .about  whether  there  might  be  some  ethnic 
problems  involved  and  whether  we  might  spread  infections,  but 
approval  was  given  and  our  clinic  was  built.  He  had  one-half  of  the 
building  for  ear,  nose,  and  throat,  and  I  had  the  other  half  for  eye 
patients.  It  worked  out  very  well  and  we  had  no  problems.  The 
Chinese  and  Americans  came  in  side  by  side  with  no  problems. 

Hughes:     Was  your  operating  room  in  that  same  facility1? 
Scheie:       The  operating  room  was  across  a  little  street. 
Hughes:     Was  that  just  for  ophthalmology  ? 

Scheie:       No,  but  I  was  given  an  area  that  was  practically  limited  to 
ophthalmology.  Dr.  Ravdin  was  very  considerate. 

Hughes:     Dr.  [Cletus]  Schwegman  told  me  that  there  was  only  one  physician 
anesthesiologist.*  I  guess  you  had  nurse  anesthetists. 

Scheie:       One  physician  anesthesiologist.  The  others  were  nurses  with 
special  training. 

Hughes:     He  said  that  the  anesthesiologist  was  responsible  for  operating 
rooms  that  were  some  distance  apart. 

Scheie:       Yes,  there  was  an  operating  room  in  each  of  the  two  hospitals. 

Hughes:     He  thought  they  might  have  been  as  much  as  a  mile  apart  and  he 
had  to  somehow  supervise  what  was  going  on  in  both  operating 
rooms. 

Scheie:       We  did  have  well-trained  nurse  anesthetists. 

Hughes:  Even  so,  I  can  imagine  when  the  cases  were  coming  fast  and  furious 
that  it  was  inconvenient  to  have  to  move  back  and  forth  between  the 
two  locations. 

Scheie:       The  anesthetist  was  Maj.  Philip  Gleason.  I  think  he  was  a  captain 
and  later  became  a  major.  He  saved  the  life  of  one  of  my  patients. 
I'd  had  x-rays  taken  preoperatively  because  the  patient  had 
suffered  a  severe  shrapnel  injury  to  his  left  eye.  They  showed  an 
inch-long  piece  of  metal  lying  horizontally  in  his  orbit.  The  foreign 
body  had  a  hook  on  one  end  that  was  pointed  toward  his  nose  near 


Telephone  interview,  January  23,  1988. 


81 

the  medial  wall  of  his  orbit.  The  foreign  body  had  passed  through 
the  eyeball  which  had  just  been  removed. 

While  removing  the  eye  and  using  a  muscle  hook  to  grasp  the 
medial  rectus  muscle,  the  hook  dislodged  the  foreign  body.  The 
patient  immediately  began  to  bleed  from  his  nose,  his  eye,  and  even 
his  mouth.  The  hook  of  the  foreign  body  had  been  around  the 
anterior  ethmoid  artery,  which  had  been  severed.  I  immediately 
packed  his  nose  and  applied  pressure  to  his  orbit.  Shortly,  the 
patient  began  to  have  trouble  breathing.  About  that  time, 
fortunately,  Gleason  came  along  and  found  that  the  nasal  packing 
used  to  stop  the  bleeding  had  been  carried  into  the  trachea.  He 
immediately  corrected  it  and  averted  a  near  calamity.  I  still  have 
the  foreign  body  in  my  collection  of  those  that  I  removed  in  India. 

Hughes:     I  don't  think  you  have  brought  out  the  fact  that  in  the  beginning  you 
were  working  in  bamboo  huts  with  dirt  floors. 

Scheie:       Yes,  that  was  before  Dr.  Marden  and  I  were  able  to  build  our  clinic. 
There  we  did  have  cement  and  brick  floors.  The  roof  was  leaf  and 
the  walls  were  bamboo.  A  dark  room  was  a  necessity  to  permit  me 
to  use  my  diagnostic  instruments,  and  a  bamboo  room  is  difficult  to 
darken.  Fortunately,  an  Indian  ordinance  outfit  built  a  room  of 
plywood  about  nine  feet  square  and  about  the  same  height  inside 
the  bamboo  building.  It  was  small  but  functioned  well. 

Later,  I  utilized  this  experience  of  working  in  a  small  space  when 
organizing  my  office  after  World  War  II  upon  returning  to  work 
with  Dr.  Adler.  Still  later,  I  did  the  same  in  economizing  on  space 
for  examining  rooms  in  our  new  [Scheie]  Eye  Institute.*  One  of  the 
principles  involved  was  to  avoid  the  need  to  move  the  patient  from 
one  chair  to  another  chair  when  performing  different  tests. 

I  had  very  limited  equipment  after  arriving  in  Ledo  in  1943  and 
was  lacking  some  essential  instruments.  For  example,  a  visual 
field  screen  is  about  a  meter  and  a  half  square  and  must  be  black. 
It  is  used  to  test  fields  of  vision  and  is  essential  in  the  diagnosis  and 
management  of  neurological  and  some  other  conditions.  I  went  to 
the  native  bazaar  and  bought  some  black  muslin  to  make  a  testing 
screen.  We  diagnosed  the  first  brain  tumor  found  in  American 
troops  in  our  theater  using  this  equipment.  He  was  sent  home  for 
brain  surgery. 

We  had  no  magnet  to  remove  metallic  foreign  bodies  from  eyes,  so  I 
had  a  round  cylinder  of  soft  steel,  probably  a  foot  long,  flown  up 
from  Calcutta.  My  sergeant  and  I,  James  Bergan,  wrapped  coil 
after  coil  of  fine  wire  around  the  core  of  steel.  It  took  the  better 
part  of  two  days  to  produce  an  induction  magnet.  It  was  crude  but 
it  was  effective.  We  also  inserted  a  screw  into  the  end  of  the  metal 


See  section  below  on  designing  the  eye  institute. 


82 


core  to  provide  a  tip  to  place  against  the  eye  when  removing  a 
foreign  body.  My  first  foreign  bodies,  some  of  which  I  have  in  my 
collection  at  home,  were  removed  using  that  homemade  magnet. 
Later,  we  had  a  Lancaster  magnet  from  the  States.  However,  we 
made  do  for  several  months  with  such  homemade  equipment. 

Hughes:     You  didn't  bring  any  instruments  with  you? 

Scheie:       I  brought  my  ophthalmoscope  but  we  had  no  idea  where  we  were 

going  and  we  were  told  that  our  equipment  would  be  waiting  for  us. 

Hughes:     What  about  intravenous  solutions  and  blood  and  the  necessary 
drugs  ? 

Scheie:       Well,  we  took  the  blood  from  the  soldiers.  The  Chinese  were  loath 
to  give  blood-it  came  from  their  ancestors.  They  practically  had  to 
be  brought  to  our  donor  station  at  gunpoint  (they  came  by  the 
truckload)  and  forced  to  give  their  blood.  They'd  never  had 
adequate  medical  care  previously  and  a  battle  injury  often  meant  a 
lost  leg  or  even  a  lost  life.  Most  of  these  fellows  were  forced  into  the 
army.  Many  of  the  Chinese  doctors  at  that  time  had  had  very  little 
training. 

Hughes:     Dr.  Schwegman  also  said  there  was  a  problem  with  anemia  in  the 
Chinese  troops. 

Scheie:       I  was  not  close  enough  to  the  problem  to  know,  but  I'm  sure  they  did. 

Hughes:     He  said  that  even  if  you  could  get  a  Chinese  to  donate,  often  the 
blood  was  too  anemic  to  use. 

Scheie:       He  may  have  been  talking  about  testing  positive  for  syphilis,  as 
well  as  anemia. 

Hughes:     Yes,  I  think  he  was. 

Scheie:       About  twenty-five  percent  of  the  Chinese  soldiers  had  a  positive 

test  for  syphilis.  Others  could  be  questionable  because  they'd  go  to 
the  native  bazaar  and  be  shot  with  an  arsenical  or  some  treatment 
to  heal  the  sore  and  possibly  reverse  their  positive  serologies.  They 
could  still  have  the  organism  and  active  syphilis. 

I  remember  vividly  Dr.  Fitz-Hugh  and  I  shared  such  a  patient.  I 
had  seen  the  patient  because  he  had  swollen  optic  nerves  and  they 
thought  he  might  have  a  brain  tumor.  Dr.  Fitz-Hugh  said,  "Well, 
under  the  circumstances,  we  can't  be  sure  of  what  he  has.  It  could 
be"-he  was  thinking  in  terms  of  tertiary  syphilis-"a  gumma.  Let's 
try  treating  him  for  it."  He  was  our  chief  of  medicine  and  a  brilliant 
man.  The  patient  was  given  a  trial  antisyphilitic  treatment  and, 
sure  enough,  his  symptoms  and  swollen  optic  nerves  cleared.  The 


83 

patient  undoubtedly  had  a  syphilitic  gumma  which  had  caused  the 
pressure. 

Hughes:     What  about  intravenous  solutions? 

Scheie:       They  were  prepared  in  India.  They  had  to  be,  at  least  at  first.  We 
were  seven  hundred  miles  northeast  of  Calcutta  and  supply  was 
difficult.  Furthermore,  the  Chinese  theater  had  priority  on  air 
deliveries,  and  combat  troops  always  had  priority.  The  Chinese 
troops  were  fighting  toward  the  Burma  Road  from  China,  as  well  as 
coming  down  from  the  India  side.  They  called  them  "Y"  forces. 
Coming  up  from  Calcutta,  a  little  more  than  midway  up,  all  goods 
had  to  be  trans-shipped,  first  by  boat  and  then  loaded  on  another 
gauge  railway.  This  made  shipping  very  difficult,  so  all  supplies 
were  delivered  with  difficulty.  Did  Clete  [Dr.  Schwegman]  say  how 
they  obtained  intravenous  fluids? 

Hughes:     He  said  that  they  made  them  and  that  there  was  a  problem  with 

pyrogens.  They  didn't  have  the  proper  means  of  purifying  them.  He 
said  there  were  side  effects  but,  amazingly,  not  life -threatening  ones. 

Scheie:       He  was  getting  febrile  reactions. 
Hughes      Yes. 

Scheie:       But  it  did  not  affect  us  because  in  ophthalmology  we  rarely  needed 
intravenous  solutions. 

I  had  a  problem  protecting  my  very  delicate  surgical  instruments. 
Miss  Margaret  Cabot,  my  operating-room  nurse,  was  a  very  diligent 
and  faithful  person.  We  learned  that  you  could  sterilize 
instruments  and  dry  them  nicely,  but  there  was  so  much  moisture 
in  the  air  that  they  would  quickly  rust  and  develop  mold.  Camera 
film  would  also  become  spotted.  I  could  show  you  some  of  the 
spotted  photographs  that  were  taken  over  there. 

We  surmounted  the  rusting  of  instruments  by  sterilizing  them, 
drying  them  in  an  oven,  and  then  submerging  them  in  paraffin  oil. 
This  prevented  air  contact  and  was  very  effective.  The  humidity 
was  very  high,  especially  during  the  hot  monsoon  season.  It  was 
the  only  time  in  my  life  that  I've  ever  had  prickly  heat.  It  came  like 
clockwork  about  mid-May  and  I'd  have  it  each  summer.  Tried 
everything.  My  friend,  Dr.  Clarence  Livingood,  the  dermatologist, 
gave  me  all  sorts  of  different  lotions  and,  finally,  I  had  the  most 
success  by  dusting  my  body  with  Scholl's  Foot  Powder. 

Hughes:     Dr.  Schwegman  also  commented  on  the  skin  diseases  caused  by  all 
the  fungi. 

Scheie:       I  guess  Livingood  and  I  were  the  two  busiest  doctors  in  the  area,  he 
with  the  skin  and  me  with  the  eye  problems. 


84 


Hughes:     Dr.  Schwegman  said  some  of  the  skin  problems,  especially  involving 
the  feet,  were  really  serious  because  the  soldiers  couldn't  walk. 

Scheie:       That's  right.  They'd  also  have  horrible  ulcers  on  their  lower  legs 
because  of  the  moisture,  perspiration,  trauma,  and  infection. 

Hughes:  Well,  because  of  all  this,  wasn't  contamination  a  problem  when  you 
were  operating? 

Scheie:       We  were  quite  successful  in  preventing  it. 

Hughes:     You  didn't  have  more  incidents  of  postoperative  infection? 

Scheie:       I  don't  believe  so.  In  fact,  the  operating  rooms  back  in  the  States, 
with  so  many  staph  infections  and  others,  were  probably  even  more 
dangerous  than  were  the  circumstances  over  there. 

Hughes:     Dr.  Schwegman  told  me  that  there  was  tension  between  the 

commanding  officer,  Colonel  Cooley,  and  the  chief  of  medicine,  Dr. 
Fitz-Hugh.  Am  I  right? 

Scheie:       I  don't  know.  The  chief  of  medicine  was  brilliant.  I'd  seen  patients 
with  him  in  the  States  and  had  come  to  know  him  quite  well.  He 
was  a  southern-gentleman  type  and  life  in  the  jungle  was  not  to  his 
liking.  Also  our  jungle  type  of  medicine  was  not  as  sophisticated  as 
I'm  sure  he  would  have  liked  it  to  be.  I'd  stayed  up  late  with  him  on 
occasional  nights  before  he  left  [for  the  States],  just  listening  to  his 
concerns.  It  didn't  seem  to  be  just  a  matter  of  conflict  between  two 
people. 

Hughes:     It  was  the  situation. 

How  many  beds  were  there  in  the  eye  ward? 

Scheie:       Well,  about  fifty.  I  had  separate  eye  wards  for  Chinese  and 

American  enlisted  men  and  they  were  quite  constantly  filled.  I  was 
very,  very  busy.  We  had  officers'  wards  for  patients  of  all  types.  I 
guess  we  had  ninety  or  more  eye  patients  in  the  hospital  much  of 
the  time. 

Hughes:     Did  you  have  to  admit  the  trachoma  patients? 

Scheie:  No,  not  unless  they  had  corneal  ulcers  or  needed  surgery.  Some  of 
them  had  to  be  operated  because  the  scarring  of  the  eyelids  turned 
the  lashes  inward  against  their  corneas,  which  became  cloudy  and 
irritated.  That  involved  plastic  surgery. 

In  fact,  one  of  these  patients  was  a  Chinese  general  who  was  about 
to  be  relieved  of  his  command  and  sent  back  to  China  because  his 
vision  was  so  poor  he  couldn't  function  properly.  He  came  to  see  me 
in  my  clinic.  His  name  was  Lt.  Gen.  Lien  Tien  Wu  who  was 


85 

commanding  general  of  the  Chinese  14th  Division.  So  you  see,  he 
was  not  only  important  to  his  division  but  his  career  was 
threatened.  He  was  probably  forty  years  of  age  and  his  advanced 
trachoma  with  eyelid  deformity,  corneal  ulceration,  and  opacity 
rendered  him  nearly  blind.  I  told  him  that  I  felt  I  could  help  him, 
and  with  his  permission  I  operated  both  of  his  eyes.  His  vision 
cleared.  He  did  extremely  well  and  was  able  to  remain  at  his  post. 

Later  he  had  a  dinner  party  for  me  at  his  jungle  headquarters  down 
the  road  near  the  combat  area  in  Burma.  He  also  had  invited  an 
American  colonel,  a  liaison  officer,  who  was  what  we  called  an  "Old 
China  Hand."  He  spoke  fluent  Chinese.  This  Old  China  Hand  and 
I  were  the  co-guests  of  honor.  I  was  there,  of  course,  because  the 
general  was  so  happy  with  his  rehabilitation.  He  sent  a  jeep  for  me 
because  his  headquarters  were  quite  a  few  miles  from  us  down  the 
Ledo  Road.  Several  tables  often  had  been  set  up,  which  was  typical 
of  a  Chinese  dinner  party.  Forty  to  fifty  people  attended  the  dinner. 
You  have  tea  before  you  sit  down  for  dinner.  Then  you  would  go 

## 

to  the  table  and  ordinarily  have  a  gentle  wine.  The  one  I  remember 
particularly,  because  of  a  visit  to  China,  was  delicious  Wanjo  wine. 
In  the  jungle,  wine  was  not  available.  There  was  only  some 
wretched  locally  distilled  liquor. 

The  local  liquor  in  our  area  was  made  by  Indians  and  was  sold 
under  various  labels  such  as  Dickams  Death  Whiskey,  Bullfight 
Brandy,  and  Lily  Brand  Gin.  All  were  basically  the  same  spirits  but 
were  flavored  differently.  They  used  oil  of  lavender  instead  of 
juniper  berry  for  gin.  There  was  nothing  much  worse  than 
awakening  in  the  morning  after  having  had  one  more  than  you 
should  have  had  and  with  this  lilac  flavor  lingering  in  your  sinuses. 

This  night  at  Gen.  Lien  Tien  Wu's  party  the  local  liquor  was 
Bullfight  Brandy.  The  Chinese  always  loved  by  one  ruse  or  another 
to  attempt  to  get  the  Americans  drunk,  but  they  didn't  always 
escape  themselves.  However,  the  Americans  lost  great  face  if  the 
Chinese  succeeded.  They  loved  to  play  this  game  with  the 
Americans,  a  game  I  learned  that  night.  They  drank  this  strong 
local  liquor  as  if  it  were  Wanjo  wine.  Much  of  the  time  it  was 
"Gombay!"  (Bottoms  up!).  Sip  as  you  will  is  suibien  in  Chinese. 

Shortly  after  we  sat  down  at  the  table  Gen.  Lien  Tien  Wu-they 
were  great  toast  makers— stood  up  and  thanked  both  the  colonel  and 
me  for  attending  and  me  for  taking  such  good  care  of  his  eyes.  He 
went  on  with  a  lovely  toast  to  the  flag  and  ended  up  by  apologizing 
for  the  quality  of  the  wine.  The  American  colonel  responded  in 
beautiful  Chinese,  and  he  also  did  so  in  English.  He  gave  a 
gracious  toast  to  Gen.  Lien  Tien  Wu,  members  of  the  14th  Division, 
the  Chinese  flag,  and  said  how  happy  he  and  I  were  to  be  there.  He 
was  speaking  for  both  of  us  since  I  couldn't  make  a  speech  in 


86 


Chinese.  Responding  to  the  general's  apology,  he  said,  "Any  wine 
drunk  among  good  friends  is  good  wine."  How  gracious! 

Fortunately,  I  was  seated  very  near  the  colonel,  because  more  toasts 
followed  and  I  found  myself  extremely  popular  when  one  Chinese 
officer  after  another  came  to  me  individually  to  propose  a 
bottoms-up  toast  and  I  found  that  I  was  drinking  with  each  one. 
Very  soon  the  colonel  tipped  me  off  as  to  their  intentions.  He  told 
me  the  only  way  to  put  a  stop  to  it  was,  "Every  time  you  see 
somebody  coming,  rise  quickly  and  propose  a  toast  to  the  whole 
Chinese  14th  Division,  the  4th  Army,  the  Chinese  flag,  anything 
which  would  require  that  all  join  the  toast,  and  propose  bottoms 
up."  This  corrected  the  situation  and  was  an  object  lesson  that 
served  me  well  on  similar  occasions. 

I  later  attended  one  other  dinner,  a  closing-out  party  of  our  Chinese 
and  American  joint  combat  headquarters,  which  was  given  by  our 
commander,  Maj.  Gen.  Hayden  Boatner.  It  was  a  pleasant  and 
interesting  evening.  Twenty  or  thirty  different  courses  were  served. 
General  Boatner  saw  to  it  that  drinks  were  not  spilled  or 
deliberately  poured  on  the  floor.  Tricks  were  part  of  their  game.  On 
this  evening  the  party  was  in  good  taste  and  good  fun  and  drinking 
was  under  good  control. 

Hughes:     Would  you  care  to  comment  on  the  role  that  your  nurses  played? 

Scheie:       They  played  a  very  vital  role.  I  operated  a  very  busy  outpatient 
clinic  and  did  considerable  surgery,  even  a  little  clinical  research 
and  some  writing,  and  the  nurses  contributed  to  all  of  this.  Miss 
Margaret  Cabot  was  my  number-one  nurse  in  both  my  clinic  and 
the  operating  room.  She  did  everything,  including  acting  as  a 
receptionist,  taking  some  of  my  notes  on  clinic  patients,  preparing 
instruments  for  surgery,  and  acting  as  my  number-one  assistant 
during  surgery.  She  had  a  wonderful  disposition,  was  very  bright, 
energetic,  a  sheer  pleasure  to  work  with,  positively  essential. 

Hughes:     Was  she  trained  for  operating-room  work1? 

Scheie:       No.  She  was  assigned  to  me  and  she  learned  by  doing.  In  fact, 
she'd  done  no  ophthalmology. 

I  had  had  a  sergeant  assigned  to  me  before  we  left  the  States  who 
was  an  experienced  optician,  but  he  jumped  ship  in  New  Zealand.  I 
never  did  know  what  happened  to  him.  To  replace  him,  James 
Bergan,  a  young  optician,  was  assigned.  He  knew  how  to  type  and 
was  willing  to  take  notes  in  addition  to  his  duties  as  an  optician. 
These  two  led  my  team  and  we  shared  many  good  times  as  well  as 
some  crises. 

Gen.  Louis  Pick  was  in  command  of  the  Ledo  Road  project.  He  later 
became  head  of  the  engineering  corps  of  the  United  States  Army. 
He  was  a  prodigious  worker  and  not  a  desk  man.  He  spent  most  of 


87 

his  time  down  on  the  road  personally  supervising  the  construction 
in  Burma.  The  job  was  an  almost  impossible  engineering  one.  In 
addition  to  jungle  conditions,  the  rugged  mountainous  terrain  and  a 
rainfall  of  about  three  hundred  inches  during  the  two  or  three 
month  monsoon  season  added  to  their  difficulties.  However,  the 
feat  was  accomplished  before  the  war  was  over. 

General  Pick  had  some  allergies  and  I'd  seen  him  on  occasion  in  the 
clinic  when  he'd  come  back  to  our  base  area.  His  face  and  eyelids 
would  be  swollen  and  burning.  He  would  have  been  on  the  road  for 
days  and  when  he  returned  to  his  headquarters  appeared 
completely  exhausted.  He  was  an  older  man,  and  my  heart  always 
went  out  to  him. 

Well,  on  this  occasion,  he'd  either  broken  or  lost  his  glasses,  which 
he  badly  needed  at  his  age.  I  refracted  him  and  we  radioed  his 
prescription  to  Calcutta.  Jim  Bergan  had  taken  necessary 
measurements  and  placed  a  rush  order.  The  glasses  arrived  in  two 
or  three  days  and  General  Pick  came  to  pick  them  up.  Bergan  was 
adjusting  the  frames  to  fit  the  general's  face  and  what  would 
happen  but  one  of  the  lenses  fell  out  and  onto  the  brick  floor  of  the 
clinic.  Bergan  became  so  excited  that  he  stepped  on  the  lens, 
shattering  it.  General  Pick,  although  he  needed  them  badly,  took  it 
with  great  equanimity.  He  patted  my  sergeant  on  his  shoulder  and 
said,  "Son,  don't  worry,  we  will  get  another."  Which  we  did.  I  will 
never  forget  his  graciousness.  Years  later,  when  he  was  head  of  the 
engineering  corps  of  the  United  States  Army,  my  reserve  unit,  the 
31st  Hospital  Care  Headquarters,  had  two  weeks  of  training  at  Fort 
Belvoir,  which  is  located  outside  of  Washington.  I  ran  into  General 
Pick  and  we  recalled  the  episode. 

Other  nurses  were  assigned  to  my  eye  wards  and  all  did  splendid 
jobs.  There  was  no  way  that  I  could  have  managed  without  these 
dedicated  people  who  served  far  beyond  a  nurse's  duties.  For 
example,  they  would  take  my  dictation  and  record  it  on  the  records 
while  I  examined  patients,  including  histories  and  physical 
exams-a  great  time  saver  for  me.  They  could  have  objected  because 
these  tasks  and  others  were  beyond  the  requirements  of  nurses.  We 
developed  a  great  feeling  of  mutual  loyalty. 

Hughes:     What  did  you  do  when  you  faced  a  surgical  or  a  medical  situation 
with  which  you'd  had  no  previous  experience? 

Scheie:       Out  there  in  the  jungle,  you  had  to  take  the  responsibility.  I  had  by 
that  time  a  modest  amount  of  experience,  counting  three  years  of 
residency  and  two  years  of  assisting  Dr.  Adler.  However,  my 
experience  with  eye  trauma  had  been  limited.  You  learned  quickly, 
for  example,  that  if  you  saw  a  perforated  eye,  a  bullet  or  a  piece  of 
steel  or  some  other  type  of  foreign  body  could  have  passed  on  into 
the  brain.  Every  such  eye  had  to  be  considered  to  have  an 
associated  brain  injury  as  well,  until  it  could  be  ruled  out  by  x-ray 


88 

or  other  means.  Being  defensive  and  on  guard  was  the  rule  in 
dealing  with  injuries  in  a  combat  area. 

Hughes:     What  do  you  mean  by  defensive? 

Scheie:       Protecting  the  patient  from  aggravating  the  injury  and  [being 
aware  of]  the  danger  of  overlooking  associated  multiple  trauma. 

Willy  Winstead 

Scheie:       The  most  tragic  event  in  my  India  experience  occurred  on  a 

Saturday  afternoon.  It  involved  three  of  our  engineers  who  were 
stationed  up  near  the  combat  area.  I  had  been  invited  to  an 
English  tea-planters  club  for  dinner  but  had  hardly  arrived  when  I 
was  informed  that  three  American  soldiers  were  on  their  way  to  our 
hospital  because  of  eye  injuries.  The  soldiers,  a  lieutenant  and  two 
enlisted  men,  had  been  dynamiting  for  fish.  This  was  common 
practice  because  the  mountain  streams  contained  delicious  fish,  and 
fresh  food  of  any  kind  was  a  rarity,  especially  for  the  advance 
troops.  Spam  and  corned  beef  were  staples.  Dynamite  sticks  tied 
together  or  a  hand  grenade  exploded  in  the  stream  would  kill  fish 
which  would  float  to  the  surface. 

In  this  instance,  they  had  tied  three  sticks  of  dynamite  together. 
The  lieutenant,  Earle  G.  Ramsey,  lit  the  fuse,  and  thinking  that  it 
was  faulty,  did  not  release  it.  He  and  the  two  enlisted  men  were 
inspecting  it  when  it  blew  up  in  his  right  hand.  He  lost  both  eyes, 
which  were  collapsed  and  riddled,  much  like  a  shredded  balloon. 
One  of  the  enlisted  men,  John  Beausang,  lost  his  left  eye  but  the 
other  was  uninjured.  The  other  enlisted  man,  Willy  Winstead,  lost 
his  right  eye,  which  had  to  be  removed.  The  left  had  some  vision 
but  was  badly  injured.  Ramsey  also  lost  most  of  his  right  hand. 
Understandably,  he  had  great  difficulty  adjusting  even  years  later. 

In  an  interview  published  in  the  Saturday  Evening  Post  in  1950, 
"Don't  Pity  my  Blindness,"  he  stated  that  he  felt  that  if  he  had  had 
other  care,  he  might  be  seeing.  However,  the  situation  was  hopeless 
and  there  was  just  nothing  that  could  have  been  done  to  save  his 
sight. 

Willy  Winstead,  on  the  other  hand,  was  always  cheerful  and  even 
buoyant,  even  though  he  had  lost  an  eye  and  had  blurred  vision  due 
to  a  cataract,  with  vitreous  hemorrhage  and  some  foreign  bodies  in 
the  other.  The  cataract  developed  rapidly  and  I  shortly  removed  it 
by  aspiration.  No  one  could  predict  how  much  vision  he  would 
eventually  have.  These  men  were  evacuated  to  the  eye  center  at 
Valley  Forge  Army  Hospital  [Pennsylvania]  as  soon  as  possible  for 
further  care  and  rehabilitation. 

Willy  Winstead,  after  his  discharge,  went  on  to  college  where  he 
earned  his  undergraduate  degree.  A  Braille  reader,  he  also 
obtained  a  master's  degree  in  history  and  a  Ph.D.  in  sociology  from 


89 

the  University  of  Missouri.  In  1953  he  obtained  a  full-time 
teaching  position  at  Christian  College  (now  Columbia  College)  in 
Missouri. 

Willy  called  on  me  in  my  office  while  on  his  honeymoon  in  1955. 
They  had  a  friend  with  them  to  do  the  driving.  Over  the  years  he 
had  always  sent  a  Christmas  card  so  we  had  remained  in  touch. 
Willy  asked  my  receptionist  if  he  could  see  me.  It  was  a  great 
reunion.  I  met  his  bride,  kidded  him,  and  said,  "How  in  the  world 
could  you  pick  such  a  pretty  girl?"  He  said,  "Well,  you've  heard  of 
the  Braille  system."  [laughter] 

Shortly  I  said,  "Willy,  I  have  not  seen  your  eyes  since  you  left  India. 
Let  me  take  a  look."  I  really  had  no  thought  that  I  might  help  him, 
but  after  examining  him  and  doing  certain  tests,  I  hardly  dared  tell 
him  the  results  of  my  findings.  He  had  a  dense  membrane  that  had 
remained  from  the  previous  vitreous  hemorrhage  and  extracapsular 
cataract  extraction.  Visual  function  tests  were  excellent  and 
indicated  an  intact  retina,  although  I  could  not  visualize  it.  "Willy, 
I  think  there  is  a  chance  of  improving  your  vision  a  great  deal."  He 
was  only  able  to  count  fingers,  but  some  of  the  most  grateful 
patients  I've  ever  had  have  been  those  whose  getting-around  vision 
had  been  restored.  I  did  tell  him  that  I  thought  there  was  a  fair 
chance  of  improving  his  vision  if  the  membrane  were  cut,  but  no 
guarantee.  I  said,  "As  with  any  eye  operation,  the  eye  could  be  lost, 
but  I  believe  that  danger  is  small."  He  replied  that  he  wanted  to 
think  it  over  for  a  short  time. 

I  suggested  calling  Jim  Bergan,  my  former  sergeant,  who  was 
working  in  an  optical  shop  a  few  blocks  away.  They  had  become 
good  friends  in  India  while  Jim  was  helping  me  to  care  for  him  at 
the  20th  General  Hospital.  I  told  him  that  I  was  sure  Jim  would 
love  to  have  lunch  with  him.  I  suspect  they  may  have  had  a  martini 
with  lunch.  At  any  rate,  when  he  returned  after  an  hour  or  two, 
Willie  and  his  bride  told  me  they  wanted  the  operation.  He  said,  "I 
want  it  done  and  how  soon  can  you  do  it?"  Well,  I  checked  the 
Veterans  Hospital  where  I  was  chief  of  the  eye  service  but  it  could 
not  be  arranged  for  a  couple  of  days.  He  said,  "Can't  you  do  it 
sooner?"  I  said,  "Willy,  I  am  operating  at  the  university  hospital  this 
afternoon  and  I  am  sure  I  can  work  you  into  that  schedule." 

Then  he  became  concerned  about  his  car,  the  friend  who  was  with 
him,  and  where  his  wife  might  stay.  This  was  a  Friday  afternoon 
before  Labor  Day,  1955,  and  I  lived  in  West  Philadelphia  near  the 
hospital.  I  said,  "Willy,  this  is  perfect  timing  because  Mrs.  Scheie 
and  I  are  going  to  the  shore  for  the  weekend.  If  I  operate  you  this 
afternoon,  I  could  see  you  before  I  leave  in  the  morning.  Your  wife 
can  do  a  great  favor  for  us  and  stay  in  our  house.  We  have  two 
dachshunds  for  which  she  can  babysit."  This  sounded  great  to  them 
so  I  called  the  operating  room  and  put  him  on  the  schedule.  Riding 
with  me  on  the  way  to  the  hospital,  he  became  increasingly 


90 

nervous.  He  said,  "I  don't  know  if  I  dare  to  do  this."  We  chatted 
back  and  forth  but  I  tried  to  keep  it  at  the  level  of  bantering.  He 
still  wanted  the  operation.  I  admitted  him  and  took  him  directly  to 
the  operating  room  where  the  procedure  went  well. 

After  my  surgical  schedule,  I  had  taken  Willie's  bride  home  to  have 
dinner  with  my  wife  and  me.  During  dinner  she  became  ill  and  left 
the  table  and  lost  her  dinner,  obviously  due  to  nervous  tension.  I 
felt  so  sorry  for  her  that  after  she  had  settled  down,  we  went  back 
to  the  hospital  to  see  Willy.  I  took  his  dressing  off  and  held  a 
magnifying  glass  over  his  eye.  What  a  thrill!  He  saw  his  wife  for 
the  first  time.  Of  the  three,  I  do  not  know  who  was  the  most 
ecstatic.  He  had  actually  been  blind  since  he  was  seventeen  years 
of  age,  at  least  twelve  years. 

## 

I  gave  him  temporary  glasses  and  discharged  him  the  next  morning, 
August  31, 1955.  They  stayed  at  our  home  over  the  weekend,  and 
on  Tuesday  morning  after  Labor  Day,  I  took  him  to  the  hospital  and 
refracted  him  for  glasses.  To  my  utter  amazement,  he  had  20/20 
vision. 

I  sent  him  to  the  optical  company  where  Jim  Bergan  was  working 
to  have  lenses  ground  and  glasses  fitted,  which  took  about  two 
hours.  After  they  had  given  him  his  glasses,  he  said,  "I  have  to  go 
out  and  see  Dr.  Scheie,"  which  he  did.  To  my  amazement  he  told 
me,  "What  am  I  going  to  do?  I  was  educated  and  have  been 
teaching  as  a  blind  man.  I  realize  they  have  protected  me  because 
of  my  blindness.  How  am  I  going  to  adjust?  I  have  never  even  had 
a  driver's  license."  He  was  delighted  yet  apprehensive.  I  have 
never  felt  more  touched,  except  possibly  by  the  blind  headhunter. 
Willy  did  go  back  to  teach  at  the  school.  (I  will  finish  this  story 
quickly)  He  continued  teaching  and  studying  and  when  I  last  heard 
from  him  he  was  president  of  a  small  college  in  California. 

Dr.  Pendergrass,  who  was  the  chief  of  the  x-ray  department  and 
whom  I  have  mentioned  before,  knew  the  science  writer  for  the 
Saturday  Evening  Post,  Steven  M.  Spencer,  whom  he  contacted  and 
suggested  that  they  might  want  to  publish  Willy's  story.  The  writer 
came  to  see  me  about  it.  I  said,  "I  can't  give  permission  for  the 
story  but  if  Willy  Winstead  wants  it  done,  I  would  have  no 
objection."  Willie  agreed  and  they  did  a  nice  story,  "My  Twelve 
Years  as  a  Blind  Man,"  in  the  December  8,  1956  issue.  Anyway,  the 
Post  gave  him  nine  or  ten  thousand  dollars  to  help  pay  for  a  new 
home  for  him  and  his  bride. 

Hughes:     Remarkable. 

Scheie:       Unfortunately,  I  recently  learned  that  Willy  died  in  February,  1975. 


91 


The  Chinese  Troops 

Hughes:     The  other  remark  that  Dr.  Schwegman  made  was  the  problem  of 
discharging  Chinese  patients. 

Scheie:       They  didn't  want  to  go  back  to  combat. 

Hughes:     Yes,  and  if  they  were  unfit  to  fight,  there  was  no  way  of  sending  them 
home.  Is  that  true? 

Scheie:       If  they  had  become  blind  or  otherwise  incapacitated,  they  were 
flown  back  to  China. 

The  problem  was  returning  soldiers  to  their  combat  units  and 
action  against  the  Japanese.  That  could  be  a  real  problem.  The 
Chinese  commanders  were  very  tough  about  it,  too. 

I  had  a  soldier,  probably  eighteen  years  of  age,  who  needed 
extensive  plastic  surgery  because  of  a  nasty  facial  injury.  He  was 
highly  intelligent,  so  between  surgeries  I  began  to  use  him  as  my 
ward  boy.  His  name  was  Wong  and  I  became  very  fond  of  him.  As 
an  aide,  he  learned  to  take  blood  pressures  and  to  do  many  of  the 
tasks  of  a  practical  nurse. 

Well,  near  the  end  of  his  rehabilitation  the  military  police  came  into 
the  Chinese  hospital  and  arrested  him  as  a  deserter.  They  took  him 
back  to  his  unit  a  few  miles  down  the  road,  put  him  in  stockade, 
and  sentenced  him  to  death.  Wong  was  able  to  break  out  of  the 
stockade  and  escape  through  the  jungle  to  avoid  recapture.  He 
arrived  at  my  clinic,  dirty,  perspiring,  and  agitated.  He  couldn't 
speak  English  but  I  could  follow  his  Chinese  "Mein  tien,  boom, 
Wong  mayo,"  meaning,  "Tomorrow,  gun  shot,  no  Wong."  He  had 
been  sentenced  to  be  shot  the  next  day.  I  didn't  know  what  to  do 
and  I  felt  a  little  at  fault,  for  he  had  been  helping  me.  Possibly,  I 
should  have  sent  him  back  to  his  unit  a  few  days  earlier. 

Now,  however,  I  hid  him  away  and  went  to  General  Ravdin  and 
said,  "Rav,  they're  going  to  shoot  this  boy,  and  he's  a  fine  person. 
He's  been  helping  us  in  the  Chinese  hospital  doing  duty  while  he 
was  recovering  from  surgery.  What  can  we  do  to  help  Wong?"  He 
was  very  kind  and  resourceful  as  usual.  I  took  Wong,  with  Ravdin's 
permission,  over  to  the  American  part  of  the  hospital,  where  he  was 
hidden.  When  the  Chinese  M.P.s  came  looking  for  him,  Wong  had 
hidden  under  a  bed  in  the  American  casualty  ward  and  he  was 
never  found.  He  was  put  to  work  in  the  intensive  care  ward. 

I  think  Ravdin  was  probably  one  of  the  first  to  use  intensive  care 
wards  for  critically  ill  patients.  Extra  nurses  and  attendants  were 
on  duty  and  eventually  Ravdin  was  even  able  to  wheedle  air 
conditioning  units  from  New  Delhi.  The  very  ill  scrub  typhus  cases 
as  well  as  the  badly  wounded  were  put  in  these  wards.  Wong 


92 

became  a  mainstay  there.  Eventually,  Ravdin  was  able  to  get  him 
pardoned  through  General  Stilwell's  intervention  and  he  never  was 
shot. 

Another  Chinese  patient  of  mine  had  had  a  dental  problem  for 
which  he  was  sent  to  the  dentist's  office.  The  Chinese  soldiers, 
probably  because  of  their  poverty,  tended  to  be  little  thieves.  We 
had  fifty  patients  on  a  ward.  Your  own  patients  would  never  steal 
from  you  and,  in  fact,  would  probably  chastise  any  fellow  soldier 
who  attempted  to. 

Well,  my  patient  had  been  to  the  dental  clinic,  and  the  dentist,  a 
friend  of  mine  by  the  name  of  Col.  Vincent  McNally,  had  taken  care 
of  him.  McNally's  watch-dentists  often  worked  without  their 
wristwatch-had  been  placed  on  a  shelf  near  his  chair.  At  the  end  of 
the  day,  he  reported  his  watch  as  missing  to  the  M.P.s.  They 
checked  McNally's  appointment  list  and  found  that  he  had  had  only 
one  Chinese  patient  that  morning.  The  watch  was  found  in  his 
bunk  and  the  soldier  was  taken  over  to  the  commanding  officer  of 
the  Chinese  hospital. 

Shortly  afterward,  he  was  escorted  to  an  empty  building  within 
seventy  to  eighty  feet  of  my  clinic.  They  tied  his  hands  behind  him 
around  a  bamboo  pole  that  supported  the  building  and  beat  him 
until  he  fell  unconscious.  I  went  over  to  see  him  a  couple  of  times 
during  the  afternoon.  There  was  nothing  I  could  do  about  the 
situation  for  it  was  their  type  of  military  discipline.  He  lay  there 
with  flies  crawling  in  and  out  of  his  bloody  nose,  unconscious  but 
moaning  once  in  a  while.  The  next  morning  I  wasn't  there  and 
didn't  see  it,  but  I  was  told  they  shot  him. 

Another  example:  The  Chinese  combat  troops  were  marching  up  to 
the  battle  zone  from  Digboi,  their  training  area  where  they  had 
been  taught  the  principles  of  hygiene  and  sanitation.  They  had 
been  told  never  to  drink  water  from  a  stream  until  it  had  been 
boiled.  During  a  rest  stop  near  a  stream,  three  of  them  could  not 
resist  this  nice,  fresh  mountain  water.  They  filled  their  helmets 
and  drank.  Their  officer  saw  them,  lined  them  up  beside  the 
stream,  and  shot  all  three  of  them. 

Scrub  Typhus 

Hughes:     Shall  we  talk  about  scrub  typhus? 

Scheie:       Scrub  typhus  was  extremely  challenging  for  us.  Pilots  who  were 
shot  down  by  Japanese  Zeros  over  the  Burma  jungle,  especially  if 
they  had  a  long  hike  out  of  the  jungle  (taking  as  long  as  ten  days  to 
a  couple  of  weeks),  would  be  brought  to  our  hospital,  running  a  high 
temperature.  Our  internists  initially  puzzled  over  the  diagnosis 
that  eventually  proved  to  be  scrub  typhus,  also  called 
tsutsugamushi  fever  or  Japanese  river  fever.  For  diagnostic  help, 


93 


various  specialty  consultants,  including  myself,  were  called  and 
asked  to  look  for  any  possible  clues. 

Examination  of  their  eyes  led  to  some  worthwhile  information.  We 
began  to  note  consistent  changes  at  the  back  of  the  eye  which 
stimulated  me  to  examine  all  of  the  typhus  patients  and  to  follow 
them  once  or  twice  a  week  and  to  record  the  findings  during  the 
course  of  their  illness.  Scrub  typhus  patients  suffer  a  diffuse 
inflammation  of  small  blood  vessels  throughout  the  body.  The 
patients  usually  die  from  circulatory  or  cardiac  complications.  The 
overall  mortality  rate  in  our  patients  was  about  eighteen  percent 
and  was  much  higher  in  individuals  over  thirty  years  of  age. 

The  characteristic  ocular  findings  were  edema  of  the  optic  nerve 
and  retina  with  retinal  folds  in  the  macular  region.  In  that  part  of 
the  world,  in  the  presence  of  persistent  febrile  illness,  the 
appearance  of  their  eyes  could  almost  certainly  establish  the 
diagnosis.  This  was  exciting  for  me  because  these  had  not  been 
described  previously.  Another  very  important  diagnostic  clue  was  a 
black  eschar  often  on  their  abdomen  or  chest,  which  was  the  site  of 
the  tick  bite  by  the  insect  that  transmitted  the  disease. 

I  accumulated  data  on  451  of  these  patients,  all  of  whom  I'd 
followed  once  or  twice  a  week.  We  learned  about  the  onset  of  eye 
changes  and  their  duration.  It  was  useful  in  judging  convalescence 
which  was  important  because  if  these  patients  were  sent  back  to 
duty  too  soon  they  could  develop  cardiac  difficulties  that  could  be 
fatal.  So  clearing  of  the  eye  signs  was  one  of  the  criteria  of 
convalescence.  The  eye  changes  appeared  not  long  after  the  eschar 
had  healed  or  had  begun  to  disappear. 

Hughes:     After  two  weeks  or  so,  according  to  your  paper.  * 

Scheie:       The  second  and  third  weeks  of  the  disease  would  be  about  right.  It 
would  be  about  the  time  the  eschar  was  healed  or  healing,  and  later 
after  the  eschar  had  cleared,  the  eye  changes  could  be 
diagnostically  important. 

Hughes:     Patients  didn't  always  have  the  eschar,  did  they? 

Scheie:       If  the  eschar  had  healed  completely,  you  couldn't  see  it  or  find  it,  or 
it  could  have  been  minimal  to  begin  with.  It  is  like  any  bug 
bite— very  unpredictable. 

Hughes:     Were  these  findings  immediately  communicated  to  other  areas  where 
scrub  typhus  might  be  encountered? 

Scheie:       Yes,  the  information  was  distributed  through  bulletins  sent  to  other 
army  units  by  the  office  of  the  Surgeon  General  of  the  Army  and  our 


Scheie  HG.  Ocular  changes  in  scrub  typhus.  A  study  of  451  patients.  Trans  Am  Ophthalmol  Soc 
1947,  15:637-77. 


94 

own  theater  surgeon.  The  disease  had  all  of  us  baffled  when  we 
were  first  confronted  by  it.  Of  course,  if  you  were  in  Malaysia, 
where  it  occurs  in  large  numbers,  fever  of  unknown  origin  would 
immediately  prompt  the  question,  "Does  he  have  typhus?" 

Our  physicians,  of  course,  had  never  seen  the  disease  in  the  States. 
I  had  heard  of  tsutsugamushi  fever  because  Hobart  Reimann  had 
been  in  the  Orient  and  covered  it  in  lectures  to  his  medical 
students.  We  medical  students  always  joked  about  it  because  of  its 
long  name.  So  I  became  the  person  who  was  the  authority  on  the 
eye  changes  of  tsutsugamushi  fever. 

Hughes:     Well,  tell  me  about  submitting  your  work  on  scrub  typhus  as  your 
thesis  for  the  American  Ophthalmological  Society. 

Scheie:       Well,  the  thesis  had  to  be  unpublished  and  original.  What  is  the 
year  of  this  publication? 

Hughes:     1947. 

Scheie:       I  had  the  microscopic  sections  of  nine  eyes  removed  at  autopsy  and 
studied  by  Jonas  S.  Friedenwald.  The  paper  was  quite  detailed  and 
the  timing  was  perfect  because  of  the  requirement  often  years  in 
ophthalmology  before  becoming  eligible  for  membership  in  the  AOS. 

Hughes:     You  had  a  rough  moment  or  two  from  Georgiana  Dvorak  Theobald? 

Scheie:       Yes,  just  a  few  days  before  the  meeting  where  acceptance  of  my 

thesis  was  to  be  voted  upon,  I  had  a  telephone  call  from  Georgiana 
Theobald.  She  was  a  very  respected  ophthalmic  pathologist  and 
chairman  of  the  thesis  committee.  She  asked  me  if  I  did  not  have 
more  references  for  my  thesis.  I  could  only  reply  that  none  were 
found  and  that  I  believed  the  thesis  was  original.  At  this  point,  I 
was  very  concerned  that  she  knew  something  that  I  did  not  and 
that  she  had  found  prior  references.  Then,  of  course,  my  thesis 
would  not  be  accepted.  I  went  to  the  meeting  with  great 
trepidation.  Research  of  the  literature  had  not  only  included  the 
Library  of  Congress,  but  also  resources  of  the  Office  of  the  Surgeon 
General,  the  Armed  Forces  Institute  of  Pathology,  and  others. 
Nothing,  however,  came  of  Dr.  Theobold's  inquiry.  The  thesis  was 
approved  by  her  committee  and  I  was  voted  into  the  society. 

Hughes:     Do  you  remember  who  else  was  on  the  committee? 
Scheie:       I  do  not. 


95 


Angioid  Streaks  of  the  Retina* 

Hughes:     Another  paper  that  you  researched  during  the  war  was  entitled, 

"Vascular  disease  associated  with  angioid  streaks  of  the  retina  and 
pseudoxanthoma  elasticum.  "**  Tell  me  how  you  got  involved  with 
that  project. 

Scheie:       It  is  a  rare  condition.  I  saw  this  patient  in  1943.  Dr.  William  Fitts, 
who  later  became  chairman  of  the  surgery  department  at  the 
University  of  Pennsylvania,  was  my  ward  officer  and  did  my 
histories  and  physicals.  This  patient,  a  mess  officer  of  a  unit  in  our 
area,  was  seen  by  him  about  midnight  with  severe  pain  in  each  eye. 
Dr.  Fitts  admitted  him  to  the  hospital.  In  spite  of  his  pain,  his  eyes 
didn't  look  seriously  involved.  By  morning  he  was  comfortable  and 
since  his  unit  needed  him,  he  was  discharged  by  Dr.  Fitts  and  asked 
to  return  to  see  me  in  the  eye  clinic  for  follow-up.  When  I  saw  him 
two  days  later,  I  learned  that  the  afternoon  before  he  had  developed 
the  pain,  welders  had  been  doing  repairs  in  the  kitchen  where  he 
was  working.  It  is  well  known  that  a  welder's  arc  gives  off 
ultraviolet  light  which  can  cause  severe  ocular  pain  with  minimal 
ocular  findings  and  the  pain  subsides  in  a  few  hours.  It  was 
obvious  that  the  welder's  arc  had  caused  his  trouble.  On  examining 
his  eyes,  there  was  no  residual  effect.  But  when  he  walked  into  my 
examining  room,  I  had  noticed  that  he  had  very  small  feet. 

Hughes:     It's  a  syndrome,  I  suppose. 

Scheie:       Yes.  The  angioid  streaks  of  the  retina  can  be  associated  with 

pseudoxanthoma,  a  dermatological  condition,  and  impairment  of 
circulation,  especially  of  the  extremities.  Some  patients  also  have 
Paget's  disease,  a  thickening  of  the  skull,  which  is  another  part  of 
the  syndrome. 

After  checking  his  corneas  with  a  slit  lamp  to  be  sure  that  they 
were  all  right,  I  began  to  question  him  about  the  size  of  his  feet  and 
if  they  troubled  him.  His  feet  were  extremely  small  for  a  grown 
man  and  he  was  wearing  a  size  four  and  a  half  shoe. 

## 

He  said  that  his  mother  used  to  fuss  with  him  and  to  cuff  him 
because  he  could  not  keep  up  with  his  brothers  and  sisters  when 
walking  together.  He  told  me  that  he  had  pain  in  his  feet  and  legs 
on  walking,  even  in  childhood.  This  had  increased  in  severity  as  he 
became  older  until  his  exercise  tolerance  at  present  was  about  five 
minutes  of  close-order  drill.  He  was  also  bothered  by  frequent 
cramps  in  his  feet  and  legs  at  night.  On  examination,  the  pulses 


* 
** 


Excerpts  from  a  further  discussion  of  angioid  streaks  have  been  inserted  here. 
Scheie  HG,  Freeman  NE,  Arch  Ophthalmol  1946;  35:241-50. 


96 


were  absent  or  nearly  absent  even  in  his  arms.  He  should  never 
have  been  in  the  army  but  at  least  he  had  been  assigned  to  the 
mess.  He  had  rough  skin  compatible  with  pseudoxanthoma 
elasticum.  Then  I  looked  at  the  back  of  his  eyes  and  saw  typical 
angioid  streaks. 

At  that  point,  I  had  a  consultation  with  our  peripheral  vascular 
surgeon,  Dr.  Norman  Freeman.  He  analyzed  the  pulses  in  detail 
using  his  specialized  equipment  and  found  marked  impairment  and 
even  obstruction  of  the  major  vessels  of  his  wrists  and  ankles.  But 
Paget's  disease  wasn't  apparent  in  my  patient,  even  by  x-ray. 

Hughes:     Isn't  pseudoxanthoma  elasticum  a  degeneration  of  the  elastic  tissue? 
Why  would  it  affect  the  skull? 

Scheie:       I  suppose  the  vessels  there  are  also  affected  and  in  someway  cause 
changes  in  the  skull.  I  can't  answer  except  that  it  happens.  Why 
does  the  skin  fragment?  Understandably  due  to  degeneration  of 
elastic  tissue  fibers.  It  is  all  part  of  the  syndrome.  Angioid  streaks 
of  the  retina  are  associated  with  vascular  disease,  skin  changes, 
and  Paget's  disease. 

I  don't  believe  that  the  blood-vessel  changes  had  been  described  in  a 
living  patient.  At  autopsy  probably,  but  I  am  not  certain  at  this 
point.  Major  Freeman  and  I  took  a  section  of  the  completely 
obstructed  ulnar  artery  in  the  right  wrist.  It  was  probably  one  of 
the  first  arterial  biopsies  on  a  patient  with  angioid  streaks.  Our 
pathologist,  James  Forrester,  said  that  it  revealed  degeneration  of 
the  elastic-tissue  layer  in  the  wall  of  the  vessel  and  a  thickened 
muscularis.  Microscopic  sections  were  also  studied  by  staff  of  the 
Armed  Forces  Institute  of  Pathology,  by  Dr.  Elexious  Thompson  Bell 
(the  former  pathologist  of  the  University  of  Minnesota),  and  by  Dr. 
Baldwin  Lucke,  the  well-known  pathologist  and  head  of  the 
department  at  the  University  of  Pennsylvania. 

We  reasoned  that  without  the  support  of  the  elastic  tissue  layer  to 
cushion  the  force  of  each  pulse,  the  muscle  tissue  of  the  wall 
thickens  to  compensate  and  eventually  hypertrophies  to  the  point 
where  it  occludes  the  vessel. 

Hughes:     What  is  the  explanation  for  the  angioid  streaks? 

Scheie:       Linear  ruptures  occur  in  Bruch's  membrane  secondary  to  elastic 

tissue  changes.  Pigment  diffuses  through  these  ruptures,  which  are 
seen  as  pigmented,  spokelike  streaks  radiating  from  the  optic 
nerve.  I  had  never  seen  these  before  but  recalled  seeing  such 
pictures  in  an  ophthalmology  textbook. 

Hughes:     I  believe  some  calcification  was  found  as  well. 


97 


Scheie:       Yes,  and  the  calcified  vessels  could  be  demonstrated  by  x-ray.  I  saw 
two  similar  cases  while  we  were  in  India  and  included  them  in  the 
paper,  but  neither  had  biopsies. 

Hughes:     My  understanding  is  that  angioid  streaks  and  the  pseudoaxanthoma 
had  been  associated  before. 

Scheie:       Yes,  and  also  with  Paget's  disease. 

Hughes:     But  where  you  made  the  contribution  was  adding  the  vascular 
disease. 

Scheie:       By  reporting  these  patients  and  the  results  of  the  biopsy.  That's 
right. 

Hughes:     Eleven  years  later  you  added  ten  more  cases.  * 

Scheie:       Well,  we  had  three  cases  in  this  1946  article.  Patient  number  two's 
symptoms  were  not  as  advanced. 

Hughes:     Cases  number  two  and  three  were  also  seen  in  Ledo? 
Scheie:       Yes. 

Hughes:     It  was  unusual,  wasn't  it,  to  see  three  such  unusual  cases  within  a 
short  period  of  time? 

Scheie:       Yes. 

[scanning  paper]  This  is  the  pulse  oscillometer  tracing.  It's  rather 
interesting.  This  is  where  the  pulses  were  practically  absent,  taken 
at  a  different  place-ankle,  wrist.  You  can  see  how  flat  the  tracing  is 
in  patient  number  one.  His  impairment  of  circulation  is  much  more 
advanced  than  in  patient  three.  The  pulsations  should  be  like  the 
one  of  the  healthy  soldier.  You  can  see  the  amplitude  in  the  tracing. 
Those  of  patient  number  one  are  almost  flat.  He  had  arterial 
hypertension  which  we  suspected  was  related  to  his  vascular 
condition. 

Hughes:     That  is  a  point  you  made  in  the  paper. 

Scheie:       The  roughening  of  the  skin  is  shown  in  this  photo. 

Hughes:     In  your  later  paper,  you  pointed  out  that  in  this  syndrome  any  of  the 
three  parts  could  be  absent  or  not  very  apparent. 

Scheie:       Yes,  I  remember  that.  Nobody  sees  a  large  volume  of  these  cases. 


*        Scheie  HG,  Hogan  TF.  Angioid  streaks  and  generalized  arterial  disease.  Arch  Ophthalmol  1957; 
57:855-68. 


98 


Hughes:     You  wrote  the  1957 paper  with  Tom  Hogan.  Who  is  he? 

Scheie:       He  was  a  resident. 

Hughes:     So  you  saw  thirteen  of  these  patients,  including  the  original  three? 

Scheie:       I  will  have  to  read  that  paper  and  see  whether  or  not  any  were 
collected  from  the  literature.  *[interruption] 

Hughes:     Did  you  treat  any  of  Merrill's  Marauders? 

Scheie:       Yes,  several,  including  Gen.  Frank  D.  Merrill.  There  was  nothing 
wrong  with  his  eyes.  He  was  in  for  a  routine  check  and  glasses  at 
the  time  he  was  hospitalized  for  a  heart  problem.  I  showed  you  the 
note  he  made  on  his  autographed  photograph.  He  was  a  very  fine 
person.  After  World  War  II,  he  became  head  of  the  state  highway 
department  in,  I  believe,  New  Hampshire.  Several  years  after 
discharge  from  the  army,  he  died  of  heart  failure. 

Hughes:     Were  you  responsible  for  caring  for  his  men? 

Scheie:       Some  of  the  lost  eyes  and  scrub  typhus  patients  were  from  Merrill's 
Marauders. 

Hughes:     Were  they  there  for  the  duration  of  the  period  that  you  were  in  India? 

Scheie:       They  came  not  too  long  after  we  arrived  and  spearheaded  the 
fighting  against  the  Japanese.  The  name  of  their  organization 
changed  later  as  replacements  arrived,  so  actually  Merrill's 
Marauders  or  their  lineage  went  on. 

Hughes:     Tell  me  about  the  winding  down  of  the  operation  in  India.  I  know 
Dr.  Ravdin  left,  and  I'd  like  to  know  why. 

Scheie:       I  left  in  May  1945  before  he  did.  Ravdin  left  because  the  war  was 
finished  in  the  CBI  theater. 

Hughes:     Why  did  John  Paul  North  come  in? 

Scheie:       Well,  Ravdin  was  our  original  chief  of  surgery  and  Col.  Elias  Cooley, 
a  career  army  officer,  was  our  commandant.  When  Colonel  Cooley 
returned  to  the  States-he  was  quite  old  and  probably  shouldn't 
have  been  on  such  a  rugged  assignment-Dr.  Ravdin  succeeded  him 
and  later  became  a  brigadier  general.  Col.  John  Paul  North 
succeeded  Ravdin  as  chief  of  surgery.  He  was  a  very  fine  surgeon 
and  a  most  compassionate  man.  He  had  a  unique  and  competent 
unit.  It  was  unbelievable  how  well  it  was  put  together.  After  World 
War  II,  North  was  made  executive  director  of  the  prestigious 


The  subsequent  ten  patients  were  also  seen  by  Dr.  Scheie. 


99 

American  College  of  Surgeon  and  remained  so  for  more  than  fifteen 
years. 

[Interview  3:  January  31, 1988]  ## 
Louis  Mountbatten 

Hughes:     Dr.  Scheie,  please  tell  me  about  your  first  encounter  with  Lord  Louis 
Mountbatten. 

Scheie:       It  occurred  on  March  7, 1944.  Everyone  was  very  excited  because 
Lord  Mountbatten  was  to  make  an  inspection  of  our  hospital  that 
afternoon.  We  spent  the  morning  making  our  clinic  spic  and  span, 
as  did  everyone  in  the  hospital.  Only  essential  clinical  work  was 
done.  However,  about  ten  o'clock  in  the  morning,  I  looked  up  from 
my  desk  in  my  bamboo  clinic  to  see  Lord  Mountbatten  himself 
standing  in  the  doorway  with  a  large  white  bandage  over  his  left 
eye.  He  was  surrounded  by  more  high-rank  generals,  both 
American  and  British,  than  we  had  ever  seen  before.  One  of  them 
was  the  famous  general,  Henry  Pownall,  who  had  commanded  the 
British  troops  in  Singapore  during  the  Japanese  siege.  He  had 
somehow  escaped  capture  and  was  now  on  the  staff  of  Lord 
Mountbatten,  who  was  Supreme  Commander  of  Southeast  Asia.  I 
was  taken  by  surprise  because  we  had  no  warning  at  all. 
Mountbatten  obviously  had  an  eye  problem. 

I  presented  myself  to  the  group  and  was  given  a  little  note  written 
by  the  famous  Burma  surgeon,  Col.  Gordon  Seagrave,  who  wrote 
two  books  about  his  experiences.  He  wrote  about  this  episode  in  his 
second  book,  Burma  Surgeon  Returns.*  He  had  marched  out  of 
Burma  with  General  Stilwell  and  had  written  about  it  in  his  first 
book.**  He  was  head  of  a  field  hospital  in  the  combat  zone  which 
Lord  Mountbatten  and  General  Stilwell  were  inspecting.  Lord 
Mountbatten  had  insisted  on  driving  his  own  jeep  and  the  wheel  of 
the  jeep  had  passed  over  the  free  end  of  a  six-foot  piece  of  bamboo 
that  was  lying  over  a  log.  The  other  end  of  the  piece  of  bamboo  was 
thrown  up  striking  a  severe  blow  to  his  left  eye,  after  which  he  was 
taken  to  Seagrave's  field  hospital.  Seagrave,  finding  a  severe 
injury,  had  him  air  evacuated  to  me  at  the  20th  General  Hospital. 
At  any  rate,  Lord  Mountbatten  arrived  at  my  clinic  about  an  hour 
and  one-half  from  the  time  he  was  injured. 

After  reading  the  referral  note  from  Dr.  Seagrave,  I  asked  Lord 
Mountbatten  to  sit  in  my  examining  chair  where  I  removed  the 
dressing  and  checked  his  vision.  He  right  eye  had  20/15  vision  but 
the  vision  of  the  left  was  limited  to  light  perception.  He  had 
superficial  lacerations  of  the  cornea,  some  embedded  bamboo 
foreign  bodies,  and  an  anterior  chamber  hemorrhage  that 


*        Seagrave  G:  Burma  Surgeon  Returns.  New  York:  Norton,  1946. 
**     Seagrave  G:  Burma  Surgeon.  New  York:  Norton,  1943 


100 


completely  filled  the  chamber  with  blood.  This  type  of  hemorrhage 
can  recur  and  be  devastating.  I  told  his  aides,  whom  I'd  left  in  the 
waiting  room,  that  I  felt  he  should  be  in  the  hospital  because  it  was 
rather  vital  that  he  be  quiet  for  a  few  days,  with  both  eyes  covered. 
Removing  the  foreign  bodies  would  be  simple  enough.  The  cuts, 
which  didn't  penetrate  through  the  cornea,  needed  no  suturing. 
The  hemorrhage,  however,  demanded  rest.  His  staff  warned  me 
that  I  would  have  a  difficult  time  convincing  him  to  be  hospitalized. 

He  was  a  rugged  individualist  who  had  organized  and  trained 
commando  troops.  He  had  participated  with  them  in  raids  on 
occupied  Europe,  including  the  Dieppe  affair.  This  was  earlier  in 
the  war  before  he  took  over  command  in  Asia.  He  was  a  commando 
and  not  a  self-indulgent  person.  In  fact,  he  prided  himself  on  his 
bravery.  He  had  been  the  last  person  to  leave  the  ship  when  the 
famous  Kelly  was  sunk,  shot  out  from  under  him  off  Malta.  That 
explains  the  painting  of  The  Kelly,  autographed  by  Lord 
Mountbatten,  at  our  home  on  the  Jersey  shore. 

He  gave  me  a  bit  of  a  bad  time  about  being  admitted  to  the  hospital 
but  I  finally  convinced  him  that  a  few  days  of  rest  in  the  hospital 
might  avoid  many  days  of  recovery  later  and  even  save  his  eye.  So 
he  agreed,  and  then  we  had  the  problem  of  where  to  put  him.  I 
didn't,  as  chief  of  the  eye  service,  control  admissions  and  certainly 
he  should  have  private  quarters.  The  officers'  wards  were  filled, 
and  it  was  questionable  whether  they  would  be  appropriate  for 
someone  of  his  stature.  So  I  went  to  General  Ravdin's  office  for  his 
help.  If  anyone  could  find  an  appropriate  place,  it  was  he  as 
commanding  officer.  He  wasn't  in  but  he  was  nearby  in  our  crude 
barbershop  getting  a  haircut,  preparing  for  inspection.  When  I  told 
him  that  Mountbatten  was  in  my  clinic  and  had  to  be  admitted  to 
the  hospital,  he  immediately  asked  where  we  should  put  him.  I  told 
Ravdin  that  I  had  come  to  him  for  his  help.  At  this  point,  Ravdin 
with  one  side  of  his  hair  clipped  and  the  other  undipped  sprung 
into  action,  [laughter]  He  threw  off  the  barber's  drape  which  was  a 
bed  sheet,  jumped  out  of  the  chair,  and  led  the  way  to  my  eye  clinic. 
Part  way  there,  he  turned  to  me  saying,  "Hank,  what  do  you  call 
him?"  "I  don't  know,"  I  said.  "The  only  name  I've  used  so  far  is 
Admiral,  but  I  think  some  of  his  fellow  officers  call  him  Supremo."  I 
learned  later  that  was  only  for  intimates.  He  would  sign  his  name 
as  "Supremo."  I  think  I  still  have  a  couple  of  those  notes. 

I  introduced  Ravdin,  who  promptly  had  him  taken  to  a  vacant 
section  of  the  Red  Cross  building.  Later  he  was  moved  into  a  small 
bamboo  building  with  a  leaf  roof  where  an  occasional  sick  officer 
stayed.  Mountbatten  remained  there  for  six  days.  Once  he  was 
there,  I  kept  both  of  his  eyes  bandaged,  which  was  accepted  practice 
for  anterior  chamber  hemorrhages.  I  would  put  sulfonamide 
ointment  in  his  eye  each  time  I  changed  the  dressing,  which  was 
about  twice  a  day,  and  atropine  once  a  day.  He  was  on  bed  rest  for 
most  of  the  time  he  was  at  the  hospital. 


101 


Lord  Louis  Mountbatten  with  Dr.  Scheie  on  combat  trail 
in  North  Burma 

Hughes:     Was  he  a  good  patient? 

Scheie:       He  was  a  model  patient  once  he  was  in  the  hospital.  He  obviously 
had  great  character  and  fortitude.  Later  he  was  conscientious 
about  posthospital  follow-up  visits.  If  he  flew  up  into  our  area,  he 
would  arrange  for  me  to  meet  him  at  whichever  airport. 

On  one  particular  occasion,  I  had  arrived  early  as  I  always  tried  to 
do  and  was  waiting  for  his  arrival.  He  was  always  preceded  by  his 
communication  plane,  The  Mercury,  commanded  by  Col.  Harold 
Grant,  which  kept  him  in  contact  with  his  headquarters  and  even 
London  and  Washington.  This  plane  was  parked  on  the  strip 
nearby  while  Mountbatten  was  in  the  hospital.  I  knew  that  he  was 
in  touch  on  a  continuing  basis  with  the  combined  chiefs  of  staff  and 
Churchill  and  President  Roosevelt.  Obviously,  the  royal  family  was 
available  to  him  whenever  he  wanted  and  of  course  his  own 
headquarters  in  New  Delhi. 

Colonel  Grant,  who  later  became  a  four  star  general  and 
commanding  general  of  the  United  States  Air  Force  following  World 
War  II,  and  I  were  chatting  when  he  said  he  thought  I  might  like  to 
hear  about  an  occurrence  during  Mountbatten's  stay  in  the  hospital. 
He  said  that  President  Roosevelt,  Churchill,  and  the  royal  family 
had  urged  Mountbatten  to  have  a  consultant  flown  in  at  the  time  he 
was  in  the  hospital.  I  guess  I  was  then  just  about  thirty-five  years 
of  age  and  an  unknown  young  captain.  Mountbatten  had  the 
courage  to  refuse,  saying,  "I  have  faith  in  Captain  Scheie,  and  if  he 
wants  help  he  will  ask  for  it."  That,  I  think,  was  a  great  tribute  to 
Mountbatten. 


102 


Hughes:     And  to  you. 

Scheie:       Not  really.  I  had  told  him,  "It's  possible  you  could  lose  your  eye." 

Any  prominent,  wealthy  individual  would  have  said,  "Well,  you  are 
nice  to  suggest  a  consultant,  won't  you  send  him  in?",  and  probably 
wouldn't  have  bothered  to  consult  with  Captain  Scheie.  I  had  been 
so  concerned  about  him  that  I  would  have  welcomed  a  consultant. 

I  think  it  was  about  the  sixth  day  in  the  hospital,  with  Mountbatten 
receiving  repeated  messages  from  his  headquarters  in  New  Delhi 
and  from  Gen.  William  Slim  and  Air  Marshall  Baldwin,  that  he  told 
me  of  his  necessity  to  leave.  These  two  men  were  in  command  of 
the  British  forces  on  the  lower  India-Burma  border.  The  Japanese 
apparently  were  building  up  their  forces,  including  several 
divisions,  to  invade  India  via  the  Imphal  Plain.  They  planned  to 
come  through  the  lower  sectors  along  the  Burma  border  and  cut  off 
American  supply  lines  from  Calcutta  to  our  sector.  Mountbatten 
explained  the  situation  to  me  and  he  said  he  must  leave  to  make 
plans  to  counter  this  almost  certain  invasion.  I  could  only  agree  for 
I  was  quite  sure  that  he  would  have  gone  whether  or  not  I 
consented. 

General  Stilwell  at  that  point  ordered  me  to  accompany 
Mountbatten  to  New  Delhi.  So  I  gathered  a  few  clothes  and  we 
were  both  taken  to  the  plane.  I  then  learned  that  we  were  going  to 
stop  at  Camella  Airport  north  of  Calcutta  for  a  meeting  with  Air 
Marshall  Baldwin  and  General  [William  Joseph]  Slim.  General 
Slim  was  in  command  of  British  ground  troops  in  that  area.  The 
flight  probably  took  one  and  one-half  hours  and  their  conference 
was  held  on  the  runway  in  the  hot  Indian  sun.  They  met  in  the 
cabin  while  the  three  or  four  of  us  who  were  not  involved  in  the 
conference  sat  in  the  shade  under  the  wing.  At  that  conference  the 
decision  was  made  as  to  what  steps  to  take  to  counter  the  Japanese 
invasion.  Troops  were  to  be  added  from  adjacent  sectors  and  some 
air  force  planes  were  to  be  shifted. 

We  took  off  for  New  Delhi,  which  was  about  1500  miles  away,  but 
the  cabin  felt  like  an  oven  because  of  sitting  in  the  hot  Indian  sun. 
The  plane  was  a  DC-3  that  had  been  given  to  Lord  Mountbatten  by 
Hap  Arnold,  commander  of  the  US  Air  Force.  It  was  nicely 
furnished  and  even  had  a  place  to  sleep  and  a  little  kitchen.  The 
plane  did  not  climb  like  a  present-day  jet  where  you  take  off  at  a 
forty-five  degree  angle  and  shortly  cruise  at  high  altitudes.  It 
climbed  slowly  on  takeoff  and  on  this  particular  day  bounced 
terribly  because  of  the  air  rising  over  rice  paddies.  I  had  known 
that  I  was  subject  to  air  sickness  and  had  learned  that  I  could 
prevent  it  by  taking  a  little  barbiturate  and,  if  necessary,  some 
atropine.  These  were  the  days  before  such  preparations  as 
Dramamine  were  available. 


103 


On  this  trip,  I  had  refrained  from  any  medication  because  of  my 
responsibility  to  my  important  patient.  However,  within  twenty 
minutes,  I  became  terribly  ill,  repeatedly  visiting  the  men's  room 
during  the  flight  to  New  Delhi,  which  took  about  five  hours.  The 
tables  were  now  turned  with  Lord  Mountbatten  looking  out  for  me. 
He  never  let  me  forget  that  trip.  He  accepted  my  abilities  as  a 
doctor  but  repeatedly  kidded  me  about  being  a  damn  poor  sailor. 

We  arrived  in  New  Delhi  just  before  the  evening  meal  and  were 
taken  to  his  quarters  where  he  lived  with  his  staff.  It  was  an 
Indian  prince's  palace,  Faridkot  House,  which  had  been  taken  over 
for  the  duration  of  the  war  and  where  I  was  also  housed  for  the  next 
two  weeks.  The  first  morning  I  was  ordered  to  report  to  the 
American  headquarters  where  Stilwell's  deputy,  General  Dan 
Fulton,  was  in  command.  He  was  a  West  Point  graduate,  a  very 
popular  general,  and  a  former  football  star  at  West  Point.  He  told 
me  that  I  was  to  stay  with  Lord  Mountbatten  until  I  could 
guarantee  that  he  would  be  all  right,  and  until  Lord  Mountbatten 
would  agree  that  I  should  leave.  As  a  result,  I  had  a  great  vacation 
with  a  beautiful  room  in  an  Indian  prince's  palace. 

Lord  Mountbatten  treated  me  royally  and  took  me  nearly 
everywhere  that  he  went,  including  staff  briefings.  He  personally 
escorted  me  through  two  barbed-wire  enclosures  to  a  top-secret 
meeting,  probably  the  only  time  a  medical  captain  ever  experienced 
anything  like  that.  Blackboards  and  projection  screens  covered  the 
four  walls  of  a  large  room  where  security  people  briefed  his  staff  on 
the  status  of  the  war  around  the  entire  world.  These  meetings  were 
held  weekly  and  it  was  fascinating  to  be  able  to  learn  about  the  war 
in  Europe  and  especially  in  our  own  theater  with  the  impending 
Imphal  invasion  and  the  moves  being  made  to  counter  it. 

Not  long  after  I  returned  to  Ledo,  the  invasion  had  started.  It  was 
on  radio  and  even  in  the  overseas  edition  of  Time  magazine. 
Criticism  was  being  directed  at  Mountbatten  for  having  been  taken 
unaware  by  the  invasion  and  being  ill  prepared.  Later,  while  the 
invasion  was  still  on,  he  visited  our  hospital,  gave  a  short  talk,  and 
asked  for  questions.  Someone  asked  him  why  he  was  taken  by 
surprise  by  the  Imphal  invasion  and  why  more  was  not  being  done. 
Of  course,  he  coulcin't  reply  to  that  but  he  did  say  they  had  been 
forewarned  and  were  meeting  it  adequately.  Sworn  to  secrecy,  I 
could  not  defend  him  even  though  I  knew  of  the  detailed  counter 
measures.  The  plan  was  to  allow  the  Japanese  to  come  out  onto  the 
open  plain  and  then  spring  the  trap  by  surrounding  and  cutting  off 
their  retreat.  This  was  accomplished  and  the  Japanese  were  badly 
defeated. 

## 

An  interesting  aside:  At  Faridkot  House  he  always  seated  me  to  his 
right  during  lunch  and  dinner  regardless  of  the  rank  of  the  other 


104 


officers.  He  would  inquire  each  day  if  he  could  do  anything  for  me. 
He  took  me  on  a  tour  of  new  and  old  Delhi  and,  best  of  all,  he 
loaned  his  plane  and  pilot  to  me  for  a  day  to  fly  to  Agra  to  the  Taj 
Mahal.  That,  of  course,  was  a  wonderful  experience.  Word  was  out 
around  headquarters  that  I  was  to  have  the  plane  this  day,  and 
colonels  and  even  one  of  the  brigadier  generals  asked  if  they  could 
come  along,  which  I'm  sure  was  Lord  Mountbatten's  intent. 

Another  very  pleasant  experience  was  a  lovely  wedding  party  he 
held  at  Faridkot  House  for  a  WAC  who  was  head  of  the  British 
Women's  Army  Corps  in  India.  She  was  on  his  immediate  staff, 
because  his  closest  aides  were  British  but  with  a  mixture  of 
Americans.  General  Maddox,  for  example,  was  an  American.  They 
had  a  church  wedding  and  Lord  Mountbatten  gave  a  beautiful 
reception  at  Faridkot  House.  I  was  invited  to  both  and  looked  out 
for  by  Lord  Louis.  I  met  people  of  all  ranks  and  nationalities.  The 
occasion  was  a  pleasant  experience,  with  music  and  dancing.  I  was 
also  enjoying  my  living  quarters. 

My  first  duty  in  the  morning  and  the  last  at  night  was  to  check  his 
eye.  The  first  morning  he  asked  me  how  I  liked  being  in  New  Delhi 
and  if  I  liked  the  quarters.  Were  they  satisfactory?  I  told  him  that 
everything  was  simply  wonderful  and  having  lived  in  the  jungle  for 
about  a  year  and  a  half  with  no  amenities  I  said,  "To  hear  a  toilet 
flush  is  almost  musical."  [laughter] 

I  was  given  an  especially  interesting  insight  into  Lord  Louis  one 
evening  when  I  went  to  look  at  his  eye  before  he  retired.  As  I  was 
leaving,  he  called  me  back  and  said,  "Captain,  do  you  realize  how 
lucky  you  are?"  I  couldn't  imagine  why  he  thought  I  was  so  lucky, 
except  possibly  to  be  taking  care  of  him  and  living  there.  He  said, 
"You're  so  fortunate  because  you're  trained  to  help  people  and  here  I 
am  trained  only  for  destruction.  Because  I'm  a  member  of  the  royal 
family,  I  cannot  even  run  for  public  office.  I  can  do  little 
constructive  politically  or  possibly  even  socially."  I  was  very 
touched  by  his  sensitivities  and  I  often  thought  of  our  conversation 
during  the  time  later  when  he  was  responsible  for  the  negotiations 
that  gave  India  its  freedom.  I  know  he  loved  Ireland  and  its  people 
where  he  had  his  own  little  castle,  his  favorite  vacation  spot.  I  have 
often  thought  that  he  would  have  liked  nothing  better  than  to  have 
helped  with  the  problems  there.  Instead  he  was  cruelly 
assassinated. 

My  conscience  must  have  bothered  me  about  my  lovely  vacation 
although  under  official  orders,  so  I  went  to  headquarters  to  see 
General  Fulton,  telling  him  that  I  was  sure  Lord  Mountbatten 
would  have  no  further  trouble  and  that  I  should  return  to  Ledo.  He 
teased  me  and  asked  if  there  was  not  some  way  that  I  could  have 
my  orders  extended  and  remain  with  Lord  Louis.  However,  he  did 
send  me  back. 


105 

I've  mentioned  one  follow-up  checkup  on  his  eye.  There  were 
others.  He  would  usually  see  that  I  stayed  for  dinner  or  lunch  and 
occasionally  spend  an  evening.  He  was  wonderful  with  troops  and 
as  regular  a  guy  as  any  American  enlisted  man. 

On  one  visit,  he  took  me  on  a  tour  of  the  Viceroy's  Palace  which  was 
historic  and  beautiful.  The  gardens  were  beautifully  designed  and 
manicured  to  the  last  detail.  Busy  as  he  was  he  took  the  time  to 
escort  me. 

Later,  I  was  sent  down  by  our  theater  headquarters  to  negotiate  in 
Calcutta  for  artifical  eyes  for  Chinese  soldiers  who  had  been 
wounded.  This  would  be  the  last  chance,  at  least  for  a  long  time,  for 
them  to  be  fitted.  Lord  Mountbatten  learned  somehow,  probably 
through  our  theater  orders,  that  I  was  in  Calcutta  and  was  staying 
at  the  Great  Eastern  Hotel.  I  think  on  the  second  day  I  was  there,  I 
received  a  note  written  by  his  aide  that  Supremo  and  Lady 
Mountbatten  would  like  to  have  me  for  lunch  or  dinner.  I  thought  it 
would  be  more  appropriate  to  elect  luncheon  and  telephoned  the 
aide  to  accept.  Lord  Louis  and  his  wife,  Edwina,  were  staying  at 
Government  House  in  Calcutta. 

The  luncheon  was  an  interesting  experience.  They  had  such  guests 
as  Lord  Tennyson,  a  descendent  of  the  famous  Tennyson,  and  people 
of  that  order.  Some  military  personnel  and  their  ladies  were 
present.  About  thirty  people  attended,  but  how  kind  of  him  to  seek 
me  out.  I  was  amazed  that  he  could  know  or  even  care  if  I  were  in 
Calcutta.  He  continued  his  friendship  until  his  death.  Lady 
Mountbatten  was  a  beautiful  and  an  extremely  gracious  hostess. 
On  his  visits  to  the  United  States  after  the  war,  I  was  often 
informed  and  asked  to  join  him  on  some  occasions.  Mrs.  Scheie  and 
I  were  also  his  guests  in  London  and  at  his  estate,  Broadlands,  on 
several  occasions. 

Patrick  J.  Hurley 

Scheie:       Neither  my  roommate  Maj.  Frank  Newburger,  the  medical  supply 
officer  at  the  20th  General  Hospital,  nor  I  had  had  a  leave.  This 
was  at  least  eight  months  or  more  after  the  injury  to  Lord 
Mountbatten.  We  elected  to  go  to  Mussoori,  which  was  in  the 
mountains  about  one  hundred  miles  north  of  New  Delhi.  We  went 
there  by  taxi.  It  was  a  famous  British  vacation  resort  in  peacetime. 
The  mountain  on  which  the  hotel  stood  was  at  an  altitude  of  several 
thousand  feet  in  the  midst  of  the  Himalayas. 

Early  in  the  morning  the  day  after  we  arrived,  a  message  was 
delivered  to  me  from  headquarters  in  New  Delhi  which  ordered  me 
to  go  to  Chungking  on  a  number-one  priority.  That  was  a 
presidential  level  priority.  I  also  was  asked  to  check  Lord 
Mountbatten's  eye  at  a  stop  on  the  way.  My  ophthalmoscope  and 
what  few  instruments  I  could  carry  had  been  sent  to  me  at  this 


106 


airstrip  where  I  did  a  routine  eye  check  on  Lord  Mountbatten. 
Then  I  flew  the  Hump  to  Kun  Ming,  China,  where  I  changed  planes. 

Flying  the  Hump  was  a  beautiful  scenic  experience.  However,  the 
planes  were  small  (DC-3s)  and  were  without  oxygen  for  passengers. 
Oxygen  was  required  for  the  pilots  when  flying  over  ten  thousand 
feet,  and  part  of  the  way  we  were  up  to  fifteen  and  twenty  thousand 
feet,  threading  our  way  between  beautiful  mountain  peaks.  We 
flew  over  the  lower  portion  of  the  Himalayas  which  extended  into 
Burma.  The  altitude  seemingly  had  no  ill  effect  but  after  I  had 
landed  I  found  that  my  memory  and  thinking  processes  were 
muddled. 

Kun  Ming  was  then  one  of  the  busiest  airports  in  the  world  because 
of  the  supplies  and  personnel  passing  through  for  both  Chinese  and 
American  troops.  I  arrived  there  on  a  Sunday,  the  same  day  I'd  left 
Mussoori,  the  vacation  spot.  Immediately  upon  showing  my  orders, 
the  commandant  of  the  base  was  asked  to  come  and  look  at  them.  A 
number-one  priority  meant  just  that,  number  one!  You,  in  the 
vernacular,  were  a  "hot  potato"  and  they  did  not  want  you  on  the 
base  for  long.  This  provided  another  interesting  experience.  The 
commanding  officer  on  this  Sunday  was  a  captain  from  the 
American  Air  National  Guard,  a  short,  heavyset  fellow,  overage  for 
captain,  with  a  short  mustache.  When  he  saw  my  priority  orders, 
he  burst  out  in  profanity,  "We  have  no  G~  d —  planes  available," 
and  no  this  and  no  that,  and  why  were  they  always  doing  this  to 
him?  You  would  think  it  happened  six  times  a  day.  A  priority  like 
that  was  rare,  but  it  apparently  complicated  his  day.  Finally 
amidst  profanity  he  did,  within  an  hour  as  I  recall,  have  a  plane 
and  pilot  to  fly  me  up  to  Chungking.  While  waiting,  I  learned  that 
this  captain  was  the  brother  of  a  rather  famous  actor  whom  I 
always  enjoyed,  Adolphe  Menjou.  He  was,  as  you've  gathered,  the 
complete  opposite  of  his  brother  Adolphe,  who  was  very  suave  and 
handsome.  Later  I  saw  the  captain  here  and  there  in  India  and  he 
proved  to  be  a  gracious  person. 

I  had  no  idea  why  I  was  going  to  Chungking  and  I  was  not  told  until 
I  arrived  at  the  American  ambassador's  home  in  that  city,  when  I 
was  informed  that  I  was  to  see  General  Pat  Hurley,  who  was  former 
secretary  of  war  under  President  Hoover.  He  had  been  President 
Roosevelt's  personal  courier  carrying  messages  between  [Gen. 
Douglas]  MacArthur  and  Gen.  Jonathan  Matthew  Wainright  from 
Corregidor  to  Darwin,  Australia,  during  the  siege  on  the 
Philippines.  He  would  fly  to  the  Philippines,  have  his  conference 
with  MacArthur  and  General  Wainright,  and  then  return  to  Darwin 
with  whatever  information  that  he  had  been  given,  which  was  then 
transmitted  to  Roosevelt.  Radio  communications  from  Corregidor 
were  impossible  at  that  point.  After  that  duty,  President  Roosevelt 
had  sent  him  to  China  as  his  special  ambassador  to  attempt  to 
bring  Mao  Tse-tung  and  Chiang  Kai-shek  together  to  fight  against 
the  Japanese.  He  had  meetings  with  Chiang  Kai-shek  and  Mao 


107 

Tse-tung  in  North  China.  That  story  is  well  told  in  several  books. 
Hurley's  mission  obviously  ended  in  a  failure. 

My  presence  had  been  requested  by  the  surgeon  for  the  China 
theater,  Gen.  George  Armstrong,  because  General  Hurley  had 
supposedly  lost  part  of  the  vision  in  his  left  eye.  A  detached  retina 
was  suspected.  I  examined  him  the  day  after  my  arrival  and  found 
that  he  had  a  defect  in  the  left  field  of  vision  of  both  eyes.  In  fact,  I 
didn't  need  visual  field  equipment  because  he  had  a  defect  by  hand 
confrontation.  However,  once  I  dilated  his  pupil  I  could  see  no  sign 
of  a  detached  retina.  His  central  visual  acuity  was  normal.  After 
questioning,  I  learned  that  on  returning  from  Corregidor  to  Darwin 
his  plane  had  been  attacked  by  Japanese  Zeros  and  that  a  bullet 
had  struck  him  on  the  right  occipital  area  of  his  head.  I  was  shown 
the  scar  which  was  now  well  healed.  On  palpation,  I  detected  a 
bony  defect  through  which  I  could  feel  his  brain  pulsate.  I  don't 
believe  this  ever  became  public  knowledge,  which  is  a  little  unusual 
because  he  was  such  a  prominent  and  outgoing  character.  Possibly 
he  didn't  want  it  known  that  anybody  could  hurt  him.  I  learned  a 
great  deal  about  him  from  later  chats.  For  example,  he  was  a  great 
friend  of  Will  Rogers  and  they  had  been  great  athletes.  He  told  me 
that  he  once  defeated  Rogers  for  the  amateur  athletic  championship 
of  the  Oklahoma  Territory. 

His  visual  field  defect  was  obviously  due  to  scar  tissue  in  the  wound 
site  which  interfered  with  the  visual  cells  in  the  right  occipital  lobe 
of  his  brain.  I  told  him  that  he  should  see  a  neurosurgeon  at  the 
first  opportunity  and  have  the  scar  corrected  and  possibly  a 
tantalum  plate  or  a  bone  graft  placed.  Hopefully  some  or  all  of  his 
vision  could  be  restored.  The  visual  loss  was  discovered  by  him  only 
after  he  arrived  in  Chungking,  or  I  am  sure  it  would  have  been 
taken  care  of  before. 

Joseph  Warren  Stilwell 

Scheie:       Since  I  was  staying  at  the  embassy,  also  the  home  of  several 
high-ranking  American  officers,  it  became  known  that  an 
ophthalmologist  was  available,  and  I  was  asked  to  examine  the  eyes 
of  several  patients.  The  first  was  General  Stilwell  who  was 
developing  cataracts  and  wanted  this  to  be  kept  a  secret.  He  knew 
that  his  vision  had  failed  somewhat  and  he  had  seen  an 
ophthalmologist 

## 

named  Colonel  Kirwin,  head  of  the  Bengal  Eye  and  Ear  Infirmary 
in  Calcutta,  whom  I  had  met.  By  the  way,  it  was  he  who  described 
a  type  of  glaucoma  that  resulted  from  eating  mustard.  I  am  not 
certain  about  the  validity  of  this  theory,  but  he  was  a  highly 
intelligent,  capable  British  ophthalmologist  who  had  been  in  the 
British-Indian  army  before  the  war.  I  had  visited  his  clinic  in 


108 

Calcutta  to  watch  him  operate.  He  was  a  very  skillful  surgeon  who 
used  four  operating  tables  in  a  row,  going  from  table  to  table.  I 
watched  him  do  fourteen  cataract  extractions,  which  took  him  about 
two  hours.  The  technique  was  simple.  The  procedures  were 
extracapsular  and  the  incisions  were  not  sutured. 

When  I  examined  General  Stilwell  he  did  have  cataracts.  The 
reason  he  had  permitted  no  American  to  examine  him  was  probably 
because  his  vision  was  poor  enough  that  he  would  have  been  sent 
back  to  the  United  States  under  army  regulations.  I  couldn't 
believe  my  ears  when  he  asked  if  I  would  be  willing  to  remove  his 
cataracts  in  our  Ledo  Hospital.  I  gently  declined  and  asked  him, 
"What  if  something  should  go  wrong?  Obviously  I  would  be  very 
upset,  and  it  would  be  your  loss  of  vision."  Furthermore,  such 
cataract  surgery  was  not  permitted  in  our  theater.  And  what  about 
the  court  martial  I  would  face  when  I  was  recalled  to  the  States? 
He  realized  that  it  wasn't  practical.  I  also  saw  several  other 
high-ranking  officers  as  patients,  including  three  or  four  generals. 

The  Soong  Sisters 

Scheie:       On  the  Saturday  evening  after  I  arrived,  some  members  of  the 
embassy  staff,  including  Gen.  Thomas  Hearn,  a  very  charming 
Colonel  McCarthy,  a  couple  of  other  officers,  and  myself  were 
invited  to  the  home  of  the  Soong  sisters,  Ching-ling  and  Soong 
Mei-ling.  Madame  Chiang  Kai-shek,  who  is  the  third  Soong  sister, 
was  not  present.  The  sisters  were  among  the  highest- ranking  and 
probably  the  best-educated  women  in  China.  Much  of  the  political 
and  social  life  of  China  at  this  time  was  in  Chungking,  the 
temporary  capital  during  the  war. 

The  sisters  were  very  attractive  and  had  a  lovely  home.  We 
gathered  in  the  living  room,  American  style,  having  wine  before 
dinner  rather  than  tea.  Conversation  was  pleasant.  They  had 
learned  that  I  was  working  with  Chinese  troops  in  Burma  and  I 
told  them  how  much  I  enjoyed  the  Chinese  soldiers.  I  also  showed 
off  some  of  the  Chinese  language  that  I  had  learned  from  them. 
They  put  up  with  this  for  a  couple  of  minutes  when  one  of  them 
really  put  me  down.  She  said,  "Captain,  gangster  Chinese-where 
did  you  learn  it?"  Then  I  realized  that  the  Chinese  I  had  been 
learning  from  Chinese  peasant  soldiers  would  not  compare  to  hers. 
I  suppose  I  wasn't  exactly  clear  as  to  the  innuendoes  of  some  of  the 
words  I  used.  Anyhow,  I  realized  that  I  must  have  sounded  like  a 
Chinese  dead-end  kid. 

Actually,  one  of  the  words  I  used  was  one  they  used  very  regularly, 
"mamaphuphu."  I  had  interpreted  it  as  something  like  "mediocre." 
I  don't  remember  what  I  had  referred  to  as  such.  I  learned  later 
that  its  meaning  in  Chinese  is  "half-assed."  [laughter]  Imagine  my 
embarrassment  when  I  learned  what  it  really  meant.  However,  I 
still  show  off  my  limited  Chinese  in  Chinese  restaurants.  Before  I 


109 

left  the  theater,  I  was  able  to  converse  in  a  practical  way  with  the 
Chinese.  In  fact,  I  worked  largely  without  an  interpreter  for  about 
the  last  year  I  was  there. 

There's  an  addendum  to  this  visit.  Our  son  Eric  often  gives  me  a 
book  on  special  occasions  like  birthdays  and  Christmas,  either  an 
historical  novel,  some  phase  of  history,  or  a  biography.  In  1985  the 
gift  was  a  book  written  by  the  Burma  surgeon's  son.  He  grew  up  in 
that  part  of  the  world  and  had  much  of  his  education  there.  The 
book  is  titled  Soong  Dynasty*  It  is  excellent  and  a  book  that  I 
highly  recommend.  It  was  coincidental  that  I  had  spent  an  evening 
with  two  of  the  sisters  and  had  come  to  know  the  author's  father, 
the  Burma  surgeon,  through  sharing  of  patients,  one  of  them  Lord 
Mountbatten. 

## 

[Interview  4:  March  28, 1988] 

Stewart  Duke-Elder 

Hughes:     Dr.  Scheie,  we  talked  last  time  about  the  China-Burma-India 

Theatre,  but  there  are  a  few  loose  ends,  one  of  them  being  the  visit 
from  Duke-Elder.  Would  you  tell  me  how  it  came  about? 

Scheie:       Yes.  Sir  Stewart  Duke-Elder  was  ophthalmologist  to  the  queen  and 
during  the  war  he  was  also  a  brigadier  and  chief,  the  number  one 
consultant  in  ophthalmology  to  the  British  armed  forces.  He 
probably  would  have  been  the  person  to  be  called  to  see  Lord 
Mountbatten  when  I  was  caring  for  him  had  Lord  Louis  not 
declined  having  a  consultant,  as  we  discussed.  A  few  months  after 
Lord  Mountbatten's  injury,  Duke-Elder  made  a  trip  through  India, 
inspecting  care  of  eye  patients  in  British  and  Indian  military 
hospitals.  Lord  Mountbatten  suggested  that  he  come  to  visit  me  at 
the  20th  General  Hospital. 

Hughes:     Did  he  watch  you  operate? 

Scheie:       I  don't  think  he  watched  me  operate  but  he  visited  my  clinic  and 
made  rounds  on  my  wards  in  both  the  Chinese  and  American 
hospitals.  He  stayed  for  about  two  days  and  I  still  have  some 
photographs  taken  during  his  visit.  To  me  it  was  a  major  event,  not 
only  because  of  his  position  but  because  he  had  made  my  life  as  a 
resident  much  easier  by  facilitating  my  studies  with  his  new  and 
informative  four-volume  Textbook  of  Ophthalmology.**  Until  then, 


Seagrave  SC.  Soong  Dynasty.  NY:  Harper  &  Row,  1985. 
**      London:  Henry  Kimpton,  vol  1-4,  1932.  The  series  was  eventually  extended  to  seven  volumes. 


110 


at  least  in  our  country,  much  of  the  ophthalmic  literature  and  many 
textbooks  were  in  German.  My  German  was  very  limited. 
Fortunately,  about  the  time  I  started  in  my  ophthalmology 
residency,  his  textbooks  became  available.  Therefore,  I  was  ready 
to  worship  at  his  feet.  In  fact,  he  had  become  quite  a  hero  of  mine. 
We  have  my  original  volumes  in  our  library  at  the  eye  institute. 
Each  has  his  autograph  given  during  his  visit  and  each  is  two  or 
three  inches  thick. 

I  have  always  been  an  early-morning  person  and  in  India  I  would 
sit  out  in  front  of  our  bamboo  hut  before  anyone  else  was  up  and 
before  breakfast  was  being  served  in  the  mess,  reading  those  books. 
I  was  kidded  about  it  several  times  by  some  of  my  fellow  officers, 
but  I  did  read  them  through  in  detail  once  and  later  once  more 
when  I  outlined  them.  I  still  have  those  notes.  So  he  came  to  mean 
a  great  deal  to  me  personally. 

Hughes:     What  was  he  like  as  an  individual? 

Scheie:       Oh,  he  was  charming  and  brilliant,  of  course.  I  think  he  was 
conceded  to  be  the  world's  outstanding  ophthalmologist  at  that 
time.  He  also  had  a  great  sense  of  humor.  He  made  rounds  with 
me  and  saw  my  scrub  typhus  patients,  whose  findings  had  not  as 
yet  been  described.  I  also  had  some  interesting  corneal  problems 
(probably  related  to  atabrine)  and,  of  course,  battle  injuries.  These 
were  the  types  of  patients  that  I  showed  Duke-Elder. 


Sir  Stewart  Duke-Elder 
in  Assam,  India 


Hughes:     Was  he  familiar  with  ophthalmological  complications  of  tropical 
diseases? 


Ill 


Scheie:       I  think  he  was  knowledgeable  about  most  eye  disease;  he  seemed  to 
be  a  walking  encyclopedia. 

While  he  was  visiting  our  hospital,  he  also  took  a  few  hours  to  visit 
an  Indian  hospital  that  was  a  few  miles  further  down  the  Ledo 
Road  from  ours,  where  they  took  care  of  British  and  Indian  troops. 
To  me,  it  was  a  thrilling  visit.  I  was  an  unknown  captain  and  he 
was  a  famous  brigadier.  I  was  able  to  do  him  one  favor.  He  was 
waiting  at  one  of  our  little  airstrips  for  a  plane  to  take  him  back  to 
Calcutta.  It  was  a  very  hot  day  in  the  jungle  and  he  was  quite 
uncomfortable.  I  was  able  to  procure  a  cold  bottle  of  beer  for  him, 
much  to  his  relief,  [laughs]  He  never  failed  to  mention  that.  His 
visit  led  to  a  friendship  that  continued  for  many  years  until  his 
death. 

Hughes:     You  would  see  him  when  you  went  to  Britain? 

Scheie:       I  would  see  him  in  London,  where  I  visited  his  home,  and  I  would 
see  him  at  meetings.  His  driving  interest  in  ophthalmology,  aside 
from  research,  was  glaucoma.  We  were  panelists  at  glaucoma 
meetings  but  we  differed  on  causes  of  that  disease.  He  believed  in  a 
neurovascular  origin  while  I  subscribed  to  the  mechanical  or 
gonioscopic  approach  to  it  as  advocated  especially  by  Otto  Barkan.* 
I  can't  say  Duke-Elder  and  I  were  intimate  friends,  but  certainly  we 
were  good  professional  friends.  Whenever  I  was  in  London,  I 
visited  him  and  occasionally  I'd  see  him  here  in  the  United  States, 
in  addition  to  professional  meetings.  I  was  thrilled  when  the 
Society  of  Contemporary  Surgery  gave  me  the  Duke-Elder  Medal 
for  glaucoma.**  After  World  War  II,  he  published  a  new 
twelve- volume  textbook,  which  is  a  classic.***  To  me  it  was 
indispensable.  And  for  me  to  meet  him  in  Ledo  and  to  have  him 
sent  up  especially  to  see  me  was  very  exciting. 

By  this  time,  the  Mountbattens  were  quite  friendly  with  our  unit 
and  the  Ledo-Bunna  area.  When  I  was  at  Government  House  in 
Calcutta  as  their  luncheon  guest,  Lord  Mountbatten  said  to  Lady 
Mountbatten,  "Now,  you  must,  while  you're  in  India,  go  up  and  visit 
the  20th  General  Hospital."  And  she  did  so  a  short  time  later. 

Hughes:     Was  it  standard  for  a  wife  to  be  in  the  proximity  of  the  war  theatre? 

Scheie:       She  was  a  major  general  in  the  British  Army  St.  John's  Nurse 

Corps.  She  was  also  very  active  in  the  Red  Cross  and  continued  her 
activities  after  the  war.  In  fact,  she  died  shipboard  not  long  after 


* 
** 


See  the  section  on  the  neurovascular  and  gonioscopic  concepts  of  glaucoma. 
In  1978  Dr.  Scheie  received  the  Duke-Elder  Award  of  the  Second  International  Glaucoma 
Congress. 
***  Duke-Elder  WS.  System  of  Ophthalmology,  vol  1-15.  St.  Louis,  MO:  Mosby  Co,  1958-74. 


112 


the  war  during  one  of  her  trips  to  the  Orient.  I  have  heard  it  was 
from  a  heart  attack. 

I  saw  her  on  only  three  occasions.  The  first  was  at  the  luncheon  at 
Ledo,  and  the  third  was  after  the  war  when  she  and  Lord 
Mountbatten  gave  a  reception  for  the  head  of  the  United  Nations, 
Dag  Hammarskjold.  It  was  held  in  the  New  York  City  apartment  of 
the  U.S.  Ambassador  to  Great  Britain,  Winthrop  Aldrich. 
Obviously  it  was  attended  by  many  famous  and  distinguished 
guests. 

A  special  dinner  in  our  mess  hall  was  arranged  for  Lady 
Mountbatten's  visit  to  Ledo.  It  was  an  unusual  affair  for  us 
because  in  spite  of  our  bamboo  roof  we  had  place  cards  and  assigned 
seating.  Being  a  captain,  I  was  placed  near  the  end  of  the  u-shaped 
table.  As  we  were  sitting  down  for  dinner,  she  noticed  where  I  was. 
She  went  to  General  Ravdin  and  said,  "General  Ravdin,  I  want  you 
to  have  Captain  Scheie  sit  here  on  my  right.  The  reason  I'm  here  is 
because  my  husband  wanted  me  to  come  up  and  see  Captain  Scheie, 
and  he  has  to  sit  beside  me."  This,  of  course,  was  quickly  arranged. 
So  that  made  me  an  even  greater  admirer. 

It  was  after  her  death  that  Mrs.  Scheie  and  I  were  Lord 
Mountbatten's  guests  on  at  least  three  occasions,  twice  at 
Broadlands.  We  had  accepted  another  invitation  to  stay  at 
Broadlands  for  June,  1980,  but  his  tragic  assassination  in  August, 
1979  rendered  that  impossible. 

Noel  Coward 

Hughes:     Perhaps  you'd  explain  how  Noel  Coward  came  to  be  at  the  hospital. 

Scheie:       He  was  a  close  friend  of  Lord  Mountbatten  and  it  was  he  who  had 
urged  him  to  visit  the  20th  General  Hospital.  Lord  Louis  arranged 
for  me  to  be  Coward's  host  for  the  week  that  he  visited  and 
entertained  our  units. 

Hughes:     Did  he  travel  and  entertain  throughout  the  war? 

Scheie:       How  much  of  the  time  he  did  this,  I  don't  know,  but  he  did  a 
considerable  bit.  Ours  were  American  troops,  of  course,  and 
ordinarily  he  wouldn't  have  visited  us,  but  he  did  so  at  Lord 
Mountbatten's  request.  He  visited  several  units  in  our  area  and 
entertained  about  twice  a  day.  Soldiers  would  gather  around  at 
mess  time  or  in  the  evening.  I  had  the  pleasure  of  accompanying 
him  to  each  of  the  units.  He  was  charming  and  had  all  sorts  of 
entertaining  stories. 

One  of  the  funniest  episodes  occurred  one  evening  when  he  was 
visiting  a  National  Guard  unit,  the  members  largely  from  Texas. 
We  had  a  great  deal  of  rain  over  there  as  everyone  knows.  This 
night  the  show  was  rained  out  and  we  were  waiting  in  a  fairly  large 


113 


bamboo  building  for  our  transportation.  Most  of  the  unit  was 
gathered  there  around  Noel  Coward.  He  was  telling  us  tales  and 
soon  the  men  began  to  respond  with  their  own.  One  Texas  officer, 
who  thought  he  was  a  poet,  insisted  on  standing  up  and  reading 
some  of  his  poetry,  [laughter]  He  almost  caused  Noel  Coward  to  go 
out  in  the  rain.  This  individual  had  utterly  no  taste  or  insight. 
Imagine  his  reading  his  dreadful  poetry  to  as  sophisticated  and 
literate  a  person  as  Noel  Coward.  But  it  was  a  pleasant  week  for 
everyone  and  hopefully  for  Noel  Coward.  It  was  certainly  a  special 
treat  for  me  to  have  had  this  assignment.  I  saw  Noel  Coward  once 
afterward  in  a  play  that  opened  in  Philadelphia.  I  think  it  was 
"Blithe  Spirit."  Polly  and  I  saw  the  show  and  entertained  him  at 
supper  afterwards.  Later  after  it  had  opened  in  New  York,  he  wrote 
a  thank-you  note  on  November  16, 1957,  and  commented  about  the 
reviews:  "The  notices  here  were  fairly  beastly  but  the  business  is 
wonderful.  The  audiences  seem  to  love  it  and  are  turning  up  in 
droves,  so  who  cares."  He  died  and  was  buried  in  the  Caribbean 
only  a  few  years  after  that. 


Isidor  Ravdin,  Noel  Coward,  Harold  Scheie 


The  Headhunter 

Hughes:     For  a  change  of  pace,  would  you  tell  me  about  the  episode  with  the 
headhunter? 

Scheie:       Yes.  The  headhunter,  whose  name  was  Rang  Lang,  was  the  chief  of 
a  tribe  of  Naga  headhunters,  referred  to  as  "Hill  People."  They 
lived  in  jungle  country  on  either  side  of  the  Burma  border.  Until  we 
built  the  road,  the  area  was  uninhabited  by  white  men.  The 


114 


headhunters  were  very  primitive  and  were  practicing  headhunters. 
The  Indian  government  had  never  been  able  to  bring  them  under  its 
control  and,  I  believe,  the  Nagas  still  give  them  problems.  Advance 
British  and  American  troops,  and  especially  porters  carrying  loads 
and  messages  forward  through  the  jungle,  were  being  attacked. 

This  was  British  territory  and  apparently  someone  had  appealed 
for  help  to  our  local  British  governor  whose  name  was  Johnny 
Walker.  His  office  and  living  quarters  were  only  about  a  mile  from 
our  hospital.  Someone  told  him  about  the  blind  headhunter  chief, 
Rang  Lang.  Walker  then  approached  our  theatre  surgeon.  The 
request  was  eventually  sent  to  our  hospital  to  see  this  man  and  try 
to  help  him  regain  his  eyesight.  It  was  hoped  that  this  might  win 
the  friendship  of  the  Nagas. 

He  arrived  at  our  hospital  after  a  three-day  hike  along  jungle  trails. 
He  had  two  relatives  with  him,  one  on  each  end  of  a  bamboo  pole 
possibly  twelve  feet  long,  and  he  holding  onto  the  middle  for 
guidance.  It  was  in  that  manner  that  he  arrived  at  my  clinic.  He 
was  wearing  little  but  a  loincloth,  his  legs  bare.  I  have  a 
photograph  of  him  as  he  was.  He  had  bamboo  spikes  through  his 
hair  to  hold  it  up  and  also  through  his  perforated  ear  lobes.  His 
teeth  were  stained  a  brownish-red  color  from  eating  betelnuts.  It 
was  impossible  to  communicate  with  him  verbally  and  it  was 
obvious  that  he  was  blind.  I  tried  to  seat  him  in  a  chair,  which  he 
refused,  so  I  had  to  squat  with  him  to  examine  his  eyes.  It  was 
apparent  immediately  that  he  had  complete  (ripe)  cataracts.  He 
could  see  light,  and  as  nearly  as  I  could  tell,  had  good  functional 
retinas  behind  the  cataracts,  which  suggested  cataract  removal 
might  give  him  good  vision. 

Arrangements  had  been  made  that  if  we  felt  we  could  help  him 
regain  his  vision  he  should  be  admitted  to  the  hospital.  This  was 
done  and  then  we  were  confronted  by  certain  problems.  He  had 
never  slept  in  a  bed  before.  His  relatives,  two  cousins,  stayed  with 
him.  We  fed  him  because  he  didn't  know  how  to  use  utensils  but 
would  scoop  his  food  up  with  his  hands.  Fortunately,  we  had  a 
Chinese  hospital  next  to  the  American  hospital  so  we  brought  the 
food  that  had  been  prepared  for  the  Chinese,  which  he  preferred  to 
American.  Even  he  would  not  eat  Spam. 

I  operated  him,  but,  I  assure  you,  with  him  asleep  under  general 
anesthesia.  When  I  would  change  his  dressings  in  the  morning,  one 
of  his  relatives  would  be  squatting  on  the  end  of  the  bed.  He  would 
be  holding  a  headhunter  knife,  about  four  feet  long,  across  his  lap. 
I  didn't  exactly  resort  to  prayer,  but  I  was  very  hopeful  that  the  eyes 
were  in  place  and  intact  each  time,  [laughter] 

We  were  not  certain  about  the  vision  in  the  first  eye,  but  I  have  a 
photograph  of  him  smiling  very  nicely  when  I  held  a  magnifying 
lens  in  front  of  it.  Thus  everything  seemed  well,  so  we  did  the 
second  a  week  later.  Both  operations  were  uneventful.  Each  was 


115 

extracapsular,  the  safest  technique.  The  posterior  capsule  of  each 
lens  was  left  in  place  as  a  membrane  and  would  have  to  be  opened 
later  by  a  minor  operation  called  a  capsulotomy.  This  was  done  on 
each  eye  as  an  outpatient  about  a  week  later.  Everything  went  well 
and  the  eventual  outcome  was  20/20  vision  in  each  eye.  He  couldn't 
read  letters,  of  course,  but  I  had  an  illiterate  E  chart.  Since  he  was 
an  intelligent  patient,  he  understood  quickly.  I  put  lenses  before  his 
eyes  and  he  would  indicate  the  direction  of  the  E's  with  his  fingers. 

When  we  had  completed  our  refraction,  Capt.  George  Hoffman,  who 
was  assisting  me,  and  I  led  him  to  a  window  in  my  bamboo  clinic 
and  let  him  look  across  our  hospital  area.  There  was  a  great  deal  of 
activity.  He  could  see  the  soldiers  walking  around  in  their 
uniforms,  a  new  sight  for  him,  as  well  as  army  ambulances  and 
other  activities.  He  was  quiet  for  a  short  time  and  then  he  began  to 
jump  up  and  down,  exciting,  smiling,  and  exclaiming,  "Uh,  uh,  uh." 
George  and  I  were  so  touched  that  both  of  us  shed  a  tear.  It  was 
thrilling  to  see  the  amazement  of  this  primitive,  who  had  never 
seen  civilization  before.  Whether  all  of  this  changed  the  attitude  of 
his  tribe  I  never  knew,  but  at  least  it  was  very  rewarding  for  me. 

We  had  great  trouble  communicating  with  him,  because  it  took  at 
least  two  different  interpreters.  The  Naga  people  have  their  own 
dialect.  I  would  need,  therefore,  an  Indian  who  understood  Naga 
dialect  and  then  an  English-speaking  interpreter  to  translate  their 
conversation.  I  gathered  that  there  wasn't  much  communication 
between  the  primitive  Nagas  and  the  Indians. 

Rang  Lang  was  an  excellent  patient  and  really  caused  no  problems. 
At  the  time  of  his  last  visit,  he  showed  his  appreciation  by  offering 
me  a  hundred  chickens  and  two  wives  from  his  village.  Over  the 
years  when  I  tell  this  story,  it  seems  that  no  one  ever  bothers  to  ask 
me  about  what  happened  to  the  chickens,  [laughter] 

The  headhunter  Rang  Lang 


116 


Hughes:     Well,  Dr.  Scheie,  I'll  ask  you.  How  did  you  handle  both  types  of  gifts? 

Scheie:       I've  lost  all  my  follow-up  notes,  [laughter] 

As  an  interesting  aside:  I  do  think  Rang  Lang  enjoyed  his  stay  in 
the  hospital.  For  example,  we  removed  the  bamboo  spikes  from  his 
ears  and  replaced  them  with  large  blanket  safety  pins  which  he 
treasured,  just  as  an  American  girl  would  treasure  her  jewels.  He 
was  very  proud  of  them  and  wore  them  when  he  went  home.  He 
was  indeed  pleasant  to  care  for.  At  least  we  could  not  understand 
any  disparaging  remarks  he  might  have  made. 

The  Wartime  Experience 

Hughes:     Please  sum  up  what  your  wartime  experience  in  Ledo  meant  to  you, 
both  in  a  personal  way  and  in  terms  of  ophthalmology. 

Scheie:       Well,  personally  the  experience  was  fantastic.  I  was  given  several 
fortunate  assignments,  which  included  both  travel  and  interesting 
people.  Travel  included  flying  the  Hump  to  Kunming  and 
Chungking  in  China  and  I  was  able  to  travel  over  a  good  bit  of 
India,  spending  time  in  New  Delhi  and  Calcutta.  I  also  visited 
Tibet,  a  country  of  spectacular  beauty. 

Professionally,  I  felt  that  I  was  years  ahead  experiencewise  when  I 
returned  to  the  United  States.  The  experience  with  tropical 
diseases  was  one  that  very  few  Americans  have  had.  The  first  year 
we  were  there  we  treated  ten  thousand  cases  of  malaria  at  our 
hospital  alone.  I  was  able  to  write  my  American  Ophthalmological 
Society  thesis  on  observations  of  previously  undescribed  eye 
changes  in  451  patients  with  scrub  typhus  who  were  followed  once 
or  twice  a  week. 

We  saw  many  patients  with  various  stages  of  syphilis.  Many  of 
these  were  in  soldiers  with  negative  serology,  because  in  China  at 
that  time  adequate  medical  treatment  was  not  available.  They 
would  go  to  a  bazaar,  have  an  injection  of  possibly  bismuth  or 
arsenical,  some  treatment  that  would  clear  up  the  acute  stage  and 
possibly  reverse  the  serology  but  not  cure  the  disease.  We  saw 
some  patients  with  leprosy.  In  fact,  I  diagnosed  one  through  his  eye 
lesion.  Most  of  the  eye  battle  casualties  and  injuries,  Chinese  and 
American,  were  evacuated  to  our  hospital  and  were  very 
instructive.  I  had  anywhere  from  seventy  to  ninety  patients  in  the 
hospital  much  of  the  time.  That  experience  would  be  difficult  to 
improve  upon. 

I  also  had  to  build  my  own  visual  field  apparatus,  which  was  a  good 
experience.  All  in  all,  the  travel  and  the  professional  experience, 
plus  the  interesting  people  I  came  to  meet  and  to  know,  and  even 
the  relationships  in  our  own  unit  were  very  profitable.  I've  often 


117 

said  that  when  I  returned,  I  felt  that  I  owed  the  American  taxpayer 
money  for  my  army  experience. 

Hughes:     What  about  organizational  skills? 

Scheie:       I  had  no  great  organizational  demands  while  in  India.  Our  eye 

section  was  very  busy  and  help  varied  from  very  little  to  as  many  as 
two  officers  helping  me.  We  obviously  had  to  organize  our  wards 
and  clinics.  We  had  separate  eye  wards  in  the  American  and 
Chinese  hospitals  but  no  significant  organizational  problems  were 
involved. 

Hughes:     I  asked  that  question  because  I  read  that  when  you  came  to  design 

the  outpatient  examining  rooms  at  the  Scheie  Eye  Institute,  you  used 
some  of  the  principles  that  you  had  developed  in  India. 

Scheie:       Oh,  yes,  but  that  stemmed  from  improvisation  rather  than 
organization.  I  wasn't  thinking  of  that  as  organizational. 

The  walls  of  our  eye  clinic  were  bamboo  and  the  roof  of  leaves.  To 
examine  eyes  you  need  a  dark  room.  Since  there  was  no  way  to 
black  out  bamboo,  I  arranged  with  an  Indian  army  ordinance 
company  to  build  a  plywood  room  that  could  be  set  up  within  the 
walls  of  my  clinic.  A  small  trap  door  through  which  patients  could 
see  a  vision  test  screen  twenty  feet  away  was  necessary.  The  room 
was  nine  or  ten  feet  square  and  had  a  plywood  roof.  It  was  enclosed 
and  even  the  small  trap  door  could  be  closed.  The  room  was  small 
but  workable  and  proved  to  be  very  efficient.  The  examining  chair 
and  other  equipment,  such  as  the  slit-lamp  microscope,  had  to  be 
very  carefully  placed  because  of  limited  space.  As  a  result, 
everything  was  right  at  hand  and  the  patient  never  had  to  leave  the 
examining  chair  for  the  various  tests.  My  instruments,  such  as  the 
ophthalmoscope,  were  always  within  reach.  I  had  only  to  partially 
turn  to  pick  medications  from  a  wall  cabinet.  The  slit  lamp  was 
placed  so  that  I  could  slide  it  into  the  patient  and  again  he  would 
not  have  to  move.  All  of  our  equipment  was  carefully  arranged  in 
the  little  space  and  the  arrangement  was  very  efficient. 

I  utilized  the  same  principles  when  I  started  practice  with  Dr.  Adler 
after  World  War  II.  Never  needing  to  move  the  patient  from  one 
chair  to  another  proved  to  be  a  great  economy  of  both  time  and 
space.  This  idea  was  also  utilized  in  1960  when  the  eye  clinic  at  the 
university  hospital  was  rebuilt  and  saving  space  was  of  essence. 
Finally,  I  think  it  became  most  efficient  when  we  built  our  new  eye 
institute.  We  had  thirty  examining  rooms,  each  small  and 
identical,  such  that  the  staff  members  never  had  to  work  in  a 
strange  kitchen. 


118 


Returning  from  India 


I  might  tell  the  story  of  my  coming  home  from  India,  showing  what 
a  rascal  I  was.  [laughter] 


Scheie: 

Hughes:     I'd  like  to  hear  that 


Scheie:       I  returned  from  India  in  1945.  My  replacement  had  arrived  and  the 
work  was  tapering.  One  of  our  senior  medical  officers,  Col.  Henry 
Hopkins,  had  herpes  zoster  or  shingles,  which  involved  the  left  eye. 
Possibly  six  weeks  later  he  developed  iritis  and  shortly  secondary 
glaucoma.  The  glaucoma  couldn't  be  controlled  and  the  eye 
remained  inflamed. 

We  had  a  medical  board  hearing  and  I  recommended  that  he  be  sent 
back  to  the  States.  He  was  a  key  professor  at  the  University  of 
Pennsylvania  Medical  School.  I  recommended  sending  him  to 
Valley  Forge  Army  Hospital  Eye  Center.  It  was  one  of  the  five 
military  eye  centers  in  the  United  States  during  World  War  II. 
Since  I  was  due  to  rotate  to  the  States,  it  was  decided  that  I  should 
accompany  Colonel  Hopkins.  At  the  board  hearing,  I  requested  that 
we  be  sent  home  on  a  high  priority  because  he  did  have  this  nasty 
inflammation  and  glaucoma  which  could  be  blinding.  However,  the 
board  decided  and  our  commanding  officer  General  Ravdin  agreed 
that  we  would  go  on  a  routine  priority,  which  often  resulted  in 
layovers  and  delayed  travel. 

At  the  Ledo  airstrip  where  I  knew  the  headquarters'  personnel  I 
asked  if  I  could  use  the  telephone  to  call  New  Delhi.  The 
commanding  officer  Col.  Charles  Davis  said,  "Sure,  Hank,  go 
ahead."  I  called  New  Delhi  and  asked  to  be  connected  with  the 
theatre  surgeon's  office.  With  him  on  the  phone,  I  said,  "This  is 
General  Ravdin  calling.  Major  Scheie  is  on  his  way  back  to  the 
States.  He's  escorting  a  person  with  a  very  nasty  eye,  one  of  our 
senior  officers,  Colonel  Hopkins.  Could  they  pick  up  a  number-one 
priority  when  they  arrive  in  New  Delhi?"  That  was  our  first  stop, 
[laughter] 

When  we  arrived  in  New  Delhi  we  picked  up  these  orders.  I  had 
learned  through  my  trip  to  Chungking  how  hot  a  number- one 
priority  was.  It  was  given  for  presidential-level  VIP  missions.  We 
were  quickly  on  a  plane  for  Karachi  and  then  Cairo.  I  remember 
circling  Cairo  shortly  after  sunrise  on  Thursday  morning.  The  pilot 
was  very  nice  and  showed  us  the  pyramids  as  we  flew  over.  Our 
next  stop  was  in  North  Africa  where  we  picked  up  a  new  plane  and 
flew  on  to  Casablanca.  Again,  no  stopovers.  We  transferred  from 
one  plane  to  another  and  finally,  at  about  ten  in  the  evening  on 
Saturday,  arrived  in  New  York  City  and  then  went  to  McGuire  Air 
Force  Base  on  a  bus.  The  next  day  I  accompanied  Colonel  Hopkins 
to  Valley  Forge  Army  Hospital.  I  stayed  in  Philadelphia  for  two 


119 

nights  and  then  went  on  to  Washington  where  I  delivered  a  pouch  of 
papers  to  the  Surgeon  General,  because  I  had  also  been  asked  to 
serve  as  a  courier. 

To  make  the  story  about  Henry  Hopkins  short,  he  eventually  lost  all 
of  the  sight  in  his  eye,  in  spite  of  excellent  care,  including  surgery. 
Herpes  zoster  involving  the  eye  is  still  an  unpleasant  condition  to 
have.  So  I  told  a  white  lie  in  arranging  our  priority. 

I  didn't  dare  tell  General  Ravdin  until  three  or  four  years  later.  I 
then  said,  "I  have  something  I  want  to  confess  to  you,  Rav,  about 
the  trip  back  with  Henry  Hopkins  after  you  and  the  board  didn't 
give  us  a  high  priority.  I  had  hoped  we  would  have  a  two  or  three 
but  I  think  even  that  was  at  the  bottom  of  the  list.  I  told  him  the 
story.  His  answer  was-you  can  edit  this  if  you  want-"Hank,  you 
son  of  a  bitch."  [laughter]  But  he  said  it  with  good  humor. 

Injection  of  Oxygen  into  Tenon's  Capsule 

Hughes:     Well,  Dr.  Scheie,  there  are  a  couple  of  papers  from  this  period  that  we 
haven't  yet  discussed.  One  of  them  is  entitled,  "Injection  of  oxygen 
into  Tenon's  capsule",  which  I  believe  you  wrote-or  at  least  did  the 
work  for-during  the  India  period.  * 

Scheie:       Yes,  it  resulted  from  a  very  practical  problem. 
Hughes:     Who  was  your  co-author,  Phillip  J.  Hodes? 
Scheie:       He  was  chief  of  our  x-ray  department. 

Hughes:     Could  you  explain  what  the  advantages  of  oxygen  are  over  other 
media?  I  suppose  it  was  mainly  gases  that  had  been  used  for 
providing  contrast? 

Scheie:       Yes.  I  had  done  the  work  because  eye  injuries  on  the  battlefield 
often  involved  multiple  foreign  bodies  in  and  about  the  eye.  A 
hand-grenade  injury  could  be  typical  of  this  and  you  couldn't  know 
which  foreign  bodies  were  in  or  out  of  the  eye.  We  had  no 
satisfactory  way  of  outlining  the  globe.  CAT  scans  are  now  used. 
The  idea  of  injecting  air  into  Tenon's  capsule  came  from  an  article 
by  Spackman.**  We  took  stereo  films  which  showed  the  eyeball 
beautifully  outlined.  It  was  easy  to  tell  which  foreign  bodies  were 
in  an  eye  and  which  ones  were  not.  But  air,  being  ninety  percent 
nitrogen,  would  absorb  slowly  over  two  to  three  days  and  would 
exert  pressure  on  the  eye.  If  there  was  a  need  for  doing  prompt 
intraocular  surgery,  the  external  pressure  exerted  on  the  eyeball 


* 
** 


Scheie  HG,  Hodes  PJ.  Arch  Ophthalmol  1946;  35:13-14. 

Spackman  EW.  X-ray  diagnosis  of  double  perforation  of  eyeball  after  injection  of  air  into  space  of 

Tenon.  Am  J  Ophthalmol  1932;  15:1007-12. 


120 


could  cause  operative  complications,  even  forcing  ocular  contents 
out  through  the  incision.  So  I  tried  other  gases. 

Carbon  dioxide  was  absorbed  so  quickly  that  it  disappeared  before 
x-rays  could  be  taken,  so  it  was  useless.  Most  of  the  oxygen  was 
absorbed  in  four  to  eight  hours.  It  permitted  excellent  stereo  views 
of  the  eye  for  the  location  of  foreign  bodies  and,  furthermore,  it 
absorbed  quickly  enough  to  permit  early  surgery.  I  used  it  after  I 
returned  to  the  States  where  I  was  assigned  to  Crile  Army  Hospital, 
which  was  one  of  the  five  military  eye  centers.  There  we  had  old 
battle  casualties,  and  occasionally  it  was  important  to  be  able  to 
outline  an  eye.  The  method  was  also  occasionally  useful  in 
peacetime. 


Crile  Army  Hospital  Eye  Center,  Cleveland,  Ohio 

Hughes:     Can  you  tell  me  why  you  were  assigned  to  Crile? 

Scheie:       Yes,  that  would  be  very  easy.  When  I  returned  from  India,  I  was  a 
courier  and  carried  a  packet  to  the  Surgeon  General,  which  I 
personally  delivered.  At  that  time  I  was  also  given  my  new 
assignment.  I  was  interviewed  by  Dr.  Derrick  Vail.  Incidentally,  he 
as  a  great  friend  of  Sir  Stewart  Duke-Elder.  Dr.  Vail  was  a 
consultant  in  charge  of  reassignments  in  the  Office  of  the  Surgeon 
General.  He  asked  where  I  would  like  to  be  assigned,  and  I'm  sure 
that  he  expected  me  to  request  Valley  Forge  Army  Hospital  located 
in  the  suburbs  of  Philadelphia.  However,  I'd  had  such  a  great 
experience  in  India  that  I  wanted  to  be  busy  wherever  I  was  sent.  I 
said,  "Well,  I  don't  care  where  I  go  as  long  as  you  send  me  to  a  place 
that  very  badly  needs  an  ophthalmologist."  He  said,  "I  have  just 
the  spot,  Crile  Army  Hospital  Eye  Center,  because  they  have  a 
backlog  of  about  five  hundred  patients  and  there  are  some  serious 
problems  there." 

First  I  had  to  go  to  Miami  Beach  on  a  hardship  leave,  demanded  by 
army  regulations.  It  was,  however,  a  very  pleasant  month.  I  was 
introduced  to  ocean  fishing  and  made  a  few  friends,  then  reported 
to  Crile  Army  Hospital.  Indeed  it  was  as  described.  Help  was 
badly  needed.  A  backlog  of  patients  was  waiting  for  eye  plastic 
surgery  or  to  have  intraocular  foreign  bodies  and  even  eyes 
removed.  Some  needed  cataract  extractions.  Most  of  these 
conditions  were  incurred  overseas  in  various  theatres.  The 
Japanese  war  was  still  on  but  ended  on  August  14, 1945.  After  that 
we  also  had  a  number  of  evacuees  from  Japanese  prison  camps. 
Some  of  them  were  nearly  blind  from  nutritional  optic  nerve 
damage,  some  with  old  battle  injuries  and  other  conditions. 
Patients  had  been  accumulating  and  morale  was  very  low.  They 
were  understaffed  and  facing  vigorous  protest  by  the  patients  when 
I  arrived.  As  a  result,  we  worked  twelve  to  fifteen  hours  a  day 


121 

doing  our  best  to  care  for  their  needs,  including  those  awaiting 
processing  and  discharge  from  the  army. 

Hughes:     I  believe  that  Crile  had  been  designated  as  a  specialized  eye  center 
only  in  1945.  Was  that  because  of  the  sudden  influx  of  casualties'? 

Scheie:       Yes,  because  of  evacuations  from  overseas  theatres. 
Hughes:     They  couldn't  be  absorbed  by  the  existing  centers'? 
Scheie:       That's  right,  and  personnel  was  always  a  problem. 

The  Staff 
Hughes:     Who  made  up  the  staff  when  you  arrived1? 

Scheie:       Our  chief  was  a  very  conscientious,  fine  ophthalmologist  by  the 
name  of  Lt.  Col.  Gilbert  Struble,  whom  I  came  to  admire  a  great 
deal.  We  frequently  saw  each  other  after  the  war.  There  were  other 
ophthalmologists  also,  and  all  quite  overworked. 

Hughes:     How  about  the  others'? 

Scheie:       I'm  just  trying  to  think.  One  was  a  lieutenant  colonel,  his  name 
was  James  Sleight.  Another  was  a  combined  eye,  ear,  nose,  and 
throat  doctor  named  Capt.  Walter  Williams.  He  was  very 
hardworking  and  dedicated.  We  worked  together  very  closely  and 
tried  to  supplement  each  other  in  our  combined  efforts.  I  could 
handle  some  of  the  eye  work  that  he  couldn't  do  and  we  did  the 
paperwork  as  a  team.  Capt.  Leo  Croll  was  an  ophthalmologist  from 
Detroit.  Sleight  was  from  Battle  Creek,  Michigan.  We  also  had  a 
fine  ophthalmologist  from  Indiana,  Pennsylvania.  I  should 
remember  his  name.  But  that  was  the  total  eye  staff. 

Hughes:     Were  you  relying  on  enlisted  men  as  well? 

Scheie:       Oh,  as  much  as  we  could,  as  assistant  nurses  so  to  speak.  We  also 
had  an  excellent  nursing  staff. 

Hughes:     Were  the  enlisted  men  selected  because  they  had  had  some  training 
in  ophthalmology? 

Scheie:       Not  necessarily.  They  were  called  medical  technicians.  You  trained 
them  to  do  whatever  you  wanted  them  to  do  in  ophthalmology. 

Hughes:     Were  there  separate  wards  for  ophthalmological  patients? 
Scheie:       Yes,  we  always  had  our  own  areas. 
Hughes:     Was  that  general  practice  in  the  military? 


122 


Scheie:       It  was  only  general  practice  if  you  had  enough  eye  work  to  justify  it. 
Of  course,  we  were  practically  the  only  eye  care  center  for  North 
Burma  and  India.  Patients  would  even  be  flown  to  us  from  China. 

Hughes:     Who  was  Albert  Darwin  Ruedemann  ? 

Scheie:       He  was  our  civilian  consultant  at  Crile.  I  should  have  mentioned 
him  because  he  was  of  great  help  to  us.  He  was  chairman  of  the 
department  of  ophthalmology  at  the  Cleveland  Clinic,  a  fine 
ophthalmologist  and  a  particularly  good  surgeon. 

Hughes:     When  would  he  be  called  in  for  a  consultation? 

Scheie:       He  usually  came  in  once  a  week  to  work  with  us,  or  more  frequently 
if  necessary  to  see  puzzling  patients. 

Hughes:     Was  that  standard  practice  in  these  military  eye  centers? 

Scheie:       Oh,  yes.  Civilian  consultants  were  available  at  all  of  the  eye 
centers.  At  Valley  Forge  Army  Hospital,  several  senior 
ophthalmologists  acted  as  senior  consultants  even  after  World  War 
II.  It  was  a  very  well-known  eye  center.  After  the  war,  I  became  a 
civilian  consultant  for  the  hospital  in  1946  and  served  for 
twenty-seven  years  until  the  hospital  closed  in  1973. 

Hughes:     Did  you  have  grand  rounds  and  staff  conferences  and  other 
attributes  of  academic  life? 

Scheie:       No,  we  were  too  busy  at  Crile,  processing  patients  and  preparing 
them  for  discharge,  but  we  would  see  difficult  cases  together  on 
rounds  which  were  held  daily. 

Hughes:     What  is  your  opinion  of  the  medicine  and  surgery  that  you  saw 

practiced  at  Ledo  and  Crile  in  comparison  to  what  you  were  used  to 
at  the  University  of  Pennsylvania? 

Scheie:       I  think  they  were  actually  very  comparable  because  we  were  an 
affiliated,  academically  oriented  unit  from  the  University  of 
Pennsylvania  Hospital.  Everyone  was  well  trained.  Fortunately  at 
Crile  Army  Hospital  many  of  the  personnel  were  from  the  affiliated 
Western  Reserve  University  Unit  which  had  recently  returned  from 
overseas.  Many  of  their  top  people  in  internal  medicine  and 
surgery  were  with  us,  so  I  was  again  fortunate. 

Hughes:     Do  you  think  that  was  the  case  in  other  military  eye  centers? 

Scheie:       To  my  knowledge,  all  of  the  eye  centers  were  excellent.  In  the 

United  States,  most  of  the  patients  with  serious  conditions  or  those 
needing  eye  surgery  were  sent  to  eye  centers.  As  a  result,  only 
minor  problems  were  cared  for  at  most  smaller  or  station  hospitals. 


123 


When  I  was  at  Camp  Claiborne,  shortly  after  we  were  activated,  I 
worked  at  the  station  hospital  for  a  while.  The  service  was 
understaffed,  even  for  routine  care,  and  optometrists  were  of 
necessity  given  more  responsibility  than  I  personally  approved  of. 
However,  it  was  wartime  and  large  numbers  of  military  personnel 
had  to  be  screened.  For  example,  the  28th  National  Guard  Division 
from  Pennsylvania  was  at  Claiborne  and  in  the  midst  of  their 
training  the  decision  was  made  to  terminate  the  division  and  divide 
the  personnel  to  form  the  82nd  and  101st  airborne  divisions.  They 
later  became  famous  for  their  exploits  as  our  first  two  airborne 
divisions.  Gen.  Matthew  Bunker  Ridgeway  commanded  one.  All 
personnel  were  required  to  have  eye  examinations. 

Hughes:     Was  there  a  problem  of  having  assistants  transferred? 

Scheie:       No  more  than  for  other  medical  officers.  I  might  have  one  or  two 
helping  me  in  India  when  a  need  for  an  ophthalmologist  arose 
elsewhere  and  one  of  them  would  be  transferred.  In  fact,  I  never 
had  any  one  ophthalmologist  remain  with  me  for  as  long  a  period  as 
my  assistant.  That  was  bad  but  also  good  because  I  had  to  take  a 
tremendous  amount  of  responsibility,  which  resulted  in  a  great 
experience.  I  came  out  of  the  service  feeling  very  fortunate. 

Hughes:     I  read  of  a  three-day  military  ophthalmologic  meeting.  It  was  held 
at  Crile  in  November,  1945. 

Scheie:       Yes,  and  it  was  chaired  by  a  good  friend  of  mine,  Trygve  Gundersen 
from  Boston. 

Hughes:     The  name  sounds  very  Norwegian.  Is  it? 

Scheie:       Yes. 

Hughes:     What  was  the  purpose  of  the  meeting? 

Scheie:       It  was  to  compare  wartime  experiences  and  observations.  People 

had  been  in  various  places  all  over  the  world  during  the  war.  There 
must  have  been  fifty  ophthalmologists  at  the  meeting  and,  with  the 
war  over,  the  timing  seemed  appropriate. 

Hughes:     People  came  from  all  the  military  eye  centers? 

Scheie:       Yes.  We  were  able  to  have  orders  issued  for  them.  It  was  a  very 
nice  meeting,  actually. 

Hughes:     Did  you  prepare  a  presentation  ? 

Scheie:       I  think  I  gave  something.  I've  forgotten  what  it  was  now.  We  at 
Crile  were  the  hosts. 


124 


Fever  Therapy 

Hughes:     I  read  of  fever  therapy  in  connection  with  Crile  Army  Hospital. 

Scheie:       Well,  you've  probably  also  heard  that  leeches  were  applied  to  the 

temple  for  an  inflamed  eye.  I  think  as  a  first  year  resident  I  applied 
the  last  one  ever  used  at  the  university  hospital.  Patients 
undoubtedly  recovered  in  spite  of  the  leech  or  at  least  the 
inflammation  ran  its  natural  course  with  no  harm  done. 

Fever  therapy  proved  to  have  some  rationale,  however.  I  was 
taught  to  use  it  as  a  resident  in  training.  In  those  days  and  during 
World  War  II,  we  had  nothing  better  for  nonspecific  eye 
inflammations,  such  as  iritis  and  uveitis,  which  we  now  know 
cortisone  will  help  dramatically.  There  is  some  evidence  that  fever 
therapy  with  its  shocklike  effect  causes  a  release  of  a  cortisone-like 
substance.  The  results  were  often  quite  dramatic. 

Hughes:     What  were  you  using  to  induce  the  fever? 

Scheie:       Typhoid  vaccine  which  contained  killed  typhoid  organisms.  The 
height  of  the  fever  usually  depended  on  the  number  of  organisms 
injected. 

Hughes:  Did  you  get  a  fairly  constant  reaction  to  the  typhoid  vaccine? 

Scheie:  Yes. 

Hughes:  I  saw  reference  to  a  fever  cabinet. 

Scheie:  I  never  used  one  of  those. 

Hughes:  So  as  far  as  you  know,  there  wasn't  one  at  Crile? 

Scheie:  Not  that  I  know  of. 

Penicillin  and  Sulfa  Drugs 

Hughes:  Do  you  recollect  when  you  first  began  to  use  penicillin? 

Scheie:       We  did  not  have  penicillin  in  India  but  we  had  sulfonamides.  I 

don't  believe  we  had  penicillin  at  Crile  Army  Hospital.  It  was  still 
on  a  restricted  ration  basis.  The  next  antibiotic  to  come  along  that  I 
recall  was  streptomycin  and  its  use  was  even  more  carefully 
controlled  by  a  committee. 

Hughes:     When  you  were  back  at  the  University  of  Pennsylvania  after  the  war? 
Scheie:       Right.  But  it  was  not  available  to  us  at  Crile. 


125 


Hughes:     Were  infections  a  problem  in  India? 

Scheie:       They  were  a  problem,  but  we  did  pretty  well.  I  used  prophylactic 
sulfonamide  drugs  a  great  deal  after  surgery.  In  fact,  I  was  able  to 
have  a  theatre  directive  circulated  which  required  medics  at  the 
scene  to  administer  oral  sulfonamides  immediately  before 
evacuation  to  any  soldier  with  an  injured  eye.  That  reduced  the 
number  of  infections  in  eyes  with  perforating  injuries.  It  was  a 
great  help  but  certainly  was  not  as  effective  as  present-day 
antibiotics. 


Commanding  General,  31st  Hospital  Center 
Headquarters 

Hughes:     Well,  Dr.  Scheie,  you  served  after  World  War  II  as  deputy  commander 
and  later  as  commanding  general  of  the  31st  Hospital  Center 
Headquarters.  How  did  that  come  about? 

Scheie:       I  was  made  the  31st  Hospital  Center  deputy  commander  because  of 
my  many  years  in  the  reserve  corps.  My  commission  dated  from 
January,  1936,  and  I  had  had  eight  years  before  this  in  the  ROTC. 
I  decided  to  retain  my  commission  after  World  War  II.  At  that  time 
General  Ravdin  had  me  appointed  deputy  commander  of  the  31st 
Hospital  Center  of  which  he  was  commanding  general.  Later  when 
he  retired,  I  succeeded  him  and  continued  in  that  position  until 
1964. 

Hughes:     What  were  your  responsibilities? 

Scheie:       Well,  the  Hospital  Center  Headquarters  had  several  United  States 
Army  Reserve  hospitals  under  our  command  and  some  smaller 
units.  Our  mission  was  to  maintain  a  state  of  readiness  in  case  of 
emergency.  We  had  weekly  meetings,  depending  upon  regulations, 
and  two  weeks  of  active  duty  in  the  summer.  Our  job  as  a  Hospital 
Center  Headquarters  was  to  coordinate  the  activities  of  the  reserve 
units  which  were  assigned  to  us  and  see  that  they  were  adequately 
trained  and  staffed. 


We  also  had  units  in  neighboring  states  assigned  to  us,  in  addition 
to  those  in  Pennsylvania.  This  was  a  large  responsibility 
considering  the  relatively  small  amount  of  time  we  had  to 
accomplish  it.  We  had  units  at  one  time  from  as  far  away  as  Ohio, 
Maryland,  and  throughout  Pennsylvania.  I  believe  that  for  a  while 
we  had  a  reserve  unit  or  two  in  New  Jersey. 


126 


Our  own  weekly  meetings  were  devoted  to  reviewing  each  unit's 
reports  and  to  maintaining  good  liaison,  particularly  pertaining  to 
training,  and  occasionally  inspection  visits. 

In  the  summer,  our  Hospital  Center  Headquarters  would  supervise 
and  organize  medical  care  to  be  furnished  by  our  units  for  National 
Guard  and  Reserve  Line  units  which  were  on  active  duty  at  various 
camps.  So  we  would  have  units  under  our  command  on  active  duty 
throughout  the  summer  during  the  reserve  training  periods.  Our 
outfit  would  have  two  weeks  of  solid,  continuous  duty,  and  then  I 
would  make  sporadic  trips  to  the  other  units  during  the  summer. 

Hughes:     Did  you  find  your  wartime  experience  helpful? 

Scheie:  Oh  yes.  You  learned  the  army  lingo,  the  system  of  reporting,  and  a 
great  deal  about  administration.  Yes,  it  was  a  great  experience  for 
me. 

Hughes:     What  is  your  opinion  of  the  army  way  of  doing  things? 

Scheie:       I  have  great  respect  for  it.  I  have  heard  jokes  about  their 

paperwork  and  organization  but  I  am  not  sure  that  it  isn't  less 
complicated  and  more  orderly  than  much  of  the  civilian 
administration  that  I  have  seen.  In  general,  the  people  were  and 
are  dedicated. 

Hughes:     In  1954  you  were  promoted  to  brigadier  general.  Do  you  know  why1? 

Scheie:       Because  I  had  assumed  command  of  the  center  and  the  position 
called  for  it.*  That  entitled  me,  if  I  did  an  adequate  job,  to  be 
promoted. 

Hughes:     At  your  retirement  from  the  army,  you  received  the  Legion  of  Merit 
Was  there  indication  of  any  particular  contribution  that  you  had 
made? 

Scheie:       The  citation  stated  that  I  demonstrated  a  thorough  knowledge  of 
the  medical  services  of  the  army  and  outstanding  ability  as  an 
administrator  and  professional  leader.  Our  unit  had  always 
performed  well  and  we  were  always  graded  well  by  people  from  the 
Office  of  the  Surgeon  General  and  the  Surgeon  General's  office  in 
our  area. 

Hughes:     Why  did  you  decide  to  take  on  this  extra  and  somewhat 

time-consuming  activity  when  you  surely  had  enough  to  keep 
yourself  busy  with  your  academic  work  and  your  private  practice? 


In  1951,  Dr.  Scheie  became  commanding  general  of  the  303rd  Hospital  Center,  later  renumbered 
the  31st  Hospital  Center.  He  was  promoted  to  brigadier  general,  US  Army  Reserves,  January  26, 
1954. 


127 


Scheie:       I  don't  know  how  I  ever  did  all  of  that,  but  as  I  look  back  it  was  a 

matter  of  loyalty  and  it  gave  me  a  sense  of  satisfaction.  I  had  taken 
my  commission  with  great  pride  when  I  graduated  from  medical 
school  and  I  prized  it,  a  bit  like  the  reason  I  went  on  active  duty  in 
World  War  II  when  I  was  exempt.  Also,  I  enjoyed  the  association 
and  I  learned  a  great  deal  about  administration,  especially  how  to 
organize  and  delegate. 

Hughes:     Skills  you  later  used  at  the  University  of  Pennsylvania1? 

Scheie:       Oh,  yes.  As  chairman  of  the  department  of  ophthalmology,  I  put  a 
great  deal  of  that  to  good  use,  and  especially  running  the  eye 
institute. 

Hughes:     Was  your  administrative  style  different  from  other  academicians 
because  of  your  military  experience1? 

Scheie:       I  learned  to  delegate  and  to  realize  the  necessity  of  holding  people 
responsible  for  assignments  by  following  up.  We  met  once  a  week. 
My  staff  carried  the  detail  work  and  coordinated  the  other  units. 
Each  week  I  would  meet  with  my  staff  and  ask  how  did  this  go  or 
that  go?  I  would  review  the  various  assignments  and  later  used 
much  the  same  methods  in  the  eye  institute.  Someone  was 
assigned  a  job  but  then  held  responsible.  The  key  to  administration 
is  willingness  to  delegate  but  to  expect  accountability. 

Hughes:     That  technique  served  you  well  both  as  chairman  of  the  department 
and  eventually  director  of  the  institute1? 

Scheie:       Oh  yes.  I  think  it  has  also  helped  me  in  work  with  various  medical 
organizations  like  the  former  Section  on  Ophthalmology  of  the 
American  Medical  Association.* 


Brigadier  General,  U.S.  Army 


Dr.  Scheie  held  several  position  in  the  section:  secretary  (1954-1959),  chairman  (1960),  and 
representative  at  large  (1970-1977). 


IV.  University  of  Pennsylvania 


The  Immediate  Postwar  Period 


Hughes:     In  1946  you  returned  to  the  University  of  Pennsylvania.  Did  you 
ever  consider  going  anywhere  else1? 

Scheie:       Not  seriously. 

Hughes:     Did  you  go  directly  from  Crile  back  to  the  University  of 
Pennsylvania1? 

Scheie:       Yes. 

Hughes:     What  did  you  find  when  you  got  there? 

Scheie:       Well,  of  course,  I'd  been  there,  knew  the  situation  well,  and  I  had 
been  very  close  to  Dr.  Adler,  who  was  the  chairman  of  the 
department.  I  came  back  to  practice  with  him  in  his  private 
downtown  office  where  we  became  partners.  We  both  did  private 
practice  in  the  mornings  and  spent  afternoons  at  the  university.  He 
was  a  very  unselfish  partner  and  gave  me  a  free  hand  to  advance 
myself  both  in  building  a  practice  and  in  my  department  activities. 

Hughes:     The  war  had  not  been  terribly  disruptive  to  the  department1? 

Scheie:       No,  because  it  was  a  small  department. 

Hughes:     Most  of  the  department  stayed  throughout  the  war  period1? 

Scheie:       I  was  the  only  close  staff  member  to  be  taken  by  the  army.  Dr. 

Leopold,  who  was  a  resident  when  I  left,  had  stayed  on  to  help  Dr. 
Adler  in  the  department  and  to  carry  on  research.  In  addition,  he 
had  Dr.  Alan  Crandall.  The  rest  of  the  staff  was  unchanged.  They 


130 

would  come  in  for  an  hour  or  so  one  or  two  days  a  week.  But  Dr. 
Leopold  was  close  to  the  department  and  contributed  a  great  deal. 
So  was  Dr.  Crandall,  who  completed  his  residency  and  stayed  on  to 
help  Dr.  Adler  with  his  practice  and  in  the  department. 

Hughes:     Elsewhere  in  the  university  had  the  war  made  an  impact1? 

Scheie:       Oh,  I  am  sure  that  it  had.  They  missed  the  excellent  people  who 

had  gone  with  the  20th  General  Hospital.  Our  unit  had  some  of  the 
best  people  from  the  hospital.  Most  of  them  were  young  or  middle 
age  and  represented  a  great  deal  of  substance.  A  good  many  of 
them  over  the  years  became  key  members  of  the  staff  and  even 
chairmen  of  departments  or  heads  of  section.  Obviously  such 
people  were  missed. 

Hughes:     You  came  back  with  considerably  more  experience  than  most  men 
would  have  had  at  your  particular  stage  of  career.   You  were  still  a 
young  man. 

Scheie:       I  came  back  and  never  did  give  it  that  much  thought.  When  asked, 
I  told  friends  how  fortunate  I  had  been,  that  possibly  I  was  ten 
years  ahead  professionally. 

More  on  Francis  Heed  Adler 

Hughes:     Did  Dr.  Adler  recognize  that? 

Scheie:       Oh,  he  was  always  wonderful  to  me  but  we  never  discussed  the 
matter.  He  never  could  quite  understand  how  I  could  say  I  had 
enjoyed  my  time  in  the  army.  As  I  stayed  in  practice  with  him,  I 
was  given  increasing  responsibility  in  the  department  and  the 
opportunity  to  build  my  own  patient  following  and  referral  sources. 
He  was  not  as  interested  in  surgery  as  I  was  and  delegated  certain 
types  to  me.  Later  he  recognized  my  interest  in  glaucoma  and  I 
saw  most  of  the  glaucoma  patients. 

At  the  university,  I  did  a  great  deal  of  the  routine  teaching  and 
assisting  the  residents.  I  guess  I  had  more  to  do  with  the  residents 
than  he  because  I  was  there  early  till  late  and  felt  the 
responsibility.  He  was  a  part-time  chairman,  and  that  was  his 
agreement.  I  never  knew  what  the  word  part-time  meant,  I  guess. 

Hughes:     He  was  older  than  you.  Did  you  look  upon  him  as  your  senior"? 
Scheie:       Oh,  yes,  and  he  had  the  deep  respect  of  everyone. 
Hughes:     So  there  was  no  question  of  equality? 

Scheie:       Oh,  no.  I  was  an  old  army  veteran  by  this  time  and  I  have  always 
had  the  attitude,  if  I  was  working  for  someone,  it  was  his  show. 


131 


Hughes:     Did  you  usually  see  things  eye  to  eye1? 

Scheie:       Oh,  yes.  We  never  ever  had  any  serious  problem.  Unfortunately, 
when  people  get  ready  to  retire,  they  may  feel  a  growing  insecurity, 
which  I  have  sensed  in  my  own  life. 


Francis  Heed  Adler  and  Harold  G.  Scheie 

[photo  by  Laurel  M.  Weeney] 


Hughes:     So  it  was  a  very  smooth  working  arrangement? 

Scheie:       Yes.  We  never  had  any  real  problems,  at  least  that  I  was  aware  of. 
It  was  his  department  and  I  recognized  that.  I  spent  considerable 
time  on  research  and  with  the  residents.  But  I  was  unaware  of  any 
conflict.  However,  I  may  have  been  insensitive.  From  my  point  of 
view,  it  was  a  wonderful  relationship. 

Hughes:     Could  you  say  something  about  his  administrative  and  teaching 
style  in  comparison  to  yours. 

Scheie:       Oh,  he  was  a  much  better  teacher  than  I.  He  was  an  excellent 

lecturer;  he  spoke  beautifully  and  wrote  equally  well.  His  Textbook 
of  Ophthalmology,  which  eventually  I  took  over,  was  a  very  fine  and 
popular  book.  He'd  written  a  book  on  physiology  of  the  eye  in  the 
1930s  which  was  the  book  on  that  subject  for  years.  He  was  a 
brilliant  person,  very  talented  in  many  fields— art,  a  fine  musician, 
had  a  Guarnerius  violin,  and  he  played  with  the  finest  musicians  in 


132 

the  city.  He  had  a  great  many  interests  and  talents  that  I  was  not 
fortunate  enough  to  have.  As  a  teacher  and  lecturer  he  was 
outstanding. 

You  asked  me  about  administrative  style.  I  don't  think  he  enjoyed 
the  details  of  running  the  department  and  it  was  small  enough  that 
the  job  was  not  terribly  demanding.  He  was  more  tolerant  of  many 
things  than  I  would  have  been. 

Hughes:     What  was  his  first  love  in  terms  of  ophthalmology? 

Scheie:       His  favorite  was  the  physiology  and  management  of  ocular  muscle 
problems  and  then  probably  teaching  and  writing.  I  never  felt  that 
he  truly  enjoyed  patients  to  an  equal  degree,  although  he  was  a  fine 
clinician  and  he  certainly  liked  to  help  people.  He  was  very 
gracious  and  friendly  to  them.  Our  patient  relationships  were  a 
little  different  because  mine  were  probably  more  informal  and 
jovial.  In  my  retirement,  I  do  miss  seeing  patients  and  the 
conviviality.  Dr.  Adler  was  comfortable  economically  and  took  three 
months  off  nearly  every  summer,  which  gave  me  the  opportunity  to 
run  the  practice  and  oversee  the  department.  This  helped  me  in 
many  ways  and  as  a  result  of  my  activities  did  not  change  greatly 
when  I  became  chairman  in  1960.  The  residents  and  the 
department  activities  had  been  almost  as  much  my  responsibility  as 
his.  It  worked  out  beautifully  and  I'll  be  forever  grateful  to  him. 

Instructor,  Graduate  School  of  Medicine* 

Hughes:     In  1946  you  became  an  instructor  in  the  Graduate  School  of 

Medicine  at  the  University  of  Pennsylvania.  To  an  outsider,  or  at 
least  to  this  outsider,  the  differences  between  the  department  of 
ophthalmology  per  se  and  the  one  in  the  Graduate  School  of 
Medicine  are  confusing. 

Scheie:       Well,  the  situation  was  and  to  me  still  is  confusing.  The  university 
had  a  separate  graduate  school  of  medicine  with  its  own 
departments,  including  ophthalmology,  headed  by  separate 
chairmen.  During  my  time,  the  dean  and  chairman  was  Dr.  Luther 
Peter,  followed  by  Dr.  Edmund  B.  Spaeth,  and  Dr.  Irving  Leopold. 
The  headquarters  for  these  departments  for  teaching  and  clinical 
work  was  at  the  Graduate  Hospital,  which  was  near  center  city, 
apart  from  the  university  hospital.  It  is  still  there  today  but  the 
graduate  school  has  been  terminated  and  the  hospital  has  been 
rebuilt  and  has  only  a  loose  relationship  to  Penn. 

Hughes:     Is  the  graduate  school  the  predecessor  of  the  present  Division  of 
Graduate  Medicine? 


Parts  of  the  transcript  of  a  later  discussion  of  the  graduate  school  have  been  incorporated  here. 


133 


Scheie:       No.  At  the  time  I  succeeded  Dr.  Leopold  in  1963,  the  graduate 

school  was  about  to  be  reorganized,  and  plans  possibly  existed  for 
terminating  it.  In  1969  this  did  occur.  I  was  chairman  of  the 
graduate  school  department  of  ophthalmology  and  until  that  time  I 
used  the  opportunity  to  combine  the  graduate  work  with  our 
residency  training. 

Hughes:     But  originally  these  two  programs  were  entirely  separate? 
Scheie:       Entirely  separate. 

Hughes:     There  was  the  residency  program  in  ophthalmology  at  the  Hospital 
of  the  University  of  Pennsylvania  and  the  graduate  course  in 
ophthalmology  given  at  an  entirely  different  location  and  under 
different  auspices. 

Scheie:       That's  right,  and  people  from  all  over  the  country  and  even  abroad 
came  to  attend  [the  latter].  Originally  it  was  independent,  and  I 
had  to  petition  for  permission  to  take  courses  during  the  second 
year  of  my  residency.  Our  succeeding  residents  and  I  continued  to 
take  selected  courses  and  we  could  also  do  research  and,  if  approved 
by  the  thesis  committee,  receive  a  doctor  of  science  degree.  I  did  a 
research  project  on  Adie's  syndrome,  wrote  a  thesis  on  the  subject, 
and  received  my  doctor  of  science  degree  from  the  Graduate  School 
of  Medicine  in  1940.  The  program  was  a  significant  motivating 
factor  in  stimulating  research  by  our  residents. 

Hughes:     Did  you  cover  subjects  similar  to  what  later  became  part  of  the 
residency  in  ophthalmology? 

Scheie:       In  1964  the  graduate  school  was  merged  with  the  undergraduate 
school  as  a  division  of  the  school  of  medicine  and  I  became 
chairman  of  the  division.  For  the  first  time  [both  programs  were] 
under  one  person.  I  then  combined  the  two  into  a  more  concentrated 
program  than  was  previously  offered.  It  was  a  great  advantage  to 
us  to  share  the  basic  science  teaching  with  the  faculty  of  the 
graduate  school.  The  course  was  given  over  a  three-month  period 
at  the  start  of  the  residency  program.  Our  own  and  other  residents 
participated. 

Also,  I  brought  in  more  speakers  from  other  schools,  such  as  Dr. 
John  Harris  from  the  University  of  Minnesota  to  teach  chemistry. 
For  pharmacology,  I  invited  Dr.  Phillip  Ellis  from  the  University  of 
Colorado,  Denver.  Dr.  Harold  Falls,  University  of  Michigan  gave 
beautiful  lectures  on  genetics.  Speakers  from  other  schools  were 
invited  to  teach  on  still  other  basic  science  subjects.  This  included 
that  great  teacher,  Paul  Boeder,  on  optics.  It  meant  concentration 
on  their  specialty  for  a  few  days.  They  would  often  stay  at  our 
home  while  in  Philadelphia,  which  added  to  my  pleasure. 


134 


Hughes:     Did  a  resident  have  any  choice  in  the  curriculum1? 

Scheie:       No,  all  of  the  residents  had  to  take  the  basic  course.  It  was 

originally  set  up  as  a  full-time  nine-month  course.  In  the  old  days, 
that  and  possibly  a  preceptorship  might  be  all  of  the  training  that 
an  ophthalmologist  might  have.  He  would  then  go  into  practice.  Of 
course,  that  was  years  ago.  I  felt  that  it  was  much  too  long  when 
combined  with  residency,  so  I  reduced  it  to  about  three  months.  All 
of  our  residents  and  others,  including  some  from  Wills,  took  the 
course. 

Chairman,  Department  of  Ophthalmology 

Hughes:     You  became  chairman  of  the  department  of  ophthalmology  in  1960. 
Were  you  the  first  full-time  chairman? 

Scheie:       I  was  the  first  full-time  chairman. 

Hughes:     Was  it  your  idea  to  make  the  departmental  chairmanship  full  time? 

Scheie:       No.  Other  people  were  interviewed  for  the  job  also  and  were  asked 
if  they  would  become  full-time  chairmen.  My  answer  was  that  I 
would  become  a  geographic  full-time  chairman,  not  on  a  salary 
basis,  but  I  would  continue  my  private  practice.  I  was  appointed 
and  I  never  received  a  salary  from  Penn. 

Hughes:     Why  did  you  choose  to  do  it  that  way? 

Scheie:       Because  I  wanted  my  independence.  The  university  had  no  budget 
for  ophthalmology.  We  received  about  $15,000  from  an  endowment 
left  by  Dr.  de  Schweinitz.  The  rest  of  the  support  came  from  my 
practice.  Without  that,  the  department,  the  eye  institute,  and 
especially  the  research  endowment  fund  could  never  have  been 
realized. 

Hughes:     You  say  that  because  of  the  contacts  you  were  able  to  make  through 
your  practice? 

Scheie:       Yes.  I  don't  believe  a  full-time  chairman  could  have  made  the  same 
contacts.  President  Gaylord  Harnwell  appointed  me  as  chairman 
with  the  understanding  that  I  would  build  the  department,  which 
included  developing  a  research  department  and  fund  raising. 
Anytime  that  I  wasn't  doing  an  adequate  job  as  chairman,  salary  or 
no,  I  understood  that  the  arrangements  could  change.  I  was  to 
decide  how  much  time  I  would  devote  to  my  practice.  All  of  this  was 
clearly  stated  at  my  request  and  with  President  Harnwell's 
agreement  in  his  appointment  letter. 

Hughes:     There  had  been  a  search  committee? 


135 


Scheie:       Oh,  yes.  The  chairman  was  Dr.  Franklin  Payne.  The  search 

committee  asked  me  if  I  could  consider  coming  full  time  at  a  salary 
and  I  had  said,  "No,  but  I'll  come  on  geographic  full  time." 

Hughes:     So  it  wasn't  an  assumption  that  you  would  follow  immediately  in  Dr. 
Adler's  footsteps? 

Scheie:       No,  they  had  a  search  committee,  [interruption] 

Retinal  Detachment  Work 

Hughes:     In  1949,  Dr.  Scheie,  you  published  a  paper  with  Bourne  Jerome 
entitled,  "Electrocoagulation  of  the  solera:  Reduction  in  ocular 
volume  and  pathologic  changes  produced,"*  which  was  a  form  of 
scleral  shortening  that  had  been  used  in  retinal  detachment  work.  It 
was  a  rather  radical  means  of  treating  retinal  detachment. 

Scheie:       The  work  was  done  on  dogs'  eyes  but  it  was  never  employed  for 
humans.  I  was  interested  when  last  week  one  of  our  retina 
specialists  came  to  me  about  some  work  that  was  being  done  on 
coagulation  of  the  sclera  that  he  considered  to  have  some  merit.  He 
was  unaware  of  the  fact  that  I  had  done  similar  work.  He  was 
talking  about  almost  the  same  thing.  Nothing  ever  came  of  my 
paper  but  the  findings  are  recorded. 

However,  experiments  with  cautery  of  the  sclera  led  to  my  filtering 
operation  for  glaucoma.  I  had  learned  that  if  you  apply  heat  to  the 
sclera  it  shrinks.  This  observation  was  utilized  later  in  developing 
my  glaucoma  cautery  operation.  Heat  applied  to  a  scleral  incision 
causes  the  scleral  lips  to  retract  and  separate  because  of  scleral 
shrinkage,  and  a  fistula  forms  to  allow  filtration  of  aqueous. 

Hughes:     Did  you  ever  do  much  retinal  detachment  work? 

Scheie:       Yes,  I  did  quite  a  bit  but  in  1971 1  started  a  retina  service  while  still 
at  HUP,  preparatory  to  moving  into  our  new  eye  institute  in  1972. 
At  that  time  I  stopped  doing  detached  retinas  because  I  felt  that  it 
had  become  a  true  specialty  and  a  very  legitimate  one.  Since  World 
War  II,  great  progress  and  many  advances  have  been  made  in  the 
field,  too  many  to  review  here. 

Hughes:     Were  you  a  member  of  a  certain  school  or  a  practitioner  of  a  certain 
approach? 

Scheie:       No,  but  I  tried  to  stay  up  to  date. 


Am  J  Ophthalmol  1949;  32:6,  60-78,  part  II. 


136 


Hughes:     Dr.  [Dohrmann  KJ  Pischel,  with  whom  I've  talked,  followed  quite 
closely  the  original  work  of  Jules  Gonin,  and  of  Carl  Lindner,  Karl 
Safar,  and  the  European  school,  with  their  refinement  ofGonin's 
treatment.  * 

Scheie:       Oh  yes.  Pischel  devised  the  special  retinal  pins  that  he  used  and  a 
special  technique  for  applying  diathermy.  The  basic  principle  was 
evolved  in  the  twenties  by  Gonin  when  he  emphasized  the 
importance  of  sealing  the  retinal  hole,  which  was  done  with  cautery. 
To  cure  a  detachment  the  hole  had  to  be  sealed.  His  principles  have 
been  utilized  ever  since,  modified  and  refined  by  many. 

Hughes:     And  that  was  Gonin's  work? 

Scheie:       That  was  basically  Gonin's  work  and  it  was  fundamental.  After 
that  there  was  a  myriad  of  ways  or  attempts  to  seal  the  hole.  Of 
great  importance  is  the  indirect  binocular  ophthalmoscope  of 
Charles  Schepens,  which  helped  find  the  hole  in  a  much  higher 
percentage  of  patients.  A  special  retinal  contact  lens  can  also  be 
very  helpful  in  finding  peripheral  holes. 

The  scleral  buckle  is  an  old  procedure  but  Schepens  should  be  given 
credit  for  improving  the  technique  and  popularizing  it.  All  cautery 
shrinks  the  sclera  somewhat  and  has  a  flattening  effect  on  the 
curvature  which  helps  to  push  the  choroid  toward  the  hole,  the 
principle  that  is  involved  with  a  scleral  buckle. 

Hughes:     This  technique  was  never  widely  used? 

Scheie:       No.  But  no  matter  how  the  cautery  is  used  some  shrinkage  results. 
I  think  most  surgeons  didn't  realize  that  they  were  causing 
shortening. 

I  never  pretended  to  be  a  retina  specialist.  I  was  a  general 
ophthalmic  surgeon  and  did  most  procedures,  including  corneal 
transplants.  I  hope  that  I  did  them  well,  but  as  the  retina 
specialists  were  doing  better  work  and  expanding  their  knowledge 
in  other  phases,  such  as  diabetes,  macular  degeneration,  and 
others,  I  established  a  retina  section  and  stopped  operating 
detachments  myself.  In  recent  years,  I  also  had  stopped  doing 
corneal  transplants  because  we  attracted  a  fine  cornea  specialist 
and  had  established  a  corneal  section  in  the  eye  institute.  Doing 
this  as  his  specialty,  he  should  get  better  results  than  nonspecialists 
and,  of  course,  promote  research  in  the  field. 


Dohrmann  Kaspar  Pischel,  MD.  American  Links  with  Germanic  Ophthalmology,  Retinal 
Detachment  Surgery.  Ophthalmology  Oral  History  Scries,  A  Link  with  Our  Past.  An  interview 
conducted  by  Sally  Smith  Hughes,  PhD,  1987,  pp  46-54. 


137 


Radiation  of  the  Cornea 

Hughes:  You  published  a  paper  in  1950,  "The  effect  of  low-voltage  roentgen 
rays  on  the  normal  and  vascularized  cornea  of  the  rabbit."*  How 
did  you  get  into  this  subject? 

Scheie:       Well,  we  didn't  know  as  much  about  cornea  then  as  we  do  today. 
Interest  in  this  topic  began  at  about  the  end  of  World  War  II.  Dr. 
A.D.  Ruedemann  was  pioneering  in  applying  beta  radiation  to  the 
cornea  for  various  conditions,  usually  to  obliterate  corneal 
vascularization.  A  beta  applicator  was  used  which  theoretically  did 
not  penetrate  deeply.  And  they  were  doing  a  great  deal  of  this  work 
at  the  Wilmer  Institute. 


Before  long  there  were  suspicions  that  radon  might  be  causing 
cataracts.  Dr.  William  Hughes  in  Chicago  eventually  documented 
these  suspicions. 

Hughes:     The  radiation  was  applied  externally? 

Scheie:       Externally  in  contact  with  the  cornea.  I  had  refrained  from  using 
the  [radon]  applicator,  but  at  that  time  our  radiology  department 
acquired  a  very  superficial  type  of  x-ray  that  was  delivered  by  the 
Phillips  Contact  Therapy  Apparatus.  I  felt  that  the  newly 
developed  x-ray  tube  offered  promise,  but  it  hadn't  been  tested 
carefully  enough  for  safety  for  ophthalmic  use.  It  yielded 
low-  voltage  roentgen  rays,  with  only  superficial  tissue  penetration. 

We  agreed  that  it  could  be  a  good  research  project.  The  actual  work 
was  done  primarily  by  Dr.  Richard  C.  Ripple,  a  skilled  roentgen 
therapist.  If  one  could  prevent  vascularization  of  corneal  grafts,  it 
would  be  helpful.  We  employed  this  superficial  x-ray  to 
experimental  animals  and  to  some  human  corneal  grafts  with  a 
very  poor  prognosis,  to  prevent  vascularization.  We  did  extensive 
studies  of  the  effect  upon  lenses  in  rabbit  eyes  using  exposures  of 
various  levels  to  see  if  it  would  cause  cataracts  and  at  what  dosage. 
It  proved  to  be  safe  but  it  was  never  widely  used.  The  project, 
however,  was  interesting. 

Hughes:     Did  that  perhaps  spark  your  interest  in  cyclotron-  induced  cataracts? 
The  workers  about  the  cyclotrons  reported  a  higher  incidence  of 
cataracts. 

Scheie:       I  wasn't  involved  in  any  of  that  research,  but  certainly  we  began  to 
be  interested  in  it.  Not  too  many  years  ago,  for  instance,  my  chief 
had  cancers  affecting  most  of  his  fingers.  The  original  workers  with 


Scheie  HG,  Dennis  RH,  Ripple  RC,  Calkins,  LL,  Buesseler  J.  Am  J  Ophthalmol  1950;  33,4:549-71. 


138 

roentgen  rays  unfortunately  had  no  idea  of  the  hazards,  such  as 
cancer  and  cataracts.  This  knowledge  was  gradually  acquired  as  a 
result  of  many  calamities.  We  know  that  some  dentists  who  worked 
in  busy  clinics  in  World  War  II  developed  cataracts  from  accidental 
exposure  to  leaky  x-ray  machines  that  weren't  screened  properly. 

We  injected  animals  to  produce  vascularization  and  then  tried  to 
prevent  it.  Our  irradiation  was  retardative  but  not  dramatic. 

Hughes:     One  of  your  conclusions  was  that  low-voltage  x-rays  limit  the  extent 
of  reuascularization. 

Scheie:       We  thought  they  had  a  significant  limiting  effect,  [interruption] 

I  know  the  work  with  the  superficial  x-ray  therapy  in  rabbits  was 
tentative.  We  did  it  to  determine  whether  or  not  these  techniques 
could  be  used  safely  on  patients,  and  in  what  amounts.  Our  paper 
states  that  these  were  clinical  observations,  with  loupes  and 
hand-held  microscopes  to  observe  the  rabbit  eyes.  A  slit  lamp  was 
used  for  all  human  clinical  work. 

Adrenocorticotropic  Hormone  and  Cortisone 

Hughes:     You  published  another  paper  the  following  year,  1951,  on 
"Adrenocorticotropic  hormone  (ACTH)  and  cortisone  in 
ophthalmology.  "*  You  say  that  the  purpose  of  the  paper  is  to  present 
preliminary  clinical  observations  on  the  local  and  systemic  use  of 
ACTH  and  cortisone  in  the  treatment  of  various  ocular  lesions.   This 
leads  me  to  believe  that  ACTH  and  cortisone  were  just  coming  into 
use  in  ophthalmology. 

Scheie:       That's  right. 

Hughes:     Do  you  remember  anything  particular  about  this  paper? 

Scheie:       I  don't  remember  anything  specific  about  the  paper  but  I  do  know 
that  I  considered  the  beneficial  effects  of  ACTH  and  cortisone  to  be 
a  potential  blessing  and  we  set  out  to  determine  that  for  ourselves. 

Hughes:     One  of  your  conclusions  was  that  systemic  therapy  was  useful  for 
acute  and  self-limited  lesions. 

Scheie:       We  felt  that  if  used  over  a  length  of  time,  it  could  be  hazardous  to 
the  patient's  health.  But  there  are  certain  conditions  where  you 
know  if  you  don't  use  it,  the  patient  may  go  blind,  so  you  take 
chances.  Most  of  the  harmful  side  effects  are  reversible.  We  used 
ACTH  and  cortisone  derivatives.  But  better  to  have  a  patient  with 
some  ill  effects  than  a  blind  patient. 


Scheie  HG,  Tyner  G,  Buesselcr  JA,  Alfano  JE.  Arch  Ophthalmol  1951;  45:301-16. 


139 


Hughes:     On  some  of  the  diseases  that  you  were  trying  ACTH  and  cortisone 

treatment,  I  would  think  you  would  not  have  a  hope  today  of  having 
any  effect.  In  fact,  you  found  that  the  treatment  was  not  effective  on 
chronic granulomatous  uveitis. 

Scheie:       I  don't  think  it's  fair  to  say  there's  no  effect  and,  of  course,  there  are 
various  causes.  For  instance,  in  toxoplasmosis  cortisone  might 
inhibit  but  the  organisms  will  still  be  there. 

Hughes:  Yes,  that's  usually  the  case  with  cortisone  treatment,  is  it  not?  What 
you're  doing  is  relieving  the  symptoms,  the  allergic  response,  but  not 
really  getting  to  the  causal  agent  itself. 

Scheie:       Sometimes  you're  relieving  it  and  preventing  blindness  while  the 
underlying  condition  burns  itself  out  because  the  active  process  is 
suppressed.  I  think  hormones  can  be  eye  saving.  Only  a  very 
inflammatory  ocular  disease  has  actual  organisms. 

Hughes:     Were  you  ever  engaged  in  the  controversy  over  the  use  of  steroids? 

Dr.  Phillips  Thygeson  was  spokesman  against  what  he  considered  to 
be  the  overuse  of  steroids  in  ophthalmology.* 

Scheie:       I  think  he  was  right,  but  I  believe,  as  with  anything  new,  we  should 
use  them  cautiously  and  learn  by  experience.  There  are  always  two 
points  of  view,  each  of  which  probably  has  some  merit.  Time 
provides  the  answers.  In  other  words,  you're  dealing  with 
substances  which  are  potentially  dangerous  and  they  should  be 
used  cautiously.  Obviously  the  patient's  health  and  overall 
well-being  come  first. 

Hughes:     A  slightly  later  paper,  in  1955,  was  on  the  use  of  cortisone  and 
corticotropin  to  treat  herpes  zoster  ophthalmicus.** 

Scheie:  I've  been  one  of  the  enthusiasts  and  believe  that  it  is  the  treatment 
of  choice.  If  I  had  herpes  zoster  ophthalmicus,  I  think  I  would  want 
ACTH  or  cortisone  immediately. 

Hughes:     To  accomplish  what? 

Scheie:       I  believe  that  the  eruption  is  due  to  an  allergy  to  the  chicken  pox 
virus.  In  fact,  I  gave  the  Montgomery  Lecture  on  herpes  zoster 
ophthalmicus.***  I  felt  very  strongly  about  it  then  and  still  do.  I 
don't  say  that  cortisone  or  ACTH  eliminates  the  virus  but  I  believe 


See  Phillips  Thygeson,  MD:  External  Eye  Disease  and  the  Proctor  Foundation,  Ophthalmology 
Oral  History  Series,  A  Link  with  our  Past.  An  interview  conducted  by  Sally  Smith  Hughes,  PhD, 
1987. 

Scheie  HG,  Alpcr  MC:  Treatment  of  herpes  zoster  ophthalmicus  with  cortisone  or  corticotropin. 
Arch  Ophthalmol  1955;  53:38-44. 

***  Trans  Ophthalmol  Soc  United  Kingdom  1970;  90:899-930. 


140 


that  it  does  suppress  the  allergic  reaction  to  the  virus  and  that  the 
eye  is  protected  while  healing  occurs.  For  example,  my  good  friend 
Colonel  Hopkins,  whom  I  brought  home  from  India  in  1945,  lost  his 
eye  from  herpes  zoster.  I  believe  it  could  have  been  saved  with 
cortisone. 

Hughes:     Was  there  any  treatment  before  cortisone? 

Scheie:       Yes,  immune  serum  from  a  patient  who  had  recovered  from  herpes 
zoster  was  thought  to  be  helpful,  but  it  was  not  dramatic.  The 
chicken  pox  virus  is  thought  to  be  harbored  in  the  semilunar 
posterior  root  ganglia  of  some  of  those  who  have  recovered  from  the 
disease.  The  virus  can  be  released  along  the  fifth  nerve  when  a 
patient  is  vulnerable  for  one  reason  or  another,  for  example,  with 
AIDS,  Hodgkin's  disease,  or  in  the  elderly. 

You  don't  have  to  give  ACTH  or  cortisone  for  long  periods  as  a  rule. 
Within  eight  to  ten  hours  the  pain  is  alleviated  and  the  patient  is 
much  more  comfortable.  Usually  in  twenty-four  hours  the  eye  is  no 
longer  painful.  The  patient  should  be  observed  carefully  but 
usually  two  or  three  weeks  of  therapy  does  no  harm.  Then 
hormonal  therapy  can  usually  be  tapered  and  the  patient  observed 
carefully  for  a  flare-up.  The  eruption  is  severe.  It  isn't  like  those  of 
chicken  pox,  I  think,  because  the  patient  has  become  allergic  to  his 
virus. 

Hughes:     Well,  you  chose  the  subject,  as  you  say,  for  the  Montgomery  Lecture, 
and  I  wonder  why? 

Scheie:       Because  I  thought  that  people  ought  to  be  using  cortisone.  The 
results  are  dramatic. 

Hughes:     Did  the  Montgomery  Lecture  help  to  get  that  point  across? 

Scheie:       Oh,  I  don't  think  everybody  believes  me— I  know  they  don't.  But 

how  many  people  have  seen  a  hundred  patients  with  herpes  zoster, 
or  whatever  number  it  was  in  the  Montgomery  Lecture? 

Hughes:  Ninety-three. 

Scheie:  I  agonized  over  those  patients  and  cared  for  each  one  myself. 

Hughes:  Why  were  you  chosen  for  the  Montgomery  Lecture? 

Scheie:  I  have  never  known. 

Hughes:     [consulting  notes]  You  saw  ninety-three  patients,  eighty-seven  of 

whom  were  treated  with  corticotropin  or  corticosteroids  or  both,  and 
another  six  who  developed  herpes  zoster  while  on  steroids  for  other 
conditions. 


141 


Scheie:       This  emphasizes,  as  I  have  pointed  out,  that  herpes  zoster  can  occur 
while  taking  steroids  for  another  disease.  There  was  no  effective 
treatment,  in  my  opinion,  till  steroids  came  along.  But  as  I 
observed  this  rather  large  number  of  patients,  I  became  convinced 
[of  the  efficacy  of  steroids]. 

Hughes:     Was  there  discussion  after  the  lecture? 

Scheie:       Oh  yes,  there  was  discussion.  I've  talked  about  herpes  zoster 

treatment  in  this  country.  Some  ophthalmologists  think  I'm  wrong 
and  others  agree.  I  believe  the  same  is  true  of  neurologists  and 
dermatologists.  I  can  honestly  say  that  I  would  want  steroids  for 
myself  or  my  family. 

Hughes:     Did  you  ever  run  into  complications  of  steroid  therapy? 

Scheie:  None  that  were  serious.  People  can  die  from  complications  of 
herpes  zoster,  especially  of  the  carotid  artery,  treatment  or  no 
treatment.  The  carotid  artery  can  leak  or  thrombose,  for  example. 

Retinal  Changes  Associated  with  Hypertension 
and  Arteriosclerosis 

Hughes:     Well,  a  paper  entitled,  "Retinal  changes  associated  with  hypertension 
and  arteriosclerosis"  was  published  in  1952.  *  /  believe  your  point 
was  to  show  the  difference  in  retinal  changes  in  hypertension  and 
arteriosclerosis,  which  I  guess  had  not  been  fully  distinguished 
before,  or  at  least  people  were  still  confusing  them? 

Scheie:       No,  my  motivation  proposed  a  classification  of  severity  of 

hypertensive  and  arteriosclerotic  changes  that  could  be  duplicated 
by  different  observers.  I  believe  that  it  has  been  accepted  to  at  least 
a  modest  extent.  The  arteriosclerotic  changes  are  a  result  of  the 
hypertension.  So  I  graded  the  two  conditions  separately  and  used 
practical  criteria  as  a  means  of  identifying  the  four  grades.  It  was 
an  attempt  to  be  both  simple  and  repeatable.  Using  that  system,  I 
found  that  our  residents  and  staff  could  see  and  grade  a  fundus 
which  I  could  see  a  month  later  and  duplicate  their  grading.  The 
paper  became  popular  with  many  reprint  requests  and 
reproductions,  even  in  other  countries.  Only  last  month  I  had 
another  request  for  it. 

Hughes:     So  the  system  is  still  used? 

Scheie:       It's  still  used,  at  least  by  some.  But  on  the  other  hand,  we  have 
better  ways  of  evaluating  hypertension  and  arteriosclerosis.  How 


Scheie  HG.  Illinois  McdJ  1952;  101:126-9. 


142 


often  the  help  of  the  ophthalmologist  is  sought  I  don't  know.  To  me 
the  system  is  still  worthwhile. 

Local  Anesthetic  Agents 

Hughes:     Well,  the  next  set  of  papers  is  on  local  anesthetic  agents. 
Scheie:       I  have  been  very  interested  in  anesthesia. 

Hughes:     In  this  particular  paper,  you  report  on  the  experimental  and  clinical 
use  ofefocane  and  a  compound  called  U-0045.* 

Scheie:       That  latter  was  an  Upjohn  product.  Dr.  James  E.  Eckenhoffwas  an 
anesthetist  and  he  did  this  work  with  us.  I  was  looking  for  an 
anesthetic  agent  with  a  duration  of  about  ten  hours.  I  had  observed 
that  after  intraocular  surgery,  particularly  for  cataract,  most 
patients  have  rather  severe  discomfort  beginning  one  to  two  hours 
after  the  operation,  which  usually  eases  off  by  around  eight  hours. 
If  you  can  prevent  it  for  eight  to  ten  hours,  the  patient  will  have 
little  or  no  postoperative  pain. 

The  throbbing  pain  begins  about  the  time  the  local  anesthetic  wears 
off,  as  can  be  observed  after  local  dental  anesthesia.  Efocane  lasted 
from  twenty -four  to  thirty-six  hours  but  was  very  destructive  to 
tissue.  It  caused  such  marked  local  reaction  that  we  used  this  only 
on  animals,  although  it  had  been  used  on  humans.  But  U-0045, 
which  was  much  less  irritating,  we  did  use  on  a  small  number  of 
humans.  Except  for  relatively  mild  irritation,  it  was  an  ideal  agent 
because  its  anesthetic  effect  would  last  for  about  twelve  hours.  I 
was  waiting  after  that  paper  for  Upjohn  or  another  pharmaceutical 
company  to  come  out  with  a  similar  but  less-irritating  version. 
However,  I  don't  believe  that  has  happened.  But  carbocaine,  which 
lasts  an  hour  or  so  longer  than  procaine,  has  been  helpful.  Efocane 
was  a  very  toxic  and  dangerous  local  anesthetic. 

Hughes:     Why  do  you  suppose  that  Upjohn  didn't  pursue  the  U-0045? 

Scheie:       Because  it  was  a  little  too  irritant.  Out  of  this  work  came  another 
paper  that  has  proved  to  be  worthwhile.** 

## 

We  tested  the  local  toxicity  ofefocane  and  U-0045  by  injecting  them 
into  the  anterior  chamber  of  eyes  and  observed  severe  reaction  with 
efocane,  especially  injury  to  the  cornea,  which  became  opaque.  It 
had  been  used  elsewhere  for  spinal  anesthesia  and  injected  near  the 


Scheie  HG,  Ellis  RA,  EckenhofTEE,  Spencer  RW.  Long-lasting  local  anesthetic  agents  in 
ophthalmic  surgery.  Arch  Oph thai mol  1955;  53:177-90. 

**      Scheie  HG,  Spender  RW,  Dripps  RD.  Anterior  chamber  injection  in  the  rabbit  as  a  method  of 
determining  irritancy  of  local  anesthetics.  J  Pharm  Exp  Therapy  1951;  115:21-30. 


Hughes: 


Scheie: 


143 


spine,  but  paraplegia  had  been  reported  in  one  or  two  patients.  We 
therefore  gave  up  any  thought  of  using  it.  I  talked  to  Dr.  [Robert 
D.]  Dripps  about  the  reaction  caused  by  injecting  efocane  into  the 
anterior  chamber,  and  after  some  more  work  he  collaborated  with 
us  on  our  paper  suggesting  this  as  a  method  for  testing  toxicity  of 
local  anesthesia.  How  widely  used  it  ever  became  in  the  anesthesia 
field,  I  don't  know.  We  felt  that  if  no  anterior  chamber  reaction 
resulted  that  it  could  probably  be  injected  safely  anywhere. 
Certainly,  if  I  were  going  to  test  new  anesthetic  agents,  I  would 
employ  anterior  chamber  injection  as  at  least  one  test. 

You  don't  know  if  the  technique  using  the  anterior  chamber  for 
testing  actually  did  take  hold1? 

I  never  followed  up  on  the  matter  with  Dr.  Dripps,  but  I'm  sure  that 
he  used  it  for  a  while  on  new  anesthetic  agents. 


Hughes:     What  anesthetics  were  in  use  when  you  first  began  to  practice1? 

Scheie:       Cocaine  and  procaine.  Dr.  Adler  was  still  injecting  cocaine  when  I 
started  helping  him  in  his  office  in  1940.  It  was  used  to  remove 
warts  on  an  eyelid,  for  opening  chalazions,  or  other  minor 
procedures.  It  was  a  beautiful  anesthetic  but  reactions  could  occur. 
In  my  practice,  I  always  used  procaine  and  later  carbocaine. 

I  have  a  paper  describing  continuous  retrobulbar  anesthesia.*  I 
used  this  method  mainly  for  retinal  detachments  where 
postoperative  pain  can  persist  for  a  considerable  time.  If  pain  could 
be  avoided  for  the  first  day  or  so,  it  was  a  great  favor  to  the  patient. 
I  made  a  chamber  from  a  section  of  intravenous  tubing  about  two 
inches  long.  One  end  was  plugged,  and  an  adapter  was  inserted 
into  the  other  end  which  could  be  attached  to  a  fine  caliber 
hypodermic  needle  over  which  was  threaded  a  fine  piece  of  plastic 
tubing.  The  retrobulbar  anesthetic  was  injected  as  usual  by 
inserting  the  needle  into  the  muscle  cone  through  the  lower  lid. 
The  syringe  was  removed  from  the  retrobulbar  needle  with  the 
needles  remaining  in  place  and  through  which  a  four-or-five  inch 
piece  of  ethylene  tubing  was  threaded.  The  needle  was  then 
removed  over  the  tubing,  leaving  the  tubing  in  place  in  the  muscle 
cone.  The  ethylene  tubing  was  now  connected  with  the  chamber 
that  had  been  sutured  to  the  skin  by  inserting  its  needle  into  the 
lumen  of  the  free  end  of  the  tubing.  If  the  patient  suffered 
postoperative  pain,  the  wall  of  the  chamber  was  wiped  with  an 
alcohol  sponge,  and  two  cc  of  anesthetic  solution  injected.  It  worked 
beautifully. 

I  think  the  last  time  I  employed  it  was  for  the  seven-year-old  son  of 
an  ophthalmologist  friend.  The  boy  had  a  severe  anterior  chamber 
hemorrhage  with  elevated  pressure  which  required  surgical  relief 


Scheie  HG.  Trans  Am  Acad  Ophthalmol  Otolaryngol  1956;  May  -  June,  389-96. 


144 


by  paracentesis.  Sometimes  this  must  be  repeated  one  or  more 
times.  This  little  boy  did  rebleed.  When  he  started  having 
recurrence  of  pressure  with  pain  due  to  the  rebleeding,  I  injected 
anesthetic  into  the  chamber  and  was  able  to  reopen  the 
paracentesis  with  no  pain  or  difficulty. 

This  technique  is  very  helpful.  If  you  anticipate  a  repeat  procedure 
or  manipulation  of  a  child's  eye  during  the  following  few  days,  the 
chamber  can  be  left  in  place  and  local  anesthetic  injected  any  time 
it  might  be  needed.  It  was  never  widely  adopted  but  I  did  use  it 
and  patients  appreciated  it.  It  was  very  valuable  for  youngsters. 

Visual  Field  Defects  in  Exophthalmos 

Hughes:     You  published  a  paper  in  1955  with  Thomas  Hedges,  "Visual  field 
defects  in  exophthalmos  associated  with  thyroid  disease.  "* 

Scheie:       That  was  a  relatively  new  finding.  These  patients  developed 
pericentral  and  nerve-fiber-bundle  defects  in  their  visual  fields 
associated  with  the  severe  bulging  eyes  of  thyrotropic 
exophthalmos.  Most  of  them  tend  to  recur  over  the  years,  I've 
learned,  and  may  cause  permanent  damage  to  the  eyesight. 

Hughes:     In  the  paper  you  said  that  you  could  find  no  direct  relationship 
between  the  level  of  thyroid  activity  and  the  degree  of  optic  nerve 
damage. 

Scheie:       That's  right.  Some  of  those  patients  even  had  low  basal  rates,  but 
some  were  thyrotoxic. 

Hughes:     Do  you  have  any  explanation? 

Scheie:       No,  it  was  just  an  observation.  Possibly  circulatory  and 
mechanical,  possibly  hormonal,  and  possibly  neurotoxic. 

Retrolental  Fibroplasia 

Hughes:     Then  there's  the  long  cooperative  study  on  retrolental  fibroplasia.  ** 
## 

Scheie:       The  study  was  a  National  Institutes  of  Health-sponsored, 

multi-institutional  study  of  retrolental  fibroplasia.  It  proved  to  be 
important  because  it  established  a  relationship  between  excessive 
oxygen  and  retrolental  fibroplasia  in  premature  children.  I  can't 
take  credit  for  it,  although  the  organizational  meeting  was  held  in 


* 

** 


Arch  Ophthalmol  1955;  54:885-92. 

Kinsey  VE.  Retrolental  fibroplasia:  Cooperative  study  of  retrolental  fibroplasia  and  the  use  of 
oxygen.  Arch  Ophthalmol  1956;  56:481-543. 


145 


my  apartment  on  Rittenhouse  Square.  The  late  V.  Everett  Kinsey 
was  the  coordinator.  He  collected  the  data  and  analysis  for  the 
study.  The  data  went  to  him  in  Detroit. 

Hughes:     Did  he  design  the  study1? 

Scheie:       I'm  not  sure  who  should  get  the  credit.  As  I  recall,  there  were  other 
factors  involved  too,  which  we  were  studying.  But  out  of  it  came  the 
fact  that  oxygen,  given  to  keep  these  children  alive,  was  an  offender. 

Hughes:     As  I  remember,  the  control  group  received  oxygen. 

Scheie:       Yes,  it  was  a  study  where  you  didn't  know  who  was  receiving 
oxygen  and  who  wasn't. 

Hughes:     What  sort  of  precautions  were  taken1?  You  must  have  had  some 
suspicion  that  oxygen  was  responsible  for  the  damage. 

Scheie:       That's  right,  but  we  felt  the  question  must  be  answered. 
Hughes:     Did  you  have  to  get  parental  permission  for  these  studies? 
Scheie:       I  don't  think  so  because  it  was  the  therapy  accepted  at  that  time. 

Hughes:     One  of  the  conclusions  (there  were  five)  was:  "Of  the  factors 

considered,  this  controlled  study  shows  conclusively  that  the  length 
of  time  the  premature  infant  is  kept  in  an  oxygen-enriched 
environment  is  the  important  factor  in  the  production  ofRLF 
[retrolental  fibroplasia]. " 

Scheie:       Yes,  that's  true. 

Hughes:     The  rest  of  the  conclusions  were  refinements  of  that  first  one. 

Scheie:       There  have  been  shifts  of  opinion.  Everybody  still  agrees  that 
oxygen  is  a  major  factor,  but  there  are  other  factors  because 
retrolental  fibroplasia  also  can  occur  with  no  oxygen  having  been 
given.  Investigations  continue  even  today,  and  retrolental 
fibroplasia,  although  not  common,  still  occurs.  Surely  oxygen 
control  wasn't  a  cure-all,  but  it  was  important.  It  was  the  first  time 
that  any  one  factor,  except  prematurity  itself,  had  been  implicated. 

Hughes:     Was  there  a  direct  clinical  response  to  the  study? 

Scheie:       Oh,  yes.  When  these  facts  became  known,  the  use  of  oxygen  was 

diminished  and  careful  controls  of  the  oxygen  level  in  the  incubator 
were  instituted.  They  had  been  freely  feeding  oxygen  in.  This  was 
a  carefully  orchestrated  study. 

Hughes:     What  was  the  basis  for  choosing  the  participants? 


146 


Scheie:       I  have  no  idea.  I  had  done  quite  a  bit  of  pediatric  ophthalmology 
and  we  had  a  fairly  large  pediatric  service  at  the  University  of 
Pennsylvania. 

Conditions  Associated  with  Pigmentary  Glaucoma 

Hughes:     Well,  one  last  paper  in  this  period,  "Idiopathic  atrophy  of  the 
epithelial  layers  of  the  iris  and  ciliary  body."*  Who  is  Hans 
Fleischhauer? 

Scheie:       He  is  a  German  who  came  to  work  with  us  as  a  visiting  fellow  for  a 
year. 

Hughes:     Did  he  come  with  an  interest  in  that  problem? 
Scheie:       No,  it  was  my  interest.  He  worked  with  me. 

Hughes:     He  apparently  was  associated  with  Ernst  Custodis  in  Germany.  Is 
that  true? 

Scheie:  I  couldn't  have  named  him.  Dusseldorf  is  where  Fleischhauer's 
from. 

That  paper  was  based  on  observations  on  my  patients.  It's  related 
to  glaucoma.  Pigment  dispersal  from  atrophy  of  the  pigment  layers 
is  the  cause  of  pigmentary  glaucoma.  I  became  interested  because 
of  that  condition.  In  fact,  I  recently  wrote  another  paper  with  Dr. 
Douglas  Cameron  analyzing  my  patients  seen  over  many  years.** 
It  is  the  largest  series  ever  reported. 

Hughes:     Did  you  find  an  association  with  glaucoma? 

Scheie:       Oh  yes,  it  is  the  cause  of  pigmentary  glaucoma  and  has  also  been 
called  pigment  dispersal  syndrome  glaucoma. 

Hughes:     Is  there  a  mechanism  for  the  dispersion  of  the  pigment? 

Scheie:  Nobody  knows  what  causes  it.  The  pigment  comes  from  the  two 
layers  of  pigment  on  the  back  of  the  iris  and  probably  the  ciliary 
body. 

Hughes:     Can  it  be  seen  in  the  infant?  Is  it  perhaps  congenital? 

Scheie:       No,  I've  never  seen  it  in  babies,  but  I  have  seen  it  in  teenagers.  It  is 
something  that  is  genetic,  I'm  sure. 

Hughes:     And  invariably  associated  with  glaucoma? 


Scheie  HG,  Fleischhauer,  HW.  Arch  Ophthalmol  1958;  59:216-28. 

Pigment  dispersion  syndrome:  A  clinical  study.  Br  J  Ophthalmol  1981;  65:264-9. 


147 


Scheie:       No.  And  that's  what  we  delved  into  a  bit  in  our  paper  in  1981.  It 
was  a  real  interest  of  mine. 

Hughes:     Well,  the  pigment  disturbances  could  be  in  many  areas  of  the  eye, 
could  they  not? 

Scheie:       I  do  not  believe  so,  but  distribution  is  characteristic.  Pigment  is 
carried  forward  through  the  pupil  by  the  flow  of  aqueous  and  is 
deposited  on  the  back  of  the  cornea  in  the  form  of  a  vertical  spindle, 
called  Krukenberg's  spindle. 

Hughes:     Why  a  spindle? 

Scheie:       Well,  the  fluid  in  the  anterior  chamber  of  the  eye  is  cooled  at  the 
front  of  the  anterior  chamber  and  is  warmed  posteriorly  by  the 
warm  iris  and  lens.  As  a  result,  the  aqueous  circulates  by 
convection  current,  rising  in  back  where  it  is  warmed  and 
downward  in  front  where  it  is  cooled.  The  pigment  is  therefore 
deposited  on  the  back  of  the  cornea  in  the  form  of  a  spindle. 

Hughes:     This  was  a  nineteenth  century  observation? 

Scheie:       Well,  I  would  think  twentieth  century.  The  slit  lamp  was 

introduced  around  1912.  Knowledge  of  the  anterior  segment  then 
began  to  evolve  rapidly.  It  enabled  the  ophthalmologist  to  look  at 
the  human  eye  with  a  microscope. 


Chief  of  Ophthalmology  Service  and  Consultant, 
Veterans  Administration  Hospital,  Philadelphia 
1953-1975 


[Interview  5,  March  29, 1988]  ## 

Hughes:     Dr.  Scheie,  in  1953  you  were  appointed  consultant  in  ophthalmology 
at  the  Veterans  Administration  Hospital. 

Scheie:       Yes,  I  was  the  first  consultant  and  chief  of  ophthalmology  at  the 

hospital,  but  considerable  negotiating  by  the  five  medical  schools  in 
Philadelphia  took  place  for  most  of  the  services.  As  agreement  was 
reached,  the  services  were  allocated.  The  Veterans  Hospital 
services  were  important  because  of  the  opportunities  for  the 
teaching  of  both  medical  students  and  residents. 

Ophthalmology  was  the  first  service  activated,  which  was  in 
December  1953.  It  was  affiliated  with  our  service  at  the  University 
of  Pennsylvania  Hospital,  located  about  two  blocks  away.  The 
affiliation  is  still  going  on.  I  remained  in  charge  as  long  as  I  was 
the  chairman  of  the  department  of  ophthalmology  at  the  University 
of  Pennsylvania  and  made  weekly  rounds,  or  more  often  if  needed. 


148 


Penn  also  had  an  affiliation  with  the  surgical  service.  Our  weekly 
grand  rounds  would  start  at  the  University  of  Pennsylvania 
Hospital,  then  proceed  to  Philadelphia  General  Hospital,  a  large 
city  institution,  and  finally  to  the  Veterans  Hospital.  This  made  for 
a  full  and  instructive  afternoon  and  helped  to  unify  the  services. 
The  residents  rotated  through  these  services,  three  months  at  each 
hospital. 

Hughes:     Did  the  ophthalmology  staff  at  those  institutions  also  come  to  Penn? 

Scheie:       Yes,  the  staff  held  appointments  to  each  hospital,  as  did  the 
residents. 

Hughes:     Did  your  military  associations  come  into  play  in  your  association 
with  the  Veterans  Administration? 

Scheie:  Well,  in  the  early  days  of  the  Veterans  Hospital,  there  were  a  good 
many  service-connected  cases,  old  injuries,  and  that  sort.  Now,  of 
course,  they  tend  to  be  a  cross  section  of  geriatric  patients. 

Hughes:     Regardless  of  your  background  in  the  military,  you  would  have 
developed  this  association? 

Scheie:       Yes,  I  would  have. 

Hughes:     What  types  of  cases  did  the  Veterans  Administration  Hospital 

contribute  that  perhaps  wouldn't  have  been  as  readily  available  if 
you  had  limited  your  focus  to  the  university  hospital? 

Scheie:       Well,  they  were  largely  indigent  patients  entitled  to  veterans'  care 
and  they  could  be  cared  for  by  residents  and  staff.  The  surgical  flow 
was  especially  important  to  us. 

Hughes:     So  it  was  a  different  type  of  patient  than  that  the  residents  were 
seeing  at  the  university  hospital? 

Scheie:       Yes,  because  at  a  private  hospital,  of  which  the  University  of 

Pennsylvania  Hospital  was  one,  there  weren't  too  many  patients 
that  could  be  assigned  to  residents  and  junior  staff.  Philadelphia 
General  was  much  like  the  Veterans,  but  those  were  city  indigent 
patients. 

Hughes:     So  a  slightly  different  type  of  patient? 
Scheie:       That's  right. 

Hughes:     The  principal  idea  was  to  increase  the  experience  of  your  staff  and 
residents? 

Scheie:       Yes,  to  supplement  our  ophthalmology  program  at  HUP. 


149 


Hughes:     Were  there  ophthalmology  residents  at  the  Veterans  Administration 
Hospital1? 

Scheie:       Yes,  but  they  were  part  of  our  program  and  all  rotated  through  each 
of  our  three  hospitals.  Later  we  added  the  Graduate  Hospital.  In 
fact,  we  still  have  a  resident  who  rotates  through  there. 


Wills  Eye  Hospital 


Hughes:     Was  there  ever  an  association  with  Wills? 

Scheie:       Well,  that  is  a  name  we  never  mention  here  at  the  eye  institute 

[Hughes  laughs]  but  we  have  exchanged  teaching  programs.  In  the 
latter  days  of  the  basic  science  course  [in  ophthalmology],  after  I'd 
taken  it  over,  Wills  residents  did  attend  at  the  Scheie  Eye  Institute. 

Hughes:     How  serious  is  that  rivalry? 

Scheie:       It's  not  serious  at  all.  Their  staff  includes  many  of  my  friends,  and  I 
hope  it's  mutual. 

Hughes:     But  the  two  institutions  have  had  very  distinct  histories. 

Scheie:       Well,  Wills  Eye  Hospital  was  founded  largely  by  University  of 
Pennsylvania  ophthalmologists. 

Hughes:     But  it  is  also  true,  is  it  not,  that  there  is  a  tendency  for  Philadelphia 
ophthalmologists  to  stick  with  one  institution  or  the  other.  It's 
unusual  to  have  appointments  at  both  institutions. 

Scheie:       That's  true.  We  do  have  joint  appointments  at  the  moment,  for 
example  in  neuro-ophthalmology,  and  we  do  attend  some  of  each 
other's  conferences.  When  I  was  head  of  the  basic  science  course, 
Wills  people  and  some  from  other  hospitals  were  officially  on  its 
staff. 

Dr.  Francis  Heed  Adler  was  chief  of  service  at  Wills  until  he  was 
appointed  chairman  of  the  department  at  Penn  in  1937.  I've  been 
on  the  consultant  staff  of  several  hospitals,  but  never  Wills.  Our 
present  relationship  is  very  friendly  and  satisfactory.  Within  the 
last  month,  I  have  had  a  very  pleasant  luncheon  at  Wills  with  the 
chairman  of  the  hospital  board,  Mr.  Louis  Esposito,  Dr.  William  C. 
Tasman,  who  is  now  their  chief  ophthalmologist,  and  their 
administrator,  Mr.  William  Kessler. 

Hughes:     Why  do  you  suppose  that  you  never  became  a  consultant  there? 

Scheie:       There  was  no  reason  to.  I  was  always  terribly  busy  and  wouldn't 
have  had  the  time  to  be  an  active  consultant. 


150 


Hughes:     Does  Wills  practice  a  different  type  of  ophthalmology  from  that 
practiced  at  Penn? 

Scheie:       I  think  in  years  past  the  men  in  training  were  not  as  carefully 

supervised  as  they  were  at  the  University  of  Pennsylvania  Hospital, 
but  their  ophthalmology  has  always  been  good  and  their  staff 
excellent. 

Hughes:     Is  there  an  emphasis  at  Wills  on  the  basic  science  aspect? 

Scheie:       Probably  not  as  great  as  at  Penn,  the  reason  being  that  they've  been 
a  free-standing  eye  hospital  during  most  of  their  existence.  Only 
recently  have  they  been  affiliated  with  a  general  hospital.  First 
with  Temple  University  with  its  broad  clinical  and  research 
activities,  but  that  affiliation  did  not  last  long,  and  they  are  now 
affiliated  with  Jefferson  University. 

I  don't  think  too  many  people  know  that  our  then  vice-president  for 
medical  affairs,  Isador  S.  Ravdin,  and  I  made  a  real  effort  to  have 
Wills  join  us  and  become  part  of  the  University  of  Pennsylvania  eye 
department  before  they  affiliated  with  Temple  University.  It  was 
seriously  considered,  but  they  decided,  for  reasons  not  known  to  me, 
to  go  to  Temple.  I  think  they  probably  felt  that  they  could  be  more 
independent  with  them  than  with  an  older,  larger  school  like  Penn. 
When  the  Temple  affiliation  broke  up,  Dr.  Robert  D.  Dripps,  who 
had  succeeded  Ravdin  as  vice-president  for  medical  affairs  at  Penn, 
and  I  again  made  another  effort  to  affiliate  with  Wills,  but  failed. 

Hughes:     Why  were  you  interested  in  a  merger? 

Scheie:       Because  they  were  long  established  and  had  a  vast  network  of 
ex-residents  practicing  in  the  New  Jersey,  Delaware,  and 
Pennsylvania  areas  who  were  a  great  referral  base.  Ours  was  much 
smaller  because  we've  had  a  residency  training  program  only  since 
1935.  Their  broad  clinical  base  would  have  nicely  supplemented 
our  academic  and  research  base.  It  would  have  been  a  nice 
marriage. 

Hughes:     What  were  their  reasons  for  choosing  Temple? 

Scheie:       I  do  not  know.  I  attended  only  part  of  the  negotiations.  Also  their 
decisions  were  made  at  their  private  meetings.  As  I  say,  I  think 
they  felt  they'd  be  more  independent  there  and  later  at  Jefferson, 
than  they  would  have  been  with  us. 

Hughes:     Why  would  they  have  expected  to  be  more  independent  at  Jefferson? 

Scheie:       Well,  ours  is  an  old  department  and  Penn  is  the  oldest  medical 

school  in  the  country  and  very  prestigious.  Penn  has  always  been 
strong  in  organizational  medicine.  Ravdin  was  a  very  energetic, 


151 


brilliant,  and  able  man.  He  had  been  president  of  the  American 
College  of  Surgeons,  as  well  as  other  organizations,  and  had 
received  many  important  honors.  He  was  a  powerful  person  in 
medicine  locally  and  nationally,  which  may  have  concerned  them.  I 
think  those  are  basically  the  reasons. 

Hughes:     Do  you  know  why  the  affiliation  with  Temple  didn't  work  out? 

Scheie:       I  do  not  know  that.  Nothing  that  I  should  be  quoted  on,  at  least.  I 
think  it  related  to  the  matter  of  independence. 

Significant  financial  support  comes  from  the  Girard  estate  will, 
made  many  years  ago.  This  money  helped  to  establish  Wills  Eye 
Hospital,  and  the  funds  are  controlled  by  the  Board  of  City  Trusts,  a 
group  that  can  be  quite  political.  The  members  are  appointed  by 
the  judges  of  the  Orphans'  Court  of  Philadelphia,  and  since  this 
board  administers  the  funds  from  the  Girard  estate,  they  have  a 
significant  impact  on  the  hospital  itself.  It  is  logical  that  they 
might  not  want  to  relinquish  some  of  the  prerogatives  that  might  be 
required  by  an  academic  institution. 

As  a  hypothetical  example,  Wills  Eye  administrators  probably  could 
not  have  come  to  Temple,  Jefferson,  or  Penn  and  said,  "Now,  I  want 
this  person  to  be  a  professor  and  another  an  assistant  professor." 
Faculty  committees  from  the  university  would  dominate  such 
decisions.  Many  other  problems  could  also  arise,  but  I  have  not 
been  privy  to  such  information. 

Hughes:     The  same  problems  presumably  also  are  true  of  a  Wills  affiliation 
with  Jefferson. 

Scheie:       That  is  highly  possible.  If  they  should  ever  leave  Jefferson,  and  I 
have  no  reason  to  suspect  that  they  would,  the  same  problems 
would  arise  in  the  future  at  any  other  university. 

Hughes:     I  understand  that  Dr.  [Thomas  DJ  Duane  was  very  instrumental  in 
facilitating  the  affiliation  between  Wills  and  Jefferson. 

Scheie:       Yes,  he  was  chairman  of  the  department  at  Jeff  and  I  think  an  ideal 
person  to  bring  this  about.  He  is  a  flexible  person  and,  I  am  sure, 
was  a  good  negotiator. 

Hughes:     He  did  not  originate  the  idea  of  the  affiliation,  did  he? 

Scheie:       Who  suggested  the  affiliation  with  Jefferson  at  the  time  they  left 

Temple,  I  don't  know.  But  as  I  have  said,  Dr.  Dripps  and  I  did  enter 
the  picture  at  that  time,  and  Wills  was  invited  to  join  the  university. 
I  offered  to  have  my  name  taken  off  the  Scheie  Eye  Institute  and 
call  it  Wills  Eye  West,  or  whatever,  because  I  thought  a  merger 
would  have  been  great  for  Philadelphia  ophthalmology  and  for  both 
institutions. 


152 


Hughes:     Has  it  ever  been  a  problem  having  two  very  well-known  eye 
institutions  in  the  same  city1? 

Scheie:       I'm  not  aware  of  any.  However,  it  would  have  been  great  to  have 
them,  with  their  tremendous  clinical  following,  merged  with  our 
smaller  following  but  better  research  facilities.  Support  also  would 
have  been  forthcoming  from  the  university  through  its  broad 
basic-science  activities.  For  example,  laser  research  work  could 
have  been  done  in  conjunction  with  the  university's  department  of 
bioengineering  and  its  advanced  basic  scientists  in  that  field.  In 
fact,  we're  involved  with  them  through  Dr.  Charles  Riva  of  our  own 
department.  So  properly  managed,  I  think  it  would  have  been  ideal. 

Hughes:     Jefferson  is  not  able  to  provide  services  of  that  standard1? 

Scheie:       If  I  understand  correctly,  Jefferson  is  not  really  as  broadly  based  in 
the  basic  sciences.  Its  emphasis  has  always  been  on  their  medical 
school  and  it  does  have  excellent  physicians  and  teachers. 

Hughes:     The  result,  however,  is  comparatively  less  research? 

Scheie:       Well,  Wills  has  never  been  known  especially  for  its  research,  but 
they  do  have  an  outstanding  reputation  in  clinical  ophthalmology. 


Chief  of  Ophthalmology  Service  and  Consultant, 
the  Children's  Hospital  of  Philadelphia,  1960-1972 

Hughes:     In  1949,  you  were  appointed  consultant  ophthalmologist  to  the 

Children's  Hospital  of  Philadelphia,  which  is  the  oldest  pediatric 
hospital  in  the  country.  Please  tell  me  how  that  came  about. 

Scheie:       The  Children's  Hospital  and  the  pediatric  department  of  the 
University  of  Pennsylvania  Medical  School  had  for  years  been 
closely  related.  The  new  Children's  Hospital,  built  and  dedicated  in 
1974  adjacent  to  and  connecting  with  the  University  of 
Pennsylvania  Hospital,  then  absorbed  the  university's  pediatric 
service,  except  for  newborns.  This  service  was  needed  by  HUP  to 
support  the  obstetrics  department.  The  new  Children's  Hospital 
has  been  very  successful. 

In  1960, 1  had  been  named  chief  of  the  eye  service  at  the  old 
Children's  Hospital  because  of  my  staff  position  at  the  university. 
Prior  to  this,  their  ophthalmologist  came  to  the  hospital  only  on 
occasional  consultant  visits.  No  one  operated  there  regularly  nor 
did  they  have  an  outpatient  service.  I  established  the  first  eye 
clinic  there.  A  wealthy  patient  provided  $1500  toward  the 
equipment.  The  present  staff  was  trained  under  my  aegis  and  Dr. 
David  B.  Schaffer  eventually  became  my  successor.  He  has  done 


153 

considerable  research  work  on  retrolental  fibroplasia  or  retinopathy 
of  prematurity.  I  carried  the  Children's  Hospital  duties  in 
conjunction  with  my  university  work  and  my  practice  with  Dr. 
Adler,  eventually  developing  a  rather  large  pediatric  following 
which  included  considerable  pediatric  glaucoma  and  congenital 
cataract  work.  I  was  able  to  popularize  the  operation  for  congenital 
cataracts  because  of  the  large  number  of  children  that  I  saw.  I 
developed  an  interest  in  mucopolysaccharidosis  and  wrote  a  paper 
made  possible  through  pediatric  referrals. 

Hughes:     So  the  Children's  Hospital  affiliation  was  really  helpful  to  the 
development  of  your  surgical  techniques? 

Scheie:       Yes,  indeed. 

Hughes:     Because  you  wouldn't  have  had  the  numbers  of  children  otherwise. 

Scheie:       That's  true. 

Hughes:     Did  you  recognize  from  the  very  start  how  valuable  that  affiliation 
would  be? 

Scheie:       Not  really,  but  it  was  very  enjoyable.  I  had  always  related  to 
children.  At  that  time,  the  results  from  ordinary  congenital 
cataracts  and  especially  those  due  to  rubella  were  often  calamitous 
and  I  believe  that  I  did  make  a  modest  contribution  to  improving 
their  prognosis. 

I  did  most  of  my  pediatric  intraocular  surgery  at  Penn,  although  I 
operated  on  children  at  both  places,  depending  on  which  was  more 
convenient  for  the  parents. 

Hughes:     When  you  operated  at  a  different  hospital,  in  this  case  at  Children's, 
did  you  take  your  residents  along  with  you  ? 

Scheie:       They  were  already  working  there  on  a  rotation  basis.  Children's 
added  another  hospital  to  our  rotation  and  it  became  important 
from  the  standpoint  of  teaching.  Today,  our  residents  still  rotate 
through  Children's  Hospital  for  three  or  four  months  at  a  time. 

Hughes:     What  about  the  nursing  staff?  Eye  operations  are  a  very  specialized 
form  of  surgery. 

Scheie:       At  Children's  we  did  not  have  enough  volume  to  justify  a  full-time 
nurse.  They  probably  have  their  own  operating  nurse  today. 

Pediatric  surgery  is  not  quite  as  diverse  as  surgery  for  adults.  I 
never  felt  deprived,  really.  Usually  one  or  two  of  the  nurses  in  the 
operating  room  would  tend  to  adopt  your  work,  take  care  of  your 
instruments,  and  assist  you.  I  operated  on  an  average  of  one 
afternoon  a  week  at  Children's. 


154 


Hughes:     When  you  were  doing  glaucoma  cases,  you  didn't  find  it  a  hardship 
having  staff  that  perhaps  wasn't  quite  as  accustomed  to  the 
procedures  as  your  staff  at  Penn? 

Scheie:       No,  I  would  think  not,  and  I  did  have  the  assistance  of  a 

knowledgeable  resident.  That  type  of  glaucoma  operation  is  quickly 
done  and  it's  a  matter  of  having  the  right  instruments.  However, 
most  of  my  glaucoma  surgery  was  done  at  the  university  hospital. 

Hughes:     For  the  obvious  reasons:  It  was  in  the  end  more  convenient  for  you 
and  there  was  a  trained  staff. 

Scheie:       Yes.  That  was  my  headquarters,  really.  We  did  have  our  own 
operating  room  and  nurses,  and  follow-up  was  easier. 

Hughes:     Did  the  residents  themselves  have  any  preference  about  where  they 
spent  their  time? 

Scheie:       Oh,  I  think  they  preferred  the  university  or  Veterans  Hospital, 
where  they  could  do  more  surgery. 

Hughes:     It  was  not  a  very  active  surgical  service  at  Children's? 

Scheie:       Well,  there  was  practically  none  until  I  started  there.  At  that  time, 
it  was  largely  my  private  surgery  plus  some  through  the  clinic.  I 
could  help  the  residents  do  the  clinic  patients  on  my  operating  days. 


Hughes: 

Scheie: 

Hughes: 

Scheie: 


Hughes: 
Scheie: 


Chief  of  Ophthalmology  Service, 
Philadelphia  General  Hospital,  1960-1975 

In  1960  you  were  appointed  chief  of  Division  A  Ophthalmology 
Service  at  the  Philadelphia  General  Hospital. 

That  was  our  big  city  hospital,  that's  right. 
What  is  Division  A  Ophthalmology? 

The  division  was  the  eye  service  of  the  University  of  Pennsylvania, 
and  it  was  quite  large  at  that  time.  The  hospital  was  a  huge,  I 
guess  2000-2500  bed,  city-indigent  institution  of  the  old  type.  The 
eye  service  was  divided  between  Temple  University  Medical  School 
and  Penn.  Actually,  we  did  most  of  our  work  together,  but  Temple 
had  its  own  surgical  days  and  we  had  ours. 

Is  there  any  characteristic  about  the  types  of  cases  that  you  would  be 
likely  to  see  at  Philadelphia  General  Hospital? 

Many  conditions  were  weird  and  the  patients  had  often  been 
neglected,  people  who  couldn't  afford  or  were  too  apprehensive  to 


155 

see  a  doctor.  I  have  some  frightening  slides  of  some  of  the  patients. 
One  comes  to  mind  immediately:  A  lady  with  a  neglected  basal  cell 
tumor,  which  had  probably  started  on  her  left  lower  lid.  By  the 
time  I  saw  her  at  Philadelphia  General,  the  left  eyelids  were  gone, 
the  orbit  completely  empty,  and  the  medial  and  inferior  wall 
missing.  You  could  see  into  her  nasal  cavity  and  maxillary  sinus. 
The  cancer  had  also  invaded  the  other  orbit  and  medial  aspect  of 
her  right  eyelids.  About  all  we  could  do  was  clean  up  the  area,  do  a 
tarsorrhaphy  to  protect  the  right  eye,  and  send  her  for  x-ray 
therapy. 

The  hospital  was  closed  on  June  30,  1977  for  economic  and  political 
reasons.  I  believe  the  city  was  somehow  able  to  provide  care  for  the 
patients  in  private  facilities. 

## 
Hughes:     Tell  me  about  your  rounds. 

Scheie:       Our  weekly  grand  rounds  included  all  of  our  hospitals  except 

Children's,  which  was  too  far  away.  We  saw  and  discussed  several 
interesting  patients  at  each  hospital.  They  were  ready  to  be 
presented  when  we  arrived. 

Hughes:     Is  it  unusual  in  ophthalmology  to  have  rounds  incorporate  so  many 
different  institutions'? 

Scheie:       I  think  our  situation  was  quite  unique.  Within  a  year  or  two  of  our 
being  given  a  service  at  Philadelphia  General  Hospital,  the  Temple 
University  service  was  also  assigned  to  us  and  we  ran  it  until  the 
hospital  closed. 

Hughes:     Why  did  Temple  drop  out? 

Scheie:       Their  school  was  far  away  across  the  city.  As  the  patients  began  to 
taper  off,  there  was  less  reason  for  them  to  come  that  distance. 

Hughes:     So  it  was  logistics? 
Scheie:       Yes. 

Hughes:     Well,  there  are  many  other  institutions  with  which  you  were 

associated.  Do  you  care  to  pick  any  of  them  to  say  a  few  words 
about? 


Other  Consultantships 


Scheie:       [scanning  curriculum  vitae]  The  consultantships  at  Camden  City 
Municipal  Hospital,  Crozer-Chester  Medical  Center,  and  Skin  and 


156 


Cancer  Hospital  are  all  more  or  less  run-of-the-mill  or  even 
honorary. 

Hughes:     Would  you  be  called  in  when  these  hospitals  had  a  case  that  they 
were  having  trouble  with? 

Scheie:       Rarely,  but  they'd  feel  free  to  refer  them  either  to  our  grand  rounds 
day  or  to  my  office. 

Hughes:     Did  you  go  to  those  institutions  on  a  regular  basis? 

Scheie:       Not  on  a  regular  basis;  I  simply  was  available.  These  consultant 
positions  were  not  very  meaningful.  The  same  with  Walter  Reed 
Army  Hospital.  I  would  go  to  Washington  occasionally  to  a  meeting. 
I  believe  I  did  the  first  corneal  transplant  ever  done  at  Walter  Reed 
Army  Hospital.  Dr.  Harry  King,  who  later  became  well  known  for 
his  work  in  cornea  and  the  preservation  of  grafts,  invited  me  to 
come  do  it.  That  was  not  the  only  time  I've  operated  at  Walter 
Reed,  because  occasionally  on  army  reserve  duty  they  would  invite 
me  to  help. 

Hughes:     Why  did  Dr.  King  ask  you  to  do  the  case? 

Scheie:       Well,  he  was  in  the  regular  army  at  that  time,  and  we  were  good 

friends.  We  had  shared  some  patients  over  the  years  so  that  we  had 
a  rather  close  relationship  professionally  and  personally.  Later, 
after  twenty  years  of  service,  he  retired  and  went  into  private 
practice  in  Washington  B.C. 

The  Valley  Forge  Army  Hospital  consulting  appointment  involved 
significant  responsibilities,  with  attendance  once  and  occasionally 
twice  a  month.  The  staff  and  I  would  see  patients  with  problems 
and  occasionally  I  would  operate  or  assist  the  staff. 

Hughes:     During  the  war,  I  know  the  emphasis  at  Valley  Forge  was  on  plastic 
surgery.  Did  that  emphasis  continue? 

Scheie:       Yes.  It  was  all  types  of  ophthalmology  and  they  had  a  large  plastic 
surgery  service,  including  eye  plastic  patients.  They  were  one  of 
the  five  military  eye  centers  and  they  also  worked  closely  with 
rehabilitation  hospitals  for  blinded  veterans.  The  fame  of  Valley 
Forge  Army  Hospital  stemmed  mainly  from  the  days  when  it  was 
running  an  eye  center  during  World  War  II.  Even  after  the  war  it 
remained  as  one  of  the  hospitals  in  the  counry  where  they  did  a 
good  bit  of  eye  work. 

Hughes:     Its  fame  began  during  World  War  II? 

Scheie:       That's  right.  They  had  very  fine  senior  ophthalmologists  assigned 
to  their  staff  during  World  War  II.  After  the  war,  they  used 
consultants  from  the  Philadelphia  area.  These  included  Dr.  John 


157 


McGavic,  Dr.  P.  Robb  McDonald,  and  myself.  We  went  there  often 
enough  that  we  did  play  an  essential  role.  They  needed  us  because 
their  staff  ophthalmologists  were  often  relative  juniors  with  little  or 
no  war  experience.  The  experienced  and  senior  wartime  staff  had 
been  discharged,  their  wartime  service  being  over. 

Hughes:     Dr.  Thygeson  served  there  briefly.  Did  you  know  that? 
Scheie:       I  didn't  know  that. 

Hughes:     He  was  there  between  his  wartime  service  in  Florida  and  at  Dibble 
Hospital  in  Menlo  Park,  California. 

Scheie:       Well,  they  had  a  very  fine  staff  during  World  War  II,  and  later  it 
was  less  experienced. 

Hughes:     Was  there  any  particular  reason  that  you  never  emphasized  plastic 
surgery  in  your  career? 

Scheie:       I've  always  had  the  feeling  that  a  good  eye  plastic  surgeon  ideally 
should  have  a  background  in  general  plastic  surgery.  I  wanted  to 
concentrate  on  ophthalmic  surgery,  although  I  always  did  the  more 
simple  plastic  procedures  but  never  the  reconstructive  type. 

Hughes:     Is  it  true  today  that  ophthalmologists  doing  plastic  surgery  have  a 
plastic  surgery  background? 

Scheie:       Not  many  have  a  general  plastic  surgery  background.  They  work 
with  experienced  ophthalmic  plastic  surgeons,  usually  for  a 
graduate  year  or  two  after  their  residency.  I  think  that  is  how  most 
of  our  eye  plastic  surgeons  have  developed. 

Hughes:     It  must  have  been  a  problem  during  World  War  II  to  find  men  who 
had  ability  in  the  area. 

Scheie:       It  was  usually  solved  at  centers  like  Valley  Forge  Army  Hospital 
where  excellent  plastic  surgeons  worked  with  ophthalmologists. 

Overseas,  I  had  Dr.  Henry  Royster,  who  was  head  of  plastic  service 
at  Penn,  to  help  me.  It  was  great  because,  although  very  busy,  he 
was  always  happy  to  assist  or  he'd  take  the  patients  on  his  own 
service.  We  worked  jointly  on  numerous  patients.  It  was  a  nice 
relationship,  a  wonderful  experience  for  me,  and  good  for  the 
patients.  Plastic  surgery  never  particularly  appealed  to  me.  I  went 
into  ophthalmology  originally  because  it  was  one  of  the  three 
happiest  services  at  the  university  hospital.  That's  one  of  the 
reasons,  I  think  the  most  important  reason,  for  my  selecting 
ophthalmology.  In  plastic  surgery  many  patients  are  not  truly 
happy  about  the  results,  no  matter  how  well  you  do.  They  may 
have  a  residual  scar  or  the  function  may  not  be  perfect.  I  did  do 
ptosis  work  in  my  practice  and  the  mothers  were  often  dissatisfied, 


158 

no  matter  how  good  the  result.  I  used  to  tell  the  mothers  of 
children  with  ptosis,  before  I'd  operate  on  them,  "Now,  this  child 
wasn't  put  together  normally,  and  by  doing  the  surgery  we're 
substituting  an  abnormality  that  is  less  objectionable  than  the 
original.  But  it  should  be  much  improved."  That  type  of  surgery 
was  not  my  favorite. 

The  reason  I  went  into  ophthalmology  was,  as  I  said,  because  it  was 
a  happy  service.  In  obstetrics,  another  happy  service,  the  mother 
goes  out  with  a  new  life  and  everyone  is  delighted.  In 
ophthalmology,  a  patient  often  comes  in  with  poor  vision  or  little 
vision  and  also  leaves  the  hospital  happy  with  a  new  life. 

Hughes:     What  was  the  third  happy  service? 

Scheie:        General  surgery,  because  again,  you  did  something  for  people.  Even 
a  simple  thing— not  so  simple  in  those  days— like  an  appendix.  But 
you  helped  a  family  and  they  felt  grateful  and  happy.  A  broken  leg, 
it's  fixed.  I  couldn't,  for  example,  be  a  neurologist  and  I  felt 
somewhat  the  same  about  internal  medicine.  The  doctor  makes  a 
diagnosis  and  then  he  devotes  much  of  his  time  to  supportive 
therapy  and  supervision  of  a  medical  regime. 

Hughes:     I  don't  think  psychiatry  would  probably  be  your  line  either. 
Scheie:       [laughter]  Oh,  no,  I  could  not  be  a  psychiatrist. 


The  Philadelphia  Home  for  Incurables-Inglis  House 

Scheie:       Inglis  House  is  a  private  institution  in  Philadelphia  where  I  agreed 
to  become  a  consultant  at  the  time  I  was  named  chairman  of  the 
department  in  1960.  They  admit  persons  with  diseases  such  as 
multiple  sclerosis  and  other  chronic  or  degenerative  diseases.  The 
residents  are  disabled  such  that  they  need  constant  care. 

We  set  up  an  eye  clinic  there  for  which  I  was  responsible.  I  did  see 
an  occasional  patient  but  the  routine  work  was  done  by  my  staff 
and  residents.  Actually,  as  chief  of  the  service,  I  incorporated  it  into 
our  service  at  the  university  hospital  and  later  at  our  new  eye 
institute.  We  were  given  a  small  or  token  stipend  that  went  to  our 
department  of  ophthalmology.  The  service  is  ongoing. 

Hughes:     Were  types  of  cases  contributed  from  Inglis  House  that  perhaps  you 
wouldn't  have  seen  anywhere  else? 

Scheie:       I  think  this  was  largely  altruistic  on  our  part.  We  would  see  an 

occasional  neurological  condition,  an  eye  emergency,  or  a  refraction. 

Hughes:     Were  the  patients  charged? 


159 


Scheie:       No,  they  weren't  charged.  The  institution  gave  the  department  a 
contribution  of,  I  think,  $600  a  year. 

Hughes:     How  were  patients  admitted? 

Scheie:       They  are  private  patients  who  are  chronically  disabled  and  are 

admitted  with  no  regard  for  race,  religion,  or  ability  to  pay.  Most 
patients,  however,  seem  to  have  families  who  provide  for  them.  It's 
interesting  that  the  Pew  family,  who  made  large  contributions  to 
the  building  fund  for  our  eye  institute,  is  extremely  interested  in 
Inglis  House.  In  fact,  Mrs.  Joseph  N.  Pew,  III,  is  chairman  of  the 
board  at  the  moment. 

Hughes:     Does  Inglis  House  have  a  long  history1? 

Scheie:       Oh,  yes.  It's  an  old  institution  in  Philadelphia,  privately  supported. 
They  have  various  activities  to  raise  money  and  they  have  an 
annual  giving  program,  of  which  I  was  chairman  several  years  ago. 


Central  Office,  Chief  Consultant  in  Ophthalmology, 
Veterans  Administration,  Washington,  D.C., 
1951-1959 

Scheie:       Being  chief  consultant  in  ophthalmology  at  the  Veterans 

Administration  in  Washington  took  a  good  bit  of  my  time.  I  was 
active  in  formulating  policies  for  ophthalmology.  These  policies,  as 
they  were  adopted  by  the  Veterans  Administration  Central  Office, 
were  applied  throughout  the  country. 

I  was  also  a  member  of  the  special  advisory  group  to  the  Veterans 
Administration  from  1956  to  1959  and  attended  its  meetings  in 
Washington.  We  had  to  approve  or  disapprove  such  things  as 
optometric  care.  We  had  to  decide  which  eye  patients  would  come 
into  veterans'  hospitals  to  be  cared  for  and  even  which  hospitals 
would  have  an  eye  service.  Originally,  I  worked  closely  with  Vice 
Admiral  Joel  T.  Boone,  who  was  the  chief  administrator  for  the 
Veterans  Administration.  It  was  a  job  I  enjoyed  but  it  did  take 
considerable  time. 

Hughes:     Do  you  know  how  your  appointment  came  about? 

Scheie:       I  suppose  because  of  my  military  service  and  experience  and  to 

some  extent  my  work  at  the  Veterans  Hospital  in  Philadelphia.  I 
had  come  to  know  Admiral  Boone  and  other  people  in  the  Veterans 
Administration.  It  was  an  interesting  committee  that  advised  on 
all  phases  of  veterans'  medicine. 

Hughes:     Were  there  representatives  from  each  of  the  specialties? 


160 


Scheie:       Yes. 

Hughes:     Were  you  the  sole  representative  from  ophthalmology1? 

Scheie:  I  was  the  sole  one  in  ophthalmology.  For  several  years,  Dr.  Robert 
M.  Zollinger,  the  well-known  professor  of  surgery  from  Ohio  State 
University,  was  chairman  of  the  advisory  committee. 

Hughes:     Was  it  a  long-term  appointment1? 

Scheie:       Yes,  and  the  board  met  formally  about  three  or  four  times  a  year  in 
Washington. 

I  was  able  to  have  the  board  approve  my  recommendation  about 
optometric  participation.  Optometrists  were  not  to  be  employed  in 
veterans'  hospitals  because  so  many  patients  had  service-connected 
conditions.  They  also  were  not  to  take  the  responsibility  for  caring 
for  service-connected  outpatients.  I  felt,  and  the  board  agreed,  that 
these  patients  should  be  seen  by  ophthalmologists. 

Hughes:     You  talk  as  though  that  is  no  longer  the  case. 

Scheie:       The  situation  has  changed  somewhat  but  I  am  not  acquainted  with 
the  details. 

Hughes:     Do  you  remember  any  other  issues? 

Scheie:       Well,  that  was  the  main  one.  We  decided  which  hospitals  should 

give  eye  care  and  we  insisted  upon  fully  qualified  ophthalmologists 
on  staffs  of  veterans'  hospitals,  affiliating  with  medical  schools 
wherever  possible. 

Hughes:     Was  there  quite  a  bit  of  homework? 

Scheie:       Only  a  modest  amount  of  paperwork  was  involved.  When 

something  came  up  that  the  administrators  in  Washington  felt  was 
a  problem,  I  usually  became  involved  and  I  might  even  be  asked  to 
come  to  the  central  office  in  Washington. 

Hughes:     Was  the  agenda  submitted  in  advance? 
Scheie:       For  the  advisory  committee  meeting,  yes. 

Hughes:     I  should  think  if  you  were  deciding  the  emphasis  in  ophthalmology 
in  specific  institutions,  you  would  need  to  know  the  problems  of  that 
particular  area. 

Scheie:       Policies  were  set,  but  after  that  the  regions  pretty  much  had  to 
solve  their  own  problems  within  that  framework. 


161 


Hughes:     What  did  you  consider  when  the  question  of  whether  there  should  be 
ophthalmology  at  a  given  institution  arose1? 

Scheie:       Well,  the  size  of  the  hospital,  the  community  it  was  in,  were 

competent  ophthalmologists  available  to  staff  it-that  sort  of  thing. 

Hughes:     Were  there  other  outstanding  people  on  the  committee  in  your  period 
of  service1? 

Scheie:       I  can't  go  through  the  names  now,  but  the  Veterans' 

[Administration]  advisory  board  was  made  up  of  outstanding 
people.  Most  of  them  were  prominent  names  in  organizational  and 
academic  medicine. 

Hughes:     What  was  your  position  as  consultant  to  the  Chronic  Disease 
Program  of  the  U.S.  Public  Health  Service? 

Scheie:       That  really  amounted  to  little.  I  was  on  a  committee,  but  it  never 
functioned  to  any  degree.  My  consultancy  to  the  health  and  welfare 
council  [Committee  for  Services  and  Facilities  to  the  Blind]  was 
similar. 

Hughes:     The  Children's  Heart  Hospital? 

Scheie:       That  was  a  small  children's  hospital  in  Philadelphia  devoted  to 

cardiac  problems.  At  that  time  rheumatic  heart  disease  was  more 
frequent  than  today.  The  hospital  had  a  relationship  to  the 
pediatrics  department  of  the  university  hospital  but  ophthalmology 
was  never  a  very  active  consultantship.  The  accommodations  were 
nice  and  the  medical  care  was  excellent.  With  the  advent  of 
antibiotics,  the  incidence  of  the  disease  has  been  greatly  reduced 
and  I  believe  the  hospital  no  longer  exists. 

[consulting  curriculum  vitae]  There's  not  much  to  say  about  the 
other  consultantships.  I  went  to  only  a  meeting  or  two  at  the 
headquarters  of  Alcon  Laboratories  in  Fort  Worth,  Texas.  I  was 
listed  as  a  consultant  but  was  rarely  utilized. 

Hughes:     What  is  Alcon? 

Scheie:       It  has  been  one  of  our  outstanding  and  most  successful  ophthalmic 
pharmaceutical  companies.  They  and  some  similar  ones  have 
contributed  a  great  deal  to  ophthalmology. 

Hughes:     What  is  your  feeling  about  the  role  of  an  academic  department  in 
testing  Pharmaceuticals? 

Scheie:       I  think  if  it's  properly  managed  and  supervised  that  it's  fine. 

Hughes:     Has  there  always  been  a  relationship  between  pharmaceutical 
companies  and  academic  ophthalmology? 


162 


Scheie:       Alcon  has  been  very  generous  in  supporting  research  projects  and 
academic  ophthalmology. 

Hughes:     And  giving  you  free  rein  to  do  the  research  which  you  wish? 

Scheie:       Yes.  I  don't  believe  such  relations  to  business  have  been  deleterious 
for  well-supervised  academic  departments. 


Chairman,  Department  of  Ophthalmology, 
University  of  Pennsylvania  School  of  Medicine, 
1960-1975 


Hughes:     The  next  topic  is  the  chairmanship  of  the  department  of 

ophthalmology.  You  became  chairman  in  1960.  Did  you  step  down 
in  1975? 

Scheie:       I  was  sixty-five  in  1974,  the  retirement  age  at  Penn  for  chairmen. 
As  an  example  of  academia,  the  administration  failed  to  replace  me 
at  that  time  or  even  ask  me  to  stay  on,  so  I  remained  as  chairman 
for  another  year.  The  last  year  or  two  of  my  chairmanship,  I  could 
sense  a  feeling  of  uncertainty  on  the  part  of  my  residents  and  staff. 
It  seemed  difficult  to  make  plans  under  those  circumstances. 
Realizing  that  the  situation  wasn't  good,  I  contacted  the  dean,  Dr. 
Edward  J.  Stemmler,  and  suggested  that  I  be  relieved.  This  was 
probably  May  of  1975. 

He  appointed  my  long-time  associate,  Dr.  William  C.  Frayer,  as 
acting  chairman.  Dr.  Frayer  had  trained  in  our  department,  grown 
up  in  it.  He  is  a  very  substantial  and  fine  person  and  an  excellent 
ophthalmologist.  During  the  year  that  he  served,  a  search 
committee  interviewed  several  candidates  and  by  August  of  that 
year,  Dr.  Myron  Yanoff  was  named  as  my  successor.  He  was 
chairman  until  January,  1986. 

Hughes:     Dr.  Frayer  was  never  considered? 

Scheie:       He  was  considered,  I'm  sure;  whether  he  would  have  wanted  it,  I 
don't  know. 

Hughes:     Were  you  consulted  in  his  case? 

Scheie:       I  was  not  consulted,  but  I  was  the  activist  who  said  I  thought 

certainly  Dr.  Frayer  should  be  named  acting  and  that  I  should  be 
relieved. 


163 


Renovating  the  Department 

Hughes:     Well,  going  back  to  1960  when  you  became  chairman,  please  describe 
the  physical  layout  of  the  department  that  you  inherited  from  Dr. 
Adler. 

Scheie:       The  building  area  was  nice  but  the  amount  of  space  for 

ophthalmology  too  limited.  Moving  my  private  practice  and 
employees  and  associates  into  the  area  necessitated  complete 
rebuilding  of  the  area.  Fortunately,  as  I've  said,  I  was  able  to 
obtain  a  gift  of  $75,000  from  Joseph  R.  Grundy  for  this  purpose.  He 
later  gave  our  department  a  million  dollar  endowment  through  his 
will.  Even  with  rebuilding,  the  space  was  never  adequate. 
However,  we  did  have  our  own  operating  room,  wards,  and  private 
rooms,  as  I  have  mentioned.  Dr.  Adler  had  quite  ample  space  for 
the  time  it  was  built  and  we  were  fortunate  to  have  it. 

## 
Hughes:     Senator  Grundy's  money  was  sufficient  to  renovate  the  space? 

Scheie:       Well,  the  hospital  supplemented  the  gift  and  we  were  able  to 

complete  the  remodeling,  creating  more  examining  rooms,  waiting 
areas,  and  other  alterations.  New  instruments  and  other 
equipment  were  needed  in  each  room  but  the  area  was  quite 
serviceable.  With  time,  however,  space  problems  became  acute  as 
our  program  grew  and  techniques  changed. 

Hughes:     Had  you  made  the  renovation  a  condition  of  your  appointment? 

Scheie:       No,  that  didn't  enter  into  it.  Once  I  knew  I  was  to  be  appointed,  I 
approached  Senator  Grundy.  The  hospital  administration  and  I 
then  planned  together.  We  had  a  fine  hospital  administrator,  Ralph 
R.  Perkins,  who  was  very  supportive.  He  realized  that  it  was  to  the 
hospital's  benefit  because  of  the  anticipated  new  and  increased  flow 
of  patients  through  the  clinic,  with  increasing  amounts  of  surgery. 
The  improvements  were  paid  for  many  times  over. 

Hughes:     Well,  we  spoke  of  bringing  your  private  practice  to  the  university. 

Were  there  any  other  conditions  associated  with  your  appointment? 

Scheie:       No,  except  that  I  do  a  good  job,  which  included  teaching, 

encouraging  research,  patient  care,  and  even  the  development  of 
funds  for  the  department.  Our  department  never  had  financial 
support  from  the  university  and  I  never  asked  for  any.  However,  we 
did  have  the  income  from  $300,000  that  Dr.  de  Schweinitz  had  left 
as  an  endowment.  This  yielded  about  $15,000  which  just  about 
paid  my  secretary's  salary,  Mrs.  Charlotte  Pace  (now  Beurer),  and 
in  1960  possibly  bought  a  few  postage  stamps.  We  had  no  other 


164 


financial  support  from  the  university  budget  for  the  eye  department 
during  my  years  at  the  university. 


Hughes: 
Scheie: 


Hughes: 
Scheie: 

Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Dr.  de  Schweinitz  had  left  that  money  himself,  or  had  he  raised  it? 

No,  he  had  left  it  in  his  will.  He  was  a  very  successful  and 
internationally  known  ophthalmologist  and  was  the  second 
chairman  of  ophthalmology  at  Penn.  He  had  succeeded  Dr.  William 
F.  Norris  in  1902.  Dr.  Norris  had  been  named  chairman  in  1874. 

Do  you  think  it  worked  to  your  advantage  or  your  disadvantage 
being  a  University  of  Pennsylvania  product  in  terms  of  your 
appointment  to  the  chairmanship? 

Well,  like  many  people  who  came  to  Philadelphia,  I  never  have  felt 
that  I  was  really  a  product  of  Penn,  not  having  attended  its  medical 
school. 

After  all  these  years?  You've  been  there  since  the  mid-thirties. 

I  think  it  was  a  help,  because  the  tradition  in  ophthalmology  at 
Penn  had  been  that  of  the  professor  manning  a  small  department. 
Dr.  Adler  retired  and  I  had  been  his  right  hand.  Once  appointed  it 
was  up  to  me  to  run  it  as  before  or  to  develop  a  larger  team  and  to 
create  a  more  adequate  place  to  work. 

Do  you  think  Dr.  Adler  expected  you  to  succeed  him? 

I  don't  know.  Dr.  Irving  Leopold,  I  understand,  was  considered  for 
the  job,  as  well  as  others.  Dr.  Adler  was  a  very  fair-minded  person 
and  I  don't  believe  that  he  would  have  injected  himself  into  the 
process.  If  anything,  he  probably  would  have  favored  me,  but  I 
don't  know.  We  never  discussed  it.  For  selfish  reasons,  he  would 
have  been  foolish  to  support  me  because  my  appointment  would 
have  disrupted  our  practice.  They  wanted  a  full-time 
ophthalmologist  in  charge  of  the  department,  preferably  on  a  salary 
basis,  which  I  would  not  consider.  After  my  appointment  I  invited 
Dr.  Adler  to  join  me  and  to  continue  our  practice  at  the  university, 
but  he  was  sensible  and  declined. 

Was  your  condition  of  going  there  without  salary  a  stumbling  block 
initially? 

I  don't  believe  so  but  I  simply  did  not  want  to  surrender  my  freedom 
to  practice  as  much  or  as  little  as  I  wanted  nor  the  ability  to  do  as  I 
wished  with  the  income.  I  planned  to  use  [the  income  from]  my 
practice  to  build  the  department  as  I  thought  best.  Initially,  I  had 
problems  with  cash  flow  to  pay  employees  and  other  expenses. 
However,  the  growth  of  the  department  of  ophthalmology  since 
1960,  including  the  eye  institute  with  its  contributions,  I  believe, 
supports  my  wisdom. 


165 


Hughes:     Why  were  you  chosen1? 

Scheie:       I  guess  because  I  worked  long  hours  and  had  been  in  everybody's 

hair.  Seriously,  probably  because  of  my  long  service  to  Penn,  nearly 
twenty-five  years. 

Hughes:     Is  that  enough  about  the  physical  improvements  that  you  made 
during  your  term  as  chairman1? 

Scheie:       I  could  mention  one  more  item  to  show  what  my  practice  brought  to 
HUP.  I  believe  ours  was  the  first  operating  room  at  the  university 
hospital  to  be  air  conditioned. 

Hughes:     Was  it  your  idea? 

Scheie:       Well,  it  was  my  idea  but  the  source  of  the  money  is  another  story. 
On  a  very  hot  July  day,  I  operated  a  wealthy  man  from  New  Jersey 
for  a  retinal  detachment  under  local  anesthesia.  It  was 
murderously  hot.  Fans  could  not  be  used  because  of  dust  hazard. 
Before  he  left  the  hospital,  he  told  me  that  he  would  contribute  the 
money  to  pay  for  the  air  conditioning.  This  was  while  Dr.  Adler  was 
still  chairman  but  not  too  long  before  1960. 

Hughes:     Why,  other  than  lack  of  money,  do  you  suppose  the  facilities  had  not 
developed  more  rapidly? 

Scheie:       Well,  actually  Dr.  Adler  had  achieved  excellent  facilities  for  the 

times  and  they  were  very  adequate  for  a  small  staff.  Our  space  was 
in  one  area,  in  adjacent  connecting  buildings.  A  wealthy  friend  and 
patient  of  his  had  given  the  money  for  the  private  and  ward  space, 
as  well  as  the  operating  room.  Over  the  years  the  area,  even 
though  rebuilt,  became  inadequate  as  my  practice  and  staff  grew. 
Furthermore,  we  had  no  designated  research  space.  I  would  think 
of  the  fine  facilities  and  contributions  of  places  like  the  Wilmer 
Institute  at  Johns  Hopkins,  the  Presbyterian  Institute  at  Columbia, 
Massachusetts  Eye  and  Ear  Infirmary,  and  a  few  others,  and  I  felt 
that  something  should  be  done  about  our  situation.  So  when  I 
became  chairman  my  prime  ambition  was  to  develop  a  department 
of  which  everyone  could  be  proud. 

Hughes:     How  many  beds  in  ophthalmology  were  there  in  Dr.  Adler's  day1? 

Scheie:       Oh,  I  am  not  certain,  probably  twenty,  but  the  hospital  agreed  to 
rebuild  the  inpatient  area,  significantly  increasing  its  capacity. 
Occasional  overflow  private  patients  were  placed  elsewhere  in  the 
hospital. 

Hughes:     So  admitting  patients  was  not  a  problem  ? 


166 

Scheie: 

Hughes: 
Scheie: 
Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


No,  it  was  never  a  problem.  These  were  very  desirable  patients 
from  the  hospital  standpoint. 

Had  admitting  patients  been  a  problem  in  Dr.  Adler's  day? 

No,  not  really. 

Twenty  beds  was  enough? 

Yes,  it  was  until  my  surgical  practice  increased.  In  all  fairness, 
much  of  my  success  in  practice  stemmed  from  my  long  association 
with  Dr.  Adler  and  with  the  University  of  Pennsylvania  Hospital. 

Staff 

Did  you  make  staff  changes  when  you  became  chairman? 

It  wasn't  a  matter  of  making  changes;  it  was  a  matter  of  attracting 
and  developing  a  staff  as  best  I  could.  One  of  the  first  moves  was  to 
name  Dr.  Thomas  B.  Duane  chief  of  research.  However,  within  a 
year,  before  he  had  a  chance  to  make  much  progress,  I  became 
partially  responsible  for  his  being  appointed  chairman  of  the 
department  of  ophthalmology  at  Jefferson  Medical  College.  I  am 
sure  that  he  has  told  you.*  His  departure  was  hurtful,  because  I 
had  no  replacement  at  that  time. 

In  1964, 1  named  Dr.  Alan  Laties  to  succeed  Duane  as  director  of 
research.  He  had  taken  a  four-year  combined  clinical  and  basic 
science  residency  and  had  shown  great  aptitude  and  initiative  in 
research.  This  was  a  key  step  in  development  because  we  could 
now  proceed  to  attract  others.  At  least  the  acorn  was  sprouting. 
Also,  I  had  obtained  the  money  and  two  thousand  square  feet  of 
space  in  the  then  new  Johnson  and  Johnson  Research  Building  on 
our  medical  school  campus. 

Did  you  have  a  method  for  finding  new  people? 

I  did  not  hurry  but  more  or  less  awaited  opportunities.  I  preferred 
people  who  had  trained  and  grown  up  with  us.  Dr.  William  C. 
Frayer,  who  had  trained  with  us  and  had  worked  with  Dr.  Adler 
and  me,  took  on  many  of  the  responsibilities  for  resident  training 
and  was  my  right  hand,  so  to  speak.  However,  he  left  to  go  to 
Jefferson  with  Dr.  Duane  in  June  1962. 

In  early  1962,  the  president  of  Jefferson  Medical  College,  William 
Bodine,  who  was  a  good  friend  of  mine,  came  to  me  with  the  dean 
and  the  chairman  of  the  board  of  the  school  for  advice  in  the 
selection  of  a  new  chairman  of  ophthalmology.  I  recommended  Dr. 


See  the  forthcoming  oral  history  of  Dr.  Duane  in  this  series. 


167 


Hughes: 
Scheie: 

Hughes: 
Scheie: 


Hughes: 
Scheie: 


Duane  along  with  at  least  three  other  possible  candidates.  They 
came  back  about  two  weeks  later  and  told  me  they'd  interviewed 
Dr.  Duane  and  were  very  impressed.  They  asked,  "Would  you  object 
to  our  inviting  him?"  I  said,  "Of  course  not.  That's  why  I  gave  you 
his  name."  And  he  was  appointed. 

Then,  to  complete  the  story,  not  long  afterward  I  met  him  in  our 
hospital  corridor  after  he'd  accepted  the  job  and  I  said,  "Tom,  what 
are  you  going  to  do  for  a  surgeon-clinician  at  Jefferson?"  Dr.  Duane 
did  little  surgery  himself.  His  prime  interest  was  general 
ophthalmology  and  research  which  he  had  been  doing  at  a  navy 
research  facility  in  Johns ville,  Pennsylvania.  He  had  a  Ph.D.  in 
physiology.  Tom  usually  had  referred  his  surgery  to  me  from  his 
private  practice  in  Bethlehem.  I  said,  "You  will  need  somebody  to 
lead  your  section  of  surgery."  He  replied,  "I  haven't  made  that 
decision  and  I  haven't  given  it  much  thought,  but  certainly  I  will 
need  someone." 

Dr.  Frayer  was  within  ten  years  of  my  age  and  he  had  been  working 
as  an  assistant  of  Dr.  Adler's  and  mine  in  our  private  practice  and 
at  HUP.  I  sensed  that  this  would  be  an  opportunity  for  him  to  be 
independent  and  have  his  own  show.  I  asked  Tom  Duane  how  he 
would  feel  about  having  Bill  Frayer  as  his  surgeon  and  right-hand 
man.  Dr.  Duane  said,  "Who  will  talk  to  him?"  I  replied,  "Tom,  I'm 
trying  to  be  good  to  both  of  you.  I  will  talk  to  Bill,"  which  I  did.  The 
result  was  that  he  went  to  Jefferson  with  Dr.  Duane  for  ten  years 
but  did  come  back  with  me  when  the  Scheie  Eye  Institute  opened  in 
1972. 

So  there  you  were  without  two  key  faculty  members. 

Yes,  there  I  was  with  real  personnel  problems,  but  I  did  recruit 
people  as  they  finished  their  training  with  us.  We  had  excellent 
residents  from  whom  I  could  develop  my  own  staff. 

Did  you  ever  take  on  people  with  whom  you  hadn't  worked? 

In  general,  that  was  not  too  successful  because  they  tended  to  come 
and  go.  One  who  did  stay  is  an  excellent  ophthalmologist  and  a 
loyal  friend,  Dr.  William  P.  Burns.  He  trained  at  Manhattan  Eye 
and  Ear  Hospital. 

New  Equipment 

What  about  equipment  in  the  department? 

We  were  always  well  equipped.  Having  the  income  from  practice 
available,  if  I  felt  a  need,  it  could  be  corrected. 


Hughes:     Were  there  things  that  you  immediately  bought  when  you  became 
chairman? 


168 


Scheie:       Well,  I  bought  equipment  for  the  examining  rooms-slit  lamps, 
refraction  equipment,  and  that  sort  of  thing. 

Hughes:     Were  those  purchases  mainly  a  function  of  a  bigger  patient  load? 

Scheie:       More  examining  rooms  had  been  created,  really  anticipating  a 

larger  patient  load.  For  example,  in  retina  work,  we  purchased  a 
$25,000  light  coagulator,  which  was  widely  used  at  that  time.  I 
always  insisted  upon  excellent  up-to-date  equipment.  In  fact, 
before  we  moved  to  the  institute,  with  retina  work  developing  as  it 
was,  I  had  purchased  laser  instruments  but  could  find  no  place  to 
install  them  so  they  remained  in  boxes,  stored  in  corridors  near  the 
elevators.  This  was  an  example  of  our  desperate  need  for  space 
during  the  year  or  two  before  the  institute  opened. 

Hughes:     Philadelphia  medicine  has  a  reputation  for  being  conservative.  How 
did  you  react  to  innovations  in  ophthalmology?  For  example,  the 
photocoagulator  and  the  laser? 

Scheie:       I  bought  them. 
Hughes:     Early  on? 

Scheie:       Philadelphia  had  been  famous  for  its  good  and  pioneering  yet 

conservative  medicine.  I  agree  with  the  philosophy  that  I've  heard 
preached  time  and  again,  "Be  not  the  first  to  take  up  the  new  nor 
the  last  to  give  up  the  old."  I  think  it's  a  little  unfair,  probably,  to 
classify  Philadelphia  medicine  as  overly  conservative.  But  in  our 
eye  institute  and  prior  to  that  we  have  tended  to  be  patient 
oriented,  not  sensation  oriented. 

Hughes:     Would  you  watch  a  new  technique  which  involved  new  equipment 
before  you  were  willing  to  invest  in  it? 

Scheie:       I  don't  know  if  people  think  of  me  as  conservative  or  radical, 

probably  both,  depending  upon  the  situation.  Unless  I  was  quite 
sure  that  something  had  evolved  to  the  benefit  of  the  patient,  I 
would  rarely  adopt  it.  And  yet,  I've  described  new  operations  that  I 
may  have  been  criticized  by  others  for  using.  But  any  time  I  felt 
that  I  could  help  a  patient,  I  would  adopt  whatever  might  be  helpful 
and  encourage  our  staff  to  do  likewise.  At  the  same  time,  I  wanted 
to  be  certain  that  it  would  do  no  harm.  I  couldn't  risk  losing  a 
patient's  eye.  I  went  into  medicine  to  help  people.  I  didn't  jump  on 
every  bandwagon. 

Hughes:     What  was  Dr.  Adler's  approach  to  innovative  techniques  and  drugs? 

Scheie:       He  was  always  innovative  and  progressive  but  I  don't  think  he  ever 
enjoyed  doing  surgery.  As  far  as  new  pharmaceuticals,  diagnostic 
techniques,  and  the  like,  I  think  he  was  as  progressive  as  anyone. 


169 


Hughes:     Where  would  you  place  the  department  on  the  scale  of  conservative  to 
liberal  in  terms  of  innovation? 

Scheie:       I  would  think  that  we  were  on  the  progressive  side,  [laughter] 

Hughes:     Aside  from  the  areas  that  you've  already  mentioned,  you  remodeled  a 
twenty -four-bed  ward  and  examining  room? 

Scheie:       Yes,  that's  right. 

Hughes:     There  were  four  private  beds?  Before  they  had  been  nonprivate? 

Scheie:       No,  they  were  semiprivate  and  private,  actually  two  private  and 
four  semiprivate  beds. 

Hughes:     And  a  pathology  lab  ? 

The  Resident  Training  Program 

Scheie:       Yes,  and  that  laboratory  follows  my  thinking  in  organizing  our 

residency  training  program.  I  had  two  types  of  residency.  One  was 
a  three-year  clinical  residency,  and  the  other  added  or  combined  one 
or  two  years  of  basic  science  training.  Dr.  Daniel  Albert  was  an 
example  of  this  latter  type.  Dr.  Alan  Laties,  later  named  my 
director  of  research,  was  another.  Dr.  Louis  Karp  was  another.  Dr. 
Myron  Yanoff,  who  later  became  my  successor,  also  took  the  long 
combined  residency.  Dr.  Laties  worked  in  neurophysiology  and 
neuroanatomy.  Drs.  Yanoff  and  Karp  worked  in  pathology.  Dr. 
Yanoff  passed  his  Board  examinations  in  pathology,  as  well  as  in 
ophthalmology.  In  other  words,  he  was  Board  certified  in  two 
specialties.  We  tried  to  have  laboratories  in  which  such  people 
could  work  after  their  residencies. 

Dr.  Laties  has  become  very  well  known  in  neuroanatomy  and 
histochemistry.  Dan  Albert's  accomplishments  speak  for 
themselves.  He  had  our  long-term  training  program  and  spent  two 
years  at  the  National  Institutes  of  Health  in  their  basic  science 
program.  Later  he  became  a  staff  member  at  Yale  [1969-19761 
where  he  did  basic  research  in  pathology  as  well  as  clinical  work. 
He  is  still  very  involved  at  Harvard  and  the  Massachusetts  Eye  and 
Ear  Infirmary  where  he  is  now  David  G.  Cogan  Professor  of 
Ophthalmology  and  director  of  the  David  G.  Cogan  Eye  Pathology 
Laboratory.  My  goal  was  to  build  our  own  basic  sciences  section 
manned  by  our  own  trainees,  in  addition  to  others  whom  we  might 
recruit. 

Hughes:     Was  this  a  new  idea  in  ophthalmology?  Because  what  you  seem  to  be 
talking  about  is  the  development  of  subspecialties  in  ophthalmology. 


170 


Scheie:       Not  to  create  subspecialties  but  an  attempt  to  emphasize  basic 

sciences  in  ophthalmology.  That's  quite  different.  I  also  wanted  to 
develop  subspecialties  such  as  retina,  cornea,  plastic  surgery,  and 
others.  Surely,  we  have  those.  My  goal  was  to  have  these  long-term 
trainees  remain  and  serve  as  an  academic  base  for  our  department. 

The  idea  came  from  my  former  professor  of  surgery  at  the 
University  of  Minnesota,  Dr.  Owen  Wangensteen,  with  whom  I  was 
quite  close  as  a  student,  although  not  as  close  as  I  was  with  Dean 
Lyon.  Dr.  Wangensteen  trained  more  chairmen  of  departments  of 
surgery  in  the  United  States  than  any  other  professor  of  surgery. 
He  required  that  his  residents  have  two  or  three  years  of  research 
before  he  would  appoint  them  to  his  surgical  residency.  They  could 
take  this  training  at  other  schools,  for  example,  with  Anton  J. 
Carlson  in  physiology  at  the  University  of  Chicago,  or  they  could 
stay  in  Minnesota.  Dr.  Wangensteen  preferred  that  they  achieve  an 
advanced  degree  in  basic  science  before  they  came  into  his  clinical 
program.  Dr.  Norman  E.  Shumway,  who  is  head  of  the  department 
of  surgery  at  Stanford  and  famous  in  transplant  work,  was  one  of 
Dr.  Wangensteen's  residents.  Dr.  Christiaan  Barnard  of  South 
Africa  was  another.  I  knew  that  I  couldn't  go  as  far  as  Dr. 
Wangensteen  did  but  I  did  encourage  the  combined  program. 

Hughes:     Was  that  a  relatively  new  approach  in  ophthalmology? 
Scheie:       I  don't  know  who  else  has  done  it  precisely  that  way. 

Hughes:     The  only  other  institutions  that  I  can  think  of  where  basic  science  in 
ophthalmology  was  an  early  interest  were  the  Institute  of 
Ophthalmology  at  Columbia  and  the  Mayo  Clinic  where  there  was 
encouragement  of  the  basic  sciences  in  the  mid-thirties. 

Scheie:       Encouragement  is  one  thing,  but  if  they  enter  this  program,  they 
agree  to  work  with  a  basic  scientist.  In  other  words,  they  agree  to 
add  a  year  or  two  to  their  residency.  Instead  of  sending  the  resident 
around  the  country  like  Wangensteen  often  did,  our  training  was  at 
the  University  of  Pennsylvania  with  our  own  basic  scientists. 

I  continued  this  program  until  I  retired.  I  had  only  fourteen  years 
as  chairman  and  during  the  last  two  or  three  years  of  one's  tenure  it 
is  more  difficult  to  motivate  and  recruit  people. 

Dr.  Yanoff  actually  became  head  of  our  pathology  section.  When  I 
was  working  with  Dr.  Adler,  he  and  I  encouraged  Bill  Frayer  to  take 
a  year  of  training  in  pathology.  He  did  that  and  spent  the  year 
working  in  the  pathology  department.  He  was  in  charge  of  our 
pathology  laboratory  at  the  University  of  Pennsylvania  until  1964, 
two  years  before  he  left  for  Jefferson.  There  was  still  another  one, 
Dr.  George  Kurz.  He  has  been  supportive  but  he  never  became  a 
vital  member  of  the  department.  He  is  a  fine  ophthalmologist  in 
New  Jersey  with  a  devoted  private  practice. 


171 


Other  Departmental  Improvements 

Hughes:     Dr.  Scheie,  I  also  have  notes  about  an  artist's  studio  that  you  added 
to  the  department. 

Scheie:       Yes,  we  had  very  fine  art  and  photography  departments,  and  the 
latter  is  still  very  active.  There  are  now  at  least  four  full-time 
people  in  our  photography  department,  but  we  no  longer  have  an 
artist. 

We  had  a  couple  of  very  fine  artists,  especially  Miss  Jean  E.  Wolfe. 
She  won  just  about  every  top  award  for  a  medical  artist,  and  her 
exhibitions  invariably  took  top  prize.  Many  of  the  illustrations  can 
be  found  in  my  Textbook  of  Ophthalmology,*  and  several  of  my 
articles  were  illustrated  by  her.  Her  work  was  beautiful. 

Hughes:     Why  was  the  service  dropped? 

Scheie:       My  successor  was  not  as  interested  in  art  work. 

Hughes:     What  had  you  done  prior  to  the  creation  of  the  art  department, 
because  many  of  your  articles  are  illustrated? 

Scheie:       I  would  go  to  an  individual  artist. 
Hughes:     Unassociated  with  the  university? 

Scheie:       Yes.  One  was  a  Mr.  Robert  Grooms.  I  have  since  seen  him  as  a 
patient  on  occasion. 

Hughes:     Do  people  at  the  institute  now  go  to  a  private  person  ? 

Scheie:       I  believe  they  rarely  use  the  same  type  of  illustration  that  I  did,  and 
statistical  tables  are  easy  to  produce.  I  also  used  those  but  I  loved 
nice  art  work  to  illustrate  surgical  procedures. 

Hughes:     What  about  a  records  room? 

Scheie:       We  have  a  nice  records  room  at  the  eye  institute  that  is  limited  to 
our  patients.  We  kept  our  outpatient  records  in  the  clinic. 
Inpatient  hospital  records  were  stored  in  the  hospital's  central 
records  room. 

Hughes:     I  understand  that  you  spent  a  good  deal  of  effort  in  the  early  days  of 
your  chairmanship  trying  to  find  research  space. 


Scheie  HG,  Albert  DM.  Adler's  Textbook  of  Ophthalmology.  Philadelphia:  WB  Saunders,  8th  ed, 
1969;  9th  ed.,  1977.  Other  examples  of  Jean  Wolfe's  work  are  contained  in  the  pamphlet:  Scheie 
HG.  Highlights  of  Surgery,  1971. 


172 


Hughes: 
Scheie: 


Scheie:       Well,  originally  none  was  available  and  we  had  to  borrow  space. 
Over  the  years  I  was  able  to  raise  some  money  and  to  provide  two 
thousand  square  feet  of  space  in  the  new  Johnson  Basic  Science 
Building.  This  was  our  first.  In  the  eye  institute,  the  sixth  floor  is 
devoted  only  to  research.  The  area  is  approximately  fifteen 
thousand  square  feet. 

Do  you  have  a  permanent  hold  on  the  research  space  that  belongs  to 
the  university? 

Oh,  yes.  I  talked  about  that  not  long  ago  to  Dr.  Edward  J. 
Stemmler,  the  former  dean  and  now  executive  director  for  the 
University  of  Pennsylvania  Medical  Center.  Dr.  Laties  and  some  of 
his  research  workers  do  much  of  their  work  in  that  space,  often 
working  with  scientists  from  other  departments. 

Hughes:     Did  you  have  that  during  Dr.  Adler's  chairmanship? 

Scheie:       No,  we  borrowed  a  lab  here  or  there  where  we  did  some  work.  Such 
space  allocations  involved  many  uncertainties,  however. 

The  Medical  Students'  Curriculum  in  Ophthalmology 

Hughes:     Did  you  change  the  curriculum  in  ophthalmology  for  medical 
students'? 

Scheie:       I  made  no  major  changes.  I  personally  gave  twelve  weekly  one-hour 
lectures  to  the  junior  class  each  year,  and  each  student  had  a 
number  of  hours  to  work  in  the  clinic  with  our  staff.  We  also  taught 
them  how  to  examine  an  eye  in  physical  diagnosis.  We'd  teach 
them  how  to  use  an  ophthalmoscope  and  at  least  what  eye 
instruments,  including  a  slit  lamp,  we  use.  But  my  own  personal 
lectures  were  not  directed  at  specialty  level.  They  largely  utilized 
my  photographic  slide  collection,  with  material  of  the  sort  you 
might  cover  in  a  lecture  for  general  practitioners. 

I've  always  taken  a  great  many  photographs.  My  lectures  would 
start  with  anatomy  and  embryology  of  the  eye  and  then  I'd  go  to 
pediatric  ophthalmology,  relating  what  they  may  have  learned  from 
the  anatomy  and  embryology  lectures  to  clinical  photographs 
(slides)  showing  common  congenital  abnormalities  of  the  eye.  From 
there  I  covered  children's  eye  problems,  illustrated  by  photographs 
of  children  seen  in  my  work  at  Children's  Hospital  and  in  my 
practice. 

I  then  gave  three  or  four  lectures  on  medical  ophthalmology.  I  have 
kept  all  of  these  slides  sorted  in  their  boxes.  Then  in  the  final 
lectures  I  tried  to  make  ophthalmology  more  exciting  for  the 
students  by  showing  slides  and  movies  of  eye  surgery.  The 
attendance  at  these  lectures  was  amazing  for  a  medical  student 


173 

body.  Much  of  the  time  there  was  standing  room  only  in  our  rather 
large  medical  alumni  amphitheater. 

Hughes:     I  know  about  Dr.  Ewing,  but  were  there  others  who  began  to  consider 
ophthalmology  as  medical  students  because  of  your  introduction  to 
ophthalmology? 

Scheie:       Oh,  I  think  that  quite  a  few  of  our  residents  over  the  years  came 
because  of  our  [medical  student]  teaching  program. 

I  also  had  a  special  elective  where  we  made  rounds  to  see 
interesting  medical  and  neurological  conditions.  I  believe  it  had 
something  to  do  with  Dr.  Leopold's  going  into  ophthalmology,  and 
possibly  several  others  over  the  years.  But  certainly  Dr.  Yanoff  and 
several  of  the  residents  of  that  vintage  went  into  ophthalmology  at 
least  partly  because  their  interest  was  stimulated.  Now  I'm 
beginning  to  wonder  if  medical  students  may  not  be  attracted 
because  they  hear  that  it's  a  lucrative  specialty.  That  is  another 
story. 

Hughes:     Was  the  course  in  ophthalmology  given  to  medical  students  more 
comprehensive  than  at  most  other  institutions? 

Scheie:       Possibly  so.  It  was  certainly  more  comprehensive  than  it  is  today, 
and  slanted  toward  the  general  physician. 

Hughes:     In  what  year  did  it  occur? 

Scheie:       These  lectures,  I  think,  were  given  during  their  junior  or  senior 
year,  their  clinical  years.  The  instruction  in  using  the 
ophthalmoscope  was  given  as  part  of  their  course  in  physical 
diagnosis  during  their  second  year.  The  students  were  divided  into 
small  groups  of  three  or  four. 

Hughes:     I  read  that  it  was  the  practice  of  the  department  to  give  each  student 
a  set  of  lecture  notes.*  Was  that  your  idea? 

Scheie:       Yes,  I  made  those  up  and  had  them  printed. 
Hughes:     Was  there  ever  thought  of  publishing  them? 

Scheie:       Much  of  the  material  is  in  the  revisions  I  did  of  Adler's  Textbook  of 
Ophthalmology  in  1969  and  1977. 

Hughes:     Did  you  encourage  members  of  your  department  to  do  collaborative 
work  with  other  university  departments  or  other  institutions? 


Scheie  HG  and  members  of  the  staff  of  the  department  of  ophthalmology.  Ophthalmology  Lecture 
Notes.  University  of  Pennsylvania  Press,  1960. 


174 


Scheie:       Yes,  I  did,  and  such  collaborations  were  essential  to  our  long-term 
residency  program.  Upon  finishing  their  residency,  if  they 
remained  on  the  staff,  residents  were  given  joint  appointments  with 
other  departments,  for  example,  Dr.  Laties  in  ophthalmology  and 
neurology.  We  had  others-Dr.  Myron  Yanoff  in  pathology  and  Dr. 
Charles  Nichols  in  pharmacology.  Dr.  Nichols  had  trained  with  Dr. 
George  Koelle  in  pharmacology.  Dr.  Elsa  Kertesz,  upon  completion 
of  her  three-year  clinical  residency,  studied  for  two  years  in  the 
department  of  human  genetics  of  the  University  of  Michigan  under 
Drs.  William  Schull  and  Harold  Falls  and  six  months  with  Drs. 
Frank  Costenbader  and  Marshall  Parks  at  the  Children's  Hospital 
in  Washington,  D.C.  She  had  a  joint  appointment  at  HUP  and 
Children's  Hospital  of  Philadelphia.  Dr.  Arnold  B.  Popkin  took 
advanced  work  in  electroretinography,  and  Dr.  David  Kozart 
received  two  years  of  training  in  electron  microscopy. 

Hughes:     Could  you  say  something  about  priorities,  fitting  in  your 
administrative  work  with  the  other  things  that  you  had  to 
accomplish  in  a  day? 

Scheie:       It  was  all  directed  toward  one  goal-improving  the  department, 

building  the  institute,  and  augmenting  quality  and  number  of  staff. 
All  of  this  required  years.  This  was  especially  true  in  developing  a 
staff  loyal  to  a  program  and  its  goals.  In  other  words,  people  may 
be  very  different  but  with  similar  overall  goals,  whether  in 
teaching,  managing  patients,  or  in  investigative  work,  basic  or 
clinical. 

An  excellent  example  is  Dr.  Madeleine  Ewing.  Her  interest  was  not 
research,  but  she  is  a  great  clinician  and  teacher.  I  hope  she  will 
some  day  be  back  when  this  institute  has  settled  down  under  a  new 
chairman.  Another,  Dr.  William  Frayer,  is  mainly  a  clinician  but 
also  is  an  excellent  well-trained  pathologist.  His  prime  interest  is 
caring  for  patients  and,  like  Dr.  Ewing,  he  is  an  excellent  teacher. 
You  need  balance  in  a  department.  We  also  have  Dr.  John  Rockey 
and  Dr.  Herbert  Blough,  who  have  Ph.D.  degrees  in  addition  to 
their  medical  degrees  but  limit  their  activities  to  research.  Several 
more  staff  men  were  added  after  Dr.  Yanoff  became  chairman  in 
1976. 

Hughes:     You  said  off-tape  that  you  had  never  fired  anyone.  Inevitably, 
though,  not  everybody  stays. 

Scheie:       I  agree,  but  I  was  so  unpleasant  that  firing  was  unnecessary  and 
they  would  quit,  [laughter]  That  answers  that  question. 

Hughes:     Well,  I  was  going  to  phrase  it  a  bit  less  bluntly  than  that. 
Scheie:       I  never  mind  being  blunt,  [laughterl 


175 

Most  of  the  staff  understood  and  related  to  our  department  before 
they  agreed  to  stay  on.  Forgetting  my  personality,  I  was  dedicated 
to  developing  a  well-rounded  excellent  department  of 
ophthalmology.  Patients  always  came  first,  and  I  have  spent  more 
time  talking  patients  out  of  surgery  than  into  having  it.  Call  it 
conservative.  My  goal  was  also  to  develop  ophthalmologists  with  a 
conscience  and  who  were  well-trained. 

The  institute  has  four  or  five  secretarial  and  technical  people, 
including  my  personal  secretary,  who  have  been  in  the  department 
for  twenty-five  to  thirty-five  years.  When  I  hired  them  it  was  with 
the  idea  that  they  would  be  long-term  employees.  However,  this  is 
no  longer  much  of  a  consideration  at  the  institute.  I  tried  to  avoid 
hiring  young  persons  who  might  leave  in  a  short  time.  My  goal  was 
to  hire  mature  people  or  young  people  who  really  needed  and 
wanted  a  permanent  job.  They  were  made  to  understand  at  the 
time  of  the  interview  that  they  were  entering  my  professional  life 
and  that  if  they  wanted  to  keep  banker's  hours  they  should  find  a 
job  in  a  bank.  Working  in  our  department,  they  might  be  expected 
to  put  in  overtime  if  necessary.  I  let  them  know  that  I  desired 
permanent  employees  who  would  feel  that  they  were  helping  me 
and  the  other  doctors  to  help  people. 

Hughes:     Did  you  say  so  in  so  many  words? 

Scheie:       Yes,  I  would  say  it  in  so  many  words. 

Mrs.  Betty  Eckert  was  my  first  secretary  and  has  come  back  from 
retirement  to  work  with  Dr.  Ewing.  For  personal  reasons,  she  had 
left  our  employ  a  few  years  ago.  One  of  the  present  technicians, 
Mrs.  Alice  Borowik,  worked  with  Dr.  Adler  and  me  before  1960  and 
joined  me  at  the  university  later.  Another  technician,  Miss  Jane 
Poticher,  is  working  in  photography,  and  another  long-term 
employee  is  working  in  the  patient  accounting  department.  An 
ophthalmic  technician-nurse,  Miss  Terry  Wlodarczyk,  has  been  with 
the  department  about  twenty -five  years.  She  was  hired  before  we 
moved  into  the  institute.  One  of  our  nurse  technicians  retired  a  few 
years  ago  after  thirty-five  years.  Miss  Margaret  Patton  worked  as 
editor  and  head  of  our  development  department  for  thirteen  years 
before  she  retired  in  1980  and  then  returned  as  a  volunteer  in  1985. 
Mrs.  Hisako  Weimert  has  been  with  us  for  seventeen  years  in 
departmental  accounting.  Mrs.  Charlotte  Beurer,  my  personal 
secretary,  had  two  young  sons  and  had  recently  divorced  when  I 
hired  her.  She  needed  a  job,  and  even  after  she  had  married  again, 
she  seemed  to  enjoy  the  job  and  stayed  on.  She  has  now  been  with 
me  for  more  than  thirty-one  years. 

Applicants  were  also  told  that  if  after  six  months  they  were 
unhappy  with  their  job  or  if  we  were  displeased,  either  of  us  could 
terminate  with  no  ill-will.  This  is  quite  different  from  quitting  or 
being  fired.  After  six  months,  chances  are  they  will  be  permanent. 


176 


Hughes:     Did  most  people  stay1? 

Scheie:       Well,  I've  named  those  that  have  but,  of  course,  not  everyone  did. 
Usually  those  who  left,  did  so  because  of  some  compelling  reason. 

Hughes:     Some  extraneous  reason. 

Scheie:       Yes.  There  was  almost  never  any  emotional  feeling  about  a 
departure. 

[Interview  6:  March  30, 1988]  ## 
Hughes:     Let's  conclude  our  discussion  of  medical  student  teaching. 

Scheie:       We  also  had  electives  up  to  three  months,  but  usually  from  two  to 
six  weeks.  The  students  would  join  us  in  our  department,  not  only 
to  see  patients  but  to  attend  conferences  and  to  observe  in  the 
operating  room  whatever  might  interest  them.  These  efforts  helped 
to  attract  residents  and  served  as  good  public  relations  on  campus. 
A  few  of  the  students  came  from  other  schools  for  these  electives. 

The  Resident  Training  Program 

Hughes:     How  many  residents  did  you  have? 

Scheie:       When  I  started,  we  had  three  a  year  and  for  a  three-year  residency. 
Over  the  years  the  number  increased  to  five  a  year.  We  also  had 
postresidency  training,  with  individuals  working  in  subspecialties 
or  doing  research  for  a  year.  The  long-term  residents  stayed  for  two 
or  three  extra  years  in  basic  science.  So  the  program  was  very 
flexible. 

Hughes:     What  did  you  look  for  in  selecting  a  resident? 

Scheie:       Well,  at  our  interview  sessions,  in  which  senior  staff  would 

participate,  we  considered  their  record  in  medical  school,  letters  of 
recommendation,  responses  to  interviews,  and  our  overall 
impressions.  I  think  the  usual  things. 

Hughes:     Were  there  certain  personal  qualities  that  you  were  looking  for? 

Scheie:       People  who  were  anxious  to  have  the  residency  and  who  were  bright 
as  well  as  highly  motivated. 

Hughes:     Did  you  give  them  some  idea  of  your  expectations? 

Scheie:       Oh,  yes.  We  outlined  our  program  to  them,  but  most  of  them  were 
familiar  with  that  before  they  applied,  and  they  knew  that  diligence 
would  be  required,  because  we  did  work  hard.  We  had  a  demanding 
program. 


177 


Hughes:     Did  you  have  residents  who  didn't  last  the  full  three  years  or 
whatever  the  term  was  supposed  to  be? 

Scheie:       I  don't  remember  ever  dropping  one  or  having  one  leave.  One  had 
so  little  surgical  aptitude  that  I  didn't  permit  him  to  do  surgery. 

Hughes:     That  was  a  matter  of  dexterity? 

Scheie:       Dexterity,  motivation,  and  insufficient  interest.  I  think  he  was  the 
only  one,  and  I  don't  believe  he's  ever  gone  on  to  do  surgery, 
although  he  practices  ophthalmology.  Dr.  Laties,  for  example,  who 
is  our  director  of  research,  was  an  adequate  surgeon  but  he  was  not 
interested.  He  went  into  research  and  neuro-ophthalmology. 

Hughes:  But  that's  the  exception,  is  it  not? 

Scheie:  That's  the  exception.  Most  of  them  do  want  to  do  surgery. 

Hughes:  And  that's  the  reason  they  came  to  you. 

Scheie:  That's  not  the  only  reason.  They  wanted  a  rounded  residency. 

Hughes:     Would  you  say  that  there  was  less  emphasis  on  the  medical  aspects 
of  ophthalmology? 

Scheie:       Oh,  no.  We  had  a  very  broad  and  excellent  program.  As  a  base  for 
training  we  had  HUP,  a  general  hospital,  and  Children's  Hospital 
for  pediatrics.  We  did  all  of  the  eye  consultations  for  both  hospitals, 
including  general  medicine  and  neurology.  Excellent  medical 
experience  was  also  available  for  residents  at  the  Philadelphia 
General  Hospital  until  it  closed,  and  at  the  Veterans 
Administration  Hospital.  Study  patients  from  our  own  clinics  and 
private  practices  were  also  available.  We  tried  to  emphasize  a 
well-rounded  experience  in  addition  to  surgery. 

Hughes:     Do  you  think  the  program  was  unusual  in  the  diversity  to  which  a 
resident  was  exposed? 

Scheie:       I  would  assume  that  was  the  goal  of  nearly  all  programs.  As  an 
exception,  until  Wills  affiliated  with  Temple  and  later  with 
Jefferson,  they  were  an  eye  hospital  and  they  didn't  have  the 
general  exposure  that  our  own  residents  would  get.  It  was  a 
different  type  of  program,  with  more  surgical  exposure. 

Hughes:     Could  you  characterize  the  relationship  you  sought  to  establish  with 
your  residents? 


178 


Scheie:       I  always  hoped  it  was  a  close  one.  I  tried  to  let  them  know  that  not 
only  was  I  interested  in  them  but  that  I  also  worked  as  hard  as 
they.  I  believe  in  retrospect  that  we  had  a  fairly  good  time-at  least 
I  did. 

Hughes:     Please  tell  me  about  your  teaching  conferences. 

Scheie:       We  would  have  morning  conferences  but  usually  not  on  my  two 
operating  days. 

Hughes:     What  did  the  conferences  consist  of? 

Scheie:       Usually  an  hour  of  didactic  teaching  or  conference,  depending  upon 
the  person  who  was  conducting  it.  But  we  tried  to  cover  all  of  the 
subjects  that  were  required  on  the  American  Board  examinations  at 
least  twice  during  each  residency. 

Presbyterian  Hospital 

Hughes:     What  was  the  relationship  of  Presbyterian  Hospital  to  the  residency 
program? 

Scheie:       Before  1972,  it  was  nil.  They  had  their  own  department  of 

ophthalmology  and  a  small  clinic,  which  we  absorbed  once  we 
moved  into  the  eye  institute.  We  built  our  institute  on  the  grounds 
of  the  Presbyterian  Medical  Center,  a  long-time  affiliate  of  the 
University  of  Pennsylvania  Medical  School. 

Hughes:     Was  there  a  rivalry  there? 

Scheie:       No,  but  several  of  their  staff  members  were  either  members  of  the 
staff  of  the  graduate  school  or  held  appointments  in  the  University 
of  Penn's  department  of  ophthalmology.  So  there  never  was,  so  far 
as  I  know,  any  serious  feelings  against  the  merger  with  the 
institute.  Presbyterian's  clinic  was  small.  Their  staff  had  the 
privilege  of  doing  surgery  and  participating  in  our  programs  if  they 
desired. 

Hughes:     The  merger  occurred  in  1972  when  the  institute  opened1? 

Scheie:       That's  right. 

Hughes:     Presbyterian's  gain  was  obvious.  What  did  you  gain  ? 

Selecting  the  Site  for  the  Scheie  Eye  Institute 

Scheie:       Well,  we  had  a  fantastic  new  building  in  which  to  work.  When 
planning  the  institute,  whether  it  was  academia  or  its  politics  or 
both,  space  could  not  be  found  on  the  university  campus  itself, 
which  was  where  I  wanted  it.  Land  was  made  available  to  us  at  the 


179 


Presbyterian  Medical  Center,  partly  because  of  the  Pew  family  who 
gave  the  initial  three  million  dollars  for  the  building  fund. 

The  decision  was  made  after  two  faculty  dinner  meetings  that 
lasted  till  midnight,  at  which  great  discussions  occurred.  The 
purpose  of  the  meetings  was  to  decide  if  and  where  the  institute 
would  be  built.  Finally,  the  president  of  the  university,  Gaylord  P. 
Harnwell,  who  presided  through  both  meetings,  took  a  vote  of  the 
faculty  and  it  was  even.  So  he  cast  the  deciding  vote  saying,  "I  don't 
necessarily  believe  in  the  omniscience  of  my  faculty."  Those  were 
his  words  at  midnight  of  the  second  meeting.  He  said,  "The  eye 
institute  will  be  built  and  at  Presbyterian." 

Hughes:     What  was  the  alternative? 

Scheie:       The  alternative  at  that  time  was  probably  not  to  build  it.  There 
were  campus  rivalries  and  jealousies,  as  exist  everywhere.  This 
was  a  rather  turbulent  time  anyway,  which  I  know  because  I  was 
chairman  of  the  Medical  Board  at  Penn  at  the  time.  But  the 
decision  was  made  and  the  institute  was  built. 

Hughes:     What  was  the  prime  motivation  of  those  in  opposition? 

Scheie:       I  think  probably  the  usual  one  of  not  wanting  one  department  to 
rise  above  the  other,  an  unfortunate  human  trait.  It  was  never 
expressed  in  those  words,  but  there  was  always  some  reason,  lack  of 
need  or  other,  that  it  shouldn't  be  done.  One  person  at  the  second 
meeting  said  that  in  his  opinion,  "All  Hank  Scheie  wants  is  to  have 
his  name  on  a  building."  That  didn't  go  over  too  well  at  a  faculty 
meeting,  and  I  had  a  feeling  that  if  he  hadn't  said  that,  President 
Harnwell  might  have  been  more  inclined  not  to  approve  the  project. 

Hughes:     Was  that  a  difficult  time  for  you  ? 

Scheie:       Yes  and  no,  but  I  try  to  take  things  in  stride. 

I  was  disappointed  at  building  the  eye  institute  on  the  Presbyterian 
campus.  Over  the  years  we  have  unfortunately  lost  a  great  deal  of 
our  close  relationship  with  the  HUP  staff  and  faculty.  Originally,  I 
continued  my  weekly  grand  rounds.  I  also  continued  to  be  available 
for  consultations,  as  were  our  staff  members.  I  continued  my 
lectures  for  medical  students  and  held  them  at  the  university 
hospital  which  helped  to  maintain  good  relations  between  the  two 
institutions. 

Much  of  this  activity  fell  by  the  wayside  following  my  retirement. 
One  person  was  put  permanently  in  charge  of  the  service  at  the 
university  hospital,  which  was  a  mistake,  and  the  institute  staff 
became  rather  removed.  For  practical  purposes,  HUP  became  a 
separate  activity  from  those  at  the  eye  institute,  which  was  never 
intended  and  did  not  need  to  be  that  way. 


180 


Hughes:     Why  was  that  allowed  to  happen  ? 

Scheie:       Poor  administration  on  the  part  of  those  in  charge  at  HUP  and  at 
the  institute.  Maintaining  a  close  relationship  with  the  HUP  staff 
and  the  medical  school  was  essential  and  was  primarily  the 
responsibility  of  my  successor  and  to  a  lesser  extent  the  medical 
school,  which  could  have  intervened. 

I  have  had  the  privilege  of  interviewing  the  number-one  candidate 
for  the  job  as  new  director  of  the  Scheie  Eye  Institute  and  have 
explained  the  problem  to  him.*  Fortunately,  he  agreed  that  there 
has  to  be  a  revision  of  thinking  and  managing  such  that  we  again 
become  a  vital  part  of  the  university  hospital.  There  should  also  be 
a  joint  committee  representing  Penn  and  Presbyterian  Medical 
Center,  possibly  board  members,  to  detect  such  overall  problems, 
including  budgeting  and  pooling  as  well  as  supervising  the 
spending  of  endowment  funds.  Each  organization  has 
responsibility  for  investing  and  reinvesting  its  own  eye  institute 
endowment  funds. 

Hughes:     Is  there  ill  feeling  on  both  sides  because  of  this  schism? 

Scheie:       No,  I  think  it's  more  a  matter  of  sharing  a  new  beginning.  The 

base,  including  financing,  is  solid.  If  I  were  on  the  staff  at  the  eye 
institute  now,  I'd  say,  "Well,  why  aren't  we  going  over  to  the 
university  more?  They  have  a  vast  amount  of  general  work  and 
consultations  to  be  done." 

I  had  selected  three  possible  sites  at  the  university  hospital  where 
the  institute  could  have  been  built,  one  of  which  would  have  been 
ideal.  In  fact,  I  had  architect's  drawings  made  for  that  particular 
location  which  the  Pew  family  had  approved.  Obstacles  were  raised 
which  foolishly  made  all  three  impossible. 

Hughes:     Why  was  the  present  site  of  the  institute  chosen? 

Scheie:       The  site  was  available  and  no  one  looked  covetously  at  it.  The 

president  of  the  university  made  the  final  decision  after  the  vote  by 
the  faculty  committee  and  that's  why  it  was  built  there.  But  he 
wasn't  given  any  realistic  alternatives.  The  desirable  locations 
adjacent  to  HUP  were  seemingly  unavailable. 

Hughes:     What  would  building  at  the  three  sites  you  had  in  mind  entail? 

Scheie:       Well,  one  would  have  involved  city  politics  to  some  extent.  It  since 
has  had  a  medical  center  building  on  it.  Another  was  a  condemned 
part  of  HUP  which  has  yet  to  be  torn  down,  and  occupancy  is  not 


At  the  time  of  the  interviews,  a  search  committee  was  looking  for  a  permanent  director  of  the 
institute. 


181 

permitted  in  the  building  today.  At  that  time  there  were  patient 
activities  in  the  building  which  apparently  could  not  be  relocated.  I 
suggested  that  we  move  our  eye  clinic  temporarily.  They  could  have 
the  space  during  construction  of  the  institute.  Again,  this  was 
impossible.  We  had  an  ideal  site  selection-the  one  for  which 
Vincent  Kling  had  made  the  drawings-which  would  have  connected 
us  with  the  new  Children's,  as  well  as  the  university  hospital.  We 
could  have  done  both  pediatric  ophthalmology  and  that  for  HUP 
very  efficiently.  Our  operating  rooms  would  have  been  ideally 
located  for  patients  from  both  hospitals.  It  would  have  been  a 
perfect  place.  But  it  didn't  come  to  pass. 

I  guess  with  every  new  building,  with  every  improvisation,  when 
you're  working  with  groups  of  people,  differences  occur.  The  Pew 
family  was  becoming  impatient  and  asking,  "Now,  when  are  we 
going  to  get  started  with  this  building  that  we've  told  Harold  Scheie 
we'll  help  with?" 

Hughes:     That  was  1969. 

Scheie:       It  would  probably  have  been  1968,  before  definitive  plans  had  been 
made. 

Hughes:     Why  did  you  say  that  the  institute  should  not  be  in  its  present 
location? 

Scheie:       Well,  we  have  failed  to  relate  as  closely  as  we  should  to  the 

university  hospital  and  its  staff.  HUP  is  the  heart  and  soul,  if  you 
wish,  of  the  University  of  Pennsylvania  Medical  School.  We  are  five 
blocks  away,  a  ten-minute  walk.  It  is  not  unsurmountable,  but 
extra  effort  is  needed  to  go  there  for  rounds  and  to  maintain  good 
staff  relationships. 

Hughes:     That  seems  such  a  strong  argument  for  locating  the  institute  at 
university  hospital,  and  yet  it  obviously  didn't  overcome  the 
opposition. 

Scheie:       Well,  the  decision  ultimately  was  an  arbitrary  one. 
Hughes:     You  mean  the  president's? 
Scheie:       That's  right. 

Hughes:     Was  his  main  purpose  in  that  arbitrary  vote  simply  to  get  the  matter 
settled? 

Scheie:       I  would  think  that  was  part  of  it.  He  had  listened  to  the  arguments 
for  at  least  three  hours  on  two  successive  nights.  I'm  sure  that  he 
had  had  considerable  other  discussions  and  advice  prior  to  those 
meetings. 


182 


Hughes:     Had  you  gone  to  any  of  the  key  figures  before  this  meeting  and  tried 
to  explain  your  rationale  for  putting  the  institute  in  one  place  rather 
than  any  other1? 

Scheie:  Yes,  but  I  had  a  feeling  that  common  sense  would  not  prevail. 
Ophthalmology  at  best  is  not  the  most  powerful  specialty  in  a 
general  hospital. 

Hughes:     Does  that  apply  to  ophthalmology  at  Penn,  though? 

Scheie:       Well,  I  think  it  applies  everywhere.  For  instance,  the  power  in  any 
university  hospital  in  a  medical  school  tends  to  rest  with  the  heads 
of  medicine  and  surgery,  and  this  is  quite  proper  but  only  to  an 
extent.  They  have  the  largest  number  of  patients  and  staff 
members  and  usually  the  largest  budgets.  As  an  example,  our 
budget  was  only  $15,000  a  year. 

But  I  think  the  institute  remains  a  great  asset  to  ophthalmology 
and  to  the  university.  We  have  excellent  and  well-funded  research 
projects  going  on  now  in  many  fields.  Our  excellent  staff  is  a  credit 
to  the  university.  However,  the  staff  at  HUP  justifiably  has  asked, 
for  instance,  "Why  don't  we  have  a  retina  specialist  here  all  the 
time?"  That  sort  of  thing  can  be  difficult  when  you  are  located  five 
blocks  away  and  are  very  busy,  but  it  could  be  managed. 

Hughes:     How  do  you  think  the  institute,  now  that  it's  been  established  for 
over  ten  years,  is  regarded  by  the  university  hospital  people1? 

Scheie:       Well,  I  think  it's  regarded  as  excellent,  and  certainly  the  institute 

has  been  a  success  locally  and  I  know  has  international  recognition. 

Grand  Rounds  and  Teaching  Conferences 

Hughes:     We  mentioned  your  grand  rounds  earlier  and  the  fact  that  three 

different  hospitals  were  included.  Tell  me,  please,  what  you  sought 
to  accomplish1? 

Scheie:       Partly  to  let  the  hospitals  know  that  our  ophthalmology  program 
was  part  and  parcel  of  their  own  services  and  to  let  our  residents 
know  that  their  activities  at  each  hospital  were  part  and  parcel  of 
Penn's  and  the  institute's  programs,  as  they  rotated  through  all 
three.  We  wanted  them  and  the  other  hospitals  and  their  staff  to 
know  they  were  a  vital  part  of  our  service  even  though  the 
headquarters  were  at  the  institute.  Also  it  was  reassuring  for  the 
patients  to  know  that  the  chief  and  staff  members  all  were  involved 
in  their  problems. 

Hughes:     How  many  people  would  be  involved  on  a  typical  day1? 


183 


Scheie:  Probably  twenty-five,  thirty  at  the  most.  We  usually  began  at  about 
one  o'clock  at  the  institute,  and  patients  had  been  preselected  at  the 
other  hospitals. 

Hughes:     How  many  patients  did  you  see  at  each  place1? 

Scheie:       It  depended  upon  the  number  of  interesting  patients-four,  five,  or 
six. 

Hughes:     Who  would  choose  the  cases? 

Scheie:       The  staff  in  charge  of  that  service  and  the  residents.  The  patients 
usually  had  an  interesting  problem  worth  discussing  and  deserving 
of  a  staff  opinion. 

Hughes:     Was  the  resident  or  the  person  in  charge  expected  to  make  a 
presentation? 

Scheie:       Yes,  because  they  were  his  patients. 
Hughes:    And  then  there'd  be  a  round-robin? 

Scheie:  Each  of  us  would  have  a  chance  to  examine  the  patients  and 
evaluate  them.  The  problem  could  involve  a  slit-lamp  exam, 
gonioscopic,  ophthalmoscopic,  a  surgical  one,  or  others.  The 
subsequent  discussions  were  great  fun,  really. 

Hughes:  Was  there  plenty  of  opportunity  for  give-and-take? 

Scheie:  Oh,  yes. 

Hughes:  How  did  the  patients  react? 

Scheie:  Well,  most  of  them  were  appreciative. 

Hughes:  It  wasn't  intimidating? 

Scheie:       Oh,  I  don't  believe  so.  I  don't  think  the  atmosphere  was  ever  an 
intimidating  one. 

Hughes:     I  read  of  Saturday  conferences. 

Scheie:       I  had  a  conference  with  the  residents  each  Saturday  from 
eight-thirty  to  twelve  noon.  We'd  show  slides  (photos  of  eye 
conditions)  that  were  unknown  to  all  of  us  except  the  resident  who 
had  selected  the  slides.  The  conference  was  good  fun,  marked  by 
banter  and  give-and-take.  After  each  discussion  the  resident  who 
had  selected  the  slides  for  the  session  would  tell  us  why  the  slide  or 
slides  had  been  projected.  Everybody  participated  as  they  wished 


184 


or  were  called  upon.  Diagnosis,  management,  or  any  pertinent 
problem  was  brought  up. 

These  Saturday  morning  conferences  meetings  were  required  for 
the  residents  but  elective  for  the  staff.  The  morning  began  with  a 
fifteen-minute  paper  prepared  by  a  resident  to  be  given  as  though 
at  a  formal  meeting.  The  paper  would  be  timed  for  fifteen  minutes 
and  critiqued,  just  as  if  they  had  given  it  at  the  Academy,  for 
example.  A  paper  could  never  take  longer  than  the  allotted  time, 
and  it  was  to  be  given  and  not  read.  Then  it  was  subject  to 
discussion.  The  residents  selected  their  own  topic  well  in  advance. 
It  might  be  something  they  were  working  on  in  the  laboratory,  a 
patient  they  had  puzzled  over,  or  other  topics.  It  was  obviously 
somewhat  stressful  for  the  resident  but  constructive.  It  was  also 
excellent  training  for  preparing  a  paper,  whether  to  be  published  or 
for  presentation.  I've  had  many  a  resident  tell  me  years  later  how 
much  that  training  meant  to  him  after  he  was  out  in  practice,  when 
the  ability  to  prepare  and  give  a  paper  can  be  very  important. 

Hughes:     All  of  these  papers  were  eventually  presented  at  a  national  meeting1? 

Scheie:       No,  the  intent  was  to  learn  to  prepare  and  give  an  acceptable  paper. 

From  these  papers,  we  would  go  to  the  slides  involving  diagnosis, 
management,  and  other  facets  of  ophthalmology  for  the  rest  of  the 
morning.  But  there  was  always  the  excitement  of  not  knowing 
what  might  appear  on  the  next  set  of  slides. 

Hughes:     What  were  you  trying  to  accomplish  for  your  residents'? 

Scheie:       A  broad  exposure  to  ophthalmology.  In  the  course  of  a  year  we 
would  cover  a  vast  amount  of  material. 

Hughes:     Was  there  any  particular  approach  to  expanding  knowledge  that  you 
advocated1? 

Scheie:       Yes,  after  the  three  month  basic  science  course,  we  had  other 

conferences.  But  you  asked  about  the  Saturday  morning  ones.  The 
other  conferences  were  held  during  the  week  on  mornings  or 
afternoons,  sometimes  both.  I  don't  think  a  day  went  by  that  we 
didn't  have  at  least  one  conference  or  lecture.  We  aimed  to  cover 
material  in  an  organized  way,  reviewing  subjects  required  on  Board 
examinations  at  least  twice  during  their  residency.  These  included 
subjects  covered  in  our  basic  science  course.  The  conferences  would 
run  for  possibly  six  or  eight  weeks  on  each  subject.  The  staff  person 
or  persons  with  special  interest  in  each  subject  were  responsible  for 
those  conferences. 

Hughes:     Did  the  residents  take  the  Boards  at  the  end  of  their  residency1? 
Scheie:       Usually  it  was  a  year  later. 


185 


Hughes:     How  did  they  fare  in  general? 

Scheie:       They  did  very  well.  We  almost  never  had  one  fail  their  Board 

exams.  They  took  the  written  part  first,  then  the  oral  or  practical. 
I  was  proud  of  their  performance. 

Teaching  Surgery 

Hughes:     How  and  why  did  you  decide  that  a  resident  was  indeed  ready  to 
take  on  an  aspect  of  an  operation? 

Scheie:       We  did  not  permit  our  residents  to  do  intraocular  surgery  until  they 
were  third-year  residents. 

Hughes:     Was  that  unusually  late? 

Scheie:       I'm  not  sure  what  other  programs  have  done.  But  by  that  time  they 
had  assisted  with  a  great  many  operations  and  had  done  parts  of 
operations  but  not  the  entire  procedure.  As  senior  residents  they 
did  their  own  surgery  and  managed  the  patients,  but  always  with 
staff  supervision.  We  did  not  permit  the  residents  to  operate  by 
themselves.  They  could  make  the  decision  to  operate,  but  they  had 
to  present  the  case  to  a  staff  man  before  it  was  finally  approved  for 
surgery. 

Hughes:  And  then  the  staff  man  made  the  decision? 

Scheie:  The  staff  man  would  help  them  make  the  decision. 

Hughes:  Would  the  staff  man  scrub? 

Scheie:  A  staff  man  scrubbed  with  them. 

Hughes:  What  would  happen  if  a  resident  got  into  difficulty? 

Scheie:       Well,  the  staff  man  would  be  there  to  advise  and  to  help  him, 

depending  on  the  situation.  It  might  just  be  to  tell  him  what  to  do 
or  to  step  in  and  finish  the  operation  for  him. 

Hughes:     Did  the  residents  ever  get  restive  at  having  to  wait  before  they  were 
given  much  chance  to  operate? 

Scheie:       Well,  it  was  essentially  a  matter  of  custom  in  our  department  and 
presented  no  real  problems. 

Hughes:     So  they  were  well  aware  that  that  was  the  system  even  before  they 
entered  the  residency? 

Scheie:       Oh,  yes. 


186 


Hughes:     How  would  you  describe  the  atmosphere  in  the  operating  room1? 
Scheie:       Well,  we  were  intense  but  had  great  satisfaction. 
Hughes:     But  no  jokes. 

Scheie:       Oh,  yes.  I  couldn't  work  without  a  bit  of  humor  here  and  there.  But 
I  was  always  very  intense  during  my  surgery  and  wanted 
concentration  from  everyone.  You're  operating  on  somebody's 
mother,  sister,  or  child,  which  was  the  philosophy  that  I've  always 
cultivated.  To  me  it  was  never  "a  patient",  while  making  the 
decision  whether  or  not  to  operate.  It  was  what  I  would  want  for  a 
member  of  my  family  or  what  I  would  want  for  myself  if  I  were 
sitting  in  that  chair.  I've  had  my  complications  and  problems  but  I 
don't  think  I've  ever  done  an  operation  that  I  didn't  very  carefully 
consider  beforehand.  I  think  probably  that  philosophy  is  one  of  the 
reasons  so  many  people  so  generously  contributed  to  our 
twelve-and-a-half-million-dollar  institute  and  its  endowment  funds. 

Hughes:     How  loyal  are  your  graduates,  both  to  you  and  to  the  institute? 

Scheie:       Well,  I  don't  quite  know  what  to  say.  It's  an  individual  thing 

always.  I  can  say  that  in  the  1970s,  when  we  were  raising  funds  for 
the  institute,  one  of  the  initial  gifts,  at  a  time  when  it  meant  a  great 
deal,  was  a  quarter  of  a  million  dollars  contributed  and  pledged  by 
our  former  residents.  That  was  a  wonderful  gesture  and  it  helped  a 
great  deal  in  approaching  potential  donors.  It  indicated  that  our 
former  residents  were  loyal  and  grateful  for  the  training  they 
received.  They  also  realized  that  we  needed  better  facilities.  I 
would  say  they  were  a  very  loyal  resident  group. 

Hughes:     Is  that  now  true? 

Scheie:  I  can  not  say  because  I  have  not  been  that  close  to  the  program  for 
nearly  twelve  years.  I  believe  the  annual  alumni  reunion  meeting 
is  not  as  well  attended,  but  times  change. 

Hughes:     You're  thinking  of  medicine  in  general  when  you  say  that? 

Scheie:       I  think  yes.  We  used  to  have  wonderful  old  alumni  reunions  and 
dinners  at  Penn  that  were  very  warm.  But  the  university  hospital 
hasn't  held  them  for  years. 

Hughes:     Because  of  lack  of  interest? 

Scheie:       Lack  of  interest  most  likely.  Also  specialized  services,  with  house 
staff  of  each  specialty  becoming  more  isolated. 


187 


Patient  Care 

Hughes:     What  importance  did  you  place  on  patient  care  in  relationship  to 
other  aspects  of  your  professional  career? 

Scheie:       Well,  I  think  caring  for  patients  is  why  we're  doctors.  I  tried  to 
combine  academic  and  patient  care  responsibilities.  Patient  care 
was  the  most  important  to  me.  I  hope  that  my  bibliography  attests 
to  that.  However,  I've  always  felt  that  anyone  who  stays  in  the 
university  atmosphere  should  be,  if  he's  in  clinical  work,  first  of  all 
as  good  a  physician  as  he  can  be,  and  in  a  teaching  environment 
certainly  he  ought  to  be  a  capable  teacher.  Not  everyone  can  or  will 
do  research,  and  I  don't  believe  you  can  require  much  more  of  your 
clinicians. 

Dr.  Ewing  is  a  fine  example.  She  is  an  excellent  teacher  and  an 
outstanding  physician  and  human  being.  She  is  overwhelmed  with 
patients  because  she  is  dedicated  to  them  and  is  not  seeking  great 
income.  Research  is  just  not  her  niche.  We  need  all  types,  but  in 
academia  you  must  have  an  interest  and  capacity  to  teach.  If  you're 
a  research  type,  you  should  also  have  the  capacity  to  teach  and 
hopefully  relate  your  basic  skills  to  clinical  programs. 

We  have  always  tried  to  do  this  in  our  department.  Our  basic 
scientists  have  always  participated  with  clinicians  at  teaching 
conferences  and  staff  meetings.  A  research  paper  was  scheduled  as 
part  of  each  monthly  meeting.  It  stimulated  interest  and  it  helped 
everyone  realize  that  we  were  in  a  joint  academic  environment  to 
advance  both  research  and  patient  care.  To  me  as  a  clinician, 
patient  care  always  came  first,  and  I  am  certain  is  at  its  best  in  an 
academic  environment. 

We  need  research  and  basic  sciences,  but  well-trained  and  critical 
physicians  are  essential  for  application  of  new  knowledge.  For 
patient  care,  I  always  wanted  a  physician-oriented  type.  Certainly, 
I've  tried  to  stimulate  research;  I  may  even  have  done  some.  But 
my  motivation  was  to  be  as  good  a  patient-care  physician  as 
possible. 

Hughes:     What  type  of  relationship  did  you  try  to  establish  with  your  patients'? 

Scheie:       Oh,  I  hope  we  always  enjoyed  each  other,  [laughter]  I  may  have 

lacked  dignity,  but  I  believe  I  had  a  warm  relationship  with  most  of 
them,  especially  the  children.  I  don't  mean  to  sound  pretentious 
but  I  tried  to  be  very  close  to  them-rich,  poor,  black,  white,  it  didn't 
matter.  I  always  enjoyed  their  visits. 

Hughes:     I  have  heard  that  even  though  you  saw  a  very  great  number  of 

patients  in  any  working  day  that  you  excelled  at  creating  an  almost 


188 


immediate  personal  touch  so  that  the  patient  felt  you  were  there  just 
for  him. 

Scheie:       Well,  I  always  enjoyed  each  patient. 
Hughes:     How  did  you  keep  them  straight? 

Scheie:       Well,  I  have  never  had  a  good  memory  for  names,  so  I  had  a  chart 
rack  outside  of  each  office.  As  I  went  from  one  office  to  another,  I 
quickly  reviewed  the  chart  before  entering.  Fortunately,  I  had  the 
capacity  to  quickly  recall  much  of  the  medical  information  on  the 
chart.  I  usually  needed  only  to  see  the  name  to  relate  to  the 
problem. 

Hughes:     You  say  that  the  name  would  recall  the  medical  history? 

Scheie:       Yes,  but  if  you  were  to  ask  me  the  name  ten  minutes  later,  I 
probably  could  not  have  repeated  it. 

Hughes:     But  you  probably  could  have  given  the  whole  history! 

Scheie:       Even  as  a  young  man,  I  might  go  to  a  club  or  somewhere 

comparable  and  see  people  that  I'd  met  before,  but  the  names  would 
escape  me.  It  was  embarrassing,  (I  might  have  subconsciously 
cultivated  it),  but  life-long  it  has  concerned  me.  Possibly  I  have  had 
a  unique  form  of  dyslexia. 

Hughes:     What  criteria  did  you  use  for  setting  fees? 

Scheie:       My  secretary  set  the  fees  for  office  visits  much  of  the  time,  and  a 

person  whom  we  had  trained  set  the  surgical  fees.  The  interviewer 
was  experienced,  considerate,  and  given  leeway  to  set  those  fees.  I 
actually  did  not  know  what  most  of  my  patients  were  charged, 
unless  I  had  intervened  and  said,  "This  patient  is  no  charge."  My 
fees  were  always  modest  and  exceptions  were  common. 

Hughes:     Was  there  a  sliding  scale? 

Scheie:       No,  there  was  no  such  thing  as  a  scale.  We  had  routine  fees  that  we 
would  adjust  or  cancel  as  we  wanted.  I  was  rather  casual  about 
fees. 

Hughes:     I  know  you  had  certain  categories  that  you  didn't  charge  at  all. 

Scheie:       If  a  very  wealthy  patient  came  in,  for  example,  why  charge  him? 

My  small  fee  was  a  nuisance  to  him  and  it  wouldn't  help  me  much. 
He'd  be  very  pleased,  I  guess.  If  he  had  insurance,  he  might  be 
charged  the  insurance  fee.  Certainly  any  person  whom  I  thought  I 
might  be  taking  bread  off  his  table  was  not  charged.  I  felt  that  my 
income  was  adequate,  even  though  I  contributed  significantly  to  the 
institute. 


189 


Hughes:     Were  your  fees  similar  to  those  of  other  ophthalmologists  in 
Philadelphia? 

Scheie:       I  never  paid  attention  to  that  frankly,  but  I  suspect  my  fees  were 
lower  than  most.  I  enjoyed  what  I  was  doing.  I  know  I  did  a  great 
deal  of  surgery  for  Blue  Shield  rates,  thinking,  "That's  a  pretty  good 
fee.  Why  should  I  charge  more  than  that?"  I've  had  younger  men 
tell  me  that  patients  would  not  think  I  was  a  very  good  doctor  if  my 
fees  were  low. 

I've  had  patients  come  to  me  for  operations  when  one  eye  had  been 
lost  following  previous  surgery.  I  might  feel  sorry  for  the  patient 
and  charge  only  Blue  Shield  rates.  I'd  see  the  first  doctor  later, 
possibly  at  a  meeting,  and  he'd  ask  me  about  my  charging  this 
patient  $300  for  my  operation,  while  he  had  charged  her  $600.  I'd 
reply  that  I  sized  her  up  as  being  of  modest  means  and  wanted  to 
help  her. 

Hughes:     But  he  felt  you  were  undercutting  him. 

Scheie:       Yes,  but  that  had  not  entered  my  mind.  Fees  weren't  my  life. 

Maybe  the  low  fees  explain  the  number  of  patients  who  came  to 
me-kept  me  humble-not  because  I  was  such  a  good  doctor. 

Hughes:     Dr.  Scheie,  I  think  there  are  a  lot  of  people  who  would  disagree  with 
you. 

What  went  through  your  mind  when  you  were  debating  whether  or 
not  to  try  a  new  drug  or  a  new  procedure  on  a  patient  for  the  first 
time? 

Scheie:       Well,  I  would  ask,  "Would  I  use  it  for  myself  or  my  family?"  I  never 
used  anything  truly  threatening.  I  tried  to  have  good  reasons  and 
justification  in  any  of  my  studies. 

Hughes:     Did  you  ever  use  human  volunteers  in  research? 

Scheie:       We  did  some  studies  on  tonography  on  normal  eyes,  but  that 

involved  little  hazard.  For  my  doctor's  thesis  and  in  my  work  with 
myasthenia  gravis,  we  tested  drugs  on  ourselves.  I  was  a  guinea 
pig  with  one  or  two  other  young  doctors.  We  injected  ourselves  with 
prostigmin  before  its  effects  were  well  known.  We  also  tested  the 
effect  of  various  strengths  of  mecholyl  eye  drops  on  ourselves  and 
animals.  But  that  was  not  out  of  line;  both  had  been  studied  before, 
but  we  wanted  to  know  quantitatively  about  its  effect  by  testing 
responses  on  ourselves. 

## 


190 


Hughes:    Were  there  any  guidelines  in  the  immediate  postwar  years 
concerning  use  of  human  volunteers  in  research? 

Scheie:       I  don't  believe  so.  They  slowly  evolved  and  are  now  required  in 
teaching  hospitals.  My  work  involved  little  of  that  type  of 
investigation. 


Books 

Hughes:     I  wanted  to  pick  up  on  the  book  that  you  published  with  Dr.  Meyer 
Wiener  in  1952,  Surgery  of  the  Eye.*  First  of  all,  who  was  Dr. 
Wiener? 

Scheie:       He  was  a  very  well-known  ophthalmic  surgeon  from  St.  Louis,  who 
invited  me  to  do  the  third  edition  of  his  book  with  him.  As  I 
remember,  the  second  half  of  the  book  was  new  and  written  by  me. 
He  revised  the  first  half.  I  still  have  one  copy  of  the  book. 

Hughes:     You  were  a  young  man.   Why  did  he  invite  you  ? 

Scheie:       I  don't  know.  I  never  asked  him,  but  I  was  pleased.  I  had  known 
him  only  through  medical  meetings.  He  may  have  known  me 
because  of  some  of  my  papers.  What  year  was  this? 

Hughes:     1952. 

Scheie:       I  guess  he  thought,  as  a  young  person  I  might  do  a  good  job. 
Besides  I  had  published  my  paper  on  goniotomy  which  was  of 
surgical  interest. 

Hughes:     How  did  you  find  time  to  write  half  a  book? 

Scheie:       How  did  I  find  time  to  do  any  of  my  projects?  It  means  disciplining 
and  organizing  your  time.  I've  always  been  a  morning  person.  Two 
mornings  a  week  before  surgery  I  worked  at  my  desk  on  things  like 
the  book  or  papers.  The  other  mornings  I  had  time  for  an  hour  or  so 
of  paperwork  before  seeing  patients  in  my  office  at  7:30  a.m.  I  did 
not  book  patients  after  1:00  p.m.  so  that  my  afternoons  were  free  for 
teaching,  writing  papers,  research,  or  whatever.  On  surgery  days  I 
had  usually  finished  by  11:00  a.m.,  which  gave  me  two  more  long 
afternoons,  as  well  as  portions  of  some  Saturdays  or  Sundays, 
although  I  tried  to  save  most  of  the  weekend  for  my  family.  I  also 
gave  up  golf. 

Hughes:     How  successful  was  the  book? 


Wiener  M,  Scheie  HG.  Surgery  of  the  Eye.  New  York:  Ornc  and  Stralton,  3rd  ed,  1952. 


191 


Scheie:       It  was  quite  successful.  The  entire  edition  was  sold.  Obviously,  it's 
now  out  of  print. 

Hughes:     Was  there  ever  a  fourth  edition? 

Scheie:       No,  Dr.  Wiener  was  older  and  dropped  out.  I  didn't  feel  that  I 
wanted  to  continue  it. 

Hughes:     Were  there  other  books  on  surgery  of  the  eye  published  in  the  fifties? 
Scheie:       I  frankly  don't  remember. 
Hughes:     There  must  have  been  a  need. 

Scheie:       There  were  some  European  books.  [Joseph]  Meller's  was  excellent, 
but  there  was  a  need  in  this  country.  However,  much  less  surgery 
was  done  in  those  days,  and  it  was  a  great  deal  more  simple. 

Hughes:     How  did  you  approach  the  subject? 

Scheie:       Well,  I  had  learned  surgery  from  Dr.  Adler,  from  watching  other 

ophthalmologists,  from  published  articles  and  attending  meetings. 

Hughes:     I  mean  in  the  book.  Was  it  largely  descriptions  of  procedures? 

Scheie:       Yes,  and  Wiener  had  two  previous  editions.  The  illustrations  were 
original  and  mine  were  new  for  this  edition.  I  think  one  of  my 
chapters  was  fairly  good,  the  one  on  local  anesthesia.  Those 
diagrams  were  excellent. 

Hughes:     Did  you  get  any  help  in  writing  your  chapters? 

Scheie:       No.  There  were  helpful  surgical  articles  in  some  of  the  journals.  I 
can't  name  an  eye  surgical  text  at  that  time,  but  I  am  sure  they 
existed. 

Hughes:     In  1969,  you  and  Daniel  Albert  edited  the  eighth  edition  of  Adler 's 
Textbook  of  Ophthalmology*  How  did  that  come  about? 

Scheie:       Well,  it  came  about  because,  again,  I  was  invited  to  do  the  book,  and 
I  asked  Dan  if  he  would  be  interested  in  doing  it  with  me. 

Hughes:     Dr.  Adler  wanted  no  part  of  it? 

Scheie:       He  wanted  to  give  up  the  responsibility  and  I  believe  suggested  my 
name  to  Saunders,  who  approached  me. 


*        Scheie  HG,  Albert  DM.  Adler's  Textbook  of  Ophthalmology.  Philadelphia:  WB  Saunders,  8th  ed, 
1969. 


192 


Hughes:     Was  that  a  big  job1? 

Scheie:       It  was  a  new  book,  really.  We  discarded  rather  than  rewrote  the 
old.* 

Hughes:     How  long  had  it  been  since  the  seventh  edition1? 
Scheie:       I  would  think  that  it  was  seven  years. 
Hughes:     Presumably  you  were  adding  new  material. 

Scheie:       Well,  it  really  was  a  new  book.  It  was  patterned  to  some  extent 

after  my  lecture  notes  for  medical  students.  The  illustrations  were 
new  and  the  book  was  very  different  from  previous  editions.  Most 
of  the  illustrations  were  from  photographs  of  my  own  patients,  and 
Jean  Wolfe  did  the  drawings  for  the  surgical  section.  She  had 
drawn  several  procedures  for  me  by  then.  I  believe  Dan  Albert  is 
now  taking  the  book  over.  I  hope  he  will. 

Hughes:     You  also  did  the  ninth  edition,  is  that  correct? 

Scheie:       Yes,  in  1977,  and  also  with  Dr.  Albert.**  The  eighth  edition  was 
also  published  in  Spanish  and  the  ninth  edition  was  published  in 
Chinese  and  in  Italian.  ***  I  believe  the  English  editions  are  out  of 
print. 

Hughes:     For  a  time,  was  it  the  textbook  for  students? 

Scheie:       No,  I  wouldn't  say  it  was  the  textbook.  I  think  probably  it  was  one 
of  the  two  most  popular  in  this  country.  The  other  was  Frank 
Newell's  textbook****  which  was  aimed  at  the  same  group.  Which 
sold  the  most,  I  never  knew.  I  do  know  that  our  editions  were  sold 
out.  I  was  never  too  concerned.  I  wished  only  to  have  a  worthwhile 
book. 

Hughes:     What  audiences  were  you  trying  to  reach? 

Scheie:       Medical  students,  residents,  and  practicing  ophthalmologists. 

Hughes:     Was  it  a  complete  treatment  with  no  particular  emphasis? 

Scheie:       It  was  a  general  ophthalmology  book,  beginning  with  anatomy  and 
embryology,  as  my  lecture  notes  did,  and  ending  with  surgery. 


* 
** 


AdlerFH.  Textbook  of  Ophthalmology.  Philadelphia:  WB  Saunders,  1962. 

Scheie  HG,  Albert  DM.  Adlcr's  Textbook  of  Ophthalmology,  Philadelphia:  WB  Saunders,  ninth 

ed,  1977. 

Spanish  translation:  Nueve  Editorial  Interamericana,  Mexico,  1972.  Chinese  translation: 
Taiwan,  1978.  Italian  translation:  Editorial  Grusso,  1985. 

****Newell  FW.  Ophthalmology  Principles  and  Concepts.  St.  Louis:  CV  Mosby,  1974. 


193 


Hyphema 

Hughes:     You  published  a  paper  in  1961  on  the  treatment  of  hyphema*  Tell 
me,  please,  what  previous  treatments  there  were  for  hyphema. 

Scheie:       None  very  satisfactory.  In  fact,  hyphema  was  Lord  Mountbatten's 
major  problem  at  the  time  of  his  injury.  There  was  a  debate  as  to 
whether  or  not  you  should  use  atropine.  There  was  always  the 
danger  of  rebleeding  or  recurrence  of  the  hemorrhage.  When  the 
blood  clotted  in  the  anterior  chamber  it  could  be  very  difficult  to 
remove,  and  absorption  could  be  very  slow  and  often  accompanied 
by  glaucoma.  I  was  the  first  to  use  fibrinolysin  when  it  was  very 
new  to  remove  these  clots,  although  it  had  been  used  in  peripheral 
vascular  surgery  to  prevent  and  to  dissolve  blood  clots  in  vessels. 

I  had  just  operated  a  child  with  congenital  glaucoma  and  very  large 
eyes  who  developed  an  anterior  chamber  hemorrhage 
postoperatively  that  had  filled  the  chamber.  It  was  especially 
threatening  to  the  eye  because  of  the  large  anterior  chamber.  I  felt 
that  the  eye  was  potentially  lost  if  nothing  were  done.  In  this  type 
of  eye  it  is  especially  hazardous  to  make  an  incision  large  enough  to 
remove  the  clot  by  pulling  it  out.  So  just  having  read  an  article  on 
the  use  of  fibrinolysin,  I  consulted  with  Dr.  Brooke  Roberts,  head  of 
the  peripheral  vascular  department  at  HUP.  He  felt  that  it  would 
be  safe.  I  found  that  it  was  very  effective  in  my  patient  and  it  could 
be  safely  used  through  a  corneal  opening  only  big  enough  to  admit 
the  irrigator.  I  then  began  a  project  with  Drs.  Ashley  and  Weiner. 
Dr.  [Alvin]  Weiner  was  one  of  our  residents  at  Philadelphia  General 
and  Dr.  [B.  John]  Ashley  was  a  resident  at  the  university  hospital. 
This  was  before  the  institute  had  opened. 

Hughes:     Was  your  technique  taken  up  elsewhere1? 

Scheie:       It  has  been  used,  as  well  as  lysin  that  you  read  about  now.  Of 
course,  I  had  nothing  to  do  with  the  basic  work  that  originated 
fibrinolysin.  How  widely  it  is  being  used  at  present,  I  do  not  know. 
I  suppose  like  other  techniques,  it  can  be  damned  or  blessed. 
However,  I  am  convinced  that  I  have  saved  some  eyes  with  its  help. 

Hughes:     There  are  no  adverse  effects'? 
Scheie:       None  from  the  substance  itself. 


Scheie  HG,  Ashley  BJ,  Jr.,  Weiner  A.    The  treatment  of  total  hyphema  with  fibrinolysin 
(plasmin).  A  preliminary  report.    Arch  Ophthalmol  1961;  66:226-31. 


194 


Hughes:     Where  did  you  obtain  it1? 

Scheie:       Merck,  Sharp  and  Dohme. 

Hughes:     It  was  readily  available  commercially? 

Scheie:       I  obtained  it  both  directly  from  the  company  or  from  our  peripheral 
vascular  surgery  department.  That's  one  of  the  advantages  of 
working  closely  with  other  departments  in  a  general  hospital.  In 
fact,  attendance  at  general  staff  meetings  can  be  very  productive. 

Hughes:     And  that's  what  had  happened? 

Scheie:       Yes.  I  checked  with  Brooke  Roberts,  who  reassured  me  about  its 
safety. 

Hughes:     Did  you  inject  it? 

Scheie:  I  employed  both  gentle  continuous  irrigation  of  the  anterior 
chamber  and  pumping  the  solution  back  and  forth.  The  clot 
dissolved  as  you  irrigated. 


Hurler's  Syndrome 


Hughes:     Well,  the  next  subject  is  Hurler's  syndrome.  Perhaps  we  could  start 
with  a  description  of  how  you  became  interested  in,  or  even  aware  of, 
Hurler's  syndrome. 

Scheie:       We  became  aware  of  this  so-called  Scheie  syndrome  through  a 

series  of  circumstances.  First-and  I  don't  believe  I  had  ever  seen  a 
Hurler's  patient  until  less  than  six  months  before— a  small, 
markedly  retarded  six-year-old  girl  was  sent  to  me  by  the  pediatric 
service  at  the  university  hospital  because  of  very  cloudy  corneas 
and  poor  vision.  She  had  all  of  the  classic  signs  of  Hurler's  disease, 
including  gargoylism. 

She  also  had  the  typical  clawlike  deformities  of  hands  and  feet. 
Many  also  have  hernias,  even  at  a  young  age,  and  develop 
thickening  of  heart  valves,  especially  the  aortic  valves.  Almost 
none  of  these  children  live  to  be  older  than  ten  years  of  age. 
Nothing  could  be  done  for  this  girl's  eyes. 

A  few  months  later,  a  brother  and  sister,  twenty-seven  and 
twenty-five  years  old,  were  referred  to  me  for  possible  corneal 
transplantation.  Both  had  very  cloudy  corneas.  The  sister  had  had 
an  unsuccessful  corneal  transplant  done  on  her  right  cornea.  These 
two  patients  were  normal  in  height  and  were  highly  intelligent. 
They  had  deformities  of  their  hands  and  feet  which  had  been 
attributed  to  arthritis.  Their  normal  intelligence  would  have  been 


195 

unusual  in  a  Hurler's  patient.  But  having  seen  the  little  girl 
recently,  the  thought  occurred  to  me  that  this  brother  and  sister 
might  have  an  unusual  type  of  a  variant  of  Hurler's  syndrome,  so  I 
had  a  consultation  with  Dr.  L.A.  Harness,  chief  of  pediatrics. 

We  had  tests  done  for  mucopolysaccharides  and  other  studies, 
which  were  positive.  Tissue  biopsies  were  also  confirmatory.  The 
patients  also  had  characteristic  heart  findings  and  an  enlarged  liver 
and  spleen.  We  also  had  other  consultations,  and  it  was  generally 
agreed  that  this  was  some  unique  type  of  Hurler's.  I  gave  the 
Sanford  R.  Gifford  Lecture  shortly  after  this,  in  1961.  This 
material  and  that  from  some  other  studies  was  reported  under  the 
title,  "A  newly  recognized  forme  fruste  of  Hurler's  disease 
(gargoylism)"* 

There  are  at  present  at  least  six  known  types  of  Hurler's  disease. 
However,  with  recent  advances  in  tissue  culture  and  other  very 
highly  technical  and  exquisite  studies  that  were  not  available  at 
that  time,  ours  is  still  recognized  as  an  entity  or  subtype.  It  is  very 
rare  and  very  few  similar  patients  have  been  reported.  Dr.  Victor 
McKusick,  the  famous  connective  tissue  specialist  from  Johns 
Hopkins,  has  seen  a  brother  and  a  sister. 

In  following  my  patients,  I  learned  that  the  brother  died  suddenly 
when  he  was  forty  years  of  age  due  to  heart  problems  was  still 
highly  intelligent.  The  sister  is  now  fifty- two,  a  semi-invalid,  but 
has  retained  her  intelligence.  Their  brains  were  apparently 
unaffected.  Both  have  been  productive.  She  has  had  not  only  heart 
problems  but  also  a  spontaneous  rupture  of  her  esophagus,  which 
was  probably  connected  with  her  disease.  The  longevity  of  this 
brother  and  sister  are  the  greatest  recorded  for  any  patient  with 
Hurler's  disease.  This  type  of  condition  is  either  a  subtype  in  the 
Hurler's  family,  which  the  experts  have  not  yet  decided,  or  it's  as  I 
originally  described,  a  variant.  I  called  it  an  incomplete  form  of 
Hurler's  because  of  the  patients'  very  normal  intelligence  and  their 
longevity.  At  any  rate,  it  has  been  fascinating. 

Hughes:     Were  you  the  first  to  associate  the  corneal  and  conjunctival  changes 
with  the  syndrome? 

Scheie:       No.  All  of  Hurler's  patients  of  the  gargoyle  type  have  cloudy 

corneas.  They  are  one  of  the  classic  signs  and  demonstrated  by  this 
brother  and  sister. 

Hughes:     To  put  it  in  simplistic  terms,  is  it  a  problem  of  mucopolysaccharide 
metabolism  ? 


Shcic  HG,  Hambrick  GW,  Jr,  Harness  LA.  Am  J  Ophthalmol  1962;  53:753-69. 


196 


Scheie:       Yes,  resulting  from  a  deficiency  of  the  enzyme  alpha-L-iduronidase. 
It  has  been  learned  since  my  paper  that  this  enzyme  is  involved  in 
classic  Hurler's 

As  a  result,  McKusick  suggested  in  1972  that  Scheie  syndrome  no 
longer  be  called  MPS  type  V  but  include  it  with  Hurler's  in  type  I. 
This  would  then  include  Hurler's  mucopolysaccharidosis  Type  MPS 
I  H  (Hurler's)  and  Scheie  syndrome  called  MPS  I  S  (Scheie).  He  felt 
that  they  should  be  considered  separate  entities  because  of  a 
distinctive  and  quite  different  clinical  appearance. 

Hughes:     Who  was  responsible  for  the  name  "Scheie  syndrome?" 
Scheie:       Dr.  McKusick,  I  suspect. 

Hughes:     In  the  paper  that  you  wrote  in  1962  with  George  Hambrick,  he  was  a 
dermatologist? 

Scheie:       He  was  a  dermatologist. 

Hughes:     Is  this  study  the  first  to  show  the  participation  of  epidermal  and 
dermal  cells  in  Hurler's  syndrome? 

Scheie:       Yes.  He  studied  the  skin  of  my  two  patients,  both  of  whom  had  skin 
and  corneal  biopsies.  I  believe  we  were  the  first  to  show  that  the 
cells  in  the  epidermis  and  in  the  basal  cells  of  the  cornea  were 
involved.  It's  obviously  a  generalized  disease  with  diffuse 
connective  tissue  cell  involvement. 

Hughes:     It  was  a  microscopic  study? 

Scheie:       Yes,  it  was  a  microscopic  study,  and  it  was  largely  his  study  on  my 
patients,  who  also  had  conjunctival  as  well  as  corneal  biopsies. 

Hughes:     You  said  in  the  paper  that  the  lesions  of  the  conjunctiva  had  not  been 
previously  noted. 

Scheie:       Probably  nobody  had  biopsied  them.  It  is  easily  done-tent  up  a 
little  of  the  membrane  with  a  forceps  and  ship  it  off. 

Hughes:     Why  were  you  chosen  to  give  the  Gifford  Lecture? 

Scheie:       I  can't  answer  that.  A  group  of  ophthalmologists  in  Chicago  sponsor 
the  lecture  and  I  was  invited. 

Hughes:     And  the  subject  was  your  choice? 


197 


Scheie:       The  subject  was  my  choice  because  I  felt  that  the  work  was  original 
and  that  they  might  enjoy  it. 

Hughes:     In  1971  you  published  another  paper  on  mucopolysaccharidosis.  * 

Scheie:       Yes.  That  was  just  a  continuing  study  of  the  patients  that  I'd 
studied  before  and  reported  at  the  Gifford  Lecture. 

Hughes:     But  there  were  new  biochemical  tests  that  had  been  developed  in  the 
interim. 

Scheie:       Yes.  And  much  more  exquisite. 

Hughes:     What  sort  of  tests  were  done  in  the  early  days? 

Scheie:       There  weren't  many  really:  Quantity  urinalysis  for  MPS,  roentgen 
studies,  and  skin  inflammatory  cycle.  It  was  largely  a  clinical 
diagnosis. 

Hughes:     This  morning  I  read  the  paper  that  you're  to  give  at  the  First 

International  Congress  on  Mucopolysaccharidosis.  **  Do  you  know 
anything  about  the  background  of  the  congress  and  who  is 
organizing  it? 

Scheie:       Well,  members  of  the  staff  of  the  University  of  Minnesota  have  been 
very  interested  in  connective  tissue  disease  and  were  given  the 
responsibility  to  organize  the  First  International  Congress  which 
was  to  be  held  there.  I  was  invited,  I  suspect,  because  at  my  age  I 
am  a  bit  of  a  museum  piece.  I  was  asked  to  explain  how  we  hit 
upon  this  variant  of  Hurler's,  and  the  answer  is  very  simple.  It  was 
the  result  of  serendipity.  Had  I  not  seen  the  little  girl  with  Hurler's 
only  weeks  before,  certainly  I  would  have  agreed  that  this  was  an 
unusual  type  of  arthritis  affecting  the  hands  and  feet  of  the  adult 
brother  and  sister,  rather  than  suspect  Hurler's  disease. 

Hughes:     Is  the  condition  well  enough  known  that  the  everyday 

ophthalmologist  would  recognize  that  a  patient  with  corneal  haze 
could  have  Hurler's? 

Scheie:       This  type  is  very  rare.  It  depends  upon  how  well  read  and 
observant  the  ophthalmologist  is. 

This  congress  will  also  include  a  discussion  of  other  connective 
tissue  diseases.  Dr.  McKusick  and  other  individuals  from  all  over 
the  world  who  have  been  working  in  the  field  of  connective  tissue 


** 


Constantopoulos  G,  Dckaban  AS,  Scheie  HG.  Heterogeneity  of  disorders  in  patients  with  corneal 
clouding,  normal  intellect,  and  mucopolysaccharidosis.  Am  J  Ophthalmol  1971;  72:1106-17. 
Experiences  with  type  V  mucopolysaccharidosis.  An  address  delivered  at  the  First  International 
Congress  on  Mucopolysaccharidosis  and  Related  Diseases,  University  of  Minnesota  Medical 
School,  Minneapolis,  Minnesota,  May  20,  1988. 


198 

disease  will  be  there  and  bring  their  data  up-to-date  and 
undoubtedly  describe  new  techniques.  The  meeting  should  be 
fascinating. 

There  is  an  entire  family  of  connective  tissue  diseases  that  reflect 
eye  changes.  Pseudoxanthoma  elasticum  is  one  of  them.  There  the 
elastic  tissue  deteriorates.  Marfan's  syndrome  is  another  that 
affects  the  eyes.  The  lenses  become  loose  and  dislocated.  They  and 
other  will  be  taken  up  at  the  congress. 

Hughes:     Is  the  eye  condition  considered  an  important  diagnostic  sign  in  these 
syndromes? 

Scheie:       I  think  it  is  with  many  of  them,  yes. 

Hughes:     For  most  of  these  diseases,  there  is  no  treatment.  Is  that  right? 

Scheie:       Well,  no.  You  can  remove  the  lenses  in  Marfan's,  just  as  you  remove 
a  cataractous  lens,  but  the  operation  is  more  hazardous.  Laser 
could  possibly  help  prevent  progression  of  retinal  degeneration  in 
patients  with  angioid  streaks.  Patients  with  angioid  streaks  tend 
to  die  early;  I  just  learned  of  the  death  of  one  of  mine  at  a  young 
age.  His  daughter  was  a  friend  of  our  daughter  in  prep  school.  He 
had  pseudoxanthoma  elasticum  and  angioid  streaks.  There  is  no 
treatment  from  the  standpoint  of  increasing  longevity. 

Hughes:     Is  there  one  cause  of  death  in  these  syndromes? 

Scheie:       I  would  suspect  usually  it's  vascular.  In  pseudoxanthoma 

elasticum,  the  elastic  layer  of  the  blood  vessels,  aorta,  and  smaller 
vessels  also  can  occlude.  I  suppose  the  aorta  can  rupture,  but 
they're  mainly  cardiac  deaths.  Hurler's  patients,  even  as  young  as 
six  years,  have  heart  murmurs  due  to  valve  thickening,  as  in  our 
first  patient.  In  the  two  with  incomplete  Hurler's,  Scheie 
syndrome,  for  some  reason  the  deposition  has  been  very  slow  and 
they've  lived  longer.  Why  wasn't  their  brain  involved?  There  it 
must  be  an  inherent  difference  of  some  kind,  but  it  isn't  quite 
understood. 


Rubeola  Retinopathy 


Hughes:     Well,  here  is  a  paper,  1972,  on  rubeola  retinopathy,  which  you  wrote 
with  Peter  Morse.  *  Who  is  he? 

Scheie:       He  is  a  retina  specialist  now  at  the  University  of  Chicago. 
Hughes:     This  paper  was  written  about  one  patient. 


Scheie  HG,  Morse,  PH.  Rubeola  retinopathy.  Arch  Ophthalmol  1972;  88:341-4. 


199 


Scheie:       I  had  seen  the  patient  when  she  was  a  young  child.  She  had  acute 
retinopathy  associated  with  rubeola.  There  was  no  question  about 
the  diagnosis  at  that  time.  I  had  seen  her  in  consultation  with  the 
pediatricians  at  the  university  hospital.  She  had  edema  of  the 
retina  and  optic  nerve  and  some  exudates  in  the  macula,  appearing 
like  a  star  figure.  These  changes  cleared  entirely  and  left  her  with 
normal-appearing  eyes,  but  over  the  years  she  developed 
pigmentary  degeneration  of  the  retina.  We  could  relate  it  only  to  the 
previous  trouble  with  her  eyes  at  the  time  of  her  rubeola. 

Hughes:     The  point  of  the  paper,  I  gathered,  was  that  the  long-term  prognosis 
for  these  patients  should  be  guarded. 

Scheie:       Yes,  in  view  of  the  late  changes  observed. 

Hughes:     Yes,  exactly.  You  say  it  much  better  than  I  can.  That  had  not  been 
recognized  before1? 

Scheie:       So  far  as  I  know,  not. 
Hughes:     There  was  no  treatment? 

Scheie:       No,  there  wouldn't  be.  On  the  other  hand,  a  secondary  condition, 
entirely  unrelated,  could  have  occurred.  But  having  followed  this 
patient  personally  over  the  years  and  to  see  this  progressively 
develop  was  not  only  interesting  but  I  felt  should  be  reported. 

Hughes:     Are  you  aware  of  any  other  follow-ups? 
Scheie:       No,  I'm  not. 


Surgery 

Hughes:  In  an  article  in  the  Philadelphia  Inquirer  George  Tyner  described 
you  as  having  "almost  infallible  surgical  judgment."*  On  what  is 
such  judgment  based? 

Scheie:       No  one  has  infallible  judgment  but  I  do  have  common  sense, 
conservatism  and,  I  hope,  humanity. 

Hughes:     Is  surgical  judgment  something  that  anybody  with  a  will  can 
develop? 

Scheie:       Well,  I  don't  know  if  that  is  true,  but  I  do  think  I  have  been  known 
for  common  sense  and  some  problem-solving  ability.  You  can  watch 
a  couple  of  carpenters,  for  one  everything  goes  smoothly  and  falls 


June  2,  1983,  3C. 


200 


into  place,  and  the  other  seems  to  be  all  thumbs.  I  don't  say  he  is 
clumsy,  but  then  why  are  some  people  accident  prone  and  others 
not? 

Hughes:     Judgment,  however,  requires  mental  ability. 

Scheie:       If  anyone  has  surgical  ability,  it  is  something  he  has  probably  been 
somewhat  blessed  with.  Common  sense  also. 

Hughes:     What  sorts  of  criteria  did  you  use  in  deciding  whether  to  operate  a 
patient  or  not? 

Scheie:       Well,  I  guess  the  one  thing  I'd  always  asked  myself  is,  "What  would 
I  want  done  if  I  were  the  patient  or  desire  for  a  member  of  my 
family?" 

Hughes:     Sometimes,  though,  you  can  help  the  patient  in  regard  to  the 

immediate  problems,  but  other  considerations  might  argue  against 
doing  the  operation. 

Scheie:       Well,  you  must  consider  general  health  and  also  in  some  older 

patients  whether  the  patient  will  have  the  intellect  to  utilize  better 
vision  after  surgery.  For  example,  if  the  headhunter  had  not  been 
blind,  I  wouldn't  have  advised  surgery.  If  he  could  still  get  around 
the  jungle  and  remove  a  head,  I  wouldn't  have  advised  surgery, 
[laughter]  That's  ludicrous,  but  on  the  other  hand,  I  always 
questioned  my  patients,  "Now,  how  are  you  handicapped?" 

I've  had  many  patients  come  to  me  where  surgery  had  been  advised, 
seemingly  only  because  of  a  diagnosis  of  cataracts.  On  questioning 
them  I  learned  they  had  no  significant  problem.  "Can  you  still 
drive  your  car?  You're  reading  as  much  as  you  want  to  read?  Can 
you  still  do  most  of  the  things  you  deem  essential?"  I  think  you 
must  fit  your  recommendation  to  the  patient,  which  requires  a  little 
kindly  interrogation  as  well  as  the  humility  to  realize  that  any 
operation  you  do  can  make  things  worse. 

A  perfect  example  was  the  truck  driver  who  had  good  vision  on  a 
test  chart,  20/20,  but  in  the  bright  sunlight  and  facing  car  lights  at 
night,  he  was  barely  able  to  manage.  He  was  a  professional  driver. 
When  examined  he  had  early  cataracts  but  located  in  such  a 
position  in  the  lens  that  sunlight  or  bright  lights  at  night 
practically  blinded  him.  For  purposes  of  his  livelihood  he  obviously 
needed  surgery,  and  the  result  was  a  very  grateful  patient. 

Hughes:     You  were  criticized  for  operating  that  case? 

Scheie:       No,  but  I  might  have  been.  He  was  a  man  with  20/20  vision.  I've 
operated  accountants  and  lawyers  under  similar  circumstances. 
They  would  have  reached  the  point  where  they  couldn't  manage  to 
do  their  fine  close  work.  However,  they  come  to  your  office  and  find 


201 

that  they  have  20/20  vision  but  cannot  function  adequately  in  their 
profession.  These  are  examples  of  the  need  for  common  sense  and 
understanding. 

Hughes:     What  relative  importance  do  you  place  on  diagnosis  as  opposed  to 
treatment?  I'm  thinking  not  only  of  your  own  work  but  what  you 
were  trying  to  teach  residents. 

Scheie:       Oh,  without  ability  to  diagnose  you  cannot  intelligently  treat.  You 
must  be  a  good  diagnostician  regardless  of  your  field  in  medicine. 
We  enjoyed  and  had  good  fun  at  our  slide  conferences  when  all  of  us 
would  have  a  try  at  the  diagnosis  We'd  often  take  votes  and  it  made 
a  great  game  but  it  was  also  a  good  learning  experience. 

Hughes:     Did  somebody  know  the  right  answer? 

Scheie:       Well,  the  person  who  prepared  the  slides  always  did  but  he  was  out 
of  the  game.  We  could  always  resort  to  him  if  we  had  to. 

Routine 

Hughes:     Please  describe  a  typical  operating  day. 
Scheie:       That's  easy  to  do-chaos. 

Hughes:     [laughs]  Well,  be  a  little  more  specific  than  that.  At  what  hour  of 
the  morning  would  you  arise? 

Scheie:       Well,  it  was  never  as  extreme  as  people  have  probably  told  you.  I 
usually  started  operating  at  about  six-thirty  or  seven  in  the 
morning.*  I  was  in  the  hospital  before  that  and  would  even  see  a 
couple  of  patients  before  surgery. 

We  had  wonderful  nurses.  Miss  Mary  Gowarty  had  been  with  me 
from  the  time  she  finished  nurse's  training  in  1959  and  she  stayed 
until  1983,  the  year  that  I  retired.  We  had  our  own  staff  of  nurses 
and  orderlies.  Some  patients  would  have  been  sedated  for  surgery 
and  ready  to  be  brought  to  the  operating  room  before  7:00  a.m.  I 
usually  utilized  four  different  operating  tables. 

Hughes:     In  different  rooms? 

Scheie:       No,  the  tables  were  in  a  large  and  modern  operating  room,  and  in 
an  adjunct  room  was  a  fifth  table  which  I  rarely  used.  However, 
other  staff  people  might  operate  in  there  while  I  was  operating.  As 
soon  as  I  had  finished  my  surgery  and  on  the  other  days  that  I  did 
not  operate,  the  staff  had  their  own  operating  schedules. 


*        Mrs.  Beurer,  Dr.  Schcie's  secretary,  says  that  it  was  sometimes  considerably  earlier  than  6:30  a.m. 


202 


During  my  surgery,  I  went  from  table  to  table.  I  would  allow  a 
senior  resident  or  an  associate,  like  Dr.  Karp  or  Dr.  Ewing,  do 
preliminaries,  such  as  a  facial  block,  but  I  always  gave  the  slightly 
hazardous  retrobulbar  anesthesia.  In  fact,  I  did  every  step  of  every 
operation  that  was  essential  to  the  outcome.  Once  I  had  done  this,  I 
would  delegate  the  closing  of  the  conjunctival  flap  to  an  assistant. 
They  liked  to  participate  and  it  permitted  them  to  actually  be  part 
of  the  operation.  They  were  experienced,  were  to  be  trusted,  and  it 
was  also  my  teaching  responsibility. 

Then  I'd  go  to  the  next  table  and  another  patient  and  do  likewise.  I 
usually  worked  with  one  or  two  of  my  staff,  in  addition  to  residents. 
I  relied  especially  on  Dr.  Ewing,  who  is  an  excellent  surgeon.  On 
the  average,  I  would  do  twelve  to  fifteen  operations  in  the  morning. 
The  most  I  ever  did-my  record-was  thirty- two.  I'm  sure  I  worked 
beyond  noon  that  day.  [laughs] 

Hughes:     How  long  did  you  spend  with  each  patient1? 

Scheie:       It  depended  upon  the  procedure. 

Hughes:     For,  say,  a  straightforward  cataract  extraction1? 

Scheie:       I  would  think  probably  my  time  with  the  patient  would  be-unless  it 
was  complicated-ten  to  fifteen  minutes. 

Hughes:     That  was  at  different  periods,  wasn't  it?  It  wasn't  fifteen  continuous 
minutes? 

Scheie:       No,  I  would  do  all  that  was  essential  to  the  outcome  of  each 
operation. 

Hughes:     And  then  move  on  to  the  next  patient? 

Scheie:       Yes.  I  let  Dr.  Ewing  or  Dr.  Karp  do  more  than  the  residents,  but  I 
took  the  responsibility  for  my  private  patients  very  seriously.  Some 
simpler  operations  were  somewhat  different.  I  might  allow  a  staff 
man  to  do  an  entire  operation  but  I  was  there  to  see  that  all  went 
well.  It  was  my  responsibility  and  I  insisted  upon  that.  I  would 
always  see  the  patients  before  I  left  in  the  evening  and  the  first 
thing  the  next  morning.  I  do  claim  to  have  been  very  conscientious 
in  my  care  of  patients. 

Hughes:     Did  you  have  any  trouble  with  postoperative  infections? 

Scheie:       Very  rarely. 

Hughes:     Was  your  aseptic  technique  any  more  refined  than  anybody  else's? 

Scheie:       No,  we  had  routine  scrubbing  rules  and  a  very  well-trained 

operating-room  and  support  staff.  I  could  have  been,  and  I  am  sure 


203 

that  I  was,  criticized  by  some  for  having  four  operating  tables  in  one 
room.  On  the  other  hand,  we  were  dealing  with  clean  cases,  and 
infection  was  not  a  problem.  I  would  do  it  that  way  if  I  were 
operating  today.  But  there  are  administrators  who  set  down 
arbitrary  rules,  so  I  might  not  be  able  to  because  times  and 
regulations  do  change. 

Hughes:     Did  you  have  a  standard  reaction  when  things  didn't  go  well  in  the 
operating  room? 

Scheie:       I'd  get  depressed  and  annoyed  with  myself.  I  was  very  serious 

about  my  surgery  and  I  tried  to  keep  everybody  on  their  toes.  To 
me  an  operation  was  a  serious  matter.  I  couldn't  stand  a  bad  result. 

Hughes:     You  have  been  criticized  for  practicing  assembly-line  surgery. 

Scheie:       Well,  I  just  mentioned  that,  and  now  I  have  learned  that  it  has  been 
reinvented  in  Russia. 

Hughes:     Yes,  thirty-two  cases  in  one  day.  [laughter] 
Scheie:       It  was  good  experience  for  my  assistants. 

Hughes:     Yes,  and  it  was  apparently  good  surgery  and  good  results,  from  what 
I  have  heard.  Did  you  have  a  reaction  to  this  charge? 

Scheie:       No,  I  had  to  live  with  the  results  and  I  couldn't  tolerate  bad  ones. 

Not  only  that,  I  took  full  responsibility  for  all  operations  and  did  the 
essential  steps  myself,  including  seeing  my  patients  in  the  office 
pre-  and  postoperatively,  and  personally  making  diagnoses  and 
decisions  pertaining  to  the  patient's  surgery,  and  relating  to  their 
families.  I  saw  the  patients  after  admission  and  twice  a  day  while 
they  were  in  the  hospital. 

Ophthalmology  was  a  large  part  of  my  life.  My  operating  time  and 
other  daily  activities  had  to  be  efficient  because  of  my  many 
responsibilities,  the  administration,  the  building  of  the  department, 
the  teaching  and  training  of  residents  and  medical  students,  and 
my  own  projects  with  papers  that  I  was  writing.  Those  were 
commitments.  If  I  had  taken  all  day  to  do  my  surgery,  I  could  not 
have  carried  these  other  responsibilities.  I  might  have  liked  a  little 
less  pressure  but  certainly  my  life  was  full.  When  I  finished 
surgery,  I  didn't  take  an  hour  or  two  break  for  a  leisurely  lunch.  I'd 
often  skip  it  entirely  or  have  a  sandwich  on  the  run.  There  was 
always  a  myriad  of  things  to  do. 

Hughes:     Was  there  ever  a  time  in  your  working  day  when  you  could  take  a 
moment  to  yourself? 

Scheie:       That  isn't  the  way  I've  always  worked.  With  Dr.  Adler,  I  was 

always  the  morning  person.  He  would  see  his  hospital  patients 


204 

when  he  finished  his  patient  schedule  downtown,  usually  early 
afternoon.  I  always  stopped  to  see  them  to  change  their  dressings 
at  around  seven  a.m.  on  my  way  downtown  to  his  office. 

Hughes:     What  surgical  instruments  have  you  designed1? 

Scheie:       Oh,  nothing  very  important.  One  was  a  right  and  left-hand  scissors 
that  I  was  very  fond  of,  which  I  used  for  making  cataract  incisions. 
They  had  a  blunt  tip  and  wouldn't  accidentally  pick  up  other 
tissues,  like  the  iris. 

Hughes:     Were  they  commercially  made? 

Scheie:       Yes,  Storz  Instrument  Company  made  them. 

Hughes:     Did  you  move  on  to  another  type? 

Scheie:       No,  I  used  them  until  I  stopped  doing  surgery.  They  were  sharp, 
with  blades  heavy  enough  to  cut  cleanly  and  not  crush  tissues  nor 
pick  up  iris.  They  were  simple  and  safe  to  use.  That's  the  story  of 
my  life.  I  tried  to  simplify  things.  I  hope  they  were  not  only 
simpler  but  safer. 

Hughes:     Were  there  any  other  instruments? 

Scheie:       Oh,  I  guess  there  were,  [laughter]  I  never  put  my  name  on  them, 
but  everybody  called  the  scissor  the  Scheie  scissor.  Some  others  I 
modified.  I  also  had  an  aspiration  needle  for  sucking  out  congenital 
and  juvenile  cataracts  that  was  made  especially  for  me  by  the 
Becton  and  Dickinson  Company.  It  permitted  removal  of  this  type 
of  cataract  by  aspiration  through  a  very  small  opening.  It  was  a 
#19  needle  made  with  a  thin  wall  to  give  a  lumen  of  a  #18  needle. 
It  also  had  a  flat  oval  grind  to  provide  a  relatively  blunt  tip.  There 
were  some  other  rather  trivial  things  like  that. 

Sutures* 

Hughes:     Do  you  remember  when  the  introduction  ofcorneal  sutures  occurred? 

Scheie:       Well,  needles  and  sutures  were  among  my  great  interests. 
Techniques  of  incision  and  their  closure  have  been  modified 
tremendously  over  the  years.  However,  nearly  all  the  principles  of 
corneal  suturing  and  types  of  incision  were  available  by  the  turn  of 
the  century.  Conjunctiva  was  very  easily  sutured  but  such  closures 
were  insecure.  By  1900,  the  greatest  need  was  for  fine  instruments, 
needles,  and  suture  material.  All  of  these  slowly  evolved  but  it 
wasn't  until  post- World  War  II  that  great  impetus  occurred  with  the 
superlative  needles  and  sutures  that  we  have  today. 


Portions  of  a  later  discussion  of  sutures  were  added  here. 


205 


Hughes:     What  technology  was  developed  that  made  the  fine  needles  and 
sutures  possible? 

Scheie:       Credit  goes  to  the  ophthalmic  surgical  instrument  companies  and 
the  research  departments  of  various  suture  and  needle  companies. 
Needles  are  now  sharpened  and  machined  under  magnification. 

During  World  War  II,  only  crude  general  surgical  needles  were 
available  to  us  in  India,  and  the  finest  catgut  or  silk  sutures  were 
4-0.  I  was  one  of  the  first  ophthalmologists,  if  not  the  first,  to  use 
corneoscleral  sutures  at  the  University  of  Pennsylvania  Hospital. 
Because  the  needles  were  coarse  and  not  very  sharp,  it  was 
hazardous  to  push  the  needle  through  tough  limbal  and  corneal 
tissue. 

Hughes:     So  surgeons  didn't  suture? 

Scheie:       Most  of  the  time  they  did  not  and  that's  why  you  hear  about 

keeping  patients  in  bed  for  a  week  or  ten  days  with  sandbags  to 
immobilize  the  head.  That  was  the  story  during  my  internship  and 
early  residency.  We  have  briefly  discussed  this. 

Hughes:     How  did  you  keep  a  child  quiet  for  that  period  of  time? 

Scheie:       Fortunately,  large  incisions  weren't  used  for  children's  cataracts. 

Hughes:     No,  but  there  would  be  other  operative  procedures  on  children's  eyes, 
would  there  not? 

Scheie:       Well,  it  didn't  matter  that  much  with,  say,  a  crossed  eye.  They  did 
try  to  keep  the  children  quiet,  but  I  felt  that  it  was  a  joke  because 
they  always  jumped  around  patch  or  no  patch  and  in  or  out  of  bed. 
Now  we  don't  patch  them. 

Hughes:     How  thin  are  sutures  now? 

Scheie:       Well,  they're  very  fme-10-0  and  finer.  I  understand  as  fine  as  15-0. 
But  they  become  quite  difficult  to  use  when  finer  than  10-0  and  are 
almost  always  used  with  a  microscope.  I  used  8-0  for  my  cataract 
work. 

Credit  for  these  advances,  often  going  to  the  ophthalmologist, 
should  go  instead  to  the  resourceful  and  skilled  instrument  and 
suture  companies.  Of  course,  ophthalmologists  have  supplied  the 
demand  and  have  offered  constructive  criticism  and  suggestion. 

I've  been  on  advisory  panels  and  I  am  still  on  one  for  Ethicon. 
Their  panel  meetings  held  each  year  during  the  Academy  annual 
meeting  are  very  instructive  and  enjoyable.  They  compare  notes 
with  the  eye  surgeons  and  set  out  to  help  satisfy  their  needs.  It  has 


206 


been  a  wonderful  story  that  started  during  World  War  II  and  has 
continued  since. 

Hughes:     What  were  those  first  postwar  sutures  made  of? 

Scheie:       They  were  silk  or  catgut.  We  had  silk  from  as  far  back  as  I  can 

remember,  but  the  fine  silk  and  the  fine  sharp  needles  came  along 
after  World  War  II. 

An  experience  I  had  in  Europe  in  the  spring  of  1948  may  be  of 
interest  to  you.  I  was  on  a  joint  mission,  five  of  us,  for  the  Office  of 
the  Surgeon  General  and  the  State  Department.  We  flew  into 
Bremerhaven  and  our  duty  was  to  inspect  all  of  the  DPA  camps  and 
American  hospitals  in  Germany  and  Austria.  While  in  Vienna  we 
visited  the  famous  Allgemeines  Krankenhaus  [General  Hospital] 
where  they  had  three  different  eye  clinics.  Out  of  curiosity-it 
wasn't  part  of  our  mission-I  visited  the  clinics  to  watch  eye  surgery. 
They  had  been  isolated  during  the  war,  but  they  had  needles  that 
didn't  seem  too  bad.  They  were  using  Japanese  women's  hair  for 
eye  suture  material. 

Hughes:     No! 

Scheie:       I  wouldn't  have  believed  if  it  I  hadn't  seen  it.  It  was  finer  and  nicer 
than  any  suture  material  we  had  in  this  country  at  that  time  and 
seemed  to  hold  and  tie  well. 

Hughes:     Were  there  any  well-known  people  that  you  observed  operating  in  the 
Viennese  clinics? 

Scheie:       Well,  there  was  Dr.  [Karl]  Hruby,  at  that  time  assistant  to  Professor 
[Karl  D.]  Lindner,  and  Lindner  himself,  whom  I  watched  operating. 
Those  are  the  two  that  come  to  mind.  We  spent  only  part  of  a 
half-day  visiting  there. 

Hughes:     Are  you  aware  of  any  schism  between  medically-oriented  and 
surgically-oriented  ophthalmologists ? 

Scheie:       I  have  never  recognized  this.  In  hospitals,  jealously  incomewise 
between  the  surgical  and  the  medical  services  can  exist.  In 
ophthalmology  that  hasn't  been  true  so  far  as  I  know.  A  person  like 
myself  who  does  both  may  be  envied,  but  then  I  have  always  done 
considerable  surgery  as  well  as  a  great  deal  of  office  and  medical 
ophthalmology  and  enjoyed  it  all.  Today  some  aggressive  surgeons 
who  are  seemingly  money  mad  have  created  ill  will.  This 
unfortunately  is  a  recent  development  accompanied  by  newspaper, 
radio,  television,  and  telephone  book  classified  advertising. 

Hughes:     Have  you  engaged  actively  in  the  debate  about  the  so-called 
buccaneers  in  ophthalmology1? 


207 


Scheie:       Yes,  I've  certainly  spoken  my  mind  in  opposition.  I'm  very 
concerned  that  our  specialty  is  being  demeaned.  The  two 
specialties  in  medicine  which  seem  to  be  the  most  criticized  for  such 
attitudes  are  plastic  surgery  and  ophthalmology. 

Hughes:     How  do  you  think  the  problem  should  be  handled? 

Scheie:       I  don't  think  it  can  be  handled  because  if  you  criticize  too  much,  a 

lawsuit  can  result.  Medicine  is  no  longer  in  the  position  that  it  was. 
Now  even  medical  societies  seem  unable  to  discipline.  Part  of  it 
stems  from  the  famous  Federal  Trade  Commission  decision  that 
permits  doctors  and  lawyers  to  advertise.  We  have  an 
ophthalmologist  in  the  Philadelphia  area  who  is  on  television 
probably  once  every  week  or  two,  and  there  are  a  few  others  who 
advertise.  Our  institute  has  not  done  so.  I'm  a  little  concerned  that 
our  university  medical  center  may  be  considering  it  but  that  would 
be  out  of  self-defense.  Jefferson  Hospital,  the  Graduate  Hospital, 
and  others  in  Philadelphia  do  advertise.  Unfortunately,  if  they  can 
do  it,  the  individual  doctor  feels  justified  in  following  suit. 

## 


The  Scheie  Eye  Institute 


Hughes:     Dr.  Scheie,  how  and  when  did  the  idea  for  the  institute  originate? 

Scheie:       It  always  troubled  me,  even  in  resident  days,  that  we  didn't  have 

better  facilities  for  our  department  of  ophthalmology.  As  chairman, 
I  wanted  our  department  to  become  the  equal  of  anyone's,  but  I  had 
never  dared  to  dream  of  building  a  separate  facility  or  institute 
until  1962  when  Senator  Grundy  left  a  legacy  of  one  million  dollars 
to  our  department.  It  was  a  memorial  to  his  sister  Margaret  M. 
Grundy  and  stimulated  me  to  think  of  other  possibilities.  Under 
the  terms  of  the  will,  I  could  have  spent  the  principal,  something 
I've  never  done.  To  this  day,  I  could  spend  the  income  or  principal 
as  long  as  I  am  connected  with  the  university.  When  I  leave  the 
principal  must  remain  in  endowment. 

This  gift  stimulated  me  to  start  an  informal  annual-giving  letter, 
typed  and  mimeographed  by  my  secretary,  and  sent  to  patients 
whom  I  thought  might  be  interested  in  contributing  to  our  eye 
department.  The  response  to  something  as  simple  as  that 
mimeographed  note  was  very  encouraging,  and  after  two  or  three 
years,  I  began  to  be  a  little  more  active  in  my  search  for  funds.  We 
developed  a  more  attractive  brochure  to  send  with  the  letter  and 
extended  our  mailing  list.  I  also  approached  the  administration  in 
the  late  sixties  about  the  possibility  of  developing  our  own  facility. 


208 


One  thing  led  to  another  and  the  final  boost  came  from  Pew 
Charitable  Trusts  with  a  pledge  of  three  million  dollars  to  build  a 
new  eye  institute,  but  I  would  have  to  raise  the  rest  of  the  money  if 
it  were  to  cost  more.  The  Pew  family  made  the  decision  that  if  it 
were  to  be  built,  it  should  be  built  soon  because  building  costs  were 
increasing  at  the  rate  of  about  fifteen  percent  a  year  at  that  time. 
Furthermore,  they  had  never  liked  government  grants  and  it  would 
have  taken  two  or  three  years  for  approval  of  such  a  grant.  For 
those  reasons,  we  decided  to  go  ahead,  about  1969,  with  definite 
plans  for  the  institute.  I  visited  various  eye  departments  here  and 
there  around  the  country  and  also  in  Europe,  including  Moorfields 
in  England,  Essen,  Hamburg,  Bonn  in  Germany,  and  Copenhagen, 
Denmark. 


Mrs.  Scheie,  Lord  Louis 
Mountbatten  and  Dr.  Scheie 
at  the  dedication  of  the  Scheie 
Eye  Institute,  October  12, 1972 


Scheie:       Of  great  assistance  to  me  in  planning  our  projected  eye  facility  were 
the  Retina  Foundation  and  the  Massachusetts  Eye  and  Ear 
Infirmary  in  Boston  and  the  Jules  Stein  Institute,  which  was  quite 
new,  in  Los  Angeles.  Our  fund  raising  was  intensified  at  this  time. 

One  of  the  most  gratifying  contributions  to  our  building  fund  was 
$250,000  contributed  by  our  former  and  current  residents.  This 
served  as  a  great  encouragement  to  me  and  was  a  great  help  when 
approaching  prospective  donors.  It  indicated  that  we  had  a 
successful  training  program  with  loyal  and  grateful  graduates. 
Contributions  continued  to  come  in  and  the  groundbreaking  took 


209 

place  on  December  8,  1969.  The  eye  institute  opened  for  the 
admission  of  patients  on  August  14,  1972,  and  we  did  our  first 
surgery  on  the  fifteenth  of  August.  The  institute  was  dedicated  on 
the  twelfth  of  October,  1972.  Our  goal  was  to  build  an  eye  institute 
that  would  cost  between  five  and  six  million  dollars,  but  before  it 
was  completed  and  equipped,  it  cost  approximately  12.5  million 
dollars,  and  it  was  entirely  paid  for  with  private  money. 

Hughes:     Dr.  Scheie,  did  you  know  from  the  start  that  you  would  get  all  of  the 
funding  from  private  sources? 

Scheie:       I  was  certain  that  we  would  have  to  because  we  had  made  the 
decision  with  the  Pew  family. 

Hughes:     Why  did  they  make  that  qualification1? 

Scheie:       Because  they  were  conservative  people  who  disliked  government 
largesse. 

Hughes:     How  had  you  gotten  to  know  them1? 

Scheie:       By  taking  care  of  some  Pew  family  members  over  the  years. 

Design 
Hughes:     Who  chose  Vincent  Kling  as  the  architect  of  the  institute? 

Scheie:       Vincent  Kling  was  chosen  by  the  Pew  family.  When  he  first  came  to 
Philadelphia  as  a  young  man  they  had  helped  him  and  had  become 
fond  of  him.  He  had  worked  with  them  on  other  projects.  In 
addition,  he  had  become  one  of  our  country's  most  talented 
architects.  At  any  rate,  he  was  engaged  for  the  project.  Before 
starting  the  project,  he  and  some  members  of  his  firm  came  to 
observe  my  work  habits,  the  handling  of  patient  flow,  and  other 
activities  in  my  area  at  the  university  hospital.  They  also  observed 
any  problems  and  used  this  information  in  developing  their  plans 
for  the  new  building. 

Kling  states  that  they  decided  the  eye  institute  should  be  round 
because,  as  he  watched  me  at  work,  he  saw  that  I  was  constantly 
going  in  circles,  [laughter]  That's  a  true  anecdote. 

Hughes:     So  it  was  his  idea? 

Scheie:       Yes.  And  our  eye  institute  is  not  only  beautiful  but  very  functional. 
I  believe  Mr.  Kling  considered  this  to  be  a  rather  personal  project 
because  of  his  loyalties  to  the  Pew  family.  Nason  and  Cullen 
Builders,  an  outstanding  firm  which  also  had  done  projects  for  the 
Pews,  was  also  engaged.  Later  Kling  said  that  this  was  the  one 
project  with  which  he  had  been  involved  where  no  disagreement 
ever  occurred  between  the  people  who  had  financed  the  effort,  the 


210 


person  or  group  it  was  being  built  for,  and  the  architect  and  the 
builder. 

Hughes:     Remarkable. 

Scheie:       Three  different  tastes  are  expressed  in  the  building.  Vincent  Kling 
was  fond  of  bricks,  a  theme  that  is  expressed  in  the  beautiful 
elevator  stacks,  the  floor  of  our  prize-winning  reception  area,  and 
other  places  in  the  building.  They  are  lovely,  dark  brown,  natural 
brick.  Mabel  Myrin,  our  chief  advocate  from  the  Pew  family,  was  a 
very  active  horticulturist  and  wanted  greenery.  We,  therefore,  have 
many  different  live  plants  scattered  throughout  the  building.  She 
exhibited  each  year  at  the  famous  Philadelphia  Flower  Show. 
Being  of  Scandinavian  background,  I  love  natural  wood  which  is 
seen  throughout  the  institute. 

The  building  is  of  superb  quality.  For  example,  all  of  the  wood  was 
hand  processed  here  at  the  institute  in  an  area  set  aside  for  the 
carpenter  shop.  Quality  was  the  goal  and  it's  one  of  few  recent 
buildings  like  it. 

Hughes:     How  closely  did  you  work  with  Mr.  Kling? 

Scheie:       Quite  closely.  He's  also  a  friend  and  patient  and  is  very  proud  of  the 
building,  as  are  Nason  and  Cullen.  The  reception  area  won  the  S. 
M.  Hexter  Award  for  the  best  interior  design  of  the  year  in 
February  of  1973.  The  prize  was  won  by  Vincent  Kling  Interior 
Design,  a  division  of  Vincent  G.  Kling  and  Associates. 

Hughes:     Had  he  been  used  to  working  with  somebody  else  so  intensely? 

Scheie:       Oh,  I  think  so.  He's  a  very  sophisticated  individual.  I  personally 
don't  know  how  an  architect  could  build  a  building  and  not  work 
closely  with  the  client. 

Hughes:     I  understand  that  you  had  an  exceptionally  close  relationship  to  the 
process. 

Scheie:       I  think  it  was  because  I  wanted  to  please  the  Pew  family  and  so  did 
the  architects  and  builders. 

Hughes:     Had  they  ever  done  a  medical  building  before? 

Scheie:       Yes.  Kling  did  Lankenau  Hospital,  also  for  the  Pew  interests,  and 
it's  a  beautiful  modern  hospital.  And  he's  done  others. 

Hughes:     How  was  the  give-and-take?  He  must  have  had  idea  that  you  didn't 
particularly  like  and  vice  versa. 

Scheie:       Well,  it  was  amazing-he's  really  a  semi-legend.  Any  suggestions 
from  me  involving  other  than  planning  of  details  pertaining  to  my 


211 

specialty  would  have  been  gratuitous.  As  far  as  the  details  of  the 
examining  rooms  and  the  operating  rooms  and  others  of  my  work 
area,  I  was  very  close  to  that.  In  fact,  the  examining  rooms  were 
near  copies  of  those  in  our  clinic  at  HUP.  Regarding  the  operating 
room,  you  must  meet  certain  state  regulations  and  criteria. 
Everyone  worked  together  trying  to  build  the  finest  institute 
possible.  Certain  regulations  also  applied  for  research  areas  and 
these  had  to  be  observed. 

One  of  our  planning  goals  carried  throughout  the  building,  even  in 
the  patient  care  areas,  was  economy  of  subsequent  operations. 
With  that  in  mind  we  regarded  the  center  of  the  building  the  source 
of  support  and  service,  and  the  patient  activities  were  located  at  the 
periphery.  For  example,  on  the  first  floor  the  examining  rooms  and 
the  units  for  patient  care  were  placed  at  the  periphery  of  the 
institute,  and  the  receptionists,  cashier,  charts,  and  appointment 
desk,  essential  common  activities  used  to  help  doctors  see  patients, 
were  located  in  the  central  area  of  the  reception  room.  On  the 
research  floor,  a  dishwashing  unit  and  an  autoclave  were  located  in 
the  center  of  the  floor  and  available  to  all  of  the  laboratories  which 
are  on  the  periphery.  The  sterilizers  and  the  walk-in  freezers  and 
other  services  used  by  all  were  also  centrally  located  and  readily 
available  to  all  of  the  research  people.  These  were  common  services 
or  utilities  that  all  of  the  laboratories  might  use  and  the 
arrangement  avoided  duplicating  such  equipment  for  each  lab. 

The  same  planning  was  made  for  the  patient  floors  with  utilities 
central  and  available  for  the  patient-care  rooms.  The  service  units 
were  placed  centrally  on  all  floors,  including  patient  care  areas,  for 
purposes  of  economy  and  efficiency. 

Hughes:     Well,  you  have  been  called  an  efficiency  expert  par  excellence,  and 

that's  what  you're  talking  about  now.  Tell  me  about  other  systems  in 
the  institute  which  feed  into  this  efficiency.  I'm  thinking,  for 
example,  of  the  button  system  that  told  as  you  were  working  whether 
patients  were  ready  to  be  seen  by  you,  or  in  a  room  awaiting  the 
attention  of  a  technician  or  physician  assistant. 

Scheie:       Yes,  we  had  a  signal  system.  A  small  panel  of  switch  buttons  is 

located  outside  the  entrance  of  each  examining  room.  Each  button 
has  a  different  color  and  when  pushed  turns  on  a  light  of  the  same 
color.  The  small  panel  signals  are  reflected  to  a  larger  panel  of 
lights  located  on  the  wall  in  all  of  the  examining  rooms  permitting 
the  doctors  to  know  the  status  of  each  room.  There  was  also  a 
master  panel  at  our  reception  desk  in  the  lobby  which  enabled  the 
receptionists  to  control  the  flow  of  patients  to  the  examining  rooms 
and  to  contact  the  doctors. 

The  panel  of  lights  beside  the  door  of  each  examining  room  revealed 
to  the  secretaries,  nurses,  technicians,  and  doctors  at  a  glance  the 
activities  in  each  room  and  whether  or  not  they  were  needed.  If  the 


212 


white  light  was  on,  it  meant  that  a  patient  was  waiting  for  a 
technician  who  would  do  certain  parts  of  the  examination.  When 
she  had  finished  with  the  patients,  a  button  might  be  pushed 
indicating  that  the  patient  was  ready  to  be  seen  by  one  of  my 
assistants.  If  my  light  was  lit,  I  would  know  that  the  patient  was 
ready  for  me.  Of  equal  or  even  greater  importance  was  the  master 
panel  in  each  room.  A  glance  at  this  panel  reflected  the  activity  in 
all  of  the  rooms  and  we  could  tell  where  we  were  needed  and  I  could 
tell  if  I  was  on  schedule. 

On  the  three  half-days  that  I  saw  patients,  I  always  saw  each 
patient  that  was  scheduled  for  me.  Upon  leaving  the  room,  each  of 
us  or  a  secretary  pushed  a  button  indicating  whether  a  room  was 
free  or  whether  a  patient  was  waiting  to  be  seen  and  by  whom. 
This  all  sounds  complicated  but  in  our  routine  outpatient  practice, 
the  system  was  efficient  and  effective. 

Hughes:     Who  designed  the  system? 

Scheie:       I  proposed  and  outlined  the  system,  of  course  not  the  details  for 
wiring. 

Hughes:     Had  you  used  it  previously? 

Scheie:       Yes,  it  was  very  helpful  at  HUP  but  the  one  at  the  institute  was 
more  sophisticated. 

Hughes:     What  other  special  features  of  the  building  did  you  think  up? 

Scheie:       Well,  I  participated  in  such  things  as  the  location  of  the  recovery 

room  in  relation  to  the  operating  room  and  the  flow  of  patients.  The 
doctors'  administrative  offices  for  paperwork  were  located  on  floors 
away  from  the  patient-seeing  area,  which  led  to  great  economy 
because  once  a  doctor  had  finished  seeing  patients,  another  doctor 
took  over  the  examining  rooms  with  their  expensive  equipment  and 
they  were  never  idle. 

The  examining  rooms  were  planned  to  within  a  quarter  of  an  inch, 
including  the  location  of  the  electrical  outlets  and  the  placing  of 
instruments.  Each  was  identical  to  the  other.  The  doctors  and 
technicians  never  had  to  work  in  a  strange  kitchen,  so  to  speak. 
The  location  of  the  examining  chair  where  the  patient  sits  was 
carefully  considered.  The  rooms  were  designed  so  that  the  patient 
never  had  to  leave  his  chair  during  the  entire  examination.  Even 
the  visual  field  tangent  screen  swung  out  on  hinges  from  the  wall  to 
which  it  was  attached  to  face  the  patient  at  one  meter.  The  slit 
lamp  was  mounted  on  a  stand  beside  the  patient,  with  an  arm 
which  allowed  the  instrument  to  swing  out  for  the  examination. 

Seats  for  accompanying  friends  or  relatives  were  built  into  the  floor 
and  wall  but  they  also  served  as  dressed-up  storage  bins.  The  top  of 
the  seat  was  hinged  to  swing  open  to  receive  paper  and  other  items 


213 

for  storage.  Because  they  were  immovable,  they  could  not  be 
pushed  around  by  guests  to  clutter  the  office  or  block  the  visual 
acuity  lane.  Having  the  patient  remain  in  one  chair  during  the 
entire  examination  was  a  great  time  saver. 

Many  ophthalmologists  have  the  patient  move  to  two  or  three 
different  places  or  even  rooms  before  the  examination  is  complete. 
Our  examining  rooms  darkened  whenever  an  ophthalmoscope  was 
picked  up  or  for  slit-lamp  study  because  the  instrument  hung  from 
an  automatic  lighted  switch  which  darkened  the  room  when  the 
instrument  light  came  on.  The  examining  chair  would  recline  so 
that  I  could  take  ocular  pressures,  gonioscope,  or  even  do  minor  lid 
surgery,  such  as  for  chalazions. 

This  office  plan  began  to  evolve  when  I  was  forced  to  work  in 
cramped  space  while  in  India  during  World  War  II.  The  ideas 
seemed  to  work  well,  and  after  the  war  when  I  joined  Dr.  Adler  I 
refined  those  ideas  and  then  had  still  another  opportunity  to 
improve  those  ideas  when  I  remodeled  the  ophthalmology  area  at 
the  university  upon  becoming  chairman.  Still  later  that  design  was 
adopted  with  only  minor  changes  for  the  new  eye  institute  where 
we  had  twenty-six  rooms. 

I  usually  utilized  six  rooms  when  I  saw  patients,  using  technician 
help  and  one  or  two  associates.  I  never  wrote  on  a  chart  but  always 
dictated  to  my  secretary  who  followed  me.  She  named  and  dated  all 
prescriptions  which  were  in  files  on  the  desk  of  each  room,  although 
I  signed  them.  In  later  years,  she  even  signed  many,  [laughter] 

My  secretary  and  I  each  had  a  telephone.  Mine  was  an  extension 
mounted  on  the  wall  in  back  of  each  examining  chair.  I  detested 
returning  phone  calls,  which  can  be  very  time  consuming.  My 
secretary  could  handle  most  of  the  calls  but  if  necessary  I  had  only 
to  take  up  my  phone  without  leaving  the  patient's  side.  You  can 
talk  on  the  phone  seemingly  forever  or  develop  the  knack  of  brevity 
and  still  be  courteous.  Little  things  such  as  I  have  discussed  make 
work  more  pleasant  and  are  great  time  savers. 

Hughes:     There  were  some  other  important  design  features.  I'm  thinking  of 

the  link  between  the  institute  and  the  hospital.  At  every  floor  was  it? 

Scheie:       Yes,  except  for  the  research  floor.  The  building  itself  was  designed 
so  that  we  would  literally  be  a  part  of  a  general  hospital.  Good 
management  meant  using  as  many  of  their  facilities  as  possible. 
Obviously  this  would  be  of  mutual  benefit.  The  eye  institute 
connects  with  Presbyterian  Hospital  at  all  levels,  except  for  the  top 
sixth  floor,  our  research  floor.  I  felt  that  there  should  be  no 
connection  on  this  floor  because  the  research  workers  should  not  be 
annoyed  by  constant  pedestrian  traffic  and  interruption  by  people 
asking  directions  or  just  stopping  to  chat.  The  other  floors  all 
connect  through  a  wide  corridor  which  facilitates  utilization  of  their 
x-ray  facilities,  clinical  laboratories,  dining,  laundry,  and  many 


214 

others.  Patients  referred  back  and  forth  for  consultations  also  have 
easy  access  and,  even  more  important,  emergency  teams  are 
promptly  available  in  the  event  of  a  cardiac  or  other  crisis 
anywhere  in  the  institute.  We  can  simply  dial  an  emergency 
number  for  prompt  help. 

Hughes:     There  were  special  features  in  the  patients' rooms  as  well. 
Scheie:       Well,  it's  been  so  long.  I  need  to  have  my  memory  refreshed. 

Hughes:     For  example,  there  was  a  light-dimming  system  and  the  television 

sets  were  large.  Accommodations  were  made  for  poor  vision,  in  other 
words. 

Scheie:       Yes,  that  is  true. 

Hughes:     Did  you  foresee  when  you  were  designing  the  building  that 
ophthalmic  surgery  would  become  increasingly  outpatient? 

Scheie:       No,  I  did  not.  I  doubt  that  many  foresaw  what's  happening,  and 

certainly  I  don't  approve  of  the  extremes  that  have  been  adopted.  I 
question  whether  all  of  the  decisions  were  made  by  the  medical 
profession.  I  think  it's  unfair  to  take  an  eighty-or  ninety-year-old 
person  to  an  operating  room  with  a  medical  evaluation  occasionally 
more  superficial  than  it  might  have  been,  sedate  him,  operate,  and 
send  him  home  in  a  few  hours,  sometimes  to  an  empty  apartment. 
That  isn't  good  or  humane  medicine.  Furthermore,  it's  not  unusual 
to  have  a  heart  or  other  medical  complication  in  older  patients  the 
day  or  so  following  operation.  Postoperatively,  mental  confusion  is 
not  uncommon  in  this  age  group. 

Hughes:     Is  that  common  practice  at  the  institute  now? 

Scheie:       Yes,  same-day  surgery  is  required  in  the  state  of  Pennsylvania  and 
I  think  more  or  less  nationally,  but  I'm  not  certain.  Keeping  a 
patient  overnight  is  difficult  and  permission  must  be  obtained. 
Should  real  problems  arise,  who  will  be  sued-the  doctor  who 
wanted  to  keep  the  patient  in  or  the  individual  who  said,  "The 
patient  cannot  stay?" 

Hughes:     So  the  law  says  that  they  must  be  discharged? 

Scheie:       That's  the  regulation  now.  We  can  not  keep  them  without  approval. 

Hughes:     Is  that  a  money-saving  device? 

Scheie:       Well,  yes.  It's  part  of  the  DRG  [Diagnostic  Related  Group]  ruling. 
And  complications  can  occur.  The  first  night,  patients  might  have 
severe  pain  from  a  hemorrhage.  An  infection  might  start,  which 
would  be  rare,  but  it's  possible.  That  sort  of  thing  you  can  correct  in 
the  hospital. 


215 


I  am  opposed  to  sending  these  people,  many  elderly,  home  shortly 
after  surgery.  We  very  possibly  hospitalized  them  for  too  long  in  the 
old  days  when  they  were  kept  for  up  to  a  week.  However,  if  it  were 
my  family  I  would  like  them  to  stay  for  at  least  a  day  or  so.  To  me 
humanity  in  medicine  has  always  meant  more  than  the 
bookkeeping  aspect. 

Hughes:     Would  you  care  to  say  something  about  the  special  features  of  the 
auditorium? 

Scheie:       We  have  a  lovely  auditorium  that  will  seat  135  to  140  people  and 
has  good  acoustics.  It  was  originally  set  up  so  we  could  show  live 
surgery,  televised  from  any  of  our  four  operating  tables.  An 
audience  of  more  than  one  hundred  people  could  watch  it  in  the 
auditorium.  I  do  not  believe  the  equipment  has  been  adequately 
maintained  but  we  did  have  some  nice  well-attended  programs  that 
were  enjoyable,  especially  during  alumni  meetings  when  former 
residents  returned,  and  occasionally  for  other  medical  or  lay  groups. 

Hughes:     The  institute  also  has  closed-circuit  color  television  and  movie 
system. 

Scheie:       Yes,  we  had  television  from  the  operating  room. 

Hughes:     Are  there  any  aspects  of  the  design  that  haven't  worked  out  well? 

Scheie:       [pause]  Well,  I  really  can't  answer  that  having  been  out  of 

management  for  twelve  years.  I  know  the  record  room  has  been 
enlarged  because  it  became  too  small  when  computerization  was 
adopted. 

Hughes:     But  when  you  were  working  actively? 
Scheie:       We  found  no  major  alterations  to  be  needed. 

Research 

Hughes:     What  fields  of  research  are  represented  at  the  institute? 

Scheie:       I'm  not  well  acquainted  with  all  of  the  areas  at  the  moment.  We 

have  considerable  research  activity  in  the  glaucoma  section,  headed 
by  Dr.  Theodore  Krupin,  regarding  circulation  of  aqueous.  Dr. 
Charles  Riva  is  doing  some  very  fine  pioneer  work  with  laser, 
studying  the  circulation  of  blood  through  the  eye  and  the  physiology 
of  retinal  blood  vessels.  His  work  is  truly  outstanding  and 
internationally  recognized.  Dr.  Alan  Laties  continues  his  busy  and 
productive  work  in  the  field  of  histochemistry  and  neuroanatomy. 
Some  of  the  studies  relate  to  fluid  mechanisms  and  neuroeffector 
mechanisms.  He's  also  very  interested  in  retinitis  pigmentosa  and 


216 

pigment  cells.  He  has  been  our  director  of  research  since  1964  and 
has  been  awarded  the  [Jonas  S.]  Friedenwald  Medal. 

Dr.  Herbert  Blough's  interest  is  viruses.  At  the  moment  he's  largely 
absorbed  in  work  on  the  AIDS  virus  but  he  has  done  a  great  deal 
with  the  herpes  virus  and  its  therapy.  Dr.  John  Rockey  is  working 
in  the  field  of  molecular  biology  and  particularly  the  molecular 
approach  to  hypersensitivity.  Dr.  Mahin  Khatami's  work  involves 
molecular  aspects  of  diabetic  retinopathy  and  the  role  of 
hyperglycemia  in  retinal  metabolism.  She  is  also  working  on 
immunopathological  aspects  of  ocular  allergic  reaction  and  the  role 
of  conjunctival  mast  cells,  antibody  production,  and  lymphoid 
hyperplasia  in  an  animal  model. 

Hughes:  How  are  these  projects  supported? 

Scheie:  Government  grants  and  endowment  funds. 

Hughes:  When  it  comes  to  endowment  funds,  who  makes  the  decision? 

Scheie:  The  chairman  of  the  department. 

Hughes:  Alone1? 

Scheie:       Yes.  Only  the  income  can  be  spent  from  our  endowment  funds.  It 
becomes  part  of  the  teaching  and  research  budget. 

Hughes:     So  the  principal  cannot  be  touched? 
Scheie:       The  principal  cannot  be  spent. 
Hughes:     Did  you  make  that  decision? 

Scheie:       Yes,  and  confirmed  by  the  trustees  of  Penn  and  Presbyterian.  I 

could  have  spent  the  principal  of  the  Grundy  money,  and  still  could, 
but  I  never  did  so  and  the  fund  has  been  kept  intact.  My  successors 
cannot  spent  the  principal.  From  the  day  I  started  fund  raising, 
except  for  the  Grundy  Fund,  all  of  the  spending  from  endowments 
has  been  restricted  to  income  only.  This  policy  will  also  apply  for 
succeeding  chairmen.  I  have  always  felt  that  the  clinicians  should 
support  themselves,  except  early  in  their  practice,  and  that  the 
income  from  endowment  be  used  to  support  programs  in  teaching 
and  research. 

Hughes:     Who  makes  up  the  board  of  governors? 

Scheie:       We  have  no  board  of  governors.  We  have  what  we  call  our  executive 
committee  but  they  are  advisory  and  have  no  legal  status.  They're 
a  group  of  thirty  people,  rather  prominent  in  the  city,  who  are 
personal  friends  and  interested  in  the  eye  institute.  We  meet  once 


217 


a  month  and  they  help  and  advise  with  fundraising  projects  like  the 
annual  Odyssey  Ball,  annual  giving,  and  other  activities. 

## 

The  founding  members  of  this  group  first  met  on  December  14, 1970. 

Hughes:     Have  there  been  changing  memberships'? 

Scheie:       Yes,  but  slowly  changing.  They  have  been  very  loyal.  We  have  no 
rigid  rules.  If  a  member  finds  he  or  she  is  too  busy  or  has  lost 
interest,  he  leaves  and  we  elect  another. 

Hughes:     Policy  decisions  are  made  by  the  director? 

Scheie:       They're  largely  made  by  the  director  of  the  institute,  who  is  also 
chairman  of  the  department  of  ophthalmology.  The  dean  is  often 
consulted.  He  is  responsible  for  the  administration  of  all 
departments  in  the  medical  school,  and  since  we  are  the 
department  of  ophthalmology  at  Penn,  we  serve  under  the  dean. 

Hughes:     Has  the  relationship  with  the  dean  been  a  happy  one1? 

Scheie:       It's  been  a  happy  one.  We  have  never  had  any  real  difficulties.  I 
happen  to  feel  that  the  supervisory  aspect  of  the  medical  school 
administration  at  our  university-and  probably  at  other  medical 
schools-is  looser  than  it  should  be.  Their  explanations  would  be 
that  they  have  never  had  real  problems  and  that  the  chairman's 
autonomy  is  respected. 

Affiliations 

Hughes:     Have  we  said  enough  about  the  role  of  Presbyterian  Hospital  in  the 
institute1? 

Scheie:       They  play  a  very  little  role.  We  raised  all  of  the  money  for  the 

building.  Endowment  funds  placed  by  me  at  Presbyterian  for  our 
Ophthalmology  Teaching  and  Research  Endowment  Fund  are 
invested  and  reinvested  by  the  board  of  trustees  at  Presbyterian. 
Income  only  can  be  spent,  and  that  only  for  teaching  and  research. 
The  chairman  of  the  department  and  institute  director  has  sole 
authority.  Anesthesia  and  the  nursing  staff  now  run  our  operating 
room. 

Until  I  retired,  I  was  in  charge  and  had  my  own  [operating]  team. 
Later  my  successor  turned  it  over  to  Presbyterian,  which  runs  it 
now.  I  preferred  to  have  my  own  control  but  my  successor  did  not. 
Presbyterian  is  very  supportive  from  the  standpoint  of  laboratories, 
dining  facilities,  x-ray  services,  etc.  The  eye  institute  lends 
financial  support  to  them  through  our  patient  referrals.  Also, 


218 

Hughes: 
Scheie: 

Hughes: 
Scheie: 


Hughes: 

Scheie: 
Hughes: 

Scheie: 


Presbyterian  receives  all  income  from  patient  care,  including  the 
operating  room. 

I  understand  there  was  a  formal  affiliation  between  the  institute  and 
the  Center  for  the  Blind. 

Yes,  and  when  the  affiliation  was  made  in  1968,  we  were  still  at  the 
university  hospital,  before  the  institute  opened. 

What  was  the  purpose  of  the  Center  for  the  Blind? 

The  Center  for  the  Blind  coordinated  several  different  services  for 
the  blind  and  partially  sighted  for  many  years.  It  was  an  old 
Philadelphia  organization  founded  in  1868.  It  gave  broad  support 
for  the  blind,  including  rehabilitation,  workshops,  ophthalmic  care, 
and  low- vision  instruction,  a  men's  and  women's  home,  and  Upsal 
Day  School  for  blind  and  handicapped  children-usually  retarded. 
Our  affiliation  included  participation  in  glaucoma  surveys  or 
screenings  and  care  of  the  ophthalmic  needs  of  their  clients.  We 
also  utilized  their  low-vision  clinic  for  our  partially-sighted  patients. 

In  1974  the  Center  for  the  Blind  awarded  you  the  Louis  Braille 
Award.   What  was  their  specific  reason? 

Probably  because  I  had  worked  closely  with  them. 

Do  you  want  to  say  anything  about  the  present  search  for  a  new 
director  of  the  eye  institute? 

There  isn't  much  to  say  about  it  except  that  Dr.  Yanoff  resigned  a 
little  more  than  two  years  ago.  Progress  has  been  very  slow  in  the 
search  for  his  successor,  possibly  because  it  is  difficult  to  find 
somebody  who  wants  to  take  on  the  broad  responsibility  for  patient 
care,  research  and  teaching,  and  administration.  However,  the 
institute  is  a  going  concern  with  a  good  patient  following  and 
significant  endowment  funds.  If  I  were  younger,  I  would  enjoy 
having  the  position. 

[Interview  8:  June  14, 1988]  ## 


Glaucoma 


Hughes:     Dr.  Scheie,  I  thought  we'd  start  today  with  a  discussion  of  theories 
pertaining  to  the  causes  of  the  various  kinds  of  glaucoma  and  their 
diagnosis  and  treatment  in  the  late  1930s  when  you  were  in  your 
residency  in  ophthalmology. 


219 


Historical  Background 

Scheie:       Do  you  want  any  background  on  glaucoma  before  that?* 
Hughes:     Wonderful. 

Scheie:       The  name  glaucoma  was  first  suggested  by  Hippocrates  who 
applied  the  term  to  a  blind  eye  having  a  sea-green  pupil. 
Throughout  antiquity  very  little  more  was  known  about  the  disease. 
A  few  centuries  later,  some  of  the  old  philosopher  scientists,  like 
Celsus,  Rufus  and  Galen  agreed  that  the  cause  of  glaucoma  should 
be  attributed  to  the  lens.  Galen  was  the  most  specific  and  stated 
that  glaucoma  was  due  to  a  drying  up  of  the  lens,  whereas  cataract 
was  caused  by  suffusion  or  evil  humor  in  front  of  the  lens  and  was 
associated  with  a  white  pupil.  Glaucoma  was  considered  to  be 
untreatable,  but  cataract  could  be  treated  by  couching  which  had 
been  done  for  centuries. 

Little  clarification  of  glaucoma  was  forthcoming  until  At-Tabari  in 
the  tenth  century  and  Sams-ad-Din  in  the  fourteenth  century 
mentioned  an  inflamed  eye  that  felt  hard.  That  was  the  first 
mention,  I  believe,  that  elevated  ocular  pressure  might  be  related  to 
glaucoma.  The  first  relatively  accurate  description  of  glaucoma  was 
made  in  1622  by  Richard  Banister  who  gave  the  first  classic 
description  of  what  today  we  would  call  chronic  closed  angle  and 
absolute  glaucoma:  The  eyeball  was  hard  to  palpation,  light 
perception  was  lost,  the  pupil  was  dilated  and  fixed,  and  the  disease 
was  of  long  duration  with  chronic  inflammation. 

Michael  Brisseau  in  two  papers,  1705  and  1709,  contributed  the 
first  major  breakthrough  when  he  dissected  two  pairs  of  eyes  taken 
at  autopsy.  One  pair  was  from  a  patient  blind  due  to  glaucoma  and 
the  other  blind  from  cataracts.  He  showed  for  the  first  time  that 
with  cataracts  the  lenses  were  opaque,  but  they  were  clear  in 
glaucoma.  He  speculated  that  glaucoma  was  probably  a  disease  of 
the  vitreous.  His  ideas  were  so  revolutionary  that  he  was  expelled 
from  the  French  Academy  of  Medicine.  After  doing  further  studies 
and  confirmation  by  others,  his  concepts  were  gradually  accepted 
and  he  achieved  respectability.  His  discovery,  incidentally,  paved 
the  way  for  [Jacques]  Daviel's  introduction  of  cataract  extraction  in 
1752.  * 

During  the  nineteenth  century  papers  began  to  appear  that 
established  elevated  pressure  as  a  characteristic  of  glaucoma. 
William  MacKenzie  first  attempted  surgery  for  glaucoma  in  1835. 
He  believed  that  the  eye  was  hard  because  of  too  much  fluid  in  the 
vitreous,  probably  caused  by  a  serous  choroiditis.  To  relieve  the 
pressure,  he  punctured  the  sclera  to  allow  the  fluid  to  escape  and 


The  following  history  is  based  on  an  unpublished  address,  "Glaucoma:  An  Overview,  1935-1985." 


220 

helped  to  establish  the  concept  of  glaucoma  as  a  hard  eye  due  to 
excessive  fluid. 

Anew  era  opened  after  1851  when  Hermann  von  Helmholtz 
invented  the  ophthalmoscope.  Workers  were  able  to  visualize  the 
optic  nerve,  and  soon  many  people  became  interested.  Albert  von 
Graefe  was  one  of  the  persons  who  made  early  observations  of  the 
optic  nerve  in  glaucoma.  Others  followed,  with  ensuing 
disagreement  regarding  whether  or  not  the  optic  nerve  was  cupped 
or  swollen.  The  ophthalmoscope  of  that  day  was  crude,  difficult  to 
use,  and  detail  seen  was  not  the  best.  Von  Graefe  initially  reported 
that  the  optic  nerve  was  swollen  but  he  shortly  corrected  that. 
Heinrich  Muller  settled  these  differences  of  opinion  in  1856  when 
he  confirmed  by  histologic  studies  that  the  optic  nerve  was  cupped. 
This  not  only  clarified  the  debate  about  cupping  but  supported  the 
concept  of  elevated  pressure  in  glaucoma. 

Von  Graefe  in  1857  came  up  with  a  new  classification  for  glaucoma. 
In  addition  to  acute  glaucoma,  its  chronic  form,  and  secondary 
glaucoma,  he  included  a  condition  that  he  termed  "amaurosis  with 
excavation  of  the  optic  nerve,"  in  which  the  pressure  was  not 
elevated.  Thus  he  had  observed  eyes  with  loss  of  vision  and 
cupping  but  without  congestion  or  recognizable  elevation  in 
pressure.  This  truly  was  a  very  important  observation,  and  two 
decades  later  in  1862  Franciscus  Cornelis  Bonders  related  it  to 
what  he  termed  chronic  simple  glaucoma,  a  term  still  used  today.  It 
is  our  most  common  and  insidious  form  of  glaucoma.  Until 
Bonders,  only  eyes  with  severe  and  advanced  disease  with  high 
pressure  had  been  recognized  as  having  glaucoma.  Although  only 
crude  tonometry  was  available,  Bonders  noted  that  the  pressure, 
though  not  markedly  elevated,  could  be  sufficient  to  cause  cupping. 
Von  Graefe  probably  developed  the  tonometer  that  Bonders  and 
probably  others  used  to  take  their  measurements  of  pressure. 

Recognizing  the  importance  of  elevated  pressure,  more  attempts  at 
glaucoma  surgery  were  made.  Von  Graefe's  iridectomy  (1857)  was 
the  most  successful  and  later  became  a  standard  for  acute 
glaucoma.  The  mechanism  is  utilized  even  now  when  we  do 
peripheral  iridectomies  for  narrow-angle  glaucoma  but  it  was  not 
fully  understood  until  the  work  of  Barkan.  Little  was  known  about 
the  causes  of  high  pressure  in  glaucoma  until  the  introduction  of 
gonioscopy  in  the  late  1920s  and  Otto  Barkan's  contributions  in  the 
1930s  and  forties.  George  Critchett  (1857)  introduced  a  procedure 
called  iridotasis  in  which  he  drew  a  piece  of  iris  into  a  paracentesis 
incision.  Another  operation  was  developed  by  Louis  de  Wecker 
between  1869  and  1871,  in  which  he  did  an  anterior  sclerotomy. 
Critchett's  and  de  Wecker's  operations  were  both  found  to  work  well 
permanently  if  a  filtering  cicatrix  resulted,  usually  associated  with 
incarceration  of  iris. 

Hughes:     Were  they  intending  to  do  just  that? 


221 


Scheie:       I  doubt  that  because  they  operated  for  empiric  reasons  hoping  to 
lower  the  pressure.  The  scleral  puncture  by  MacKenzie  in  1930 
was  done  for  the  same  reason.  The  thought  of  permanent  filtration 
probably  didn't  occur  to  them  originally. 

Hughes:     Were  they  aware  that  they  had  created  a  filtering  scar? 

Scheie:       It  was  recognized,  whether  by  these  same  observers  I'm  not  sure, 
but  it  was  learned  that  the  pressure  became  normal  when  a 
filtering  scar  resulted. 

Hughes:     When  was  that  approximately? 

Scheie:       Probably  considerably  later.  Iridencleisis  was  not  described  until 
1906  by  Soren  Holth. 

The  next  great  advance  in  glaucoma  occurred  with  the  introduction 
of  miotics  about  the  time  of  the  founding  of  our  department  of 
ophthalmology  in  1874.  It  was  the  fourth  oldest  department  of 
ophthalmology  in  the  country  to  have  its  own  chairman,  William  F. 
Norris.  The  Miami  Medical  College  in  Cincinnati  was  the  first,  in 
1868. 

The  year  after  our  department  was  founded,  Ludwig  Laqueur 
introduced  eserine,  an  extract  of  the  calabar  bean,  for  the  medical 
treatment  of  glaucoma.  It  had  been  used  in  Africa  to  torture 
prisoners.  They  gave  each  individual  a  large  dose,  and  if  he 
survived  he  was  considered  innocent.  It  was  also  observed  that  the 
prisoners'  pupils  became  small.  Laqueur  employed  that  knowledge 
for  the  treatment  of  glaucoma.  Adolf  Weber  introduced  pilocarpine 
in  1876.  It  is  interesting  that  even  today  pilocarpine  is  one  of  our 
mainstays  in  the  medical  treatment  of  glaucoma,  although  timolol 
and  others  are  increasingly  important.  Eserine  is  rarely  used  now, 
but  it  was  popular  during  my  earlier  days  in  ophthalmology.  It 
does,  however,  cause  irritation  and  follicular  conjunctivitis  when 
employed  for  long-term  therapy. 

Hughes:     Where  does  pilocarpine  come  from? 

Scheie:       It  is  an  extract  of  a  plant,  Pilocarpusjaborandi. 

Hughes:     You  mentioned  other  advances. 

Scheie:       Interest  in  the  mechanisms  of  glaucoma  continued.  [Max]  Knies  in 
1876  and  Weber  in  1877  speculated  that  glaucoma  was  due  to  an 
overproduction  of  fluid,  as  MacKenzie  had  suggested  in  1835. 
Knies  and  Weber  did  pathological  studies  on  eyes  and  found 
adhesions  (closure  of  the  angle)  of  the  iris  to  the  angle  wall  to  which 
they  attributed  glaucoma.  Knies  thought  the  adhesions  resulted 
from  inflammation  and  caused  elevated  pressure  by  obstructing 
the  outflow  of  aqueous.  Weber  thought-as  was  taught  for  many 


222 


years-that  the  ciliary  body  had  become  swollen  and  the  iris 
adherent.  Because  the  eyes  that  had  been  removed  were  blind,  and 
most  of  them  probably  had  been  painful  with  absolute  glaucoma, 
the  adhesions  were  a  red  herring  from  the  standpoint  of  the  original 
mechanism.  Little  was  learned,  therefore,  about  the  origins  of 
glaucoma,  but  the  histological  findings  were  accurate.  As  a 
resident,  I  repeatedly  saw  glaucoma  diagnosed  by  our  pathologist 
because  of  a  microscopically  closed  angle. 

An  Englishman,  Priestly  Smith,  was  interested  in  aqueous  flow 
(1879-1881).  He  too  felt  that  glaucoma  was  due  to  changes  in  the 
ciliary  body  that  resulted  in  obstructed  aqueous  flow  from  the  eye. 
He  observed  that  some  of  the  eyes  were  small  with  shallow 
chambers  and  felt  that  this  could  induce  glaucoma.  Following  these 
contributions,  our  knowledge  of  mechanisms  remained  more  or  less 
static  until  the  1920s  through  the  1940s. 

Hughes:     Were  people  using  these  various  explanations  for  all  forms  of 
glaucoma? 

Scheie;       Knowledge  was  nebulous  except  for  the  clinical  classification. 
Glaucoma  was  still  a  hard  eye,  but  instruments  for  accurate 
measurement  of  pressure  were  not  available  until  [Njalmar  August] 
Schiotz  in  1905  gave  us  the  first  reliable  tonometer,  which  became  a 
standard.  The  slit  lamp  had  not  yet  been  developed. 

Hughes:     So  to  them  it  was  an  elevated-pressure  problem? 

Scheie:       High  pressure,  the  mechanisms  an  enigma,  was  more  or  less  the 
state  of  our  knowledge  when  I  started  my  residency  in  1937.  But 
certain  important  technical  advances  were  made  over  the  years.  In 
fact,  some  of  these  made  Barkan's  contributions  possible  and  those 
of  many  others  during  the  twenties,  thirties,  and  forties, 
[interruption] 

Instrumentation 

Scheie:       In  1905,  Schiotz  developed  the  first  truly  accurate  tonometer,  and  it 
has  been  used,  with  refinements,  for  many  years.  It  is  an  excellent 
instrument  and  was  a  historic  contribution.  In  almost  all  of  the 
ophthalmic  literature  until  quite  recent  years,  Schiotz  tension 
readings  are  quoted.  Alexander  Nicolaewitsch  Maklakov  developed 
an  applanation  tonometer  in  1885  that  flattens  a  portion  of  the 
cornea.  The  pressure  is  calculated  from  that.  This  instrument, 
however,  was  not  highly  accurate.  In  1954,  Hans  Goldmann 
introduced  his  refined  applanation  tonometer  that  is  now  used 
almost  exclusively  by  most  ophthalmologists. 

I  personally  was  never  as  excited  about  the  Goldmann  tonometer  as 
many  ophthalmologists  were,  undoubtedly  partly  because  of  my 
vintage,  but  also  because  the  Schiotz  tonometer  is  accurate  and 


Hughes: 


Scheie: 


223 


simple  to  use.  You  can  quickly  take  three,  four,  or  five  readings  on  a 
patient,  taking  care  to  have  the  eyelids  held  away  from  the  eyeball 
to  prevent  the  pressure  of  the  lids  or  the  patient's  squeezing  to  alter 
the  reading.  The  value  is  accurate,  and  I  think  the  difference 
between  carefully  done  readings  with  the  Goldmann  tonometer  and 
the  Schiotz  is  not  very  significant.  I  have  found,  however,  that 
applanation  readings  tend  to  be  slightly  higher  than  Schiotz 
measurements. 

Is  the  Goldmann  tonometer  a  more  elaborate  and  expensive  piece  of 
equipment1? 

Yes,  but  it  is  not  prohibitive.  Having  cared  for  many  glaucoma 
patients,  I  have  had  both  tonometers  available  and  used  by 
assistants  and  sometimes  by  myself. 


Hughes:     Is  the  Schiotz  no  longer  taught  to  residents'? 

Scheie:       Until  I  retired  as  chairman,  both  were  taught.  I  would  think  nearly 
all  residents  today  can  use  either  but  are  taught  to  live  with  the 
applanation.  When  I  was  active,  until  1976,  both  tonometers  were 
used  somewhat  interchangeably  in  our  clinic  but  left  to  personal 
preference. 

Beginning  during  the  1890s,  the  Danish  school  of  ophthalmology, 
also  called  the  Copenhagen  school  of  ophthalmologists,  made 
tremendous  contributions  to  perimetry  that  have  become  vital  to 
the  diagnosis  and  management  of  glaucoma.  They  demonstrated 
the  importance  of  the  tangent  screen.  Jannik  Petersen  Bjerrum  in 
1891  developed  quantitative  perimetry  and  described  his  Bjerrum's 
scotoma  which  is  characteristic  of  glaucoma  although  other 
conditions  can  cause  it.  Henning  Roenne  elaborated  the  Roenne 
step  in  1909,  which  consists  of  characteristic  loss  in  glaucoma  of  the 
lower  nasal  field  emanating  from  the  blind  spot.  And  Erich  Seidel 
in  1914  described  Seidel's  sign,  which  is  the  extension  of  the  blind 
spot.  These  defects  are  classic,  and  once  they  occur  glaucoma  must 
be  suspected,  or  with  other  signs  of  glaucoma  they  can  be 
confirmatory. 


Another  instrument  that  helped  to  revolutionize  ophthalmology  was 
the  slit-lamp  microscope  introduced  by  Allvar  Gullstrand  in  1911. 
The  eye  can  be  seen  under  high  magnification  up  to  sixty  times 
with  adjustable  amounts  of  illumination  and  varying  widths  of  the 
slit-lamp  beam.  The  front  of  the  eye  being  transparent,  the 
slit-lamp  beam  illuminates  or  takes  an  optical  slice  or  optical 
section  of  the  transparent  anterior  segment  of  the  eye.  This  section 
is  examined  under  magnification.  As  explained  to  students,  we 
literally  examine  a  slice  of  the  eye.  It  transformed  our  examination 
of  the  eye  and  even  lay  the  groundwork  for  microscopic  surgery. 


224 


The  fundus  can  be  examined  even  to  the  extreme  periphery  with  a 
special  contact  lens.  The  slit  lamp  is  also  used  with  a  gonioscopic 
lens  to  see  the  angle  of  the  anterior  chamber  and  for  laser 
trabeculectomy. 

Many  ophthalmologists,  including  myself,  had  used  the  slit-lamp 
microscope  for  many  years  to  remove  corneal  foreign  bodies, 
sutures,  and  for  other  manipulations.  Slit-lamp  study  became  a 
routine  part  of  every  eye  examination.  The  gonioscopy  lens 
introduced  by  [Maximilian]  Salzmann  in  1914  led  to  clarification  of 
our  understanding  of  glaucoma,  but  at  least  twenty-five  years  went 
by  before  its  significance  in  the  diagnosis  and  management  of 
glaucoma  was  recognized.  Early  articles  began  to  appear  by 
Thornburn  (1927)  and  Werner  (1932)  and  [Manuel  Uribe]  Troncoso 
(1925-35),  who  also  published  a  textbook  on  the  subject.  Otto 
Barkan  developed  a  stand  to  hold  a  microscope  to  facilitate 
gonioscopy  examination  using  magnification. 

Hughes:     Had  Salzmann  developed  the  contact  lens  for  use  in  glaucoma1? 

Scheie:       I  don't  know,  but  he  was  undoubtedly  searching  for  a  way  to  see 
into  the  periphery  of  the  anterior  chamber. 

Hughes:     Was  he  interested  in  glaucoma? 

Scheie:       I  cannot  answer  that.  At  any  rate,  subsequent  advances  in  our 

knowledge  of  glaucoma  could  not  have  occurred  without  gonioscopy. 

Twentieth  Century  Contributions 

Scheie:       During  the  1920s,  several  significant  contributions  were  made  that 
were  to  be  very  important  in  further  unraveling  some  of  the 
mysteries  of  glaucoma.  [E.J.]  Curran  in  1920  suggested  the  idea  of 
pupillary  block  as  a  cause  of  glaucoma.  He  had  observed  eyes  in 
which  filtering  operations  seemingly  had  failed  but  the  glaucoma 
was  cured.  He  suggested  that  the  peripheral  iridectomy  and  even 
iridotomy  had  corrected  the  pupillary  block  by  equalizing  the 
pressure  between  the  anterior  and  posterior  chambers.  He  felt  that 
the  angle  deepened  over  the  region  of  the  hole. 

[J.G.]  Raeder  suggested  in  1923  that  there  were  two  types  of 
glaucoma:  one  with  a  shallow  anterior  chamber  as  a  result  of 
increased  pressure  behind  the  lens;  the  other  with  a  deep  anterior 
chamber  caused  by  increased  pressure  in  front  of  the  lens.  Both 
Raeder  in  1923  and  [Bengt]  Rosengren  in  1930  noted  that  patients 
with  acute  glaucoma  had  shallow  anterior  chambers,  whereas 
patients  with  simple  glaucoma  had  anterior  chambers  of  normal 
depth.  Clear  ideas  were  not  suggested,  however,  as  to  the 
mechanisms  involved. 


225 


Workers  were  beginning  to  realize  that  the  angle  of  the  anterior 
chamber  was  where  some  of  the  answers  to  glaucoma  would  be 
found  and  that  there  was  a  relationship  between  angle  depth  and 
glaucoma.  Barkan  recognized  this  and  in  the  mid-thirties 
suggested  his  classification  of  glaucoma  that  helped  to  clarify  the 
nature  of  narrow-angle  glaucoma  and  to  distinguish  it  from  the 
chronic  simple  type  which  he  called  wide-angle  glaucoma.  Actually, 
the  term  wide-angle  was  a  mistake  because  chronic  simple 
glaucoma  can  occur  in  eyes  with  angles  of  any  depth  as  long  as  the 
aqueous  has  access  to  the  trabeculum/canal  of  Schlemm  drainage 
mechanism.  If,  however,  the  angle  is  sufficiently  narrow  in  an  eye 
with  chronic  simple  (open-angle)  glaucoma  it  is,  in  addition,  subject 
to  an  attack  of  acute  (narrow-angle)  glaucoma. 

Hughes:     Was  it  Barkan  who  developed  that  terminology? 

Scheie:       Yes,  it  was  Otto  Barkan  who  proposed  the  terminology 

narrow-angle  where  the  iris  is  bowed  sufficiently  forward  making  it 
difficult  to  see  angle  structures.  It  is  that  type  of  eye  where  an 
attack  may  develop  if  the  pupil  dilates. 

Hughes:     So  he  was  recognizing  that  there  were  two  completely  separate 
mechanisms  to  cause  glaucoma? 

Scheie:       Two  separate  mechanisms,  that's  correct. 
Hughes:     And  that  was  new? 

Scheie:       At  least  he  clarified  it.  It  was  an  outgrowth  of  the  work  of  several 
people  in  the  twenties,  but  Barkan  crystallized  it  and  made  it 
understandable.  He  also  pointed  out  that  a  peripheral  iridectomy 
could  cure  and  even  prevent  acute  attacks.  He  wasn't  the  first  to  do 
it,  but  until  then  it  had  been  done  for  empiric  reasons. 

Hughes:     You  said  earlier  that  von  Graefe  had  done  basal  iridectomies. 

Scheie:       Yes.  He  and  others  observed  that  iridectomy  could  control  the 

pressure  of  some  eyes.  Eventually  it  became  the  procedure  of  choice 
for  acute  glaucoma  and  it  was  the  operation  that  Dr.  Adler  taught 
during  my  residency.  An  entire  segment  of  iris  is  removed  to  its 
base  at  its  attachment  to  the  ciliary  body. 

Hughes:     What  is  the  advantage  of  a  peripheral  iridectomy  over  a  basal? 

Scheie:       The  pupil  remains  intact.  The  peripheral  iridectomy  involves 
making  only  a  small  hole  through  the  periphery  of  the  iris.  It 
short-circuits  the  flow  of  aqueous  to  avoid  the  resistance  caused  by 
contact  between  the  posterior  surface  of  the  iris  and  the  anterior 
surface  of  the  lens.  The  periphery  of  the  iris  falls  back  to  open  the 


226 


angle,  and  aqueous  is  given  access  to  the  drainage  angle.  It  is 
simpler  and  safer  than  basal  iridectomy. 

Hughes:     Von  Graefe  had  no  idea  why  the  procedure  worked? 

Scheie:       No.  He  had  no  knowledge  of  the  relationship  of  glaucoma  to  angle 
depth. 

Hughes:     After  Barkan  had  come  up  with  these  two  different  mechanisms,  did 
his  surgical  technique  follow  very  closely? 

Scheie:       Yes,  and  he  realized  that  the  peripheral  iridectomy  would  be 
effective  only  for  narrow-angle  glaucoma. 

Actually,  Barkan's  concepts  were  not  accepted  immediately  by  the 
Europeans,  particularly  the  English  school  headed  by  the  famous 
Sir  Stewart  Duke-Elder.  One  of  the  prime  arguments  against  his 
concepts  was  the  term  wide  angle  for  chronic  simple  glaucoma, 
because  it  actually  does  occur  in  angles  of  any  depth.  I've  been  at 
meetings  with  him  where  lively  discussions,  pro  and  con,  occurred. 
Sir  Stewart  once  jokingly  referred  to  the  debate  as  the  new 
British-American  war.  He  continued  to  believe  strongly  that 
glaucoma  was  due  to  a  neurovascular  disturbance.  However,  there 
was  little  objective  evidence  to  substantiate  it. 

There  have  been  many  blind  alleys  in  the  history  of  glaucoma  that  I 
could  have  brought  out  but  did  not  for  the  sake  of  brevity.  The 
gonioscopic  approach  took  years  for  general  acceptance  and  there 
are  still  some  ophthalmologists  who  more  or  less  adhere  to 
Duke-Elder's  thinking. 

I  read  a  short  article  on  open-angle  glaucoma  not  long  ago 
questioning  whether  or  not  glaucoma  is  really  a  pressure  problem 
or  whether  it's  inherent  in  the  optic  nerve.  It  seems  to  be  part  of  an 
ongoing  discussion  among  some  of  the  glaucoma  specialists  but  I 
will  not  become  involved.  There  is  such  a  thing  as  glaucoma 
cupping  and  visual  field  defects  occurring  in  eyes  with  normal  or 
even  below  normal  pressure,  called  low  tension  glaucoma. 
However,  this  condition  could  be  due  to  vulnerable  optic  nerves  that 
could  not  withstand  even  normal  pressure.  The  gonioscopic 
classification  would  consist  of  pre-glaucoma,  an  eye  with  a  very 
narrow  angle  that  has  been  symptom  free.  On  slit-lamp 
examination,  the  periphery  of  the  iris  is  seen  in  close  proximity  to 
the  angle  wall.  By  gonioscopy  the  angle  is  extremely  narrow  and 
little  of  the  angle  is  seen.  Such  a  patient  is  subject  to  an  acute 
attack  at  any  time  and  may  have  a  positive  mydriasis  test. 

Hughes:     Is  angle  depth  a  congenital  defect? 

Scheie:       Yes.  I've  seen  two  sisters  develop  an  acute  attack  in  the  same  week. 
Most  of  our  physical  characteristics  are  genetic  or,  if  you  wish, 
congenital. 


227 


Types  of  Glaucoma 

Scheie:       We  have  spoken  about  pre-glaucoma  which  I  put  in  the  same 

category  as  interval  glaucoma.  Let  us  say  that  a  patient  has  had  an 
acute  attack  controlled  medically.  The  patient  now  can  be  said  to 
have  interval  glaucoma  because  another  attack  will  almost 
certainly  occur.  So  we  have  pre-glaucoma,  acute  (angle-closure) 
glaucoma,  and  interval  glaucoma. 

The  mechanism  of  acute  glaucoma  can  be  compared  to  a  rubber 
dam  floating  in  a  sink  near  the  screened  outlet.  As  long  as  the 
rubber  dam  floats  freely  and  water  escapes  from  the  sink,  no 
problem  occurs,  like  aqueous  in  an  eye  with  a  narrow  angle. 
However,  when  the  dam  happens  to  be  carried  onto  the  sink  screen 
by  the  outflow  of  fluid,  obstruction  occurs  and  fluid  no  longer  can 
escape.  This  is  comparable  to  what  happens  in  an  eye  during  an 
acute  attack  when  the  iris  comes  into  contact  with  the  trabeculum 
to  obstruct  the  drainage  mechanism.  When  that  happens  an  acute 
attack  ensues. 

I  have  outlined  the  mechanisms  of  three  phases  of  narrow-angle 
glaucoma  and  the  fourth  phase  is  chronic  narrow-angle  glaucoma, 
(chronic  congestive  glaucoma)  which  results  from  angle  closure  by 
synechiae.  It  can  develop  slowly  and  insidiously  from  an 
uncontrolled  acute  attack  or  from  repeated  mild,  acute  attacks. 
After  medical  control  of  an  acute  attack,  a  prophylactic  peripheral 
iridectomy  should  be  done  to  prevent  recurrence.  Chronic 
narrow-angle  glaucoma,  however,  usually  requires  a  filtering 
operation. 

Congenital  or  infantile  glaucoma  (buphthalmos)  can  occur  at  birth 
or  at  any  time  until  two  or  three  years  of  age,  a  time  when  the  eye 
can  undergo  enlargement  under  increased  pressure.  Juvenile 
glaucoma  occurs  in  older  children  and  young  adults,  up  to  thirty 
years  of  age,  and  behaves  like  open-angle  glaucoma.  I'm  certain 
that  genetics  is  very  important  to  all  types. 

Finally,  there  is  secondary  glaucoma,  which  can  be  caused  by 
uveitis,  tumors,  or  any  condition  that  interferes  with  outflow 
mechanisms.  Uveitis  can  cause  glaucoma  by  peripheral  anterior 
synechiae  which  obstruct  the  drainage  mechanisms  or  by  producing 
osmotic  changes  in  the  aqueous  or  even  in  other  ways.  There  are 
many  other  types  of  secondary  glaucoma. 

Hughes:     Is  the  classification  you  just  described  the  one  that  is  currently  in 

use? 

Scheie:       I  think  it's  one  that  most  ophthalmologists  would  accept. 

Differences  of  opinion  are  healthy  but  I  believe  it  is  quite  generally 
approved.  There  is  wide  agreement  on  these  mechanisms,  thanks 
to  the  gonioscopic  lens,  to  Barkan,  and  to  the  contributions  of  many 


228 


others.  One  of  the  people  interested  in  glaucoma  whom  I  most 
admired  was  Dr.  Joseph  Haas  of  Chicago.  He  didn't  write  a  great 
deal  but  he  was  a  very  astute  clinician.  Dr.  Peter  Kronfeld,  with 
whom  Haas  worked,  Dr.  Bernard  Becker,  Dr.  Morton  Grant,  and  Dr. 
Paul  Chandler,  Dr.  Robert  Shaffer  in  San  Francisco,  and  many 
others  were  very  involved. 

The  Neurovascular  and  Gonioscopic  Concepts 

Hughes:     So  at  that  time,  if  you  believed  in  a  neurovascular  etiology,  there  was 
no  point  in  looking  into  the  angle.  Was  that  it? 

Scheie:       Well,  that  was  more  or  less  true  of  many  ophthalmologists.  It  took 
a  while  for  the  gonioscopic  approach  to  gain  acceptance  and  of 
course  for  ophthalmologists  to  learn  the  technique. 

Hughes:     What  was  the  essence  of  the  neurovascular  theory? 

Scheie:       Glaucoma  was  related  to  a  neurogenic  disturbance  affecting 

circulation  to  the  eye  and  its  pressure,  whereas  the  mechanical 
theory  inferred  that  the  pressure  rose  due  to  obstruction  of  aqueous 
outflow. 

Hughes:     Did  the  theory  influence  the  operative  procedure? 

Scheie:       Oh,  yes.  It  influenced  the  entire  management  of  the  disease.  It 

separated  primary  glaucoma  into  two  types.  The  treatment  for  one 
was  primarily  medical  and  the  other  surgical.  Much  of  the  credit 
for  the  gonioscopic  approach  should  be  given  to  Barkan  in  San 
Francisco.  He  was  another  ophthalmologist  whom  I  looked  up  to 
and  respected  a  great  deal.  He  was  more  responsible  for  originating 
and  clarifying  the  gonioscopic  approach  than  anyone  I  could  name. 
I  was  really  a  follower  of  his  and  tried  to  preach  the  gospel,  so  to 
speak. 

Hughes:     Was  Duke-Elder  the  originator  of  the  neurovascular  theory? 

Scheie:       He  had  a  great  deal  to  do  with  it  and  was  the  chief  proponent.  In 
fact,  I  participated  in  an  international  meeting  at  Montreal.  The 
discussion  went  back  and  forth,  and  he  referred  to  it  as  the  second 
British-American  war. 

Hughes:     When  was  peace  declared? 

Scheie:       Well,  it  never  was.  Even  to  this  day,  I  think  there  exist  differences 
of  opinion  and  there  are  still  some  adherents  to  his  school. 
Certainly  there  is  an  element  of  truth  that  the  neurovascular 
element  plays  a  part  in  glaucoma,  but  I  think  it  is  a  secondary 
factor  rather  than  the  actual  cause. 


229 


I  did  not  agree  with  the  neurovascular  theory,  even  though  as  an 
intern  and  resident  I  was  brought  up  on  it.  You  have  no  idea  what 
a  relief  the  gonioscopic  approach  to  glaucoma  was  to  me.  Dr.  Adler 
and  the  entire  ophthalmology  staff  at  the  University  of 
Pennsylvania  had  not  used  a  gonioscope  and  the  neurovascular 
theory  was  in  vogue.  There  was  inadequate  rationale  for  the 
treatment  of  glaucoma.  Dr.  Adler  might  see  a  patient  and  prescribe 
a  treatment  while  I  could  see  the  patient  later  and  not  understand 
the  reason  for  his  recommendation.  Indications  for  medical  versus 
surgical  treatment  especially  were  not  clear. 

For  example,  if  a  patient  came  in  with  pressure  in  the  forties  or 
fifties,  an  ophthalmologist  might  recommend  a  basal  iridectomy 
because  it  was  felt  that  the  high  pressure  indicated  an  impending 
acute  attack.  Without  gonioscopy  we  could  not  know  whether  or  not 
an  acute  attack  might  occur.  The  pressure  was  not  an  indication 
because  it  can  be  very  high,  even  seventy  to  eighty,  in  open-angle 
glaucoma.  Some  prominent  ophthalmologists  believed  that  the 
diagnosis  of  glaucoma,  either  chronic,  simple,  or  acute,  was 
sufficient  to  be  an  indication  for  surgery. 


Grant's  work  with  tonography  accelerated  the  acceptance  of  the 
gonioscopic  concepts  of  glaucoma.  He  showed  that  in  narrow-angle 
glaucoma  before  an  acute  attack  (pre-glaucoma),  the  outflow  of 
aqueous  from  the  eye  is  normal.  During  an  acute  attack  when  the 
angle  is  closed  and  the  pressure  elevated  and  the  outflow  is  greatly 
diminished,  approaching  or  reduced  to  zero,  this  indicates  angle 
closure.  When  the  attack  has  been  neutralized  by  medical 
treatment  and  the  pressure  is  again  normal,  the  outflow  of  aqueous 
returns  to  normal.  This  demonstrates  that  narrow-angle  glaucoma 
has  normal  outflow  during  the  interval  between  attacks  and  during 
pre-glaucoma,  whereas  during  an  acute  attack,  with  the  angle 
closed,  no  fluid  can  escape  from  the  eye. 

When  the  angle  is  obstructed,  we've  learned  that  the  pressure 
begins  to  go  up  within  a  half  hour  or  an  hour,  so  this  knowledge  is 
used  as  a  provocative  test  to  confirm  the  diagnosis.  We  find  a 
narrow  angle  by  gonioscopy  by  dilating  the  pupil  with  a  mydriatic 
or  by  placing  the  patient  in  a  dark  room  and  measuring  his 
pressure  each  half  hour  for  the  next  couple  of  hours.  If  no  pressure 
rise  occurs,  the  eye  probably  is  not  in  immediate  danger  of  an  acute 
attack.  If  it  is  positive,  most  ophthalmologists  would  advise  a 
prophylactic  peripheral  iridectomy. 

On  the  other  hand,  in  open-angle  glaucoma  the  obstruction  is  in  the 
trabeculum/angle-wall  mechanism  and  is  persistent.  If  the 
pressure  is  high,  the  outflow  by  tonography  is  usually  reduced. 

Hughes:     Is  overproduction  of  aqueous  a  factor? 


230 


Scheie:       It  can  be,  particularly  in  secondary  glaucoma,  but  I  believe  it  is  a 
rare  cause  of  primary  glaucoma.  However,  I've  often  wondered  if 
some  acute  attacks  of  narrow-angle  glaucoma  might  have  been 
produced  by  increase  in  aqueous  secretion  and  flow  during  an 
emotional  upset.  Acute  attacks  are  known  to  occur  under  those 
circumstances  and  an  increase  in  aqueous  flow  could  cause  the  iris 
to  bow  forward  into  contact  with  the  trabeculum.  Supporting  this 
thesis  is  the  fact  that  patients  with  open-angle  glaucoma  who  suffer 
sudden  stress  are  apt  to  develop  higher  pressure  than  normal.  It 
seems  possible,  therefore,  that  overproduction  of  aqueous  might 
play  a  part  in  precipitating  an  acute  attack. 

Hughes:     Does  pilocarpine  cause  the  iris  to  contract? 

Scheie:       Yes,  and  the  pupil  constricts. 

Hughes:     And  that,  in  turn,  causes  the  iris  to  fall  back? 

Scheie:       The  sphincter  muscle  constricts  and  retracts  the  iris  from  the  angle 
wall,  opening  the  angle. 

Hughes:     So  it's  just  a  mechanical  obstruction? 

Scheie:       Yes,  in  fact,  the  gonioscopic  theory  has  also  been  called  the 
mechanical  theory. 

Hughes:     This  is  in  contrast  to  the  neurovascular  approach? 

Scheie:       Which  is  based  on  nothing  objective  but  is  largely  speculative. 

Hughes:     Was  the  neurovascular  approach  tied  in  with  surgical  and  medical 
philosophy? 

Scheie:       Not  really.  We  had  nothing  objective  to  base  treatment  on  except 
pressure  until  clinical  gonioscopy  came  along. 

Hughes:     Well,  if  you  have  the  mechanical  view  of  glaucoma,  there  certainly 
are  surgical  approaches  that  you  could  take. 

Scheie:       We  have  learned  that  in  open-angle  glaucoma,  there's  no  urgency 
for  surgery  because  there  is  no  danger  of  an  acute  attack.  The 
needed  surgery  can  be  mutilating  to  the  eye  and  accompanied  by 
complications,  so  we  avoid  it  if  possible.  Furthermore, 
approximately  fifteen  percent  of  filtering  operations  fail  to  control 
the  pressure.  Surgery  is  therefore  advised  only  after  medical 
therapy  fails  to  control  the  intraocular  pressure  and  vision  is 
threatened. 

Most  of  the  operations  being  done  are  filtering  procedures.  To  be 
successful,  they  must  establish  a  fistula,  which  in  itself  is  a  threat 
to  the  eye.  Laser  trabeculectomy  is  still  somewhat  experimental, 


231 

and  questions  are  being  raised  as  to  whether  or  not  the  control  of 
pressure  will  be  permanent.  However,  it  is  safe.  Because  the 
treatment  of  narrow-angle  glaucoma  is  primarily  surgical,  the 
diagnosis  should  be  made  as  early  as  possible  and  a  peripheral 
iridectomy  done  before  an  acute  attack  occurs.  Medical  therapy  is 
used  to  terminate  an  acute  attack  and  to  prevent  one  until  an 
operation  can  be  done.  Today  iridectomy  is  usually  done  with  a 
laser.  Surgery  is  done  during  an  acute  congestive  attack  only  if  the 
pressure  cannot  be  controlled,  which  is  rare. 

If  the  acute  attack  is  neglected,  a  filtering  operation  may  be 
indicated.  Almost  any  operation  can  result  in  cataract  formation, 
even  many  years  later,  just  as  a  bruise  to  the  lens  from  an  injury 
can  result  in  cataract  formation  years  later.  If  one  sees  a  unilateral 
cataract,  with  or  without  glaucoma,  it  is  advisable  to  suspect  a 
possible  former  eye  injury.  This  can  frequently  be  detected  by 
examining  the  eye  with  a  gonioscope  to  look  for  possible  evidence  of 
a  contusion  angle  deformity. 

Goniotomy 

Hughes:     Well,  Dr.  Scheie,  is  the  next  step  to  talk  in  more  detail  about  Otto 
Barkan's  goniotomy? 

Scheie:       Goniotomy  was  advocated  for  surgery  of  congenital  glaucoma  by 

Otto  Barkan  and  first  reported  in  1942.*  This  was  an  old  operation 
described  by  an  Italian  named  [Carlo]  de  Vincentiis  in  1893**,  who 
used  it  for  different  types  of  glaucoma  and  obviously  without  a 
gonioscopic  lens.  He  wrote  two  or  three  papers  but  by  the  turn  of 
the  century  it  had  proved  to  be  ineffective  and  fell  into  disuse. 
Barkan  revived  it  and  wrote  two  papers,  one  on  its  use  for  adult 
open-angle  glaucoma  and  the  other  for  congenital  glaucoma.  Late 
failure  occurred  in  the  adults  but  it  proved  to  be  permanently 
effective  for  congenital  glaucoma.  The  operation  consists  of 
inserting  a  goniotomy  knife,  designed  by  Barkan,  just  within  the 
limbus  and  sweeping  the  tip  across  the  anterior  chamber  and 
carrying  it  along  the  wall  of  the  opposite  angle,  debriding  the 
opposite  trabecular  region. 

Hughes:     Was  the  idea  to  allow  for  egress  of  the  aqueous? 

The  thinking  was  that  it  might  remove  or  open  abnormal  tissue  in 
the  trabeculum  or  overlying  and  obstructing  it,  thereby  establishing 
the  outflow  of  aqueous.  This  did  work  well  in  children,  with  lasting 
control. 

Barkan,  in  his  1942  paper  reported  seventeen  eyes  that  he  had 
operated.  The  pressure  was  normalized  in  sixteen  of  them.  J. 


Barkan  O.  Operation  for  congenital  glaucoma.  Am  J  Ophthalmol  1942;  25:552-68. 
**      de  Vincentiis  C.  Incisione  dcll-angolo  irideo  nel  glaucoma.  Ann  di  Ottal   1893;  22:540-2. 


232 


Hughes: 

Scheie: 

Hughes: 

Scheie: 

Hughes: 

Scheie: 


Hughes: 
Scheie: 


Ringland  Anderson,  an  Australian,  conducted  a  survey  of  the  world 
literature  and  many  ophthalmologists  in  1939  and  said  that  he  had 
learned  of  a  baby  with  buphthalmos  who  had  grown  up  to  have 
useful  industrial  vision.* 

In  a  1948  report,  Barkan  reported  seventy  six  eyes,  and  in  sixty-  six 
of  these  the  pressure  was  normalized.**  The  patients  had  been 
followed  from  one  to  ten  years.  He  urged  early  diagnosis  and 
prompt  surgical  intervention.  I  took  up  the  use  of  goniotomy  in 
1946. 

How  did  you  learn  of  it? 

Through  the  literature  and  by  word  of  mouth. 

But  you  never  visited  Barkan? 

I  did,  but  not  at  that  time. 

How  was  goniotomy  received  in  those  early  days? 

In  congenital  glaucoma  most  ophthalmologists  were  dubious 
because  the  prognosis  had  been  so  poor  with  all  types  of  operation. 
Furthermore,  the  operation  had  been  given  up  in  the  early  1900s, 
and  Barkan  had  led  to  some  confusion  in  reporting  a  series  of 
patients  with  adult  open-angle  glaucoma  whose  results  were 
favorable  when  he  reported  them  but  failure  occurred  later.  More 
than  that,  congenital  glaucoma  is  quite  rare  and  few 
ophthalmologists  saw  a  significant  number.  Barkan  seemed  to  have 
a  monopoly  on  the  West  Coast  and  eventually  I  saw  many  on  the 
East  Coast.  Still  later,  patients  came  not  only  from  the  United 
States  but  from  abroad.  Their  outlook  had  been  so  poor  that 
ophthalmologists  didn't  like  caring  for  them.  No  one  likes  poor 
results,  particularly  for  a  baby.  But  my  paper  was  important,  not 
by  way  of  originality,  but  because  it  confirmed  Barkan's  work  with 
children. 

What  is  the  title? 

"Goniotomy  in  treatment  of  congenital  glaucoma."***  So  that  made 
it  a  rather  important  paper  and  it  probably  encouraged  other 
ophthalmologists  to  use  the  procedure. 


Hughes:     Did  Barkan  begin  to  do  the  same? 


Anderson  R,  Jr.  Hydrophthalmk  or  Congenital  Glaucoma.  London:  Cambridge  University 
Press,  1939. 

Barkan  0.  Technic  of  goniotomy  for  congenital  glaucoma.  Trans  Amer  Acad  Ophthalmol  1948; 
52:  210-26. 

***  Arch  Ophthalmol  1949;  42:266-82 


233 


Scheie:       Yes.  Barkan  realized  his  operation  wasn't  effective  for  adults  and 
he  restricted  its  use  to  congenital  glaucoma. 

Hughes:     Had  you  realized  right  from  the  beginning  that  it  would  only  be 
applicable  in  congenital  glaucoma? 

Scheie:       In  view  of  poor  results  with  conventional  surgery,  we  decided  that 
we  should  try  it  on  the  basis  of  Barkan's  encouraging  report. 

Hughes:     Did  you  try  it  initially  in  open-angle  glaucoma? 
Scheie:       No,  I  never  used  it  for  open-angle  glaucoma. 
Hughes:     Because  you  suspected  that  it  wouldn't  be  effective? 

Scheie:       Yes,  and  the  fact  that  we  had  other  operations  that  were  effective  in 
adults.  We  were  desperate  because  of  our  lack  of  success  in 
children.  Congenital  glaucoma  patients  were  assigned  to  me  by  Dr. 
Adler. 

Hughes:     I  believe  you  did  your  first  goniotomy  in  1946.  What  would  have 
been  the  surgical  procedure  for  open-angle  glaucoma  at  that  time? 

Scheie:       It  would  have  been  the  Elliott  corneoscleral  trephine  or  an 

iridencleisis.  These  operations  were  not  very  effective  in  children 
and  vitreous  loss  was  a  hazard,  especially  in  buphthalmic  eyes. 
Thus  our  reasons  for  taking  up  goniotomy.  The  decision  to  do  so 
was  made  at  a  staff  conference. 

Hughes:     Did  you  follow  Barkan's  procedure  or  did  you  evolve  modifications? 

Scheie:       Well,  I  did  his  procedure  but  did  not  use  the  gonioscopy  lens.  He 
used  the  lens  to  visualize  the  angle  as  he  swept  it  with  the  knife.  I 
felt  it  was  more  of  a  hindrance  than  a  help.  I  used  a  magnifying 
loupe,  which  enabled  me  to  see  that  the  tip  of  the  knife  was 
posterior  to  Schwalbe's  line,  yet  not  cutting  the  iris.  This  meant 
that  the  tip  of  the  knife  could  only  be  in  the  trabecular  area.  The 
technique  was  quite  simple,  safe,  and  it  was  successful. 

In  my  first  report  I'd  operated  fourteen  eyes  with  control  of 
pressure  in  eleven,  results  that  were  comparable  to  Barkan's.  I 
always  liked  to  keep  procedures  as  simple  as  possible.  I  guess 
that's  the  key  to  my  surgical  philosophy.  Because  of  its  simplicity, 
goniotomy,  at  least  in  my  experience,  was  easy  to  perform  and  very 
safe. 


234 


The  Academy  Symposium  on  Glaucoma,  1948 

Hughes:     Is  now  the  time  to  bring  up  the  Academy  symposium  which  occurred 
in  October,  1948?* 

Scheie:       Yes,  that  probably  should  have  been  brought  up  earlier. 

Debate  had  continued  as  to  whether  or  not  the  gonioscopic  approach 
to  glaucoma  was  valid.  Many  people  like  myself  believed  in  it  and 
felt  that  it  provided  a  basic  understanding  of  glaucoma  and  better 
rationale  for  treatment.  It  seemed  to  be  a  breakthrough  and  it  was 
important  to  me  that  more  be  heard  about  it. 

The  origin  of  the  1948  symposium  might  be  of  some  interest.  Dr. 
Algernon  B.  Reese  was  then  chairman  of  the  program  committee  for 
the  American  Academy  of  Ophthalmology.  The  highlight  of  the 
Academy  meeting  every  year  was  a  major  symposium  with  several 
different  speakers  on  some  aspect  of  ophthalmology.  Dr.  Reese  and 
the  program  committee  had  decided  that  the  symposium  in  1948 
should  be  on  the  subject  of  retinal  disease.  I  was  invited  to  be  the 
chairman  and  organizer  and,  of  course,  was  very  flattered. 
However,  I  had  written  little  and  had  no  special  knowledge  in  the 
subject.  Worse,  there  had  been  few  new  developments  in  retina  at 
that  time.  There  had  been  a  plethora  of  papers  beginning  probably 
in  the  1870s,  eighties  and  nineties  when  ophthalmologists  described 
many  new  retinal  conditions.  But  not  much  had  emerged  since 
then,  so  I  felt  that  a  half-day  symposium  was  not  justified. 

At  any  rate,  I  discouraged  that  subject  but  suggested  a  symposium 
on  glaucoma  that  would  include  a  presentation  of  gonioscopic 
concepts,  which  were  not  understood  by  everyone.  The  suggestion 
was  accepted  and  the  symposium  planned.  Derrick  Vail,  a  senior 
ophthalmologist,  was  made  chairman.  I  suspect  the  committee 
wanted  a  more  senior  and  prestigious  ophthalmologist  to  chair  this 
important  subject.  I  was  asked  to  present  the  segment  on  medical 
treatment.  Other  participants  were  Dr.  Peter  Kronfeld,  Dr.  Jonas 
Friedenwald  (a  legend  in  ophthalmology),  Dr.  John  H.  Dunnington, 
and  Dr.  Paul  Chandler. 

Hughes:     Were  the  speakers  Dr.  Vail's  choices? 

Scheie:       I  suppose  they  were,  with  approval  of  the  program  committee.  Dr. 
Kronfeld  was  well  known  for  his  work  in  glaucoma  and  his  advocacy 
of  gonioscopy.  The  committee  presented  the  material  from  the  point 
of  view  of  the  gonioscopic  approach.  We  had  several  meetings  of  the 
committee  to  insure  a  coordinated  presentation. 


Symposium:  Primary  Glaucoma.  Presented  at  the  53rd  Annual  Session  of  American  Academy  of 
Ophthalmology  and  Otolaryngology,  October,  1948,  Chicago.  In:  Trans  Am  Acad  Ophthalmol 
Otolarygol  1948-9;  169-242. 


235 


Hughes:     Was  there  an  explicit  purpose  for  the  symposium? 

Scheie:       Well,  the  purpose  was  to  clarify  and  to  help  popularize  these  new 
concepts  for  grassroots  ophthalmologists.  Actually,  it  later  seemed 
to  have  been  almost  a  challenge  to  the  European  group,  particularly 
Sir  Stewart  Duke-Elder.  For  a  number  of  subsequent  years  several 
of  the  other  panelists  and  I  were  involved  in  an  ongoing  debate. 
But  the  symposium  did  serve  a  great  purpose,  because  it  helped  to 
clarify  our  knowledge,  at  least  in  this  country. 

It  was  appropriate  that  I  not  be  chairman  because  I  was  still  quite 
young  at  the  time  and  the  prestige  of  Drs.  Vail,  Chandler, 
Dunnington,  Kronfeld,  and  Friedenwald  added  greatly  to  the 
significance  of  the  symposium. 

Hughes:     Was  it  not  a  bit  strange  that  you  were  given  the  assignment  of  a 

paper  on  the  medical  means  of  treating  glaucoma,  when  what  you 
were  primarily  doing  at  that  time  was  operating  on  congenital 
glaucoma? 

Scheie:       Well,  I  wasn't  that  well-known  and  I  think  medical  treatment  was  a 
natural,  considering  my  work  with  Adie's  syndrome,  what  with 
writing  about  the  neurohumoral  theory  of  transmission  of  nerve 
impulses.  I'm  not  sure  that  many  of  the  ophthalmologists  at  that 
time  were  too  well-versed  in  that  area.  The  concepts  of  most  of  our 
glaucoma  medications  fitted  into  my  work  on  Adie's  pupils. 

The  Adie's  pupil  involves  a  partial  denervation  beyond  the  terminal 
ganglion  of  the  parasympathetic  nervous  system.  The  substances 
used  for  the  Adie's  study  and  those  used  for  the  medical  treatment 
of  glaucoma  were  eserine,  prostigmin,  DFP  [difluorphosphate], 
pilocarpine,  furmethide,  carcholin,  and  mecholyl.  Furmethide  was 
later  discarded  as  too  irritating.  However,  all  of  them  stimulated, 
directly  or  indirectly,  the  motor  end-plate  of  the  muscle  fiber. 

Hughes:     What  came  out  of  this  symposium? 

Scheie:       Well,  I  think  the  gonioscopic  approach  received  a  great  boost.  It 

helped  gain  gradual  acceptance  by  ophthalmologists.  The  opinions 
of  the  panelists  carried  considerable  weight.  I  have  always  taken 
pride  in  having  suggested  the  symposium. 

Hughes:     Was  this  conference  a  call  to  arms  to  Duke-Elder? 

Scheie:       It  was  not  meant  to  be  but  he  did  take  notice.  He  felt  very  strongly 
about  his  neurovascular  theory  and  I'm  sure  some  people  still  do 
today. 

Hughes:     The  fact  that  he  was  a  man  of  such  stature  in  ophthalmology  must 
have  meant  a  considerable  obstacle  to  accepting  the  gonioscopic 
classification. 


236 


Scheie:       Well,  the  evidence  in  favor  of  it  was  rather  insurmountable. 
Hughes:     Is  there  such  an  entity  as  low-tension  glaucoma? 

Scheie:       Yes,  but  its  true  nature  is  obscure.  A  subject  of  considerable 

discussion  at  the  moment  is  the  part  played  by  the  optic  nerve  in 
glaucoma.  I  don't  quite  accept  many  of  the  arguments  being 
advanced.  In  my  opinion,  pressure  causes  optic  nerve  cupping  and 
degeneration.  A  baby  born  with  glaucoma  but  with  supposedly 
healthy  optic  nerves  will  inevitably  develop  cupping  unless  the 
pressure  is  controlled.  This  is  also  true  in  patients  of  any  age  with 
secondary  glaucomas  such  as  aphakic,  traumatic,  and  others. 

We  do  know  that  low-tension  glaucoma  exists  but  I  wonder  if  it  is 
not  a  situation  where  the  nutrition  of  such  optic  nerves  is 
insufficient  to  withstand  even  normal  intraocular  pressure.  I  find  it 
difficult  to  believe  that  the  optic  nerve  cupping  does  not  result  from 
such  mechanisms.  The  situation,  in  a  way,  reverts  to  the  old 
neurovascular  mysteries.  To  me,  glaucoma  is  a  disease  of  pressure. 
I  realized  that  I  could  be  wrong  and  certainly  any  leads  should  be 
pursued.  And  I  do  concede  that  optic  nerves  can  deteriorate  and 
visual  field  defects  progress  seen  after  normalization  of  pressure 
but,  again,  is  this  nutritional  in  an  eye  with  an  optic  nerve  already 
damaged  by  pressure? 

Goniopuncture 

Hughes:     Well,  is  the  next  step  goniopuncture? 

Scheie:       Yes,  whatever  you  wish. 

Goniopuncture  was  developed  as  a  result  of  seeing  a  nineteen 
year-old  girl  with  juvenile  glaucoma  at  our  weekly  staff  conference. 
The  glaucoma  was  advanced  with  very  high  pressure,  forty  to  fifty, 
and  she  had  marked  visual  field  loss.  Because  she  was  young  with 
her  life  ahead  of  her,  everyone  agreed  that  she  must  be  operated.  It 
was  realized  that  conventional  filtering  for  glaucoma  would  leave 
her  with  an  abnormal  eye.  Since  I  had  been  doing  goniotomies 
successfully  in  infants  and  young  children,  the  question  was 
brought  up  as  to  whether  a  goniotomy,  instead  of  a  conventional 
procedure  such  as  a  trephine,  should  be  tried  because  she  had 
juvenile  glaucoma.  Dr.  Adler  was  presiding  at  the  meeting  and  the 
decision  was  made  that  I  do  a  goniotomy,  which  I  performed  on  her 
left  eye  in  1949. 

Everything  went  smoothly  and  the  pressure  was  normal 
postoperatively.  However,  when  I  examined  her  with  a  gonioscopic 
lens  four  or  five  days  later,  to  my  chagrin  I  saw  a  gaping  cleft  in  the 
trabeculum  along  the  area  where  the  knife  swept  nasally  from 
about  eleven  o'clock  or  eleven-thirty  downward  to  the  five  o'clock 


237 

area.  I  had  done  as  much  of  the  angle  as  possible.  The  incision  had 
been  perfectly  placed  in  the  trabecular  area,  but  at  about  the  four 
o'clock  meridian  I  could  see  a  small  area  where  I  was  certain  that  I 
had  penetrated  the  entire  thickness  of  the  overlying  sclera.  I  was 
crestfallen,  thinking  that  I'd  done  something  dreadful. 

I  then  looked  at  the  overlying  limbal  conjunctiva.  To  the  naked  eye 
it  appeared  normal,  but  with  a  slit  lamp  I  could  see  what  appeared 
to  be  diffuse  filmy  edema  of  Tenon's  capsule  and  conjunctiva 
overlying  the  area  where  I  suspected  the  perforation.  I  could  only 
conclude  that  it  was  due  to  aqueous  draining  into  the 
subconjunctival  space  through  a  fistula  that  I  had  accidentally 
created.  Otherwise,  the  eye  looked  fine  and  the  pressure  remained 
normal. 

She  was  seen  again  at  staff  conference  a  week  after  the  operation 
and  I  suggested  that  I  had  probably  created  a  fistula  so  that  instead 
of  the  effect  of  a  goniotomy  I  had  inadvertently  done  a  filtering 
operation.  She  was  observed  for  three  weeks  and  then  seen  once 
more  at  staff  conference  where  it  was  decided  to  do  a  similar 
procedure  on  the  other  eye. 

## 

Instead  of  sweeping  the  angle  on  that  eye,  I  made  a  simple 
puncture  using  a  goniotomy  knife  through  the  corneoscleral  wall  in 
the  trabeculum  at  about  one  o'clock.  This  eye  also  did  well,  just  like 
the  first  eye,  and  the  pressure  was  normal.  It  is  of  some  interest  to 
know  that  I  continued  to  see  her  until  my  retirement  in  the  mid 
1980s.  She  had  lost  some  visual  field  over  the  years  but  the 
pressure  had  remained  normal  in  the  second  eye  all  of  those  years. 
The  pressure  in  the  first  eye,  probably  twenty  years  later,  had  a  late 
rise  in  pressure,  and  I  had  performed  a  successful  iridectomy  with 
cautery  at  that  time.  I  had  learned  that  the  operation,  which  I 
termed  the  goniopuncture,  was  not  effective  in  patients  over  thirty 
years  of  age,  so  I  did  not  repeat  the  procedure  on  her  at  that  time. 
Neither  eye  had  developed  a  cataract  when  I  last  saw  her. 

Hughes:     The  first  eye  failed  because  the  opening  filled  in  ? 

Scheie:       I  gonioscoped  all  of  the  goniopuncture  patients  postoperatively  and 
found  that  in  individuals  under  thirty  years  of  age  the  site  of  the 
puncture  permanently  gapes  and  stays  open,  while  in  older  patients 
only  a  slit  can  be  seen  at  the  punctures.  This  suggests  that  in  these 
patients  the  tissue  of  the  corneoscleral  wall  is  rigid  and  gaping 
cannot  occur  and  they  do  close  off  in  days  or  weeks.  It  seems 
comparable  to  a  rubber  dam  which  gapes  if  punctured  if  held  under 
slight  tension,  but  rigid  nonelastic  material  will  not  do  so.  In 
youngsters,  the  intraocular  pressure  causes  the  puncture  to  gape 
and  filtration  occurs.  The  edges  don't  coaptate  as  they  do  in  the 


238 


Hughes: 


Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


ure 


more  rigid  sclera  of  adults  over  thirty  years  of  age.  It  is  known  that 
adults  do  have  more  rigid  sclera  than  do  youngsters. 

Over  the  years  I  used  goniopuncture  for  many  patients,  but  only  for 
juvenile  and  congenital  glaucoma.  In  the  latter,  I  increasingly 
combined  goniotomy  and  goniopuncture  into  the  same  procedure 
with  excellent  results,  thus  utilizing  the  mechanisms  of  each, 
[interruptionl 

I  also  used  goniopuncture  as  a  primary  procedure  for  some  eyes 
with  infantile  glaucoma.  As  a  primary  procedure,  it  controlled 
pressure  in  fifty-two  percent  of  the  eyes  with  infantile  glaucoma  as 
compared  with  fifty-seven  percent  where  I  used  goniotomy  alone.* 
The  overall  was  seventy-six  percent  with  a  combined  procedure.  So 
I  found  that  goniopuncture  also  can  be  helpful  in  managing 
congenital  glaucoma.  It  was  my  operation  of  choice  for  young 
patients  with  Axenfeld  syndrome  (angle  cleavage  syndrome)  where 
the  angle  is  occluded  by  embryonic  tissue  and  goniotomy  can  not  be 
done  because  of  it. 

My  understanding  is  that  you  frequently  combined  goniopunct 
with  goniotomy.  Why  would  goniotomy  be  necessary  if  the 
goniopuncture  indeed  remains  patent? 

The  punctures  do  not  all  remain  open  and  that  is  why  I  mentioned 
the  above  figures.  My  reasoning  was  that  in  congenital  glaucoma  a 
goniotomy  theoretically  frees  the  trabeculum  while  goniopuncture 
is  a  safe  filtration  operation.  You  are  therefore  utilizing  two 
different  mechanisms,  the  effect  of  which  should  be  complementary. 
So  on  most  of  my  congenital  glaucoma  patients  in  the  later  years  of 
my  practice,  I  combined  the  two  procedures. 

I  heard  speculation,  perhaps  yours,  that  in  goniotomy  there  probably 
was  an  area  of  puncture. 

Yes.  I  should  have  mentioned  that  when  I  was  discussing  Barkan's 
work.  The  question  always  occurred  to  me  as  to  whether  or  not  a 
fistula  had  been  produced  during  some  goniotomies.  However,  I 
have  seen  many  patients  that  have  had  goniotomies  and  I  have 
never  recognized  edema  of  the  conjunctiva  and  Tenon's  capsule  that 
you  see  after  goniopuncture.  I  don't  say  it  doesn't  occur  at  times. 
The  conjunctival  edema  following  a  successful  puncture  is  filmy  and 
easily  overlooked. 

What  was  the  reaction  to  goniopuncture? 

The  reaction  was  printed  in  the  newspaper,  [laughs]  I  gave  the 
goniopuncture  paper  on  the  last  day  of  the  meeting  of  the  American 
Medical  Association  in  San  Francisco  in  1950,  and  I  left  shortly 


Scheie  HG.  Goniopuncture:  An  evaluation  after  eleven  years.  Arch  Ophlhalmol  1961;  65:38-48. 


239 


after  I'd  made  the  presentation.  Planes  were  slow  in  those  days 
and  I  arrived  in  Philadelphia  at  about  six  or  seven  o'clock  in  the 
morning.  Since  I  had  a  patient  with  herpes  zoster  staying  at  the 
Warwick  Hotel,  which  was  a  block  from  my  office,  I  felt  my  first 
duty  after  leaving  the  airport  should  be  to  visit  him. 

When  crossing  the  hotel  lobby  on  the  way  to  the  patient's  room,  I 
was  stopped  by  an  acquaintance  who  said,  "Have  you  seen  the 
morning  paper?"  I  had  not.  In  the  patient's  room,  I  was  also  asked 
if  I'd  seen  the  morning  paper.  So  on  my  way  out  of  the  hotel,  I 
picked  up  the  paper,  the  Philadelphia  Inquirer,  and  glanced  at  it. 
The  front  page  subheadline  read,  "Slip  of  Knife  Aids  in  Eye 
Surgery."*  Obviously,  the  public  relations  department  of  the 
American  Medical  Association  had  permitted  the  newspaper 
reporters  to  read  the  scientific  papers  that  had  been  given  at  the 
meeting  the  previous  day,  and  the  headline  had  sensationalized  it  a 
bit.  [laughs]  I  suppose  it  represented  either  a  good  ad  or  one  of  the 
hurdles  I  have  had  to  surmount  in  building  a  surgical  practice  in 
Philadelphia. 

Hughes:     What  was  the  reaction  of  your  colleagues  in  ophthalmology? 

Scheie:       None  that  I  know  of,  except  for  their  jokes.  I  hope  that  they  knew 
that  I  wouldn't  have  solicited  such  an  ad. 

Hughes:     Did  anybody  quickly  begin  to  do goniopuncture? 

Scheie:       No,  it  never  became  popular.  In  fact,  many  people  said  that  it  was 
worthless,  which  was  untrue. 

Hughes:     How  could  they  say  that  when  you  were  getting  good  results? 

Scheie:       I  suspect  they  had  done  very  few,  had  done  them  improperly,  or 

hadn't  done  any.  [laughs]  Also,  they  might  have  been  done  on  older 
people.  It  is  somewhat  comparable  to  goniotomy  when  Barkan 
published  erroneous  results  in  adults.  It  would  have  hurt  the 
image  of  the  operation. 

Hughes:     Was  there  ever  a  problem  with  infection  with  goniopunctures? 

Scheie:       To  the  best  of  my  knowledge,  I  never  had  an  infection,  early  or  late. 
I  don't  have  the  figures  right  at  my  fingertips. 


June  30,  1950. 


240 


The  Scheie  Procedure 

Hughes:     Well,  the  next  thing  I  wanted  to  discuss  is  the  Scheie  procedure, 
which  I  believe  you  first  reported  in  1958? 

Scheie:       Yes,  there  were  two  articles  which  appeared  close  together.* 
Hughes:     Can  you  tell  me  how  you  got  the  idea  of  the  cautery? 

Scheie:       Yes.  For  background,  Dr.  Bourne  Jerome  and  I  had  done  some  work 
studying  the  effect  of  heat  upon  the  sclera,  namely  the  amount  of 
shrinkage  resulting  from  heat  applied  superficially  to  the  sclera. 
This  pertained  to  retinal  detachment  surgery  and  scleral  resection. 
Scleral  resection  obviously  causes  a  reduction  in  ocular  volume  and 
indents  the  sclera  and  choroid  toward  the  detached  retina.  We 
found  in  animals  that  we  could  cause  considerable  scleral  shrinkage 
by  applying  only  a  small  amount  of  cautery,  reducing  the  ocular 
volume  as  much  as  eleven  percent. 

Hughes:     How  did  that  work  apply  to  glaucoma? 

Scheie:       I  had  been  doing  simple  peripheral  iridectomies  for  glaucoma. 

Occasionally  annoying  bleeding  occurred  while  I  was  making  the 
anterior  scleral  incision.  When  a  new  and  easily  used 
nonpenetrating  cautery  became  available,  I  began  to  use  it  to 
prevent  the  bleeding.  I  noticed  that  occasionally  a  filtering  cicatrix 
occurred.  Obviously  the  incision  was  filtering,  a  complication  which 
rarely  occurred  with  the  small  incision  used  for  peripheral 
iridectomy  I  began  to  puzzle  about  the  reason,  and  the  thought 
occurred  to  me  that  the  cautery  was  shrinking  the  sclera  and 
separating  the  lips  of  the  incision.  I  began  to  watch  more  carefully 
and  I  could  see  the  edges  of  the  incision  retract  and  separate  as  the 
cautery  was  applied  for  hemostasis.  I  used  this  observation  to 
develop  the  new  filtering  operation. 

Initially,  I  used  it  for  eyes  with  narrow-angle  glaucoma  where  I  had 
debated  whether  or  not  simple  iridectomy  would  be  adequate  or 
whether  filtration  might  be  needed.  Then  I  began  to  utilize  it  for 
open-angle  glaucoma.  Out  of  this  came  the  procedure  which  I  called 
iridectomy  with  scleral  cautery.  I  believe  that  it  has  been  a 
worthwhile  addition  to  glaucoma  filtration  surgery,  and  it  had  been 
used  throughout  the  world  and  is  still  employed  by  many. 

In  the  late  sixties,  J.E.  Cairns  of  England  described  his 
trabeculectomy  operation,  which  consisted  of  excising  a  segment  of 
the  trabeculum  after  making  a  scleral  flap.  It  was  initially  believed 


Scheie  HG.  Retraction  of  scleral  wound  edges  as  a  fistulizing  procedure  for  glaucoma.  Amer  J 
Ophthalmol  1958;  45:(4)  Part  II,  220-8.  Scheie  HG.  Peripheral  iridectomy  with  scleral  cautery 
for  glaucoma.  Arch  Ophthalmol  1959;  61:139-291  &  146-298. 


241 

to  restore  normal  filtration,  but  it  is  now  quite  generally  agreed 
that  it  is  another  filtering  operation,  basically  an  anterior 
sclerectomy  beneath  a  scleral  flap.  It's  an  excellent  and  safe 
operation.  The  scleral  flap  helps  to  avoid  delayed  reformation  of 
the  anterior  chamber  which  can  follow  filtering  operations. 

The  main  objection  to  the  iridectomy  with  cautery  is  a  significant 
incidence  of  hypotony,  possibly  fourteen  to  fifteen  percent,  as 
compared  to  eight  percent  with  other  filtering  procedures.  The 
advantages  of  the  cautery  procedure  are  that  it  is  very  safe  and 
easy  to  do.  However,  Cairns'  operation  is  now  more  popular, 
although  many  ophthalmologists  are  still  using  the  cautery, 
especially  for  reoperations. 

Hughes:     The  trabeculectomy  is  a  cutting  procedure? 

Scheie:       Yes.  A  segment  of  the  angle  wall  (trabecular  area)  is  removed.  The 
scleral  flap  covers  the  incision,  is  sutured  back  in  place,  and  helps 
to  prevent  persistent  flat  anterior  chambers.  It  is,  however,  a 
filtration  procedure,  but  the  incidence  of  hypotony  seems  smaller. 
During  my  last  years  in  practice,  I  used  the  scleral  flap  for  my 
cautery  operation  with  excellent  results.  I  also  used  it  for  combined 
filtration  and  cataract  operations. 

Hughes:     What  is  the  advantage  of  the  flap? 

Scheie:       It  helps  to  prevent  excessive  postoperative  drainage  of  aqueous  and 
leads  to  earlier  reformation  of  the  anterior  chamber.  A  flap,  added 
to  my  procedure,  retains  the  simplicity  of  the  operation  and 
minimizes  disadvantages. 

Hughes:     When  you  were  thinking  about  scleral  cautery,  were  you  influenced 
by  the  work  that  was  going  on  in  retinal  detachment  surgery,  namely 
the  procedures  originated  by  Jules  Gonin  and  then  modified  by 
Lindner,  where  Gonin  used  a  hot  cautery  and  then  Lindner  refined 
the  technique?  It  consisted  of  making  holes  that  remained  patent  for 
a  while.* 

Scheie:       It  didn't  make  holes.  No,  they  used  that  technique  to  seal  the 

retinal  holes  and  to  permit  the  retina  to  fall  back.  Mine  was  just 
curiosity.  I  wanted  to  see  how  much  reduction  in  ocular  volume 
would  result  from  heat  applied  superficially  to  the  sclera. 

Hughes:     They  were  also  making  punctures  to  drain  subretinal  fluid,  and 

those  punctures  remained  patent  for  a  while.  Weren't  you  trying  to 
do  the  same  thing?  You  were  trying  to  prevent  a  hole  from  plugging 
up. 


See  the  oral  history  of  Dr.  Dohrmann  Pischel  in  this  series. 


242 


Scheie:       Yes,  by  separating  the  scleral  wound  edges.  The  punctures  you 
have  just  mentioned  drained  retinal  fluid.  They  did  that  to  allow 
the  retina  to  fall  back,  but  at  the  time  they  caused  irritation  which 
promoted  the  adhesions  to  hold  the  retina  in  place. 

Our  work  was  purely  experimental,  done  on  animals,  to  see  how 
much  we  could  reduce  the  ocular  volume  by  using  reasonable 
amounts  of  superficial  cautery.  Scleral  resections  cut  out  a  wedge  of 
sclera  and  forced  the  outer  coats  of  the  retina,  choroid  and  sclera, 
inward  toward  the  detached  portion  of  the  retina.  We  asked,  "Could 
the  same  result  be  obtained  by  superficially  applied  heat?" 

Hughes:     You  were  thinking  of  the  parallel  between  your  finding  that  when 
you  used  the  cautery  the  lips  of  the  incision  gaped,  and  their  using 
drainage  punctures  in  retinal  detachment  surgery? 

Scheie:       Oh,  I'm  sure  we  were.  When  they  inserted  the  [retinal]  pins,  the 
adjacent  sclera  would  shrink  to  leave  a  small  gaping  hole  through 
which  drainage  of  subretinal  fluid  would  occur. 

Hughes:     Dr.  Ewing  said  something  interesting  when  I  talked  to  her.  *  She 

said  in  the  years  that  she  was  here  at  the  institute,  first  as  a  resident 
and  later  while  practicing,  she  never  once  heard  the  operation 
referred  to  as  the  Scheie  procedure.  You  did  not  call  it  that? 

Scheie:       No.  It  started  here  as  iridectomy  with  scleral  cautery  and  always 
has  been  called  that. 

Hughes:     Who  gave  it  the  name  Scheie  procedure? 

Scheie:       Oh,  I  guess  in  most  of  the  operating  rooms  in  the  country  it  was 
simply  referred  to  as  the  Scheie  procedure  and  in  others  as 
thermosclerectomy. 

Hughes:     Well,  the  next  step  is  to  discuss  some  of  your  papers  related  to 
glaucoma. 

Scheie:       Anything  you  say. 

Pseudoglaucoma 

Hughes:     The  first  one  I  want  to  talk  about  is  on  pseudoglaucoma.  In  this 
paper  you  present  four  cases.  ** 

Scheie:       Yes,  and  we  touched  upon  it  this  morning  under  visual  fields  when 
we  mentioned  that  there  were  conditions  that  could  mimic 
glaucoma. 


Interview  with  Dr.  Madeleine  Ewing,  Philadelphia,  January  28,  1988. 
**     Scheie  HG,  Blazer  HA.  Pseudoglaucoma.  Arch  Ophthalmol  1950;  44:  499-513. 


243 


Hughes:     That  fact  was  not  widely  recognized  in  1950? 

Scheie:       No,  it  wasn't.  The  paper  was  written  to  report  interesting  patients 
and  to  emphasize  that  there  are  serious  conditions  that  could  be 
misdiagnosed  or  overlooked.  One  of  these  was  a  minister's  wife  in 
Philadelphia  who  had  a  brain  tumor  that  required  surgery,  [scans 
paper]  Yes,  the  patient  had  been  treated  for  glaucoma  for  a  couple  of 
years  and  had  visual  field  defects  that  could  have  been  due  to 
glaucoma.  However,  we  brought  her  into  the  hospital  for  study,  had 
x-rays  done,  and  found  that  her  visual  field  defects  really  resulted 
from  pressure  on  the  optic  nerves  by  a  pituitary  tumor  which 
needed  to  be  operated. 

Patient  two  had  syphilis.  Patient  three,  I  remember  vividly,  was  a 
man  from  our  glaucoma  clinic.  He  had  been  seen  and  followed 
there  for  many  years.  Both  eyes  had  been  operated  in  1922  for 
glaucoma,  which  I  am  sure  he  never  had.  Typical  bilateral 
colobomas  of  the  optic  nerve  and  visual  field  defects  compatible 
with  glaucoma  had  simulated  that  condition.  The  appearance  of 
the  optic  nerves  was  classic.  So  the  paper  was  meant  as  an  alert  to 
situations  that  could  simulate  glaucoma  but  were  really 
pseudoglaucoma. 

Hughes:     Well,  it  was  important  in  that  it  might  save  an  eye. 

Scheie:       It  might  even  save  lives,  as  in  the  patient  with  the  brain  tumor  and 
the  patient  with  syphilis. 

Induced  Ocular  Hypertension 

Hughes:     Well,  the  next  paper  was  published  the  same  year  and  is  entitled 

"Ocular  hypertension  induced  by  air  in  the  anterior  chamber,"  which 
you  wrote  with  Dr.  Prayer.  * 

Scheie:       Yes,  that  paper  was  gratifying. 
Hughes:     Why  do  you  say  that? 

Scheie:       Well,  it  solved  a  problem.  A  patient  had  a  rise  in  pressure  following 
injection  of  air  into  the  anterior  chamber,  [scans  paper]  We  had 
injected  air  into  the  eye  of  a  sixty-five-year-old  lady  who  had  been 
under  treatment  for  open-angle  glaucoma. 

Hughes:     Well,  that  was  one  of  my  questions:  Under  what  clinical  conditions 
would  one  inject  air  into  the  anterior  chamber? 

Scheie:       Well,  the  anterior  chamber  was  empty  after  a  goniopuncture,  so  we 
filled  it  with  air 


Arch  Ophthalmol  1950;  44:691-702. 


244 


## 
Hughes:     Why  did  you  inject  air? 

Scheie:       To  replace  the  aqueous  and  reform  the  anterior  chamber  rather 
than  leave  it  empty. 

Hughes:     With  the  idea  of  trying  to  keep  the  angle  open1? 
Scheie:       Yes.  We  thought  air  was  innocuous. 
Hughes:     It's  not  absorbed? 

Scheie:       Slowly.  About  an  hour-and-a-half  after  we  put  the  air  in,  the 

patient  began  to  complain  of  severe  pain  in  the  eye.  Her  angle  had 
been  open  before  the  goniopuncture,  but  when  I  saw  her  because  of 
her  pain,  the  appearance  was  that  of  an  iris  bombe,  which 
ordinarily  meant  that  the  pupillary  border  was  adherent  to  the 
lens,  and  aqueous  could  not  pass  through  the  pupil  and  into  the 
anterior  chamber.  The  midportion  and  the  root  of  the  iris  would 
therefore  be  pushed  or  bowed  forward,  and  the  angle  of  the  anterior 
chamber  would  appear  closed. 

Hughes:     And  that  causes  the  obstruction? 

Scheie:       Right.  It's  ordinarily  caused  by  adhesions  of  the  pupillary  border, 
but  we  learned  that  the  block  here  was  caused  by  air.  When  air 
filled  the  anterior  chamber,  the  posterior  surface  of  the  bubble  and 
the  anterior  surface  of  the  iris  formed  a  ball- valve  mechanism. 
Aqueous  secreted  behind  the  iris  by  the  ciliary  body  could  not  flow 
forward  through  the  pupil  because  of  the  contact  between  the 
posterior  surface  of  the  air  bubble  and  the  anterior  surface  of  the 
iris.  It  took  a  while  for  us  to  figure  that  out,  but  it  was  the  same 
mechanism  that  causes  glaucoma  associated  with  anterior 
dislocation  of  the  lens.  We  found  later  that  Barkan  had 
encountered  it  once  after  he  had  filled  the  anterior  chamber  with 
air  following  a  cyclodialysis.* 

Well,  I  unknowingly  thought  that  if  some  air  is  good,  a  little  more 
would  be  better,  so  I  injected  more  air  to  push  the  iris  back.  But 
this  was  my  first  experience  with  air  block,  and  relief  was  only 
temporary.  In  about  two  hours,  pain  and  elevation  of  pressure 
recurred.  The  air  had  remained,  but  I  couldn't  understand  why  the 
pressure  was  elevated  in  spite  of  the  air.  Finally,  a  few  hours  later 
the  patient  was  still  having  pain  and  the  air  was  completely 
removed. 


Barkan  0.  Cyclodialysis,  multiple  or  single,  with  air  injection:  An  operative  technique  for 
chronic  glaucoma.  Am  J  Ophthalmol  1947;  30:1063-73. 


245 


The  rise  in  tension  had  been  obscure  but  there  seemed  to  be  several 
possibilities:  Closure  of  the  angle  through  adhesions  of  the  iris  to 
the  trabecular  region  of  the  angle,  which  didn't  seem  feasible,  or 
even  the  possibility  of  a  neurovascular  mechanism. 

Hughes:     That's  Duke-Elder's  theory  of  glaucoma. 

Scheie:       Yes,  that  still  had  to  be  considered. 

A  third  possibility  was,  as  I  mentioned  earlier,  obstruction  of  the 
normal  flow  of  aqueous  from  the  posterior  to  the  anterior  chamber 
resulting  from  a  ball-valve  mechanism. 

We  did  experiments  on  animals  and  proved  that  air  injected  into 
the  anterior  chamber  could  cause  a  pupillary  block  with  elevation  in 
pressure  occurring  within  thirty  minutes  to  an  hour.  In  the  animal 
eye,  with  its  deep  anterior  chamber,  the  pressure  corrects  itself  if 
the  animal  remains  upright  because  the  air  bubble  rises  and  is 
smaller  when  compressed.  Then  the  lower  pupillary  border  can 
work  its  way  around  the  air  bubble  which  allows  the  trapped 
aqueous  to  escape  from  the  anterior  chamber  and  the  pressure 
normalizes.  In  humans  this  can  not  happen  because  the  chamber  is 
too  shallow. 

We  did  two  experiments  on  patients  who  were  about  to  have  their 
eyes  removed  and  made  graphs  of  the  length  of  time  it  took  for  the 
glaucoma  to  develop,  which  was  about  two  hours.  Never  again  did  I 
put  too  much  air  in  an  anterior  chamber. 

Hughes:     Do  you  think  other  surgeons  took  your  warning? 

Scheie:       I  don't  know,  but  certainly  the  facts  were  there,  including  the 

simulated  attacks  of  acute  congestive  glaucoma.  The  tension  rises 
rapidly  and  remains  high  until  the  pupillary  block  obstruction  is 
removed.  If  it  persists,  adhesions  may  develop  by  the  time  the  air 
is  absorbed,  and  the  situation  then  is  identical  to  neglected  acute 
narrow-angle  glaucoma  with  anterior  peripheral  synechia. 

Peripheral  Iridectomy 

Hughes:     Well,  the  next  paper  is  about  peripheral  iridectomy,  which  we've 
already  talked  about.  *  How  did  you  come  to  write  the  paper  with 
Dr.  Haas? 

Scheie:       He  was  a  good  friend  and  one  of  the  people  whose  work  and 

judgment  I  most  admired  in  the  glaucoma  field.  The  decision  to 
write  that  paper  came  about  while  he  and  I  were  having  a  social 
evening.  Dr.  Haas  had  worked  with  Dr.  Kronfeld,  and  I  came  to 


Peripheral  iridectomy  in  narrow  angle  glaucoma.  Trans  Amer  Acad  Ophthalmol  Otolaryngol 
1952;  July-Aug:  589-95. 


246 

know  him  through  that  association.  In  fact,  whenever  I  was  able,  I 
liked  to  observe  in  their  clinic. 

Hughes:     That  was  here? 

Scheie:       No,  it  was  in  Chicago.  Many  people,  including  Barkan,  had 

observed  that  after  peripheral  iridectomy  the  chamber  deepened  in 
the  area  of  the  iridectomy.  They  felt  that  the  pressure  had  been 
normalized  because  the  angle  had  opened  in  the  area  where  the 
iridectomy  had  been  done. 

While  Dr.  Haas  and  I  were  chatting,  we  learned  that  each  of  us  had 
observed  separately  that  the  entire  circumference  of  the  angle  of 
the  anterior  chamber  opened  after  a  peripheral  iridectomy  if  it  was 
done  during  the  pre-glaucoma  phase  when  there  were  no  synechiae. 
Also,  separately  we  had  concluded  that  the  peripheral  iridectomy 
had  eliminated  what  in  reality  was  a  physiologic  iris  bombe  or  a 
relative  iris  block  effect  by  allowing  the  aqueous  to  flow  through  the 
iridectomy.  I  think  the  idea  helped  a  bit  in  clarifying  the 
mechanism  of  narrow-angle  glaucoma. 

Hughes:     Are  you  ready  for  another  one? 
Scheie:       I  am  always  ready. 

Gonioscopy  in  Tumor  Diagnosis 

Hughes:     In  1954  you  wrote  a  paper  called,  "Gonioscopy  in  the  diagnosis  of 
tumors  of  the  iris  and  ciliary  body  (emphasis  on  intraepithelial 
cysts.)"*  This  paper  illustrated  another  application  of  the 
gonioscope. 

Scheie:       Yes.  These  cysts  are  behind  the  iris  and  cause  a  bulge  on  the 

anterior  surface  by  pushing  the  stroma  forward,  as  could  any  tumor 
in  that  location.  A  malignant  melanoma  is  always  a  possibility  and 
eyes  with  cysts  have  been  removed  because  of  a  mistaken  diagnosis 
[of  melanoma]. 

By  using  gonioscopy,  with  the  pupil  widely  dilated  through 
installations  of  neosynephrine  and  homatropine,  I  learned  that  I 
could  see  behind  the  iris  and  even  visualize  the  ciliary  processes  as 
well  as  have  a  direct  view  of  the  cause  of  the  iris  bulge.  The  cysts 
were  usually  intraepithelial,  which  most  commonly  form  between 
the  two  layers  of  ciliary  epithelium  and  are  transparent  because  the 
inner  layer  of  ciliary  epithelium  is  nonpigmented.  However,  if  they 
arise  from  the  base  of  the  iris,  they  appear  dark  brown  or  black 
because  the  posterior  layer  is  pigmented  and  can  simulate  a 
melanoma.  Melanomas  are  apt  to  have  a  nodular  appearance.  It 


Scheie  HG.  Arch  Ophthalmol  1954;  51:288-300. 


247 


has  been  satisfying  over  the  years  for  me  to  be  able  to  see  these 
occasional  cysts  and  other  lesions  behind  the  iris. 

Hughes:     And  the  only  way  you  can  be  sure  what  they  are  . . . 
Scheie:       ...  is  to  look  at  them. 
Tonography* 

Hughes:  You  published  a  paper  the  following  year  on  tonography  which  you 
wrote  with  Dr.  Robert  W.  Spencer  and  Dr.  Ernest  D.  Helmick**  My 
understanding  is  that  Dr.  Grant  was  trying  to  advance  tonography 
as  an  important  diagnostic  tool  in  ophthalmology. 

Scheie:       He  wasn't  guilty;  others  were. 
Hughes:     What  was  your  quibble? 

Scheie:       We  did  two  papers  on  tonography,  which  caused  considerable  feeling 
among  some  ophthalmologists  who  were  great  enthusiasts.*** 

In  both  of  our  papers,  we  could  only  conclude  that  tonography  was 
not  sufficiently  accurate  or  reproducible  in  the  individual  patient  as 
to  be  helpful  in  diagnosing  or  managing  a  patient.  As  an  indication 
for  surgery  or  in  making  a  diagnosis  on  a  patient,  we  felt  that  it  was 
a  waste  of  time  unless  the  glaucoma  was  severe.  Some 
ophthalmologists  were  even  using  a  tonographic  tracing  to  alter  the 
strength  of  the  patient's  miotic  therapy  from  visit  to  visit. 

Unfortunately,  their  enthusiasm  for  the  test  spread  like  wildfire. 
Millions  of  dollars  were  spent  on  tonography-and  innumerable 
man-hours-I  hate  to  think  of  the  time  wasted  on  it.  We  concluded, 
as  did  Morton  Grant,  that  tonography  is  reliable  only  for  studying 
large  groups  of  patients  where  you  can  arrive  at  statistical  results, 
for  example,  the  effect  of  a  drug  in  chronic  simple  glaucoma.  But  to 
make  decisions  on  an  individual  patient  with  a  tracing  which  is  not 
reproducible  was  not  justified.  Bernard  Becker,  in  discussing  our 
paper,  which  I  gave  before  the  American  Ophthalmological  Society 
in  1956,  said  that  I  had  just  set  our  knowledge  of  glaucoma  back  ten 
years. 

Hughes:     What  was  your  response? 

Scheie:       Well,  I  had  stated  my  case,  and  at  that  point  it  was  like  arguing 
religion.  I  wrote  no  more  papers  on  the  subject  and  it  took  nearly 
thirty  years  before  we  were  proved  to  be  correct  in  our  position  that 


** 


Parts  of  the  transcription  of  an  earlier  discussion  of  tonography  have  been  incorporated  here. 
Tonography.  Arch  Ophthalmol  1955;  54:515-27. 
***  The  second  paper  is:  Scheie  HG,  Spencer  RW,  Helmick  ED.  Tonography  in  the  clinical 
management  of  glaucoma.  Arch  Ophthalmol  1956,  56:797-818. 


248 


tonography  was  of  little  value  in  diagnosing  or  treating  individual 
patients.  It  eventually  was  proved  not  to  be  worth  the  money  spent 
on  the  equipment,  the  time  it  took  to  do  it,  or  even  the  money  spent 
on  the  paper  for  the  tracing.  However,  millions  of  dollars  had  been 
wasted  on  equipment,  patients'  time,  technicians'  salaries,  and 
ophthalmolgists'  efforts  worldwide,  to  say  nothing  of  problems 
created  by  erroneous  conclusions.  The  fact  is  that  tonography  has 
been  largely  abandoned  and  our  two  papers  have  been  verified.*  In 
the  interim  one  had  to  have  tonographic  values  to  publish  a 
glaucoma  paper. 

Largely  because  of  Morton  Grant's  outstanding  work,  we  had 
started  work  on  tonography  with  enthusiasm  about  the  possibility 
of  having  objective  measurements  to  study  and  treat  glaucoma.  If  a 
tonographic  tracing  had  told  us  whether  or  not  a  patient  had 
glaucoma,  measured  response  to  treatment,  or  given  other  helpful 
information,  it  would  have  been  a  godsend.  We  needed  help 
especially  in  the  diagnosis  of  mild  or  borderline  cases.  However,  its 
greatest  inaccuracy  occurred  [in  precisely  these  cases].  I  don't  think 
ophthalmologists  were  critical  enough.  They  jumped  on  a 
bandwagon,  and  voices  of  authority  deemed  tonography  to  be 
essential. 

Hughes:     Why  were  people  initially  enthusiastic? 

Scheie:       Because  Morton  Grant  and  others,  in  studying  large  number  of 

glaucoma  patients,  presented  reliable  statistical  data  which  helped 
establish  the  gonioscopic  approach  to  glaucoma  as  advocated  by 
Otto  Barkan.  Furthermore,  we  needed  help  so  badly,  we  would 
grasp  at  straws. 

Hughes:     Is  the  problem  in  the  technique  itself,  the  fact  that  the  measurement 
itself  is  not  reliable?  Or  is  it  the  fact  that  the  tension  is  variable? 

Scheie:       I  think  it  is  because  you  are  dealing  with  the  human  body.  Aqueous 
flow  can  vary,  for  example,  depending  upon  whether  the  patient  is 
relaxed  or  tense.  There  are  many  things  we  don't  understand.  But 
the  fact  is  that  you  can't  duplicate  the  tracing  of  a  patient  from  one 
day  to  another,  and  if  you  can't  duplicate  it,  which  one  are  you  going 
to  draw  conclusions  from? 

Hardly  anyone  does  it  any  more.  Even  Becker's  clinic,  I 
understand,  doesn't  bother  with  it.  And  certainly  Bob  Shaffer,  who 
was  one  of  Becker's  closest  collaborators,  has  given  it  up.  So  has 
the  Wilmer  Institute  where  Becker  trained. 


Teitelbaum  CS,  Podos  SM,  Lustgarten  JS.  Comparison  of  standard  and  computerized  tonography 
instruments  on  human  eyes.  Am  J  Ophthalmol  1985;  99:403-10.  Feghali  JG,  Azar  DT,  Kaufman 
PL.  Comparative  aqueous  outflow  facility  measurements  by  pneumatonography  and  Schiotz 
tonography.  Invest  Ophthalmol  Vis  Sci  1986;  27:1776-80.  Gaasterland  DE.  Studies  of 
reproducibility  of  the  tonographic  determination  of  facility.  Trans  Am  Ophthalmol  Soc  1987; 
95:208-21. 


249 


Grant  did  a  terrific  job  when  he  studied  groups  of  patients  with 
narrow-angle  glaucoma  and  open-angle  glaucoma.  He  thus  made 
major  contributions  toward  the  understanding  and  acceptance  of 
Barkan's  theories.  Eyes  with  narrow  angles  in  the  pre-glaucoma 
state  have  normal  outflow  of  aqueous  by  tonography.  During  acute 
attacks  the  outflow  becomes  zero  or  near  zero.  And  in  the  interval 
between  attacks  if  no  synechiae  have  formed  and  the  tension  is 
controlled  early,  chances  are  it  returns  to  normal. 

In  chronic  simple  (open-angle)  glaucoma  repeated  measurements  of 
the  ocular  pressure  leave  no  need  for  tonography.  The  higher  the 
pressure,  the  lower  the  outflow,  and  it  can  be  near  zero.  Then  you 
have  borderline  eyes.  Do  they  have  glaucoma  or  not?  Unless  they 
have  other  signs  of  glaucoma,  I  would  not  accept  a  diagnosis  on  the 
basis  of  a  tonographic  tracing  alone.  Now,  if  the  outflow  is  below 
0.15  cu  millimeter/min/millimeter  pressure,  they  may  have 
glaucoma.  Below  0.11,  they  almost  certainly  have  it,  but  those 
patients  will  have  elevated  pressures  and  are  usually  not  diagnostic 
problems. 

Hughes:     So  there  was  no  case  where  tonography  was  very  useful? 

Scheie:       Not  in  my  clinical  management.  But  with  adequate  numbers,  for 
research,  yes. 

Hughes:     Was  it  the  San  Francisco  group  that  was  particularly  advocating 
tonography? 

Scheie:       Well,  I  don't  know  about  the  group,  but  Bob  Shaffer  was  an 

advocate  of  tonography  and  so  were  most  ophthalmologists.  There 
seemed  to  be  a  bandwagon  for  tonography  around  the  country.  All 
you  need  to  do  is  look  at  textbooks  and  articles  of  those  years, 
including  those  of  Becker  and  Shaffer.  As  it  became  more  widely 
accepted,  I  began  to  wonder  if  I  was  the  problem.  However,  our  own 
work  in  tonography  was  carefully  done,  and  we  had  started  with 
bias  in  its  favor.  Actually,  our  conclusions  worried  me  a  great  deal 
because  I  wondered  how  all  of  those  people  could  be  wrong. 

Hughes:     But  they  were? 
Scheie:       It  seems  so. 

Hughes:     Was  it  Shaffer  who  actually  developed  the  instrumentation  and  the 
application? 

Scheie:       No.  I  believe  the  instrumentation  was  developed  by  Robert  Moses 
and  M.  Bruno  in  St.  Louis,  and  I  think  Grant  refined  it  some. 
Shaffer  may  have  contributed  to  had  input  into  the  final  type  of 
instrument.  It  was  also  modified  by  instrument  companies. 


250 


Angle- width  and  Pigmentation  Grading  by  Gonioscopy 

Hughes:     In  a  paper  in  1957  called,  "The  width  and  pigmentation  of  the  angle 
of  the  anterior  chamber,"  you  presented  a  system  of  grading  by 
gonioscopy.  * 

Scheie:       Yes.  The  width  was  based  upon  how  much  of  the  angle  you  could 
see,  and  that  was  determined  by  the  position  of  the  base  of  the  iris. 
If  the  iris  is  sufficiently  forward  or  anterior,  you  may  not  be  able  to 
see  into  the  angle.  I  used  a  system  of  grading  from  one  to  four, 
grading  angle  depth  and  pigmentation  separately.  The  most 
heavily  pigmented  angle  was  called  grade  IV  and  the  least  grade  I. 
A  nonpigmented  angle  was  so  stated.  For  angle  width,  grade  I 
narrow  was  very  slightly  narrowed  and  grade  IV  narrow  was  closed. 

Hughes:     Had  anybody  tried  to  grade  these  two  factors  previously? 

Scheie:  Becker  in  1961  and  [William]  Van  Herick  in  1969.**  Dr.  Becker 
had  almost  the  same  grading  system,  but  in  reverse.  However  I 
published  mine  before  he  did  his.  [laughter] 

Hughes:     Did  that  cause  problems? 

Scheie:       Not  really.  Being  on  the  side  of  tonography,  Becker's  word  carried 
more  weight  than  mine.  I've  seen  and  followed  large  number  of 
patients  with  pigmented  angles.***  The  glaucoma,  when  present  in 
both  eyes,  was  almost  invariably  more  severe  in  the  eye  with  the 
greater  pigmentation.  I  would  suspect  the  possibility  of  glaucoma 
by  finding  pigment  on  the  back  of  the  cornea  (Krukenburg's  spindle) 
by  slit  lamp.  With  the  gonioscopic  lens  you  could  predict  that  the 
more  heavily  pigmented  eye  would  have  the  more  severe  glaucoma. 
The  cause  of  pigmentary  glaucoma  is  unknown,  but  in  whatever 
way,  the  pigment  must  interfere  with  the  outflow  of  aqueous. 

Cyclodiathermy 

Hughes:     Well  then,  a  paper  in  1952  on  cyclodiathermy?**** 

Scheie:  That  operation  destroys  part  of  the  ciliary  body  to  cut  down  the 
amount  of  aqueous  that  flows  into  the  eye.  It's  a  safe  operation, 
easily  done. 


Scheie  HG.  Arch  Ophthalmol  1957;  58:5112. 

Van  Herick,  W:  Estimation  of  width  of  angle  of  anterior  chamber.  Am  J  Ophthalmol  1969, 
68:626.  Becker  B,  Shaffer  RN.  Diagnosis  and  Therapy  of  the  Glaucomas.  CV  Mosby  Co:  St. 
Louis,  1961,  50. 

Cameron  RC,  Scheie  HG:  Pigment  dispersion  syndrome:  A  clinical  study.  BrJ  Ophthalmol  1981; 
65:264-9. 

*  ^Scheie  HG.  Cyclodiathermy  in  the  treatment  of  glaucoma.  Western  J  Surg  Ob  Gyn  1952; 
60:322-6. 


251 


Hughes:     Apparently,  you  were  comparing  two  techniques? 

Scheie:       Yes,  multiple  punctures  versus  nine  to  twelve,  with  diathermy  to  be 
continued  for  up  to  ten  seconds. 

Hughes:     According  to  your  paper,  Alfred  Vogt  had  used  forty  to  sixty 
punctures. 

Scheie:       Yes.  But  there  were  too  many  punctures  and  too  close  to  the  limbus. 

I  didn't  originate  the  technique  I  used.  I  copied  it  from  Ramon 
Castroviejo  in  New  York  City.  I  had  worked  with  him  for  about  a 
year  and  a  half,  going  to  New  York  City  one  day  a  week.  He  was  an 
outstanding  surgeon  and  I  loved  to  watch  him  work  and  I  learned  a 
great  deal. 

Hughes:     At  Columbia? 

Scheie:       Yes.  He  did  this  operation  for  most  patients  with  open-angle 
glaucoma  and  I  used  his  technique. 

The  Vogt  technique  applied  the  punctures  over  a  band,  probably  six 
or  eight  millimeters  wide,  beginning  within  one  and  a  half  to  two 
millimeters  of  the  limbus.  The  heat  applied  so  near  the  limbus 
would  occasionally  injure  the  cornea  and  corneal  edema  would 
occur.  The  results  weren't  consistent  and  in  some  eyes  the  pressure 
recurred. 

At  least  Castroviejo's  operation  was  safe.  Nine  to  twelve  punctures 
were  each  placed  about  six  millimeters  back  from  the  limbus.  The 
diathermy  needle  was  held  in  place  for  ten  seconds.  Corneal  edema 
did  not  occur  but  the  pressure  tended  to  recur.  So  I  gave  it  up, 
except  for  blind,  painful  eyes. 

Hughes:     The  idea  is  to  cut  down  on  the  . .  . 

Scheie:       .  .  .  secretion  of  aqueous. 

Hughes:     Sheerly  by  tissue  or  cell  destruction? 

Scheie:       Yes.  It  was  meant  to  be  a  destructive  operation.  Laser  is  now  being 
used  for  the  same  purpose. 

Hughes:     Was  your  objection  to  Vogt's  procedure  the  secondary  damage  that 
could  be  done  to  the  cornea? 

Scheie:       No,  my  main  objection  was  that  it  wasn't  permanent. 
Hughes:     Why  would  it  tend  to  be  more  permanent  with  fewer  punctures? 

Scheie:       I  don't  know  that  it  was.  That's  the  objection  to  both  procedures, 
except  with  Vogt's  you  can  damage  the  cornea. 


252 

Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 


At  least  you  weren't  doing  that. 

Yes,  that  is  correct.  Castroviejo's  is  a  safe,  simple  operation,  and 
that  has  always  appealed  to  me,  but  too  often  it  wasn't  permanently 
effective. 

## 

Sources  of  Error  in  Perimetry 

In  a  paper  published  in  1953,  you  pointed  out  some  of  the  potential 
sources  of  error  in  perimetry.  * 

As  I  said  earlier  in  the  interview,  one  of  the  best  ways  to  follow  the 
effectiveness  of  glaucoma  therapy  is  to  do  repeated  visual  fields,  in 
addition  to  pressures  and  inspection  of  the  optic  nerve.  Visual 
fields  should  be  done  every  three  months  to  a  year,  depending  upon 
the  patient's  glaucoma  control,  but  rarely  should  the  interval  be 
longer  than  that.  The  patient  would  come  in  and  I'd  find  that  the 
visual  field  defect  was  much  worse  than  it  had  been  a  year  ago.  Yet 
when  I  dilated  the  pupil,  the  optic  nerve  was  unchanged  and  the 
visual  field  defect  returned  to  its  appearance  of  the  previous  year. 
After  a  few  patients  like  that,  I  began  to  be  interested  in  conditions 
that  could  simulate  progression  of  a  visual  field  defect. 

Two  prime  causes  were  a  miotic  pupil  and  increasing  nuclear  lens 
changes.  If  the  patient  had  used  his  miotic  drops  just  before  being 
examined,  miosis  could  reduce  the  amount  of  light  entering  the  eye 
from  the  test  target  and  the  glaucoma  defect  might  appear  bigger. 
So  the  ophthalmologist  might  think  that  the  patient  had  lost  vision 
from  his  glaucoma.  There  is  standard  lighting  for  the  perimetry,  so 
that  couldn't  be  the  cause.  Another  possible  explanation  for 
simulated  defects  in  visual  fields  is  nuclear  cataract  which  can 
filter  out  light  and  the  test  target  becomes  less  of  a  stimulus.  So  it 
was  a  very  practical  everyday  paper,  like  several  of  mine. 

The  Miotic  Resistant  Pupil 

Then  in  1953,  there  was  a  paper  with  George  Tyner  called, 
"Mechanism  of  the  miotic  resistant  pupil  with  increased  intraocular 
pressure.  "**  This  again  was  related  to  your  interest  in  glaucoma,  I 
assume. 


Scheie:       Yes. 


** 


Scheie  HG,  Day  RM.  Simulated  progression  of  visual  field  defects  of  glaucoma.  Arch  Ophthalmol 
1953;50:418-33. 

Tyner  GS,  Scheie  HG.  Arch  Ophthalmol  1953;  50:572-79. 


253 


Hughes:     What  were  the  practical  applications  of  this  paper? 

Scheie:       Well,  they  came  from  problems  we  were  having  with  patients 

during  acute  attacks  of  glaucoma.  Some  with  elevated  pressure 
during  an  acute  attack  would  develop  miotic-resistant  pupils. 
Miotics,  including  pilocarpine  and  eserine,  would  not  constrict  the 
pupil.  We  have  other  means  of  reducing  the  pressure,  but  we  would 
want  the  pupil  constricted  to  open  the  angle  to  help  break  the  acute 
attack.  Explanation,  so  far  as  we  knew,  had  never  been  given.  We 
were  curious  as  to  whether  the  eye  with  the  elevated  pressure  had 
absorbed  the  miotic,  whether  the  nerves  supplying  the  iris  had  been 
affected,  or  whether  the  muscle  itself  was  unable  to  respond  to  such 
a  stimulus. 

So  we  simulated  acute  glaucoma  in  animals  and  approached  the 
problem  using  various  tests  and  concluded  that  the  muscle  had 
been  rendered  inert  by  the  pressure.  We  used  air  to  maintain 
elevated  pressure  in  some  of  our  experimental  animals,  but  even  a 
direct-acting  substance  like  calcium  would  not  stimulate  the  muscle 
cell  to  contract.  So  we  had  to  conclude  that  the  muscle  cell  itself 
was  inactivated  by  the  pressure  and  could  not  respond  to  the  miotic. 

Glaucoma  and  Iris  Atrophy 

Hughes:  Another  paper  was  with  Dr.  Prayer,  "Cure  of  narrow  angle  glaucoma 
by  iris  atrophy,"  in  1963.*  You  reported  two  cases  in  which  repeated 
attacks  of  acute  glaucoma  were  terminated  by  iris  atrophy.  Was  that 
an  unusual  observation? 

Scheie:       I  think  it  was  fairly  unusual.  Certainly,  we  didn't  see  it  too  often.  A 
physiologic  iris  bombe  or  bowing  forward  of  the  iris  occurs  to  some 
extent  even  in  normal  eyes  and  is  caused  by  resistance  to  aqueous 
flow  where  the  posterior  surface  of  the  iris  in  the  pupillary  area  and 
the  anterior  surface  of  the  lens  are  in  contact  over  the  area  adjacent 
to  the  pupil.  Iris  atrophy  involving  this  area  could  reduce  or 
eliminate  that  contact  and  the  bombe.  The  iris  would  then  drop 
back  as  it  does  after  peripheral  iridectomy,  and  we  believe  that  is 
what  happened  with  our  patients. 

Hughes:     You  suggested  on  the  basis  of  these  observations  that 

sphincterectomy  might  be  prophylactic  against  acute  attacks  of 
narrow-angle  glaucoma. 

Scheie:       I'm  quite  sure  that  sphincterectomy  would  have  the  same  result  as 
iris  atrophy. 

Hughes:     Did  you  ever  try? 


Amer  J  Ophthalmol  1963;  55:335-8. 


254 


Scheie:       No,  we  didn't  because  peripheral  iridectomy  was  so  simple.  But  I'm 
quite  certain  it  would  be  effective. 

Hughes:     Dr.  Prayer  was  interested  in  glaucoma? 

Scheie:       Well,  yes,  but  you  do  see  many  different  names  on  my  papers.  We 

did  the  work  together  and  my  co-workers  received  credit  for  helping 
and  for  writing  a  paper  with  me.  I  have  always  felt  that  the  senior 
author  should  at  least  have  had  the  idea. 

Hughes:     Was  Dr.  Prayer  a  resident  at  that  time'? 

Scheie:       He  was  a  member  of  the  staff  and  working  with  me.  It  was  at  about 
the  time,  1962,  that  I  arranged  for  him  to  go  to  Jefferson  Medical 
College  to  help  Tom  Duane.  I  had  always  felt  very  close  to  Bill,  and 
Tom  was  a  good  friend  with  whom  I  had  worked.  Being  named 
chairman  of  the  department  of  ophthalmology  at  Jefferson  and  later 
at  Wills  Eye  Hospital  was  very  good  for  Tom  and  well  deserved. 

Hughes:     I  think  he  would  agree. 

Scheie:       The  job  of  ophthalmologist-in-chief  at  Wills  can  be  a  little  difficult. 
You  have  to  deal  with  a  large,  strong  staff,  and  the  Board  of  City 
Trusts.  Tom  is  a  gentle  person,  bright,  decent,  and  he  did  a  great 
job.  I've  forgotten  what  year  Wills  affiliated  with  Jefferson.  They 
were  affiliated  with  Temple  before  that. 

Hughes:     Wills  affiliated  with  Jefferson  in  1972* 

Scheie:       Problems  apparently  had  developed  at  Temple,  and  before  long 

Wills  affiliated  with  Jefferson  University  and  built  a  new  hospital 
adjacent  to  Jefferson's.  When  they  affiliated  with  Jefferson,  Tom 
became  the  chief  at  Wills  also. 

Oral  Glycerol 

Hughes:     In  1966  you  published  a  paper  on  "Oral  glycerol:  The  mechanism  of 
intraocular  hypotension.  "** 

Scheie:       I  had  something  to  do  with  initiating  it,  but  it's  largely  a  chemical 
paper.  Nobody  seemed  to  quite  know  how  glycerine  taken  by  mouth 
worked  in  lowering  pressure.  We  found  that  it  reduced  aqueous 
production. 

Hughes:     Was  there  any  particular  advantage  of  oral  glycerol  over 
osmotically-active  substances? 


For  the  recent  history  of  ophthalmology  at  Wills  and  Jefferson  see  the  forthcoming  interview  in 
this  series  with  Thomas  D.  Duane,  MI) 

**      Scheie  HG,  McCurdy  DK,  Schneider  B.  Am  J  Ophthalmol  1966;  61:304-9. 


255 


Scheie:       It's  safer  than  urea. 

Hughes:     The  co-authors  were  in  which  department? 

Scheie:       Dr.  McCurdy  was  in  the  department  of  medicine  and  Dr.  Schneider 
was  a  resident  in  our  department. 

Iris  Nevus  and  Glaucoma 

Hughes:     You  wrote  a  paper  in  1975  with  Yanoff,  "Iris  nevus  (Cogan-Reese) 
syndrome-a  cause  of  unilateral  glaucoma."* 

Scheie:       That  is  an  interesting  condition  which  is  rather  mysterious. 

Hughes:     Were  you  the  first  to  point  out  the  distinction  between  iris  nevus, 
essential  iris  atrophy,  and  malignant  melanoma? 

Scheie:       Oh,  no.  But  I  had  several  of  these  unusual  patients  and  had 

become  very  interested  in  the  iris-nevus  syndrome  and  its  clinical 
features. 

Hughes:     People  must  have  been  mixing  up  the  three  conditions  or  you 
wouldn't  have  bothered  to  write  a  paper  on  them. 

Scheie:       They  are  confusing  and  difficult  to  manage,  [skims  paper]  Yes,  I  did 
quite  a  bit  of  work  on  the  subject  and  gave  the  material  as  the 
Bedell  Lecture  in  1973. 

Hughes:     What  is  the  Bedell  Lecture? 

Scheie:       It  is  given  at  the  Wills  Eye  Hospital's  annual  conference.  It's  given 
in  honor  of  Arthur  J.  Bedell  who  was  an  alumnus  and  a  well-known 
and  respected  figure  in  ophthalmology. 

Hughes:     Why  do  the  patients  with  iris-nevus  syndrome  present  a  headache? 

Scheie:       Well,  it  is  difficult  to  maintain  useful  vision.  The  cornea  often 
becomes  edematous,  and  the  glaucoma  is  difficult  to  treat. 
Fortunately,  it  usually  involves  only  one  eye. 

Dr.  Ewing  is  following  one  of  my  patients  whom  I  saw  quite  a  few 
years  ago  and  who  had  been  operated  mistakenly  by  another 
ophthalmologist  for  narrow-angle  glaucoma,  mistaking  the  nevus 
strands  of  iris-nevus  syndrome  for  synechiae  due  to  glaucoma.  The 
patient  has  since  developed  corneal  edema. 

Hughes:     How  did  you  treat  the  syndrome? 


Arch  Ophthalmol  1975;  93:963-70. 


256 


Scheie:       There  isn't  much  you  can  do.  You  control  the  glaucoma,  but  corneal 
edema  often  develops  later,  as  do  cataracts.  Dr.  Yanoff  looked  at 
some  of  the  irides  that  I  had  removed  and  found  these  abnormal 
nevus  cells  on  the  surface,  but  they  were  known  before.  No  one  sees 
a  large  number  of  such  patients.  Peripheral  iridectomy,  just  the 
simple  one,  doesn't  do  it  because  it's  not  narrow-angle  glaucoma. 
What  look  like  peripheral  synechiae  show  in  the  chamber  angle,  but 
they  are  actually  part  of  the  nevus  picture.  Abnormal  nevus  cells 
growing  over  the  drainage  angle  undoubtedly  cause  the  glaucoma. 

Hughes:     So  there  are  two  problems. 

Scheie:       Oh,  it's  a  miserable  type  of  glaucoma. 

Pigment  Dispersion  Syndrome 

Hughes:     Well,  the  last  paper  that  I  have  to  discuss  today  was  published  in 
1981  on  pigment  dispersion  syndrome.  *  We  talked  a  little  about 
pigment  problems.  Four  hundred  and  seven  seems  an  amazingly 
high  number  of  patients  that  you  reported  on  with  this  syndrome. 

Scheie:       That's  my  lifetime  collection.  They're  considered  to  be  fairly  rare 
and  this  is  the  biggest  series  so  far.  The  British  Journal  of 
Ophthalmology  accepted  the  paper,  possibly  because  of  the  799 
eyes.  That  alone  was  worth  publication. 

Hughes:     Is  pigment  dispersion  syndrome  frequently  associated  with 
glaucoma1? 

Scheie:       Oh,  yes.  It's  a  definite  type  of  glaucoma.  Pigmentary  glaucoma 
might  have  been  a  better  word,  but  on  the  other  hand  many 
patients  with  pigment  dispersal  do  not  have  glaucoma. 

Hughes:     Do  you  have  any  theory  about  why  it  is  more  frequent  in  men? 

Scheie:       It's  genetic,  I  guess.  Why  do  men  have  whiskers  on  their  chin  when 
women  do  not? 

Hughes:     Yet  not  every  patient  with  pigment  dispersion  syndrome  has 
glaucoma? 

Scheie:       Yes,  but  if  you  follow  them  over  the  years,  more  develop  it. 
Hughes:     So  you  think  it's  a  matter  of  time? 


Scheie  HG,  Cameron  JD.  Pigment  dispersion  syndrome:  a  clinical  study.  Br  J  Ophthalmol  1981; 
65:264-9. 


257 


Scheie:       I  think  so,  and  possibly  the  tissue  response  of  the  person  to  his  own 
pigment  after  deposition  in  an  abnormal  place.  It  has  always 
fascinated  me. 

There's  a  paper  in  this  bibliography  on  the  transillumination  of  the 
iris  that  shows  where  the  pigment  comes  from.*  It's  a  condition 
that  has  interested  me  for  a  long  while  and  probably  because  of  this 
interest,  I  studied  these  eyes  very  carefully  from  the  standpoint  of 
glaucoma.  It  has  been  suggested  that  the  cause  of  transillumin 
ation  is  the  iris  rubbing  on  the  zonule,  causing  pigment  to  be 
rubbed  off. 

I  have  a  comparable  paper  that  was  published  on  another  condition. 
It's  called  pseudoexfoliation  of  the  lens  capsule.  Flecks  of  material 
that  we  think  may  come  from  the  lens  capsule  or  possibly 
precipitate  from  the  aqueous  may  cause  obstruction  to  outflow  of 
aqueous.  It  has  a  characteristic  picture  but  it  is  easy  to  overlook.  I 
had  a  great  many  of  these  patients,  which  Dr.  Theodore  Krupin  and 
some  of  his  associates  analyzed  and  published,  with  me  as  a 
co-author.** 

Hughes:     Did  you  reach  a  conclusion  about  what  the  cause  was? 

Scheie:       No,  it's  a  mysterious  condition  like  pigmentary  glaucoma.  The 
glaucoma  tends  to  be  severe  and  difficult  to  manage. 

## 
Hughes:     What  about  "idiopathic  atrophy  of  the  pigment  layers  of  the  iris"?*' 

Scheie:       Today,  this  would  be  called  pigment  dispersal  syndrome.  Idiopathic 
atrophy  of  the  pigment  layers  occurs  at  the  base  or  periphery  of  the 
iris  and  can  be  seen  by  observing  the  iris  while  holding  a 
transilluminator  on  the  sclera.  Ninety-seven  eyes  were  studied  and 
forty-two  had  glaucoma,  probably  because  the  liberated  pigment 
somehow  obstructs  the  trabeculum,  which  is  heavily  pigmented. 
The  pigment  is  also  deposited  on  the  corneal  endothelium  as 
Krukenberg's  spindle,  and  on  the  posterior  surface  of  the  equator  of 
the  lens.  This  was  described  in  1944  by  John  Bellows.**** 

Hughes:     Would  the  pigment  on  the  back  of  the  lens  interfere  with  the  function 
of  the  lens? 


** 


Scheie  HG,  Fleischhauer,  HW.  Idiopathic  atrophy  of  the  epithelial  layers  of  the  iris  and  ciliary 
body.  Arch  Ophthalmol  1958;  59:216-28. 

Henry  JC,  Krupin  T,  Schmitt  M,  Lauffer  J,  Miller  E,  Ewing  MQ,  Scheie  HG.  Long-term  follow-up 
of  pseudoexfoliation  and  the  development  of  open-angle  glaucoma.  Ophthalmol  1987;  94:  545-51. 

***  See  first  footnote. 

****Bellows  JG.  Krukenberg's  spindle  and  its  relation  to  annular  pigmented  bands  on  the  periphery 
of  the  lens.  Arch  Ophthalmol  1953;  36:1398. 


258 


Scheie:       No,  because  it  is  located  at  the  equator  and  on  the  zonule.  The 
pigment  probably  comes  from  the  epithelial  layers  of  the  iris  and 
the  ciliary  body  and  is  liberated  by  some  idiopathic  atrophy. 

Operating  for  Glaucoma 

Hughes:     Dr.  Ewing  told  me  that  over  the  course  of  your  career  you've  seen 
about  twelve-thousand  patients  with  glaucoma  or  problems 
somehow  related  to  glaucoma,  and  that  within  this  number  were 
three-hundred  to  four-hundred  cases  of  congenital  glaucoma, 
probably  the  largest  in  the  world,  wouldn't  you  say?* 

Scheie:  I  don't  know,  really.  Barkan  may  have  seen  more. 

Hughes:  Do  you  think  of  yourself  as  a  glaucoma  specialist? 

Scheie:  No. 

Hughes:  What  are  you  ? 

Scheie:       A  general  ophthalmologist,  interested  in  whatever  comes  along, 
[laughter] 

Hughes:     Who  just  happened  to  see  twelve-thousand  glaucoma  patients  along 
the  way! 

Scheie:       Well,  I  didn't  just  happen  to;  I'm  sure  many  of  them  were  referred. 
My  practice  during  the  last  fifteen  or  twenty  years,  I  guess,  was 
mainly  surgery  and  glaucoma.  I  would  do  as  many  as  ten  cataracts 
on  an  operating  day,  sometimes  less  and  occasionally  more.  I 
operated  two  half-days  a  week  and  they  were  very  busy.  However,  I 
spent  more  time  talking  people  out  of  surgery  than  I  did  trying  to 
convince  them  to  be  done.  I  never  strongly  urged  a  patient  to  be 
operated  unless  it  was  potentially  sight  saving.  With  certain  types 
of  glaucoma,  there  could  be  urgency  for  operating.  But  if  people 
were  getting  along  well  with  cataracts,  especially  in  one  eye,  why 
operate? 

Hughes:     Please  say  a  little  more  about  those  decisions  in  relationship  to 

glaucoma,  because  I  understand  that  the  boundary  between  an  eye 
with  glaucoma  and  one  without  is  very  shady,  that  you  can't  go 
strictly  on  pressure  readings. 

Scheie:       I  agree.  Some  people  would  say  I  treated  narrow-angle  glaucoma 
radically.  But  I  think  it  is  now  widely  accepted  that  early 
narrow-angle  (pre-and  interval)  glaucoma  should  be  operated.  I 
was  conservative  to  the  extent  that  I  always  did  provocative  tests 


Interview  with  Dr.  Madeleine  Q.  Ewing,  Philadelphia,  June  14,  1988. 


259 

on  such  eyes.  If  the  pressure  did  not  rise  during  a  pupillary  dilation 
test,  I  rarely  operated  unless  the  patient  had  an  acute  attack.  If  it 
rose  and  I  felt  that  an  acute  attack  threatened,  I  would  recommend 
a  peripheral  iridectomy. 

Nowadays,  iridectomy  is  even  simpler  with  the  laser.  The  laser 
wasn't  being  widely  used  for  glaucoma  at  the  time  I  stopped  doing 
surgery.  But  if  I  were  operating  today,  I  would  probably  use  it.  And 
yet  I  can't  remember  a  major  complication  resulting  from  a 
peripheral  iridectomy.  I  am  not  sure  that  by  using  the  laser  the 
groundwork  is  not  being  laid  for  an  occasional  cataract.  Possibly, 
fifty  years  from  now,  somebody  will  read  this  and  confirm  my 
suspicions.  But  it  does  give  me  a  sense  of  unease. 

I  did  not  operate  open-angle  glaucoma  unless  the  pressure  was 
sufficiently  high  that  I  could  be  certain  that  vision  would  be  lost,  or 
unless  it  was  a  young  person  with  infantile  or  juvenile  glaucoma. 
Then  it  wasn't  a  matter  of  selling  surgery  but  preventing  blindness. 
A  person  in  his  teens  with  severe  glaucoma,  even  with  no  cupping, 
is  not  going  to  go  through  life  without  losing  his  vision.  The 
patient's  age  is  always  a  major  consideration.  But  for  the  average 
adult  with  glaucoma,  I  wanted  to  know  [before  I  operated]  that 
medical  treatment  was  failing  or  that  the  pressure  was  unduly  high 
and  that  there  was  no  alternative  to  surgery. 

## 
Hughes:     Is  there  any  more  you  care  to  say  about  glaucoma? 

Scheie:       I  just  think  that  the  younger  generation  of  ophthalmologists  will 
never  be  as  grateful  as  I  for  the  gonioscopic  approach  to  glaucoma 
and  the  understanding  that  it  has  provided.  It  brought  daylight  to 
a  field  where  darkness  had  existed  since  medieval  times.  Little  had 
been  learned  about  glaucoma  until  Helmholtz  and  his 
ophthalmoscope  in  1851.  As  a  result,  the  next  decade  or  two 
revealed  almost  all  that  we  knew  until  miotics  came  along  in 
1974-5,  and  they  were  used  empirically.  Finally,  the  breakthrough 
made  possible  by  gonioscopy  gave  us  present-day  understanding  of 
glaucoma.  The  nature  of  the  obstruction  of  aqueous  in  open-angle 
glaucoma  will  undoubtedly  come  from  basic  scientists  and  their 
laboratories. 


260 


Cataracts 


Historical  Background 
[Interview:  June  15,  1988]  ## 

Hughes:  Dr.  Scheie,  I  thought  today  we'd  talk  about  cataract  surgery.  Could 
you  review  some  of  the  history  pertaining  to  techniques  for  cataract 
surgery? 

Scheie:       The  history  of  cataract  surgery  before  1750  is  really  quite  a  simple 
one  and  well  documented.  Cataract  had  been  recognized  as  a  cause 
of  poor  vision  for  centuries  before  the  birth  of  Christ.  For  at  least 
six  or  seven  centuries  before  the  birth  of  Christ,  couching  was  done 
to  displace  the  cataract  and  provide  a  clear  pupillary  space. 

As  a  result  of  couching  and  its  attendant  complications,  some  of  our 
semimodern  techniques  were  inadvertently  practiced  long  ago.  For 
example,  when  inserting  a  couching  needle  through  the  sclera  to 
displace  the  lens  posteriorly,  the  lens  capsule  might  be  cut  or  torn. 
That,  of  course,  is  equivalent  to  a  discission  operation  and  probably 
led  to  the  discission  operation  for  congenital  cataracts.  It  also 
became  known  that  the  lens  could  absorb  completely  if  the  capsule 
were  opened. 

Discussion,  or  opening  the  lens  capsule,  was  adopted  for  congenital 
cataracts  and  as  a  ripening  procedure  for  senile  cataracts.  It 
involves  opening  the  capsule  and  letting  the  lens  material  absorb  or 
be  digested  by  aqueous.  Absorption  may  be  complete  or  more 
discissions  may  be  needed  to  stir  up  residual  lens  material.  It's 
ordinarily  a  safe  procedure  but  synechiae  can  form  and  the  iris  can 
become  adherent  to  the  lens  material  and  the  anterior  chamber 
become  deformed.  A  pupillary  membrane  may  form  which  can  be 
very  dense  and  difficult  to  open  to  provide  a  pupillary  space. 
Instead  of  removing  the  lens  material  cleanly,  absorption  is  left  to 
nature.  Repeated  operations  are  frequently  necessary. 

Hughes:     Did  those  early  people  realize  what  was  happening? 

Scheie:       I  don't  believe  they  realized  exactly  what  a  cataract  was  until 

around  the  beginning  of  the  eighteenth  century  when  two  eyes  were 
dissected  by  Banister,  and  the  difference  between  cataract  and 
glaucoma  was  recognized.  It  was  only  then  that  the  two  conditions 
were  differentiated. 

The  first  surgical  removal  of  the  lens  was  done  in  1752  by  Dr. 
Jacques  Daviel.  From  that  time  on,  methods  were  refined  and  new 


Portions  of  a  later  historical  discussion  have  been  added  here. 


261 

techniques  evolved.  Discission  of  congenital  cataracts  became  an 
accepted  procedure.  A  cutting  instrument  was  inserted  through  the 
sclera  into  the  lens  through  the  cornea.  Optical  iridectomy  I  cannot 
date,  but  it  was  widely  used  in  Europe  in  lieu  of  cataract  extraction. 
A  congenital  cataract  may  be  central  and  the  vision  can  be 
improved,  sometimes  dramatically,  by  a  sector  iridectomy  which 
enlarges  the  pupil.  Iridectomy  is  simple  and  quite  safe.  The  vision 
is  almost  never  perfect,  that  is  20/20,  but  it  can  be  greatly 
improved.  In  those  days  it  was  a  worthwhile  adjunct  and  it  even  is 
today. 

Extracapsular  versus  Intracapsular  Extractions 

Hughes:     What  techniques  were  being  used  when  you  entered  ophthalmology 
in  1937? 

Scheie:       Daviel  did  extracapsular  extractions  that  remained  in  vogue  until 
the  famous  British-Indian  surgeon,  Col.  Henry  Smith,  near  the 
beginning  of  the  twentieth  century  began  to  use  the  intracapsular 
technique  which  removed  the  entire  lens  in  its  capsule. 

When  I  started  my  residency  in  1937,  both  methods  were  being 
used.  Residents  were  usually  not  allowed  to  do  intracapsular 
operations  because  they  were  considered  dangerous,  and  I 
originally  did  extracapsulars.  Later  as  senior  residents  we  were 
occasionally  allowed  to  do  intracapsulars.  This  was  during  the 
introduction  of  that  technique. 

Hughes:     Why  was  the  intracapsular  procedure  considered  dangerous? 

Scheie:       Because  of  vitreous  loss.  The  lens  is  quite  firmly  attached  to  the 
zonule  and  is  removed  by  a  combination  of  traction  with  a  forceps, 
which  grasps  the  lens  capsule,  and  pressure  on  the  sclera  inferior  to 
the  limbus.  Some  techniques  involved  pressure  above  as  well  as 
below  and  really  expressed  the  lens.  The  danger  of  vitreous  loss  was 
great. 

Hughes:     I  have  a  quote  from  the  interviews  with  Dr.  Thygeson,  which  I 
thought  you  might  be  interested  in.  He  said,  "Dr.  [John] 
Wheeler"-who  was  at  Columbia-" touted  the  extracapsular  operation 
for  cataract,  and  Dr.  [Arnold]  Knapp  brought  in  the  intracapsular 
operation  .  .  .  The  funny  thing  was  that  Knapp's  type  of  operation 
became  predominant  after  a  while.  Everybody  did  the  intracapsular 
operation.  But  now  it  has  gone  back  to  the  extracapsular."*  Do  you 
know  why  Dr.  Wheeler  espoused  the  extracapsular? 


Phillips  Thygeson,  MD.  External  Disease  and  the  Proctor  Foundation.  An  oral  history  conducted 
in  1986-87  by  Sally  Smith  Hughes,  PhD.  The  Foundation  of  the  American  Academy  of 
Ophthalmology,  San  Francisco,  California,  and  the  Regional  Oral  History  Office,  The  Bancroft 
Library,  University  of  California,  Berkeley,  1988,  72. 


262 


Scheie:       Because  of  less  danger  of  vitreous  loss.  The  problem  with  the 

extracapsular  is  that  you  leave  lens  cortex  and  the  posterior  capsule 
behind,  which  later  frequently  opacifies,  even  though  it's  clear  at 
the  time  of  surgery.  Cells  can  proliferate  over  the  capsule  and 
debris  may  precipitate  onto  it  and  in  time  may  blur  vision.  A 
secondary  operation  (capsulotomy)  may  be  necessary  and  that 
always  has  been  one  of  the  main  objections  to  the  extracapsular 
technique.  Also  lens  cortex  may  be  left  behind  which  can  cause 
severe  reactions  with  synechiae  and  late  complications.  The  danger 
of  secondary  glaucoma  following  surgery  is  greater  following  an 
extracapsular  extraction.  But  the  extracapsular  was  defended 
because  of  the  safety  of  the  operation  itself. 

The  reason  we've  gone  back  to  it  is  that  the  present  technique  of 
placing  lenses  behind  the  iris  is  safest  with  extracapsular 
extraction.  Dr.  Charles  D.  Kelman's  lens  emulsifier  and  a  very 
newly  developed  aspirator  remove  lens  cortex  cleanly.  The  posterior 
capsule  is  left  in  place  to  protect  the  face  of  the  vitreous  and 
support  the  new  lens.  Before  that  the  intraocular  lenses  were 
placed  in  the  anterior  chamber  when  doing  intracapsular 
extraction.  The  lens  was  located  in  front  of  the  iris  and  many 
complications  could  result.  In  fact,  I  was  never  willing  to  insert  one 
of  those  lenses  because  in  my  practice  I  saw  so  many  of  the 
complications  of  other  surgeons.  If  I  were  operating  today  I  would 
be  doing  the  operation  with  the  lens  placed  behind  the  iris. 

Phacoemulsification 

Hughes:     Do  you  remember  when  phacoemulsification  became  widely  used  in 
ophthalmology? 

Scheie:       Yes,  it  was  probably  in  the  mid-sixties.  Dr.  Kelman  had  been  a 

resident  at  Wills  Eye  Hospital  and  occasionally  came  to  observe  my 
surgery  at  the  University  of  Pennsylvania  Hospital.  I  often  told  a 
guest,  "I'm  pleased  that  you  came  today  because  I  have  two  or  three 
lenses  to  aspirate,  and  even  I  can  do  them  without  complications." 
[laughs] 

Dr.  Kelman  later  told  me  that  one  of  the  reasons  he  became 
interested  in  phacoemulsification  was  that  he  had  watched  me 
aspirate  congenital  cataracts  and  cataracts  in  young  people  up  to 
thirty  years  of  age  using  a  simple  modified  intravenous  needle.* 
His  lens  fragmentation-aspiration  method  is  basically  an 
aspiration  made  possible  by  using  ultrasound  to  fragment  the  lens 
while  simultaneously  aspirating  the  fragments. 


Scheie  HG.  Aspiration  of  congenital  soft  cataracts:  A  new  technique.  Am  J  Ophthalmol.  1960; 
50:1048-56. 


263 


Why  didn't  we  aspirate  all  cataracts  by  suction?  I've  probably  told 
you  how  safe  my  technique  was  for  me  and  that  it  had  made 
congenital  cataract  surgery  enjoyable.  Kelman's  phacoemulsifier 
made  it  possible  to  aspirate  cataracts  in  adults  because  it 
emulsified  the  nucleus.  I  was  so  interested  in  the  method  that  I 
invited  him  to  lecture  at  one  of  our  HUP  staff  conferences. 
Following  this,  I  bought  two  of  the  machines,  one  for  a  back  up. 

Hughes:     Well,  he  had  the  inspiration  from  you  but  then  the  technical  part .  .  . 
Scheie:       I'm  not  sure  whom  he  worked  with. 

Hughes:     Are  there  dangers  to  phacoemulsification?  What  happens  to  the 
surrounding  structures? 

Scheie:       There  are  dangers.  It  must  be  done  under  a  microscope  and  care 
must  be  taken  not  to  injure  cornea  and  iris  or  to  rupture  the 
posterior  capsule.  I've  used  the  emulsifier  on  several  occasions  but 
not  routinely.  I  was  the  first  to  employ  it  here  at  the  eye  institute. 
I  thought  it  was  something  that  I  should  at  least  investigate  and  be 
familiar  with.  It's  a  beautiful  instrument  but  it  can  damage  the 
iris,  the  posterior  capsule  of  the  lens,  or  the  cornea,  which  was  the 
complication  that  I  feared  the  most. 

Hughes:     Can  it  be  very  precisely  targeted? 

Scheie:       Yes,  but  a  microscope  must  be  used.  The  iris  is  retracted  by  wide 
pupillary  dilation  but  with  great  care. 

Hughes:     Was  it  because  of  the  danger  that  you  didn't  use  it  very  often? 

Scheie:       Well,  it  was  something  new  and  my  results  with  my  conventional 
intracapsular  extractions  were  satisfactory.  I  was  not  inserting 
anterior  chamber  lenses,  and  this  was  before  the  posterior  chamber 
lens  was  widely  accepted. 

Intraocular  Lenses* 

Scheie:       I've  never  been  one  to  do  procedures  that  I  did  not  consider  safe. 
Each  patient  should  be  treated  like  a  member  of  your  family.  So 
most  of  the  things  that  I  have  written  and  talked  about  evolved 
slowly  and  safely. 

I  did  a  great  deal  of  surgery  until  five  years  ago  when  I  abruptly 
stopped.  I  began  to  ask  myself-that  was  one  year  after  my  heart 
surgery-what  I  was  doing  and  why  I  was  doing  it.  Also,  I  would 
never  have  put  in  one  of  the  implant  lenses  which  were  the  rage  in 
those  days,  the  anterior-chamber  type.  In  my  office  I  had  seen  in 


*        Portions  of  an  earlier  discussion  of  intraocular  lenses  have  been  incorporated  here. 


264 

consultation  a  tremendous  number  of  complications  due  to  them, 
and  many  eyes  were  lost.  I  could  not  and  would  not  do  that  to  my 
patients.  However,  I  did  tell  my  residents  and  staff  that  I  would 
participate  in  a  project  done  as  part  of  a  controlled  NIH  [National 
Institutes  of  Health]  study  with,  say,  one  of  a  half-dozen  or  a  dozen 
schools  utilizing  uniform  procedures  and  keeping  accurate  data, 
especially  on  the  complications. 

Many  implants  were  being  done  with  great  fanfare,  but  no  one 
knew  the  true  incidence  of  complications.  Some  entrepreneurs 
would  talk  about  these  lenses  at  short  courses  and  other  meetings 
but  you  would  hear  little  about  the  problems.  You  heard  only  about 
the  beautiful  results  when  successful  but  very  little  about  the  early 
and  late  failures.  I  took  the  complications  that  I  was  seeing  as  a 
warning  signal.  Ophthalmologists  felt  pressured-and  that  was 
happening  all  around  the  country-to  put  in  these  lenses,  but  today 
that  type  of  operation  is  practically  abandoned.  The  lenses  are  now 
being  inserted  behind  the  iris  after  doing  an  extracapsular 
extraction,  which  is  a  very  different  operation  and  one  that  I  would 
be  doing  if  I  were  operating.  But  when  I  think  of  the  hundreds  and 
even  thousands  of  eyes  that  have  been  ruined  by  what  in  reality 
was  experimentation  on  human  beings  with  little  control,  I  find  it  is 
difficult  to  accept. 

Hughes:     Did  you  speak  out  publicly1? 

Scheie:       I  certainly  did  speak  out  publicly.  In  fact,  as  I  said,  I  gave  the 

Derrick  Vail  Lecture  in  Nairobi  in  1980  before  the  Fourth  World 
Congress  of  the  Society  of  Eye  Surgeons  on  complications  of  that 
type  of  surgery*  I  have  at  least  a  couple  hundred  of  such  slides  in 
my  collection. 

Hughes:     What  sort  of  things  could  go  wrong? 

Scheie:       Mainly  the  corneal  problems  caused  by  contact  with  a  displaced 

lens.  The  most  serious  complication  was  corneal  edema  caused  by 
the  lens  coming  in  contact  with  the  cornea.  As  a  result,  the  need  for 
corneal  transplantation  increased  tremendously  around  this 
country. 

I  was  concerned  about  the  way  the  lens  had  been  introduced.  By 
the  way,  the  first  one  was  done  about  forty  years  ago  by  Dr.  Harold 
Ridley  of  London,  a  friend  of  mine.  He  was  the  pioneer,  but  I  felt  he 
had  been  a  little  erratic  in  placing  a  plastic  lens  in  an  eye. 
However,  it  was  soon  taken  up  in  this  country.  Such  things  as 
impure  plastic,  which  could  cause  irritation,  dislocated  lenses,  and 
other  problems  resulted. 


Cataract  complications:  Shifting  emphasis.  Fourth  World  Congress  of  the  Society  of  Eye 
Surgeons,  Nairobi,  1980. 


265 


The  intraocular  lenses  were  accompanied  by  much  fanfare  in  our 
country  with  many  ophthalmologists  on  the  bandwagon.  I  felt  at 
the  time  that  this  was  not  wise  and  that  their  use  should  be 
restricted  to  a  small  number  of  institutions  which  would  pool  their 
results  and  evolve  objective  data. 

Hughes:     Were  there  many  different  types  of  intraocular  lenses  available 
almost  immediately? 

Scheie:       There  were  and  more  are  still  appearing. 
Hughes:     It  was  something  that  industry  leaped  into1? 

Scheie:       Industry  helped  to  promote  it  and  was  important  in  developing  new 
and  improved  lasers.  From  all  of  this  activity  have  come  some  of 
the  entrepreneurs  that  concern  many  of  us  in  ophthalmology- 
cataract  specialists  doing  large  number  of  cataract  operations  a 
week,  and  with  great  fanfare.  I  was  uneasy  about  anterior  chamber 
lenses  from  the  beginning  and  never  used  one,  but  if  I  were 
operating  at  this  time  I  would  be  doing  the  post-placed  lenses.  In 
the  meantime,  many  eyes  were  subjected  to  complications  and  that 
worried  me.  We  should  have  a  program  in  this  country  that 
requires  supervision  and  control  when  certain  innovative  but 
potentially  hazardous  and  unproved  practices  are  being 
investigated. 

Hughes:     Why  wasn't  there  control  in  this  particular  case1? 

Scheie:       It  became  popular  very  quickly  and,  I  add,  widely  publicized.  Once 
it  was  widespread,  there  was  probably  no  way  of  controlling  it. 

Hughes:     There  was  considerable  public  demand  as  well,  was  there  not? 

Scheie:       Yes.  I  should  add  that  when  no  complications  occurred  the  patients 
loved  the  lenses  and  were  very  happy. 

Hughes:     People  at  the  institute  now  insert  the  intraocular  lens,  do  they  not? 

Scheie:       Yes,  using  the  posterior  chamber  technique.  The  results  of 

posterior  chamber  lens  procedures  combined  with  extracapsular 
extraction  are  much  improved  over  those  of  the  anterior  chamber 
operations  and  have  seemingly  revolutionized  cataract  surgery.  It 
is  now  done  in  preference  to  other  techniques,  which  is  appropriate 
because  it  means  so  much  to  the  patient. 

Cataract  Ripening 

Hughes:     I  came  across  the  term  "cataract  ripening"  and  I  wonder  if  you 
would  tell  me  about  that. 


266 


Scheie:       The  first  person  to  suggest  ripening  for  cataract  extraction  was 
William  Gibson,  a  Philadelphia  eye  surgeon,  in  1811,  who  urged 
opening  the  anterior  lens  capsule  to  speed  up  incomplete  cataracts 
for  extracapsular  extractions.  It  permitted  the  aqueous  humour  to 
penetrate  into  the  lens  to  soften  and  to  liquefy  the  cortex.  The  lens 
became  opaque  (cataract  complete)  so  that  after  delivery  of  the 
nucleus,  the  cortex  could  be  washed  out  quite  easily.  In  a  younger 
patient  where  the  nucleus  has  not  yet  become  hard,  the  lens  can  be 
removed  through  a  smaller  opening.  I  used  the  ripening  operation 
for  younger  people  under  thirty  years  of  age  and  for  congenital 
cataracts  in  children  so  that  the  lenses  could  be  aspirated. 

Hughes:     How  did  surgeons  of  Gibson's  generation  place  the  needle?  Did  they 
use  a  microscope? 

Scheie:       The  needle  was  inserted  through  the  periphery  of  the  cornea. 

Microscopes  were  not  available.  Without  the  cataract  ripening  the 
patient  had  to  wait  until  the  cataract  was  complete. 

Hughes:     Was  that  a  matter  of  days? 

Scheie:       Oh,  no.  It  could  be  months  or  years.  This  was  avoided  by  the 
ripening  procedure  which  was  never  widely  adopted. 

Hughes:     I  read  that  the  process  could  be  speeded  up  by  breaking  the  capsule. 

Scheie:       That's  what  the  ripening  operation  is.  You  go  in  with  a  needle  and 
open  the  capsule. 

Hughes:     Then  it's  a  matter  of  a  much  shorter  passage  of  time,  isn't  it? 

Scheie:       It  could  be  hours  or  days.  After  the  capsule  is  opened  the  ocular 
pressure  often  goes  up.  Removing  the  lens  cures  the  glaucoma, 
which  is  an  osmotic  phenomenon. 

Cataract  Aspiration 

Hughes:     When  did  you  begin  to  use  the  suctioning  technique  in  cataract 
extraction  ? 

Scheie:       It  was  in  1943  in  the  China-Burma-India  theatre.*  One  of  my  early 
experiences  was  with  a  man  in  his  early  forties  who  came  in  with  a 
penetrating  injury  of  his  eye  involving  the  lens.  The  cornea  and  the 
lens  had  been  traversed  by  a  mortar  shell  which  I  removed  with  a 
magnet.  I  was  not  experienced  enough  with  trauma  at  the  time  to 
hurry  the  cataract  along  and  remove  it.  In  a  matter  of  probably  two 


Scheie  HG.  Aspiration  of  congenital  or  soft,  cataracts:  A  new  technique.  Am  J  Ophthalmol  1960; 
50;  1048-56. 


267 


Hughes: 
Scheie: 


Hughes: 
Scheie: 
Hughes: 
Scheie: 


or  three  weeks,  he  had  an  irreversible  problem  with  inflammation 
and  eventually  lost  the  sight  of  the  eye. 

Putting  two  and  two  together,  I  felt  that  I  had  been  at  fault  by 
failing  to  remove  the  injured  lens.  Many  of  us  had  not  seen  a  large 
number  of  eye  injuries  and  their  consequences  but  I  kept  his 
situation  in  mind  for  the  future.  Most  of  the  injuries  were  in  young 
soldiers.  The  man  I  just  mentioned  was  older  and  his  lens  had  a 
hard  nucleus.  The  nucleus  was  soft  in  youngsters  up  to  thirty  years 
of  age.  If  the  lens  would  swell  and  become  opaque,  I  could  then 
insert  a  #19  intravenous  needle  through  a  puncture  opening  and 
aspirate  it,  avoiding  the  need  for  a  large  incision.  It  was  a 
technique  that  I  evolved  overseas  as  a  result  of  caring  for  injured 
young  soldiers. 

After  I  returned  to  the  United  States  I  had  a  special  needle  made  by 
Becton  and  Dickinson.  It  has  the  outside  diameter  of  a  #19 
intravenous  needle  but  with  a  thin  wall  which  provides  the  lumen 
of  a  #18  needle.  So  it's  a  thin-walled,  large-bore  #19  needle  with  a 
flat  oval-grind  tip.  By  injecting  saline  as  I  inserted  the  needle  into 
the  anterior  chamber,  it  did  not  catch  on  the  iris.  The  technique 
was  simple  and  with  no  danger  of  vitreous  loss  and  no  problems 
with  wound  closure.  In  Philadelphia,  I  began  to  use  it  for 
congenital  cataracts,  a  condition  accompanied  by  a  significant 
number  of  surgical  complications  with  older  techniques.  At  that 
time  about  twelve  percent  of  the  blindness  in  school  children  was 
due  to  congenital  cataracts. 

Why  were  there  so  many  problems  with  cataract  extraction? 

Because  the  incisions  used  for  linear  extractions  were  large  enough 
to  permit  vitreous  loss,  a  serious  complication.  Also  the  lens 
material  often  could  not  be  removed  cleanly  and  remained  in  the 
anterior  chamber  where  it  could  cause  inflammation  with 
adhesions  and  other  problems.  The  ripening  operation  in  children 
and  infants  required  only  very  light  anesthesia.  Only  a  minute  or 
two  was  needed  to  open  the  lens  capsule  with  a  knife  needle. 
Anywhere  from  a  few  hours  to  a  week  later  the  lens  would  be  soft, 
usually  completely  opaque,  and  easily  aspirated.  The  pressure 
became  elevated  in  some  patients,  but  aspiration  of  the  lens  would 
immediately  relieve  both  it  and  the  discomfort.  The  operation  is 
safe  with  almost  no  complications. 

Were  you  the  first  to  revive  the  suction  technique? 
No.  The  suction  technique  went  back  to  the  1700s. 
I  know,  but  it  hadn't  been  used  in  recent  years. 

It  had  rarely  been  used  and  I  don't  know  that  it  had  ever  been  used 
for  congenital  cataract,  but  to  say  that  I  devised  the  suction 


268 

technique  or  the  preliminary  needling  is  inaccurate.  As  I 
mentioned,  Gibson  had  used  the  latter  for  senile  cataract.  He  found 
that  it  ripened  an  incomplete  cataract  and  made  extraction  simpler. 
When  the  cortex  was  softened,  the  hard  nucleus  could  be  expressed 
with  ease  and  the  cortex  washed  from  the  chamber. 

Hughes:     Is  it  fairly  easy  to  do  an  adequate  cleaning  job  of  the  capsule  itself? 
Scheie:       Yes,  but  it  may  cloud  later. 

## 

I  liked  guests  to  watch  the  aspiration  needle  being  inserted  through 
the  opening  made  by  the  knife  needle  for  the  ripening  procedure 
and  then  to  see  the  opaque  lens  being  sucked  out.  The  lens 
material  disappeared  dramatically  through  the  aspirating  needle. 
Sometimes,  however,  the  lens  material  did  not  come  out  cleanly 
because  the  pupil  dilated  poorly  and  the  iris  had  interfered  with  the 
suction.  Rarely,  it  might  have  to  be  repeated. 

Since  the  phacoemulsifier  has  the  same  amount  of  fluid  flowing  into 
and  out  of  the  eye,  suction  proceeds  and  the  chamber  remains  deep. 
The  phacoemulsifier  makes  suction  removal  of  nearly  all  cataracts 
possible.  But  the  aspiration  technique  is  worthwhile  even  if  it  was 
an  outgrowth  of  the  original  technique  of  the  old-timers. 

Hughes:     Dr.  Ewing  mentioned  that  there  was  quite  a  variety  of  techniques 
that  had  been  evolved  for  placing  the  fluid  in  the  eye  and  doing  the 
extraction  at  the  same  time.*  You  seem  to  do  it  with  great  ease  but 
some  surgeons  have  problems  handling  the  suction  and  the  injection 
of  the  fluid  as  well. 

Scheie:       Great  care  must  be  taken  not  to  suck  against  the  posterior  capsule 
because  it  can  tear  and  also  not  to  suck  against  the  iris.  The 
aperture  of  the  needle  should  be  turned  away  from  those  structures 
and  the  pupil  kept  widely  dilated.  Aspiration  is  simple  and 
effective  in  children  where  the  lens  material  is  very  soft.  I  think  if  I 
were  operating  today,  I  would  probably  not  use  the  phaco  for 
children  but  I  would  use  it  for  adults  and  post-placed  implant 
lenses. 

I  was  extremely  grateful  for  the  suction  procedure  as  I  used  it, 
because  I'd  seen  so  many  complications  with  congenital  cataracts, 
with  various  techniques.  Discission  of  the  lens  opened  the  anterior 
capsule  and  allowed  nature  to  absorb  the  lens.  It  was  a  technique 
that  I  grew  up  with.  Two  or  three  or  even  more  needling  procedures 
might  be  needed  to  further  stir  up  the  lens  material  and  promote 
absorption.  The  end  result,  unfortunately,  could  be  a  fibrotic 
membrane  with  the  iris  bound  to  the  residual  lens  material  and 


Interview  with  Dr.  Madeleine  Ewing,  Philadelphia,  June  14,  1988. 


269 


capsule.  Secondary  glaucoma  and  iris  bombe  were  not  unusual.  A 
subsequent  operation  was  nearly  always  necessary  to  cut  the 
residual  membrane  to  provide  a  clear  pupillary  opening.  Retinal 
detachments  and  secondary  glaucoma  were  not  unusual.  I  dreaded 
congenital  cataracts  until  after  World  War  II  when  I  began  to 
utilize  my  aspiration  technique  that  had  been  so  useful  for  young 
soldiers. 

Hughes:     Did  that  become  very  quickly  the  preferred  technique? 

Scheie:       I  don't  know  how  widely  it  was  adopted.  Actually, 

phacoemulsification  is  an  adaption  of  the  suction  technique  and  a 
very  ingenious  development. 

Hughes:     What  are  the  causes  of  cataract? 

Scheie:       Genetic  is  the  most  common.  Congenital  cataracts  can  be,  and 
often  are,  familial.  Somewhere  along  the  lineage  you  may  find 
another  person  with  them.  Unfortunately,  cataracts  can  be 
associated  with  other  abnormalities  of  the  eye  and  they  are 
frequent  in  rubella.  You  learned  about  the  little  patient  of  mine 
this  morning  who  had  rubella  cataracts  and  very  small  eyes  which 
led  to  problems.  So  not  all  congenital  cataracts  do  beautifully. 
Patients  with  otherwise  normal  eyes  usually  do  well  but  those  with 
associated  problems  and  anomalies  may  carry  a  poor  prognosis. 

Hughes:     Is  the  small  eye  characteristic  of  rubella  infection? 
Scheie:       No,  but  it's  common. 

Criteria  for  Operating  for  Cataract 

Hughes:     Tell  me  some  of  the  criteria  that  you  considered  when  you  were 
deciding  whether  to  operate  for  cataract. 

Scheie:       The  criterion  I  never  solely  depended  upon  was  my  vision  chart.  In 
young  children  and  the  mentally  handicapped  you  can't  use  it.  In 
adults,  many  factors  must  be  considered. 

I  remember  vividly  a  truck  driver  and  another  patient  who  was  an 
accountant.  I  advised  the  accountant  against  surgery.  He  had 
early  localized  posterior  subcapsular  cataracts  with  20/20  vision  on 
the  Snellen  chart  but  he  complained  and  complained.  He  saw  me 
two  or  three  times  hoping  to  improve  his  vision  because  he  was 
having  great  difficulty  with  his  fine  work.  I  was  inexperienced  at 
that  time  and  felt  that  with  6/6  vision  and  his  minimal  lens  changes 
surgery  was  not  indicated.  This  was  a  mistake  and  before  long  he 
sought  other  help  and  was  operated  elsewhere  with  a  good  result, 
which  ended  the  difficulties  with  his  close  work. 


270 

The  other  was  a  truck  driver  who  was  still  driving  and  had  6/60 
vision,  legal  blindness.  He  said  that  he  had  something  wrong  with 
his  eyes  and  would  I  look  at  them  and  help  him  if  I  could? 
Unbelievably,  he  had  cataracts  even  though  he  was  still  driving  a 
truck.  Everyone  would  have  agreed  that  I  was  justified  in 
operating.  I've  had  truck  drivers  come  in  because  of  light  scattering 
at  night  and  poor  vision  in  bright  sunlight  due  to  early  posterior 
subcapsular  cataracts,  yet  they  had  20/20  or  20/15  vision  on  a 
Snellen  chart.  They  needed  help  as  badly  as  the  accountant  and 
their  livelihood  could  be  restored  by  cataract  surgery.  Yet  I've  heard 
ophthalmologists  say,  "That  man  would  even  operate  on  patients 
with  20/20  vision." 

A  history  is  important.  I  always  determine  why  the  patient  feels 
handicapped  before  deciding  for  or  against  cataract  surgery.  I  have 
spent  my  share  of  time  talking  patients  out  of  surgery,  particularly 
the  person  who  came  in  with  a  unilateral  cataract,  incomplete  in 
the  eye,  and  doing  everything  that  he  wanted  to  do.  If  it  didn't 
interfere  with  his  life  except  for  blurred  vision  in  one  eye,  I  would 
advise  against  surgery.  However,  if  the  cataract  was  complete, 
because  such  cataracts  can  be  a  threat  to  the  eye,  that's  different. 
Then  the  age  of  the  patient  and  his  activities  are  important. 
Nowadays,  with  newer  and  safer  techniques,  implant  lenses,  and 
quick  recoveries,  indications  for  surgery  may  be  more  liberal. 

Steps  in  Operating  for  Cataract 

Hughes:     Would  you  describe  the  steps  you  took  from  the  moment  that  the 

patient  first  arrived  in  your  office  to  the  postoperative  period1?  I'm 
particularly  interested  in  hearing,  after  talking  with  Dr.  Swing,  how 
you  anticipated  potential  problems  with  certain  patients  and  took 
steps  to  compensate. 

Scheie:       Well,  as  I  said  yesterday,  I  always  felt  that  surgery  should  be 

defensive  and  directed  toward  protecting  the  patient.  The  surgeon 
should  anticipate  possible  complications  and  then  hopefully  be  able 
to  prevent  them.  While  I  examined  a  patient  in  my  office,  I  would 
make  notes,  such  as  whether  to  use  hypertonic  agents  to  soften  an 
eye  for  an  extremely  near-sighted  person  where  vitreous  loss  might 
occur.  A  careful  physical  examination  should  be  done  to  determine 
possible  general  health  problems  that  might  interfere  during  or 
after  surgery.  If  a  lens  is  subluxated  or  partially  dislocated, 
protective  steps  can  be  taken  before  or  during  surgery.  I  would 
always  look  for  any  clues,  ocular  or  otherwise,  that  might  help  in 
preventing  complications. 

Hughes:     One  of  Dr.  Swing's  examples  was  that  you  might  tip  back  a  heavy 
patient's  head  while  elevating  the  head  of  the  operating  table. 


271 


Scheie:       Yes,  and  it  would  be  in  that  type  of  patient,  hypertonic  agents 
would  be  used  to  soften  the  eye  to  avoid  vitreous  loss.  The  big 
danger  in  obese  patients  is  that  they  tend  to  have  a  high  vitreous 
pressure.  So  you  prepare  for  eventualities. 

Hughes:     Was  this  less  likely  to  happen  with  local  anesthesia? 

Scheie:       I  don't  believe  so.  Also  if  the  patient  was  very  near  sighted  and  the 
type  who  might  develop  a  detached  retina,  a  complete  iridectomy 
might  be  advisable  so  that  the  detachment  surgeon  could  more 
readily  see  retinal  breaks  or  tears.  The  iridectomy  can  be  a 
protective  measure  for  a  person  whom  you  anticipate  might  develop 
a  detached  retina. 

Hughes:     How  was  the  operating  room  set  up  for  cataract  surgery? 
Scheie:       I  don't  think  quite  the  same  as  for  other  operations. 

Hughes:     I'm  thinking  of  the  alignment  of  the  patients  and  the  role  of  the 
residents  in  the  operating  room. 

Scheie:       Well,  we  had  a  preparation  room  where  the  eyes  were  cleaned,  and 
eye  drops  instilled,  and  the  patient  given  a  final  check.  I  always 
operated,  at  least  when  my  schedule  was  full,  utilizing  four  tables. 
I  would  go  from  one  table  to  another,  allowing  staff  assistants  or 
residents  to  do  what  I  thought  was  safe  for  my  patients.  I  always 
did  the  essential  parts  of  each  operation,  the  ones  which  could  affect 
the  outcome  of  each  operation.  I  always  gave  the  facial  nerve  blocks 
so  the  patient  couldn't  squeeze  his  eyes  shut.  More  rarely,  I  might 
let  an  associate  like  Dr.  Ewing  give  that,  but  most  of  the  time  I  did 
it.  I  always  gave  the  retrobulbar  anesthesia  where  a  hemorrhage 
might  occur  or  an  optic  nerve  be  damaged.  During  all  the  years  Dr. 
Ewing  was  with  me,  I  can't  remember  specifically  a  time  when  I've 
let  anybody,  including  her,  give  retrobulbar  anesthesia  to  my  own 
patients. 

After  the  anesthesia  and  blocks,  the  patient  was  draped  and  a  lid 
speculum  was  inserted.  The  patient  was  then  ready  for  me.  During 
a  cataract  operation  I  might  let  an  assistant  dissect  the 
conjunctival  flap,  because  it's  difficult  to  have  any  trouble  with  that, 
but  I  always  did  the  corneal  incision  and  the  essential  part  of  the 
operation.  I  occasionally  allowed  Dr.  Ewing  to  do  one  because  fully 
trained  associates  must  be  given  responsibility,  but  they  were  my 
private  patients  and  they  were  treated  as  such. 

My  assistants  or  a  senior  resident  would  help  with  delivery  of  the 
lens  and  retraction  of  the  iris.  During  removal  of  the  lens,  they 
would  hold  both  ends  of  a  double-arm  safety-type  suture  and  pull  it 
up,  closing  the  incision  to  protect  the  eye  as  the  cataract  was 
withdrawn.  They  held  this  suture  taut  while  I  tied  the  other  three 


272 


sutures.  After  that  the  eye  was  secure  and  I  would  let  a  senior 
resident  or  Dr.  Ewing  take  over  and  complete  the  closure.  In  the 
meantime,  the  next  patient  was  ready  for  me.  I'd  say  the  average 
length  of  time  spent  by  me  in  doing  a  cataract  operation  would  be 
around  twelve  or  fifteen  minutes.  Of  course,  everything  was 
prepared  and  ready.  We  also  had  an  expert  nursing  staff. 

Hughes:     Tell  me  exactly  who  did  what  during  the  extraction  of  the  lens. 

Scheie:       Well,  I  used  the  cryo  applicator  to  fix  the  lens  and  remove  it.  My 
assistant  applied  a  soft  wick-type  sponge  to  the  iris  to  retract  the 
pupillary  border  upward,  exposing  the  upper  part  of  the  lens  to  the 
cryo.  As  the  lens  emerged,  the  assistant  would  grasp  the  ends  of 
the  double-armed  suture  and  protect  the  eye  by  pulling  on  the  ends 
of  the  suture  to  close  the  incision  as  I  removed  the  lens.  I  would  tie 
the  twelve  o'clock  suture  and  two  others,  one  on  each  side,  before 
going  to  the  next  table.  My  assistant  would  tie  the  final  two 
sutures  and  close  the  conjunctiva  but  I  was  involved  with  every 
essential  step,  even  cranky. 

Hughes:     What  do  you  mean  by  that? 

Scheie:       I  was  very  intense  due  to  the  desire  to  avoid  mistakes.  I  guess 
possibly  like  a  good  athlete  you're  bearing  down,  you're 
concentrating  and  no  nonsense.  You're  going  to  win  the  game.  That 
kind  of  cranky. 

Hughes:     Did  you  expect  your  residents  to  anticipate  your  needs? 

Scheie:       Yes!  [laughter] 

Hughes:     Was  there  time  to  explain  what  you  were  doing  as  you  went  along? 

Scheie:  I  think  I  talked  most  of  the  time-partly  [due  to]  tension  and  also  as 
an  outlet.  I  enjoyed  operating  with  my  assistants  around,  but  I  was 
always  bearing  down. 

Anesthesia 

Hughes:     Did  you  make  the  decision  about  whether  the  anesthesia  should  be 
local  or  general? 

Scheie:       I  always  put  my  preference  on  a  slip  which  was  attached  to  the 

hospital  chart,  but  the  final  decision  was  made  by  the  anesthetist 
who  always  saw  my  patients  the  day  before  surgery.  Dr.  Robert 
Dripps  established  this  rule  when  I  was  working  at  HUP,  and  Dr. 
John  Neigh  continued  it  here  at  the  institute. 

Dr.  Dripps  and  I  had  an  experience  many,  many  years  ago  that 
neither  of  us  ever  forgot.  Just  after  World  War  II,  when  I  was 
somewhat  junior  on  the  staff,  I  was  to  do  a  cataract  operation  on  a 


273 

schoolteacher  and  Bob  Dripps  was  giving  her  general  anesthesia. 
To  our  horror  she  suddenly  expired  on  the  table  with  no  warning, 
probably  a  heart  block.  Attempts  at  resuscitation  failed  and  the 
experience  was  unforgettable  for  both  of  us.  We  learned  that  the 
worst  of  the  unexpected  could  occur  at  any  time. 

Hughes:     Was  an  anesthesiologist  present  for  local  anesthesia  ? 

Scheie:       Not  until  recent  years.  But  one  was  available  on  short  notice.  In 
later  years,  we  increasingly  used  what  was  called  standby 
anesthesia.  The  anesthetist  would  have  an  intravenous  in  place 
and  ready  to  be  used  for  supplementary  sedation  or  even  for  general 
anesthesia  should  an  emergency  arise. 


Postoperative  Care 

Hughes:     What  happened  postoperatively  in  an  average  cataract  case1? 

Scheie:       Most  of  my  patients  received  prophylactic  antibiotics  and  were 

given  sedation  and  other  medication,  if  needed.  All  of  them  were 
ambulatory  as  soon  as  their  sedation  wore  off.  It  was  my  practice  to 
keep  them  for  five  to  seven  or  even  eight  days,  depending  on  their 
age  and  upon  actual  or  possible  ocular  or  medical  complications. 
There  could  be  a  hemorrhage,  a  painful  secondary  glaucoma,  or  the 
patient  could  even  become  disoriented  due  to  age  and  sedation. 

In  recent  years,  postoperative  care  has  changed  as  a  result  of  the 
DRGs.  I  think  some  aspects  of  this  are  wrong  and  affect  good 
medical  practice.  Patients  are  treated  as  outpatients,  coming  to  the 
hospital  the  day  of  surgery  and  being  sent  home  the  same  day.  I 
was  always  concerned  about  the  general  health  of  my  older  patients 
and  insisted  on  thorough  medical  workups.  I  wonder  if  some  of  the 
medical  studies  and  workups  are  as  adequate  as  they  would  be  if 
given  in  a  hospital.  That  is  my  number  one  concern. 

Number  two,  it  seems  so  wrong,  nor  is  it  good  medicine,  to  send 
home  older  patients  who  might  encounter  complications  and  severe 
pain  during  the  night  or  the  next  day.  Of  course,  people  of  all  ages 
are  involved  but  many  of  them  are  in  their  seventies  or  eighties  or, 
nowadays,  even  nineties.  They  might  have  an  intraocular 
hemorrhage,  a  rise  in  pressure,  or  even  an  infection.  The  usual 
time  for  complications  is  during  the  first  three  to  four  days  and  can 
cost  the  sight  of  an  eye.  In  these  days  of  malpractice,  if  accidents 
happen  because  patients  are  not  allowed  to  remain  in  the  hospital, 
who  should  be  sued?  The  doctor  would  probably  be  number  one, 
even  though  he's  doing  this  under  protest.  Who  is  to  look  out  for 
the  older  patient  who's  living  alone  and  who  might  panic  after 
surgery  because  of  severe  pain  or  have  some  other  problem  such  as 
disorientation? 


274 


Hughes:     There's  no  allowance  for  that  situation1? 

Scheie:       There's  no  allowance  that  I  know  of.  Approval  is  necessary  to  bring 
a  patient  into  the  hospital  a  day  early  for  studies  or  to  keep  them 
overnight.  I  don't  think  this  is  good  medicine,  and  I'm  afraid  that  I 
have  to  attribute  it  to  third  party  controls  and  policies.  I  certainly 
wouldn't  want  to  be  treated  that  way  myself  nor  have  my  mother  or 
father  so  treated. 

Hughes:     Was  sedation  needed  in  very  young  patients  to  protect  the  incision1? 

Scheie:       We  certainly  had  it  available  and  if  they  became  restless  we  used  it. 
Incisions  were  not  a  problem  because  they  were  small  and  well 
sutured.  I  think  children  receiving  general  anesthesia  in  operating 
for  cataract  today  should  still  be  kept  in  the  hospital,  at  least 
overnight.  And  I  think  that  is  even  good  policy  for  extraocular 
muscle  surgery. 

I  can  remember  a  near-fatal  calamity-a  complication  that  occurred 
the  night  after  I  had  operated  for  strabismus  in  a  child  who  had 
had  general  anesthesia.  The  child  was  in  our  pediatric  ward  at 
HUP  and  in  the  late  evening  developed  laryngeal  edema  with 
obstruction  of  her  airway.  Her  life  was  saved  only  because  she  was 
in  the  hospital  where  she  could  be  intubated.  As  you  can  see,  I  am 
opposed  both  from  sentiment  and  practicality  to  having  patients  in 
and  out  the  same  day. 

Hughes:     Do  the  DRGs  apply  to  children  as  well? 

Scheie:       Our  pediatric  surgery  now  is  done  over  at  Children's  Hospital,  and  I 
don't  know  how  strict  they  are. 

Hughes:     What  are  some  of  the  possible  complications  of  cataract  surgery? 

Scheie:       I  think  I've  mentioned  the  major  ones.  In  the  older  age  group,  it's 
the  same  thing  that  could  happen  under  stress  anywhere-heart 
attacks,  bronchial  problems,  and  disorientation.  I've  had  strokes 
occur  in  the  hospital.  If  a  stroke  occurred  at  home,  there  would  be 
less  chance  of  survival,  especially  if  the  person  lived  alone,  and 
certainly  it  would  be  a  panic  situation  for  the  family,  particularly 
coming  on  the  heels  of  ocular  surgery.  Any  complication  you  can 
imagine  might  occur,  and  not  necessarily  because  of  the  surgery. 

Hughes:     Well  you  mentioned  the  use  of  antibiotics  postoperatiuely,  and  I 
understand  that  you  prescribed  them  preoperatively  as  well. 

## 

Scheie:       Prophylactic  antibiotics  were  given  prior  to  intraocular  surgery  and 
postoperatively  for  two  or  three  days.  Whether  or  not  I  was 


275 

justified,  I'm  sure  has  been  debated.  But  some  other  branches  of 
surgery  use  it  and  I'm  quite  sure  that  a  modest  number  of 
ophthalmologists  do. 

One  of  the  reasons  that  I  favored  it,  particularly  preoperatively,  was 
that  when  you  open  the  eye,  the  antibiotic  comes  into  the  eye  at 
blood  levels  with  plasmoid  aqueous.  I  always  believe  that  gave  us 
extra  protection  against  infection.  And  I  also  continued  patients 
postoperatively. 

Hughes:     Did  you  have  any  problem  with  infection1? 

Scheie:       I  can't  say  that  I've  never  had  an  infection,  but  rarely.  My  surgery 
was  done  fairly  rapidly,  and  the  eye  was  not  open  for  a  long  period 
to  possible  contamination.  A  resident  might  do  a  cataract  and 
require  forty-five  minutes  to  an  hour,  whereas  the  time  the  eye  was 
open  in  my  hands  was  usually  a  matter  of  ten  or  fifteen  minutes, 
[interruption] 

Cryoextraction 

Hughes:     Dr.  Scheie,  you  mentioned  cryoextraction. 

Scheie:       Yes,  that's  done  with  a  freezing  unit,  a  thin  fingerlike  applicator 

with  a  fine  tip  that  contains  a  freezing  unit  that  freezes  to  the  lens. 
It  gives  a  broader  and  firmer  attachment  to  the  lens  than  a  capsule 
forceps.  A  forceps  pinches  a  bit  of  the  capsule  by  which  the  lens  is 
removed.  The  capsule  can  tear  and  lens  material  is  then  difficult  to 
remove.  The  cryo  gives  a  broader  and  deeper  attachment  because 
the  freezing  penetrates  into  the  lens  substance  itself. 

Hughes:     When  did  that  come  in? 

Scheie:       Oh,  cryo  has  been  available  since  1960.  It  was  introduced  by 

Theodorus  Krawicz,  a  Polish  ophthalmologist,  in  a  Polish  journal 
and  also  in  the  British  Journal  of  Ophthalmology.*  At  one  time  dry 
ice  was  placed  inside  a  small  cylinder  which  transmitted  the 
freezing  to  the  tip  which  froze  onto  the  lens.  However,  a  tip 
utilizing  carbon  dioxide  gas  became  the  standard,  [interruption] 

Alpha-chymotrypsin 

Hughes:     Dr.  Scheie,  would  you  tell  me  please  about  the  introduction  of 
alpha-chymotrypsin  ? 


Krawicz  T:  Intracapsular  extraction  of  intumesccnt  cataract  by  application  of  low  temperature. 
Br  J  Ophthalmol  1961;  45:279-83. 


276 


Scheie:  Yes.  Alpha-chymotrypsin  was  introduced  to  ophthalmology  by 
Joaquin  Barraquer  in  1958.*  It  is  an  enzyme  that  softens  the 
zonule,  the  supporting  ligament  of  the  lens. 

Hughes:     Was  it  Barraquer  who  actually  discovered  that  fact1? 

Scheie:       So  far  as  I  know,  yes.  At  least  he  introduced  it  to  ophthalmology. 
He's  a  very  fine  surgeon,  by  the  way,  in  Barcelona. 

Hughes:     He  was  looking  specifically  for  something  that  would  dissolve  the 
zonule? 

Scheie:       No.  I  believe  he  had  put  it  into  the  vitreous  for  another  purpose 
and  found  that  the  lens  became  loose. 

Hughes:     Was  it  very  specific  so  that  it  only  acted  on  the  zonule  itself? 

Scheie:       Yes.  My  concern  was  that  it  might  cause  other  problems-injure  the 
retina,  damage  the  cornea  or  other  structures  within  the  eye.  As  a 
result,  I  did  not  adopt  its  use  for  some  time.  I  felt  that  my  results 
from  cataract  extraction  were  good  without  it.  Later,  after  it  had 
been  approved  by  people  like  Derrick  Vail  and  other  surgeons  of 
stature  in  the  country,  I  began  to  use  it  in  April  1960.  It  showed  no 
ill  effects  and  did  facilitate  delivery  of  the  lens. 

Hughes:     What  was  the  technique  for  introducing  it? 

Scheie:       You  inject  a  few  drops  of  alpha-chymotrypsin  behind  the  iris,  wait  a 
minute  or  two  for  it  to  exert  its  effect,  and  then  remove  the  lens. 
You  can  not  use  it  for  intracapsular  cataract  extraction  in 
youngsters.  Although  a  youngster's  zonular  attachment  can  be 
softened  by  alpha-chymotrypsin,  the  attachment  to  the  face  of  the 
vitreous  remains  intact.  This  is  quite  firm  in  a  young  person  whose 
vitreous  could  literally  be  pulled  out.  As  a  result, 
alpha-chymotrypsin  was  used  only  for  adults. 

Hughes:     Was  it  readily  available  commercially? 

Scheie:       Yes,  it  was.  As  I  state  in  this  paper,  "Clinical  and  experimental 

observations  using  alpha-chymotrypsin,"  three  and  one-half  years 
later  and  after  using  it  for  more  than  twelve-hundred  operations  for 
senile  cataract,  I  was  convinced  of  its  advantages  and  felt  that 
disadvantages  were  nil.**  I  injected  a  quarter  of  a  cc  behind  the 
iris  at  the  six  o'clock  meridian,  waited  varying  lengths  of  time,  two 


Barraquer,  J.  Enzymatic  zonulolysis:  Contribution  to  the  surgery  of  the  crystalline  lens 
(preliminary  note).  Acta  Ophthalmol  1958;  36:803. 

**      Scheie  HG,  Edwards,  DL  Jr,  Yanoff  Y.  Am  J  Ophthalmol  1965;  59:469. 


277 

to  four  minutes,  and  then  irrigated  to  remove  any  that  was  left. 
This  was  probably  unnecessary,  because  in  a  paper  that  I  wrote 
with  Myron  Yanoff  and  K.C.  Tsou  we  found  that  the  aqueous  itself 
quickly  neutralized  the  effect  of  alpha-chymotrypsin.* 

I  also  did  some  experimental  work  with  David  L.  Edwards,  in  which 
we  irrigated  into  and  along  the  corneal  incisions  in  rabbits.  We 
studied  the  tensile  strength  of  those  incisions  to  determine  their 
healing  at  three,  seven,  fourteen,  and  twenty-one  days.  The  left  eye 
was  used  as  the  test  eye,  receiving  alpha-chymotrypsin,  and  the 
right  eye  was  the  control.  The  incision  was  three  millimeters  long 
at  the  center  of  the  cornea  for  all  the  rabbits.  The  left  eye  was 
irrigated  with  1  to  5,000  alpha-chymotrypsin  and  the  right  eye  with 
saline  solution,  the  same  solution  in  which  the  alpha-chymotrypsin 
was  dissolved.  A  pre-placed  suture  which  had  been  placed  at  the 
time  of  surgery  was  removed  on  the  seventh  postoperative  day,  and 
the  eyes  enucleated  at  stated  time  intervals.  With  a  needle  inserted 
into  the  eye  through  a  clear  cornea,  we  determined  the  amount  of 
pressure  to  break  the  wound  open.  The  data  showed  that  by  the 
seventh  postoperative  day,  the  wound  was  pretty  well  healed  in 
each  group,  showing  that  alpha-chymotrypsin  didn't  interfere  with 
wound  healing. 

Whenever  there  was  a  bulging  eye-the  type  that  might  be 
encountered  in  a  heavy,  short-necked  individual,  or  possibly  a 
person  with  high  myopia  where  vitreous  loss  might  occur-I  did  not 
use  the  enzyme  because  as  the  zonular  weakened,  vitreous  was  apt 
to  extrude  the  lens  and  be  lost.  During  extraction  of  the  lens,  the 
incision  was  closed  as  the  lens  was  removed  by  having  my  assistant 
pull  up  a  double-armed  suture  to  simultaneously  close  the  incision. 
That  helped  to  maintain  an  intact  vitreous  face  and  to  prevent 
vitreous  loss.  I  concluded  that  alpha-chymotrypsin  was  helpful  so  I 
used  it  for  most  of  my  extractions. 

Hughes:     Were  there  any  disadvantages? 

Scheie:       None  that  I  found,  except  bulging  eyes  with  threatened  vitreous 
loss  due  to  high  vitreous  pressure  and  in  some  cases,  transient 
glaucoma.  It  didn't  interfere  with  wound  healing  or  cause 
postoperative  reactions. 

Miotic  Agents  and  Anesthesia 

Hughes:     You  published  a  paper  in  1949,  with  Dr.  Gaylord  Ojers  as  co-author, 
"Choice  of  a  miotic  agent  following  retrobulbar  anesthesia."* 
Apparently  some  ophthalmologists  at  the  time  were  using  eserine  to 
constrict  the  pupil  following  cataract  surgery,  and  I  don't  know 

*        Scheie  HG,  Tsou  K-C,  Yanoff  M.  Inhibition  of  alpha-chymotrypsin  by  aqueous  humour.  Arch 

Ophthalmol  1965;  73:399. 
**      Amer  J  Ophthalmol  1949;  32:1369-75. 


278 


whether  you  found  that  eserine  was  ineffective  after  retrobulbar 
anesthesia  or  whether  it  was  already  known. 

Scheie:       That  related  to  my  work  with  Adie's  syndrome  and  was  mentioned 
later  in  the  paper  on  medical  treatment  of  glaucoma  in  1949.*  H.K. 
Anderson  in  1905  had  demonstrated  that  if  you  removed  the  ciliary 
ganglion,  the  terminal  one  in  the  parasympathetic  motor  nerve 
pathway  to  the  pupillary  muscles,  the  effector  substance  for  the 
pupillary  muscles,  acetylcholine,  is  no  longer  produced.** 
Therefore  eserine,  which  acts  indirectly  by  protecting  acetylcholine, 
would  be  ineffective.  Pilocarpine,  however,  acts  directly  on  the 
muscle  cell  and  will  produce  miosis  even  after  retrobulbar 
anesthesia.  Furthermore,  if  you  constrict  the  pupil  with  eserine 
and  then  give  a  retrobulbar  injection  of  local  anesthesia,  the  pupil 
will  promptly  dilate. 

Hughes:  Were  some  people  using  eserine  after  retrobulbar  anesthesia? 

Scheie:  Yes,  without  realizing  the  contradiction. 

Hughes:  And  wondering  why  they  weren't  getting  an  effect? 

Scheie:  That's  right. 

Hughes:  Were  you  the  first  to  work  this  out? 

Scheie:       No.  The  principle  was  worked  out  by  Otto  Loewi,  H.K.  Anderson, 
Henry  H.  Dale,  and  others.***  Loewi  is  the  scientist- 
pharmacologist  who  is  recognized  as  having  evolved  the 
neurohumoral  theory  which  was  generally  accepted  by  the  time  I 
became  interested  in  Adie's  pupil  and  which  I  applied  to  my  work 
on  the  syndrome. 

Hughes:     It  was  interesting  to  see  the  room  last  night  at  the  College  of 

Physicians  of  Philadelphia  where  you  gave  one  of  the  papers  on  the 
syndrome. 

Why  do  you  want  the  pupils  to  constrict  after  cataract  surgery? 

Scheie:       One  of  the  serious  complications  of  cataract  surgery  is  that  the  iris 
prolapse  can  cause  wound  and  other  complications.  Constricting 
the  pupil  helps  to  prevent  prolapse  by  retracting  the  iris  away  from 
the  incision. 

Hughes:     How  long  did  you  hope  to  maintain  the  constriction  postoperatively? 


Scheie  HG.  Symposium:  Primary  glaucoma:  III  -  The  treatment  of  primary  glaucoma  by  medical 
means.  Trans  Am  Acad  Ophthalmol  Otolaryngol  1949;  Jan-Feb,  186-212. 

Anderson  HK.  J  Physiol  1905;  33:414-38. 

Cannon  WB,  Rosenblueth  A.  Autonomic  Neuro -Effector  Systems.  New  York.  The  Macmillan 
Company,  1937.  Citing  work  of  Loewi,  Anderson,  Dale,  and  others. 


279 


Scheie:       Until  the  anterior  chamber  is  formed,  which  is  usually  within  an 
hour.  When  cataract  extraction  is  done  under  local  anesthesia,  the 
patient  will  often  have  severe  pain  in  two  or  three  hours  after  the 
anesthesia  wears  off.  Much  of  the  pain  is  caused  by  spasm  of  the 
pupillary  sphincter.  My  rule,  rather  than  order  morphine  or 
codeine  or  other  analgesics,  was  to  instill  atropine  into  the  eye  to 
stop  the  spasm  and  relieve  the  pain. 

Hughes:     Did  other  ophthalmologists  use  atropine? 

Scheie:       I  don't  know  how  many  did,  but  it  should  be  used  only  after  the 
anterior  chamber  is  formed. 

Procedures  for  Cataract  Extraction 

Hughes:     As  far  I  could  figure  out  from  your  bibliography,  the  first  paper  you 
wrote  on  cataract  extraction  was  in  1956. 

Scheie:       "A  method  of  cataract  extraction  following  filtering  operations  for 
glaucoma."* 

Hughes:     You  had  been  doing  extractions  much  prior  to  that,  had  you  not? 

Scheie:       Oh,  I'd  been  doing  them  since  early  in  my  residency,  but  extractions 
following  successful  filtering  operations  were  infrequent.  The 
problem  was  how  to  make  the  incision  without  disturbing  filtration. 
In  other  words,  the  challenge  was  to  be  able  to  remove  the  cataract 
and  not  eliminate  the  filtering  area.  Several  ophthalmologists  had 
been  interested  and  some  of  their  techniques  were  discussed  or 
mentioned  in  the  paper. 

Hughes:     Well,  in  this  particular  paper  you  mentioned  three  possible  sites  for 
the  incision,  which  were  under  current  use  or  debate.  One  of  them 
was  superiorly  through  the  filtering  area.  The  one  you  advocated 
was  superiorly  through  clear  cornea  adjacent  to  but  avoiding  the 
filtering  area.  A  third  possibility  was  inferolaterally  or  directly 
inferiorly. 

Scheie:       Yes,  in  other  words,  the  lower  part  of  the  eye,  well  away  from  the 
filtering  area. 

Hughes:     Yes.  Totally  avoiding  the  filtering  area. 
Scheie:       Right. 

Hughes:     Why  was  it  that  you  recommended  the  second  method,  which  was 
superiorly  through  the  clear  cornea? 


Arch  Ophthalmol  1956;  55:818-29. 


280 


Scheie:       Well,  partly  because  it's  easier  to  perform.  Inferiorly,  the 

conventional  technique  must  be  reversed  which  makes  for  a  feeling 
of  insecurity.  I  also  had  observed  that  corneal  edema  occurred  more 
frequently  when  the  operation  was  done  below.  In  a  subsequent 
paper  I  believe  I  explained  the  reasons  why*  The  operation  is  more 
difficult  when  done  below  because  it's  technically  not  as  easy  as 
doing  it  from  above.  If  done  through  the  filtering  area  itself,  sealing 
off  the  incision  may  be  slow  and  reformation  of  the  anterior 
chamber  can  be  delayed.  Failure  of  filtration  with  recurrence  of 
glaucoma  is  not  unusual. 

Hughes:     Right.  I  couldn't  understand  why  anybody  would  consider  doing  it 
there. 

Scheie:       Well,  some  very  good  ophthalmologists  advocated  that  approach. 
Hughes:     Can  you  remember  their  argument? 

Scheie:       I  think  mainly  because  it  was  easiest  to  perform.  I  had  adapted  the 
operation  through  clear  cornea.  There  was  nothing  particularly 
unique  about  it  except  my  incision  and  the  fact  that  it  was  made 
through  clear  cornea  just  within  the  filtering  area.  It  was  almost 
like  my  routine  extraction  but  without  a  conjunctival  flap.  My 
routine  cataract  extraction  was  also  done  through  clear  cornea,  but 
the  perpendicular  corneal  incision  was  made  beneath  a  flap  of 
conjunctiva  which  had  been  carried  into  clear  cornea. 

Hughes:     You  said  in  this  paper  that  you  had  the  impression  that  cornea 
healed  more  quickly  than  sclera. 

Scheie:       I  think  it  does. 

Hughes:     There  must  be  a  physiological  reason. 

Scheie:       Well,  I  think  probably  because  of  the  type  and  number  of  cells,  and 
in  my  experience  corneal  incisions  are  stronger  than  scleral 
incisions. 

Hughes:     Was  cataract  correlated  to  any  degree  with  glaucoma  surgery? 

Scheie:       Yes,  the  incidence  of  cataract  increases  following  filtering 

operations  for  glaucoma,  especially  if  hypotony  results.  The  surgery 
itself  can  contribute  to  or  cause  cataract  formation.  It  is  well 
known  that  cataract  occurs  earlier  in  an  eye  that's  had  a  filtering 
operation  for  glaucoma  than  in  a  fellow  eye.  We  now  operate 
chronic  simple  or  open-angle  glaucoma  only  if  vision  is  threatened 


Scheie  HG,  Muirhead  JF.  Cataract  extraction  after  filtering  operations.  Arch  Ophthalmol  1962; 
68:34-41. 


281 


because  the  operation  may  fail  and  the  eyes  are  subject  to  later 
cataract  formation  and  to  other  problems. 

I  think  we  might  follow  that  up  by  going  to  the  other  paper  that  I 
wrote  on  cataract  after  filtering  operation.* 

Hughes:     Apparently  the  debate  over  the  best  site  for  the  incision  was  still  not 
settled. 

Scheie:       Oh,  it  probably  never  will  be  settled,  but  I  believe  most  of  the 
operations  are  done  superiorly. 

[scans  paper]  This  paper  reported  cataract  extraction  after  filtering 
procedures  on  102  eyes.  Sixty-five  had  had  a  filtering  operation 
above  and  the  cataract  incision  made  superiorly  through  clear 
cornea  to  avoid  the  filtering  cicatrix.  Six  of  these  eyes  developed 
corneal  edema  but  two  had  suffered  vitreous  loss.  Twenty-six  eyes 
with  glaucoma  surgery  done  above  had  cataract  extraction  below  to 
avoid  the  filtering  area.  Eleven  other  eyes  had  had  the  filtering 
operation  done  inferiorly  and  because  I  knew  that  cataract 
extraction  would  be  needed  before  long.  The  subsequent  cataract 
extraction  was  done  above  in  my  routine  manner. 

Hughes:     How  much  time  elapsed  between  operations? 

Scheie:       I  would  have  to  get  the  records  for  that.  The  complication  that  was 
of  greatest  concern  when  cataract  extraction  was  done  below  was 
subsequent  corneal  edema.  A  corneal  transplant  could  be  done  but 
they  don't  do  as  well  in  aphakic  eyes. 

Of  the  sixty-five  eyes  where  the  cataract  operation  was  done 
through  clear  cornea  above,  six  had  corneal  edema  but  vitreous  loss 
followed  in  four  of  the  eyes.  That's  six  out  of  sixty-five.  In 
twenty-six  eyes  the  extraction  was  done  below  after  the  filtering 
operation  had  been  done  above.  Seven  of  those  eyes  had  corneal 
edema.  So  that  left  two  with  unexplained  corneal  edema  out  of 
sixty-five.  No  vitreous  loss  occurred  in  the  extractions  done  below, 
but  corneal  edema  occurred  in  seven  of  twenty-six  eyes,  as 
compared  to  two  in  sixty-five  when  done  above  through  clear  cornea. 

I  felt  that  the  reason  for  this  large  difference  in  corneal  edema  was 
due  to  deposition  of  cells  and  pigment,  which  had  undoubtedly 
interfered  with  healing,  on  the  inner  aspect  of  the  incision.  By  slit 
lamp  I  could  see  the  pigment  and  debris  deposited  on  and  within 
the  inner  aspect  of  the  incision.  I  also  noted  that  the  edema  started 
at  the  site  of  the  incision  and  gradually  extended  centrally.  The 
deposit  started  early  during  the  postoperative  period.  I  therefore 
stopped  doing  extractions  inferiorly  and  this  may  have  been 
something  of  a  contribution. 


Scheie  HG,  Muirhead  JF.  Cataract  extraction  after  filtering  operations.  Arch  Ophthalmol  1962; 
68:34-41. 


282 
Hughes: 

Scheie: 

Hughes: 

Scheie: 

Hughes: 

Scheie: 


Hughes: 


Scheie: 

Hughes: 

Scheie: 


In  the  paper,  six  years  after  the  1956  paper,  you'd  modified  the 
technique  somewhat.  Was  the  modification  in  terms  of  the  site  of  the 
incision  or  in  the  actual  way  the  incision  was  made? 

From  this  diagram,  I  don't  recall  any  real  differences  in  technique. 
In  one  group  the  filtering  operation  had  been  done  below  and  the 
cataract  extraction  done  above  using  my  routine  technique. 

I  can't  remember  if  it  was  this  paper  or  not  that  the  actual  angle  of 
the  incision  itself  was  a  subject  of  debate. 

No,  these  two  were  both  done  in  the  same  way. 
Perpendicular? 

Perpendicular  incisions,  yes.  And  my  reason  was  that 
perpendicular  edges  abut  firmly  against  each  other  after  the 
sutures  which  were  placed  through  the  cut  edges  are  tied.  The 
wound  edges  do  not  slide  and  override  and  are  more  firmly  closed 
by  postoperative  edema. 

There  was  another  interesting  paper  in  1959,  the  Charles  H.  May 
Memorial  Lecture,  and  the  topic  was,  "Incision  and  closure  in 
cataract  extraction.  "*  In  a  way  it  was  a  review  paper  of  the  various 
techniques  that  were  being  used  currently.  One  statement  that 
interested  me  was  that  you  had  long  been  interested  in  wound 
closure,  which  you  yourself  alluded  to  just  a  few  minutes  ago. 

Yes,  I  was. 

Can  you  tell  me  how  and  why  that  interest  arose? 

I  became  extremely  interested  in  wound  closure  during  my  intern 
and  residency  days  and,  of  course,  it  extended  into  the  years  after 
that  residency. 

## 

During  the  thirties  at  the  University  of  Pennsylvania  Hospital,  and 
I  believe  at  Wills  Eye  Hospital  and  many  other  places,  only  an 
occasional  surgeon  used  sutures  to  close  a  cataract  incision.  There 
were  several  reasons  for  that.  The  suture  techniques  were  known 
and  available,  but  as  I  have  said,  needles  and  sutures  were  so 
coarse  that  they  were  difficult  and  hazardous  to  place. 
Furthermore,  some  ophthalmologists  believed  the  eye  was  too 
sensitive  to  tolerate  sutures. 


Arch  Ophthalmol  1959;  61:431-52. 


283 


I  was  among  the  early  ones  at  HUP  to  use  firm  sutures,  and  that 
was  with  permission  during  the  last  year  of  my  residency.  In  those 
days,  our  patients  were  kept  in  bed  with  both  eyes  covered,  with  no 
pillows,  and  with  sandbags  beside  their  heads.  Twenty-four-hour 
nursing  care  was  given  so  that  the  patient  wouldn't  turn  or  try  to 
get  up  to  go  to  the  bathroom.  Obviously  the  surgeon's  great  fear 
was  wound  separation  because  the  incision  had  no  support,  and 
danger  of  vitreous  loss  and  hemorrhage  was  always  a  threat. 

Highlights  of  the  history  of  wound  closure  in  cataract  surgery  are 
shown  in  these  diagrams  [in  my  paper].  The  first  attempts  at 
wound  closure  in  cataract  surgery  were  by  Louis  August  Desmarres 
in  1858.  He  used  an  uncut  bridge  of  conjunctiva  at  twelve  o'clock. 
Other  types  of  conjunctival  closure  soon  evolved,  the  Kuhnt  flap  in 
1898  and  the  Van  Lint  flap  in  1911.  None  gave  adequate  support 
and  postop  care  remained  unchanged. 

I  would  like  to  emphasize  that  the  basic  principles  for  making  and 
closing  incisions  were  all  available  by  the  turn  of  the  century  and 
are  illustrated  in  this  article.  There  was  the  Williams  suture  of 
Henry  W.  Williams  of  Boston,  a  very  famous  American  ophthalmic 
surgeon.  He  described  his  wound  closure  in  1865,  the  incision  being 
made  in  clear  cornea.  It  was  closed  by  interrupted  silk  sutures. 
Suarez  de  Mendoza  in  1888  made  a  partially  penetrating  incision 
into  the  cornea  with  preplaced  sutures  through  the  cut  edges. 
Accuracy  [of  closure]  was  insured  thereby.  Leopold  Mueller  in  1903 
used  preplaced  sutures  through  a  corneal  flap  that  had  been 
dissected  upward  from  two  millimeters  inside  the  limbus  before  the 
eye  was  opened.  It  also  added  greatly  to  accuracy  of  closure,  and 
the  sutures  could  be  pulled  up  quickly  to  close  and  protect  the  eye 
after  delivery  of  the  lens. 

Then  there's  the  Kalt  suture  (1894)  which  was  a  preplaced  bridge 
suture.  The  needle  was  inserted  and  a  vertical  bite  was  made 
superficially  through  cornea  and  then  through  the  conjunctiva  and 
sclera  above  the  limbus.  The  closure  wasn't  too  accurate  because 
the  edges  would  tend  to  override. 

I  might  also  mention  a  paper  in  1940  by  John  McLean,  which  I 
quoted  in  the  Charles  H.  May  Memorial  lecture,  who  described  his 
technique  and  outlined  what  he  believed  to  be  the  ideal  suture  and 
wound  closure:  It  should  provide  firm  closure.  It  should  be  placed 
before  the  incision  is  made  so  that  it  can  be  tied  down  quickly  to 
protect  the  eye  if  vitreous  loss  threatens.  It  should  be  placed 
through,  not  over,  the  edges  of  the  incision.  A  conjunctival  flap 
should  cover  the  incision,  and  should  not  be  so  complicated  that  the 
everyday  surgeon  can't  use  it.  I  think  certainly  his  important 


284 


Hughes: 


criteria  can  be  easily  satisfied  today  because  of  the  beautiful 
needles  and  sutures  as  well  as  instruments  available  to  us.* 


You  said  in  your  paper  that  your  present  wound-closure  technique 
was  a  composite  of  many  persons'  ideas  but  that  the  incision  "may  be 
somewhat  original.  "  Were  you  referring  to  the  perpendicular 
incision  ? 


Scheie:       Yes. 

Hughes:     Why  did  people  continue  to  use  the  incision  where  the  lips  might 
override? 

Scheie:       Because  in  ophthalmology,  like  most  fields  of  clinical  medicine,  we 
find  many  different  ideas  and  approaches.  Many  may  not  be  highly 
scientific  nor  even  carefully  investigated.  In  my  own  experience,  I 
gradually  evolved  the  perpendicular  incision,  largely  as  an 
outgrowth  of  my  operation  for  cataract  after  filtering  operations 
where  a  perpendicular  incision  was  made  through  clear  cornea.  My 
cataract  incision  today  involves  splitting  a  conjunctival  flap  slightly 
into  clear  cornea  where  a  perpendicular  incision  is  made  into  the 
anterior  chamber  with  a  sharp  #15  Bard  Parker  knife  blade.  This  I 
enlarged,  extending  the  perpendicular  incision  with  scissors  having 
blunt  tips,  to  avoid  cutting  and  buttonholing  the  iris. 

I  did  some  work  on  enucleated  eyes  as  well,  to  compare  the 
perpendicular  incision  with  the  beveled  incision.  When  these  eyes 
were  sectioned,  it  was  quite  obvious  that  when  sutures  were  placed 
and  tied  the  perpendicular  edges  were  accurately  approximated, 
whereas  the  edges  of  the  beveled  incisions  tended  to  slip  and 
override.  I  used  that  incision  and  wound  closure  until  I  stopped 
operating.  That  was  illustrated  in  a  drawing  in  the  article  on 
incision  and  closure  in  cataract  extraction.  The  incision  was 
covered  with  a  conjunctival-corneal  flap  which  was  dissected  into 
the  cornea  far  enough  to  allow  a  perpendicular  incision  into  the 
anterior  chamber.  So  well-closed  and  well-made  incisions  of  various 
types  revolutionized  the  safety  of  cataract  surgery. 

Nowadays  surgeons  using  even  smaller  incisions  are  doing 
cataracts  as  outpatient  procedures.  As  I  said  before,  I  would  have 
hesitated  to  let  a  patient  go  home  on  the  day  of  the  operation,  not 
only  from  the  standpoint  of  wound  closure  but  also  medical  care 
was  often  needed.  I  always  liked  to  see  my  patients  morning  and 
night,  twice  a  day,  while  they  were  in  the  hospital. 


Portions  of  the  discussion  of  sutures  which  follows  on  the  tape  were  combined  in  the  section  on 
sutures  in  this  text. 


285 


Hughes:     Well,  would  you  like  to  turn  to  aspiration  of  congenital  or  soft 
cataracts?  I  know  we  talked  about  that,  but  I  want  to  refer 
specifically  to  the  paper  that  you  wrote  on  that  subject  in  I960.* 

Scheie:       I  mentioned  earlier  in  this  interview  that  there  are  various 

operations  for  congenital  cataracts  and  that  most  of  them  evolved 
from  the  early  days  of  cataract  extraction  and  even  during 
couching.** 

Discission  was  the  procedure  I  was  brought  up  to  do  by  Dr.  Adler. 
As  his  resident  and  as  a  young  man  in  practice,  that  was  regarded 
as  the  procedure  of  choice  because  operatively  it  was  very  safe.  The 
sequelae  concerned  me. 

Hughes:     Surely,  they  must  have  concerned  Dr.  Adler  as  well? 
Scheie:       It  concerned  everyone  and  we  did  have  other  approaches. 
Hughes:     Well,  this  paper  talks  about  Dr.  Adler  advocating  linear  extraction. 

Scheie:       Yes,  that's  another  technique  that  was  an  outgrowth  of  David's 
extraction  in  the  1850s.  He  made  a  corneal  incision,  opened  the 
capsule,  and  with  the  help  of  a  spoon,  later  called  the  Daviel  spoon, 
massaged  the  nucleus  and  cortical  material  from  the  eye.  The 
problem  is  that  the  lens  material,  unless  the  cataract  is  complete,  is 
viscid  and  difficult  to  remove  from  the  anterior  chamber.  Usually 
there  is  residual  lens  material  and  vitreous  loss  is  a  danger. 

## 

The  operation  in  children  became  known  as  linear  extraction  and  it 
was  also  utilized  by  William  Gibson  in  1811,  and  many  other 
ophthalmologists.***  I  believe  Gibson  also  performed  the  first 
ripening  operation  which  he  used  before  doing  extracapsular 
extractions  in  older  patients. 

Hughes:     Well,  what  other  procedures  were  available  when  your  paper  was 
written  in  1960? 

Scheie:       S.  Lewis  Ziegler  urged  making  an  incision  in  the  form  of  a  vertical 
V  through  the  entire  thickness  of  the  congenital  cataract.****  This 
permitted  aqueous  to  enter  and  absorb  the  lens.  It  was  called  the 
Ziegler  operation. 


* 
** 


Scheie  HG.  Aspiration  of  congenital  or  soft  cataracts.  Amer  J  Ophthalmol  1960;  50:1048-56. 

Portions  of  an  historical  discussion  which  follow  on  the  tape  were  added  to  the  section  in  the  text 

on  the  historical  background  of  cataract  procedures. 
***  Gibson  W.  Practical  Observations.  Ix>ndon,  1811,  p. 103. 
****Ziegler  SL.  Complete  V-shapcd  incision  for  zonular  and  pyramidal  cataracts.  JAMA  1921; 

77:1100. 


286 

Hughes: 
Scheie: 


Hughes: 
Scheie: 

Hughes: 
Scheie: 


Hughes: 


Scheie: 


Why  did  he  think  that  was  better1? 

Because  with  only  a  puncture  into  the  eye,  instead  of  an  incision, 
vitreous  loss  was  avoided.  With  the  lens  opened  widely  he  felt  that 
it  would  absorb  more  quickly.  Numerous  ophthalmologists  adopted 
it.  In  fact,  William  Benedict  told  me  that  he  used  the  operation  as 
his  choice  for  congenital  cataracts  at  the  Mayo  Clinic.  I  had  no 
experience  with  it.  In  fact,  I  had  been  brought  up  to  believe  it  was 
hazardous  and  might  lead  to  complications,  including  retinal 
detachment. 

In  your  aspiration  technique,  you  apparently  used  something  called 
the  knife  needle, 

It  was  a  needle  with  a  sharp  six-millimeter  knife  at  the  end.  It's  a 
well-known  instrument. 

So  it  wasn't  something  you  designed1? 

No. 

The  disadvantage  of  my  aspiration  technique  was  that  unless  the 
cataract  was  complete  and  could  be  aspirated  immediately,  the 
preliminary  needling  was  only  a  ripening  procedure  for  a  child  and 
another  anesthetic  was  necessary  a  few  days  later. 

## 

Dr.  Scheie,  six  years  later  in  1966,  you  published  a  paper  on  further 
experience  on  the  aspiration  of  congenital  or  soft  cataracts.*  In  this 
paper,  you  said  that  you  had  been  using  the  technique  since  1950. 
Yet  the  first  paper  that  I  saw  describing  the  technique  was  published 
in  1960.  Why  did  you  wait  ten  years? 

Partly  for  reasons  of  follow-up  and  also  to  obtain  a  significant 
number  of  eyes. 

[scanning  paper]  Now,  in  this  report,  I  had  operated  131  eyes. 
Eighty  of  these  had  been  uncomplicated  congenital  cataracts  and 
twenty-five  were  thought  to  be  due  to  maternal  rubella,  while 
twenty-six  were  secondary  cataracts  due  to  other  causes.  Of  the 
eighty  eyes  operated  for  uncomplicated  congenital  cataract, 
seventy-three  had  a  clear  pupillary  space  and  an  excellent  result. 
Seven  required  capsulotomy.  However,  as  with  extracapsular 
extractions,  most  patients  would  need  a  capsulotomy  later  when  the 
capsule  became  clouded  from  deposits  and  proliferation  of  cells. 


Scheie  HG,  Rubcnstcin  RA,  Kent  RH.  Aspiration  of  congenital  or  soft  cataracts:  Further 
experience.  Trans  Am  Ophthalmol  Soc  1966;  64:319-31. 


287 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 

Scheie: 

Hughes: 


I  had  learned  that  the  complications  of  rubella  cataracts  could  be 
devastating  and  present  very  different  problems  from  ordinary 
congenital  cataracts.  Uncomplicated  congenital  cataracts 
occasionally  had  associated  abnormalities,  such  as  microphthalmia, 
posterior  embryotoxon,  amblyopia,  and  others. 

As  far  as  postoperative  or  surgical  complications,  in  the  eighty 
congenital  cataracts,  we  had  iris  bombe  in  only  one  patient  and 
rupture  of  the  posterior  capsule  during  surgery  in  three  patients. 
Twenty-five  congenital  cataracts  due  to  maternal  rubella  were 
operated;  six  went  on  to  phthisis  bulbi  from  postoperative 
inflammation.  Two  others  had  posterior  synechiae  with  iris  bombe" 
and  a  poor  prognosis.  The  results  in  secondary  or  complicated 
cataracts  depended  upon  their  cause.  The  operative  complications 
were  minimal  for  routine  congenital  cataracts  and  I  was  extremely 
pleased  with  the  aspiration  method. 

Had  you  changed  it  in  any  way  in  the  six  years  since  the  first  paper? 

The  technique  remained  quite  identical  throughout  my  surgical 
career. 

Rubella  Cataracts 

Well,  you  mentioned  rubella,  [interruption] 

I'm  going  to  recite  some  figures  that  came  from  a  paper  I  gave  at  a 
rubella  conference.*  This  was  a  paper  on  congenital  rubella 
cataracts.  We  had  had  quite  a  number  of  these  in  our  area.  Some 
of  the  patients  presented  were  operated  by  staff  members  of  mine 
at  Children's  Hospital  of  Philadelphia  and  at  two  or  three  other 
hospitals. 

[scans  paper]  The  total  number  of  eyes  in  our  study  was  forty-nine. 
Postoperative  complications  occurred  in  forty-five  percent 
(twenty-two)  of  the  eyes,  as  compared  to  the  very  small  number  of 
complications  we  had  in  uncomplicated  congenital  cataracts.  The 
problem  was  postoperative  ocular  inflammation,  often  devastating, 
and  with  thirteen  lost  eyes.  Virus  cultures  were  done  on  sixteen 
eyes  at  the  time  of  surgery,  and  the  rubella  virus  was  recovered 
from  seven. 

Who  was  actually  doing  the  virus  cultures? 

The  Children's  Hospital  laboratories. 

Was  Stanley  Plotkin  associated  with  the  Children's  Hospital? 


Scheie  HG,  Schaffcr  DB,  Plotkin  SA,  Kcrtesz  ED.  Congenital  rubella  cataracts,  surgical  results 
and  virus  recovery  from  intraocular  tissue.  Arch  Ophthalmol  1967;  77:440. 


288 


Scheie:       Yes.  I  might  add  also  that  he  had  his  cultures  done  at  Wistar 
Institute,  a  very  well-known  research  group  of  which  he  was  a 
member.  The  virus  was  grown  in  tissue  culture  media  of  green 
monkey  kidney  cells. 

Hughes:     Who  is  David  Schaffer? 

Scheie:       Schaffer  was  one  of  our  residents  who  specialized  in  pediatric 

ophthalmology.  I  had  been  chief  [of  ophthalmology  at  Children's] 
for  many  years  and  eventually  Dr.  Schaffer  was  named  chief  in 
1972. 

Hughes:     And  Elsa  Kertesz  ? 

Scheie:       Dr.  Kertesz  was  another  resident  who  had  specialized  in  pediatric 
ophthalmology  and  who  remained  on  our  staff  for  a  year  or  two 
upon  completing  her  residency.  She  did  most  of  her  work  at  the 
Children's  Hospital. 

All  of  these  rubella  cataracts  were  removed  by  aspiration.  Of  the 
greatest  interest  in  our  paper,  aside  from  the  high  percentage  of 
postoperative  complications  due  to  inflammation,  were  the  results 
of  cultures  of  aspirated  lens  material.  Those  cultures  were  positive 
for  rubella  virus  in  seven  eyes.  The  ages  of  the  children  from  whom 
we  obtained  a  positive  lens  culture  were  from  eleven  months  and 
the  oldest  was  eighteen  months,  in  contrast  to  cultures  of  other 
body  tissues  and  secretions  where  the  virus  usually  disappears  by 
one  year  of  age.  This  led  us  to  think  that  possibly  the  virus  had 
been  encapsulated  and  trapped  in  the  lens  during  embryonic  life, 
probably  during  the  first  three  months,  where  it  remained  viable 
and  was  liberated  to  cause  the  postoperative  inflammation  when 
the  lens  was  opened. 

Hughes:     You  couldn't  control  the  infection? 

Scheie:       There's  no  treatment  for  rubella  virus. 

Hughes:     Was  this  the  first  report  of  possible  encapsulation  of  the  virus? 

Scheie:       At  about  the  same  time,  or  possibly  before,  an  Australian  group  had 
recovered  the  virus.  However,  it  was  not  known  to  us.  I  spoke 
before  a  meeting  of  the  Australian  Ophthalmological  Society  in 
Sydney,  October  15-20,  1967,  where  I  reported  our  results  and 
compared  notes.* 

[scans  paper]  Of  the  twelve  eyes  cultured,  five  had  positive  cultures, 
and  three  of  these  five  developed  serious  inflammatory 
postoperative  complications.  The  incidence  of  inflammation  did  not 


Scheie  HG.  Rubella  syndrome  and  cataracts.  Trans  Ophthal  Soc  1967;  31:44. 


289 

seem  to  be  as  high  in  the  older  children.  Of  the  seven  eyes  with 
negative  cultures,  only  two  had  postoperative  complications. 
However,  a  negative  culture  is  not  foolproof  because  the  virus  might 
not  have  grown. 

We  began  to  think,  as  a  result  of  the  figures  gained  from  more 
cultures,  that  possibly  we  ought  to  postpone  any  surgery  until  the 
child  was  older.  We  concluded  it  should  be  after  two  years  of  age,  by 
which  time  the  virus  would  almost  always  have  disappeared  from 
the  lens  and  surgery  would  be  safer.  We  almost  never  found  a 
positive  culture  in  aqueous. 

Our  results  ideally  would  have  involved  more  patients,  but  at  about 
this  time  the  rubella  vaccine  became  available  and  there  were 
almost  no  rubella  cataracts  to  care  for  and  hopefully  there  never 
will  be. 

I  also  should  mention  that  knowing  of  the  postoperative 
complications  following  opening  of  the  lens  for  cataract  extraction, 
probably  an  optical  iridectomy  only  should  be  done,  which  seems 
safe.  This  could  tide  the  child  over  visionwise  until  he  is  two  or 
three  years  of  age,  when  the  cataract  could  be  removed  and  the 
virus  should  be  long  gone.  In  iridectomy  done  on  five  patients 
under  one  year  of  age,  four  had  no  problem  but  one  lost  an  eye  from 
postoperative  inflammation.  On  iridectomies  done  on  three 
patients  over  one  year  of  age  we  had  no  complications.  We  began  to 
feel  that  under  one  year  of  age  only  iridectomy  should  be  done. 
This  reasoning  was  supported  to  some  extent  by  aqueous  cultures. 

Forty-one  patients  had  needling  and  aspiration.  Twenty-four  of  the 
children  were  twelve  months  or  younger.  Eleven  did  well  while 
nine  of  the  eyes  were  lost  from  inflammation.  On  the  other  hand, 
seventeen  patients  over  the  twelve  months  of  age  were  done  with 
only  three  eyes  being  lost.  As  time  went  on,  we  became  more 
convinced  that  the  longer  we  waited,  the  safer  the  operation. 
Certainly  in  our  experience  fewer  eyes  were  lost  when  operated 
beyond  one  year  of  age.  The  oldest  child  from  whom  we  recovered  a 
positive  culture  at  that  time  was  two  years  of  age. 

Hughes:     Do  you  want  to  go  on  to  the  next  paper  on  rubella? 

Scheie:       "Is  delayed  cataract  surgery  safer  for  rubella  victims?",  in  1968.* 

The  problems  of  rubella  were  a  challenging  and  frustrating 
experience  with  so  little  known  on  the  subject.  It  was  a  relatively 
new  condition  at  best,  the  syndrome  having  been  recognized  in  1941 
by  an  Australian  named  Sir  Norman  Gregg.**  He  reported 
seventy-eight  infants  born  with  eye,  ear,  and  heart  abnormalities 


Scheie  HG.  Clinical  Trends  1968;  Jan-Feb,  3. 

**     Gregg  NM.  Congenital  cataracts  following  German  measles  in  mother.  Trans  Ophthalmol  Soc 
Aust  1941;  3:35. 


290 


whose  mothers  had  rubella  during  the  first  trimester  of  pregnancy. 
Later  he  was  knighted  by  the  queen  for  his  discovery. 

Hughes:     Is  he  an  ophthalmologist1? 

Scheie:       Yes. 

In  Australia,  I  reported  that  we  had  been  having  serious 
postoperative  inflammatory  complications  in  operating  rubella 
cataracts.  These  included  lost  eyes,  occluded  pupils,  and  phthisis 
bulbi  in  thirty-five  percent  of  our  rubella  eyes  compared  to  almost 
none  in  ordinary  congenital  cataracts.  We  urged  deferring  surgery 
until  two  years  of  age  and,  if  possible,  of  doing  an  optical  iridectomy, 
which  seemed  quite  safe  and  could  give  sufficient  vision  to  help  in 
the  child's  development.  We  had  recovered  virus  from  the  lens  of  a 
twenty-two  month  old  patient. 

An  Australian  by  the  name  of  M.N.  Manson  had  found  a  positive 
culture  in  a  patient  twenty-six  months  of  age,  and  Dr.  L.Z.  Cooper, 
also  from  Australia,  mentioned  in  a  letter  to  me  that  he  had  found 
one  in  a  patient  thirty-five  months  of  age.  That  was  the  situation 
when  efforts  dwindled  because  the  disease  began  to  disappear  due 
to  the  vaccine. 

Hughes:     Do  you  remember  when  the  live  vaccine  came  in? 

Scheie:       A  killed  virus  vaccine  became  available  in  1963,  but  was  not  widely 
effective.  A  live  virus  vaccine  was  introduced  in  1967,  but  it  was 
unstable  and  lost  effectiveness  if  not  properly  refrigerated.  In  1980, 
a  stable  live  vaccine  became  available. 

I  stated  at  a  meeting  in  New  York  City  that  prior  to  coming  to  the 
decision  [to  defer  surgery  until  age  two],  I  had  operated  on  fifty-four 
eyes  of  infants  whose  mothers  had  been  infected  during  the  recent 
rubella  epidemic.  Forty-three  percent  of  these  eyes  developed 
severe  postoperative  complications  which  finally  led  to  the  loss  of 
nineteen  eyes.  By  that  time  I  was  convinced  that  delayed  surgery 
was  safer  and  our  statistics  seemed  convincing. 

Hughes:     What  was  the  sequence  of  virus  studies  in  rubella? 

Scheie:       The  first  rubella  virus  recovery  from  eyes,  as  nearly  as  I  could 

determine,  was  by  Horstman  in  1965,  with  a  positive  culture  from 
tears  and  conjunctival  scrapings  of  rubella  patients.*  Another 
paper  was  by  Bellanti,  who  was  the  first  to  recover  intraocular 
virus  from  the  lens  of  an  infant  eight  days  of  age.**  I  don't  know  if 
he  had  operated  the  congenital  cataract  at  that  age  or  whether  the 


Horstman  DM  et  al.  Maternal  rubella  and  the  rubella  syndrome  in  infants.  Am  J  Dis  Child 
1965;  110:408. 

Bellanti  J  Act  al.  Congenital  rubella:  Clinicopathologic,  virologic  and  immunologic  studies.  Am 
J  Dis  Child  1965;  110:464. 


291 


Hughes: 
Scheie: 


child  had  died.  Then  more  to  the  point  I  guess,  Reid  from 
Australia*,  Cotlier  and  his  associates  from  St.  Louis**  (though 
possibly  at  NIH  at  that  time),  and  our  group  at  the  University  of 
Pennsylvania  had  recovered  virus  from  the  lenses  of  infants  with 
rubella,  ranging  in  age  from  five  weeks  to  twenty-one  months.  One 
of  our  patients  was  twenty-one  months,  and  later  we  had  one 
twenty-six  months  of  age. 

Did  people  listen  ? 

Yes,  I  do  think  many  listened. 


The  Light  Coagulator  and  the  Laser 

Hughes:     Dr.  Scheie,  I  know  this  came  towards  the  end  of  your  career,  but  I 

want  to  hear  a  little  about  the  YAG  [yttrium  aluminum  garnet]  laser 
and  its  impact  on  cataract  surgery. 

Scheie:       Just  so  you  won't  think  that  I'm  too  old-fashioned,  before  I  answer  I 
want  you  to  know  that  I  bought  and  used  the  first  clinical  laser  in 
our  department  while  we  were  still  at  the  university  hospital.  It 
was  one  of  the  early  ruby  instruments.  That  would  probably  have 
been  1969  or  1970.  I  used  it  to  seal  retinal  holes.  It  wasn't  being 
used  for  glaucoma  at  that  point  and  it  wouldn't  have  had  adequate 
power. 

I  also  obtained  and  employed  a  light  coagulator.  I  think  that  was 
probably  in  the  late  fifties  when  I  was  still  Dr.  Adler's  assistant  but 
doing  most  of  the  retinal  detachment  surgery.  Here  at  the  eye 
institute  I  also  acquired  and  was  the  first  to  use  the  Kelman 
phacoemulsification  instrument.  I  paid  for  one  and  used  other 
funds  to  buy  another,  because  I  would  not  use  mechanical 
equipment  without  a  backup.  If  the  instrument  should  break  down 
during  an  operation,  a  lost  eye  could  possibly  result.  Hopefully,  I 
was  not  too  outdated. 

Hughes:     [laughs]  I  never  thought  you  were,  Dr.  Scheie. 

Scheie:       Well,  many  people  thought  I  was  too  conservative  but  then  on  the 

other  hand  some  thought  I  was  too  radical.  So  you  can't  always  win 
and  should  not  try  to  please  everybody.  These  instruments  had  all 
been  developed  by  others  and  seemed  to  be  proving  their  worth.  I 
therefore  felt  that  it  was  time  to  find  out  for  myself. 


** 


Reid  RR  ct  al.  Isolation  of  rubella  virus  from  congenital  cataracts  removed  at  operation.  Med  J 
Aust  1966;  1:540. 

Cotlier  E  et  al.  Rubella  virus  in  the  cataractous  lens  of  congenital  rubella  syndrome.  Am  J 
Ophthalmol  1966;  62:233. 


292 


Hughes:     So  in  all  these  cases  you  felt  the  instrumentation  had  been  proved? 

Scheie:       "Proved"  is  too  large  a  word,  but  at  least  promising  and  seemingly 
safe.  I  try  to  be  critical  of  everything  I  do  and  to  carry  that  attitude 
over  to  the  work  of  others,  but  it  does  not  mean  that  I  won't  try  new 
ideas,  especially  if  they  show  promise. 

I  used  the  light  coagulator  that  Gerd  Meyer-Schwickerath  devised 
on  numerous  retinas.  Later,  as  I  have  said,  the  ruby  laser. 
However,  we  were  about  to  move  into  the  new  institute  where  I 
established  the  retina  service  and  stopped  doing  retinal  surgery 
myself.  Phacoemulsification  was  of  great  interest  to  me  because  of 
my  aspiration  of  cataracts  in  young  people,  but  I  used  it  sparingly 
because  it  could  injure  an  eye.  I  did  feel  secure  with  aspiration  of 
cataracts  in  young  patients  but  I  never  felt  quite  at  ease  with 
phaco.  There  were  too  many  ways  in  which  you  could  have 
difficulty,  and  the  results  from  my  conventional  cataract  procedure 
in  older  patients  were  excellent.  Now,  however,  phaco  can  be 
advantageous  in  doing  extracapsular  extractions,  especially  with 
pseudophakic  lenses. 

The  YAG  laser  was  becoming  available  about  the  time  I  stopped 
surgery  and  it  has  proved  to  be  the  method  of  choice  for  doing 
capsulotomies.  Someday  a  goniopuncture  may  be  done  with  a  laser. 

Hughes:     Nobody  has  tried  that? 

Scheie:       Not  so  far  as  I  know.  I  think  they've  tried  to  create  a  fistula  with  it, 
but  in  a  different  way. 

Hughes:     Was  the  YAG  laser  developed  specifically  for  ophthalmology? 

Scheie:       I  think  mainly,  yes.  Whether  it  was  made  for  that  purpose  initially, 
I  am  not  sure.  I  think  it's  most  frequently  used  for  opening  the  lens 
capsule,  eliminating  introduction  of  a  knife  into  the  eye— a 
significant  advance. 

Hughes:     Is  that  its  only  use  in  ophthalmology? 

Scheie:       We  have  various  wavelengths  and  types  of  laser  for  different 

situations,  like  laser  for  diabetic  retinopathy-another  tremendous 
advance.  I  am  not  well  versed  in  laser  technology  and  should  not 
comment.  I  know  there  will  be  many  adaptations,  but  you  and  I 
would  need  a  laser  consultant.  Possibly  a  laser  could  be  used  to  do 
my  preliminary  opening  of  the  lens  capsule. 

Hughes:     Are  all  students  at  the  institute  competent  in  laser  techniques? 

Scheie:       Yes,  it  is  now  part  of  their  training.  Laser  therapy  for  glaucoma  is 
promising.  Laser  trabeculectomy  is  an  accepted  procedure  although 
its  effect  may  not  be  permanent.  It  is  not  as  effective  as  a  filtering 


293 

operation  and  is  probably  most  useful  for  glaucomas  with  relatively 
mild  rises  in  pressure,  and  of  course  the  angle  must  be  open 
because  the  trabecular  area  is  treated.  It  has  few  complications, 
however,  and  can  be  a  supplement  to  medical  treatment. 

Peripheral  iridotomy  (iridectomy)  by  laser  for  narrow-angle 
glaucoma  is  accepted  by  most  ophthalmologists.  We  have  talked 
about  that.  I'm  concerned,  however,  that  some  of  these  patients 
may  have  lens  injury  that  could  lead  to  cataract,  even  years  later.  A 
seemingly  mild  injury  to  the  lens  with  no  damage  to  vision  can 
cause  a  problem  twenty  years  or  more  later.  I  was  about  twenty 
years  old  (about  sixty  years  ago)  when  I  injured  my  left  eye.  In 
about  1973  or  '74, 1  became  aware  of  blurring  of  vision  in  my  eye 
and  it  has  slowly  become  worse,  the  cause  being  that  of  a  slowly 
developing  cataract,  probably  due  to  the  trauma  years  before. 

Hughes:     Is  the  YAG  difficult  to  use? 

Scheie:       No,  it  is  apparently  fairly  easy  to  use. 

Hughes:     What  is  your  opinion  about  the  current  interest  in  creating  a  board 
to  certify  cataract  surgeons? 

Scheie:       I  think  it's  ridiculous-one  more  opportunity  to  further  the 
commercialism  of  eye  surgery. 

Hughes:     What  type  of  surgery  did  you  most  enjoy  doing? 

Scheie:       I  enjoyed  all  of  it,  but  cataract  surgery  was  probably  the  most 

gratifying.  So  many  patients  were  happy  and  grateful.  Congenital 
glaucoma  surgery  also  was  rewarding  because  goniotomy  had 
dramatically  improved  a  dismal  prognosis.  Barkan  was  wise 
enough  to  adopt  it  and  I  was  fortunate  to  pick  it  up  from  him. 

Congenital  cataracts:  What  could  make  one  happier  than  enabling 
a  child  to  see?  Glaucoma  surgery  done  following  concepts  gained 
from  gonioscopy  was  also  very  rewarding.  It's  still  dramatic  for  me 
to  be  able  to  put  a  tiny  hole  into  the  iris  to  cure  or  prevent  acute 
glaucoma,  a  condition  that  can  blind  in  a  matter  of  days  if 
untreated. 


Hughes: 


Membership  in  Medical  Organizations 

[Interview:  March  31, 1988]  ## 

Dr.  Scheie,  we're  looking  at  the  three-and-a-half-page  list  of 
organizations  to  which  you  belong  and  are  now  going  to  discuss 
some  of  the  highlights. 


294 


Academia  Ophthalmologica  Internationalis 

Hughes:     Perhaps  we  could  start  with  the  Academia  Ophthalmologica 
Internationalis. 

Scheie:       The  society  was  organized  mainly  through  the  efforts  of  Professor 
Jules  Franpois  of  Ghent,  Belgium.  The  membership  is  made  up  of 
distinguished  ophthalmologists  from  countries  around  the  world 
and  is  limited  to  fifty  members.  New  members  must  be  proposed, 
their  curriculum  vitae  reviewed,  and  then  be  voted  into  the  society 
by  the  members.  I  was  a  founding  member  and  remained  active 
until  1984  when  I  became  an  emeritus  member. 

The  members  meet  annually,  and  the  program  consists  of  papers 
pertaining  to  topics  on  the  history  of  ophthalmology.  Another  major 
goal  is  to  stimulate  and  promote  ethics  in  ophthalmology.  Usually 
the  meetings  are  in  conjunction  with  some  other  national  or 
international  society  of  ophthalmology. 

Hughes:     Has  any  history  been  written? 

Scheie:       Yes.  Historical  presentations  from  the  annual  meeting  and  other 
material  are  published  in  bound  volumes.  One  of  the  recent 
American  members  is  Dan  Albert.  His  election  was  very 
appropriate  because  of  his  great  interest  in  the  history  of 
ophthalmology  and  his  expertise  in  many  other  areas  of 
ophthalmology,  particularly  in  ocular  tumors,  pathology,  and 
research.  Drs.  Edward  and  Irene  Maumenee,  Frank  Newell, 
Bradley  Straatsma,  Bruce  Spivey,  Edward  Norton,  and  Frederick 
Blodi  are  members.  John  Harry  King  was  also  a  founding  member, 
as  was  Saul  Sugar  of  Detroit  and  John  Bellows  of  Chicago.  Jules 
Francois  was  president  for  the  first  two  or  three  years,  and  Frank 
Newell  has  been  the  most  recent  president. 

American  Academy  of  Ophthalmology  and 
Otolaryngology 

Hughes:     You  were  vice-president  of  the  American  Academy  of  Ophthalmology 
and  Otolaryngology  in  1961-1962. 

Scheie:       I  was  proud  to  hold  this  position  although  at  that  time  it  involved 
little  responsibility. 

I  became  a  member  as  soon  as  I  was  eligible,  either  1940  or  1941. 
Except  for  wartime,  it's  been  a  very  rare  meeting,  if  any,  that  I've 
ever  missed.  Like  so  many  of  my  colleagues,  I  always  taught  an 
instruction  course  one  or  two  hours,  sometimes  more,  during  the 
meeting.  I  also  gave  scientific  papers  before  the  general  assembly 
on  several  occasions.  I  have  always  been  proud  of  my  membership. 
The  Academy  has  become,  I  think,  the  most  important  and 


295 


prestigious  [ophthalmology]  society  in  this  country,  particularly 
since  it  separated  from  otolaryngology. 

American  Association  of  Ophthalmology 

Hughes:     The  American  Association  of  Ophthalmology. 

Scheie:       The  American  Association  of  Ophthalmology  was  a  direct  outgrowth 
of  the  Section  on  Ophthalmology  of  the  American  Medical 
Association.  It  originated  from  two  committees  that  were  appointed 
by  Erling  W.  Hansen  and  myself  the  year  (1954-1955),  he  was 
chairman  of  the  section  and  during  one  of  the  years  when  I  was 
secretary.  The  committees,  which  were  headed  by  Harold  Falls  and 
Ralph  Rychener,  studied  relations  to  optometry,  opticianry,  and  the 
dispensing  of  eyeglasses. 

The  Association  went  on  to  become  in  my  opinion  an  influential 
organization,  with  representatives-I  believe  two-from  each  state. 
They  had  their  own  agenda,  annual  meetings,  officers,  and  for  legal 
reasons  were  in  no  way  part  of  the  American  Medical  Association. 
The  appointment  of  the  committee  was  the  result  of  a  stormy 
session  of  the  eye  section  during  an  annual  meeting  of  the  AMAin 
Atlantic  City  that  went  on  until  about  1:00  a.m. 

American  Board  of  Ophthalmology 

Hughes:  In  1959,  you  became  a  member  of  the  Board  of  Examiners  of  the 
American  Board  of  Ophthalmology.  Could  you  tell  me  how  that 
came  about? 

Scheie:       Well,  the  American  Board  of  Ophthalmology  elects  its  own 

members.  The  Board  elected  me  to  membership  and  I  served  from 
1959  to  1967,  two  four-year  terms.  I  considered  it  an  honor  to  be  a 
member,  and  the  association  was  pleasant  but  required 
considerable  time.  I  did  not  enjoy  the  oral  examinations  because 
the  examinees  were  so  tense  and  nervous.  I  also  found  it  difficult, 
although  a  necessity,  to  flunk  anyone— even  those  who  deserved  it. 
Otherwise  serving  was  pleasant  and  rewarding. 

Hughes:     What  fields  did  you  examine  in? 

Scheie:       We  examined  in  different  areas.  One  year  it  might  be  surgery; 
another  year  it  might  be  refraction,  etc.  The  purpose  of  the 
examinations  was  to  test  a  candidate's  general  ophthalmologic 
knowledge,  his  capacity  to  be  a  good  clinical  ophthalmologist.  It 
was  not  to  see  if  he  had  done  research  or  had  other  special  skills, 
say,  in  pathology  or  optics.  It  was  meant  to  be  a  fair, 
across-the-board,  general  test. 


296 


Hughes:     Do  you  think  passing  the  American  Board  of  Ophthalmology  was  a 
good  indication  of  qualification  in  the  specialty? 

Scheie:       I  think  it  served  a  good  purpose  and  supported  high  standards  of 
training  in  ophthalmology.  It  was  the  first  of  all  the  specialty 
boards,  by  the  way,  leading  the  way  for  other  specialties. 

Hughes:     Who  else  served  on  the  Board  during  your  time? 

Scheie:       Oh,  there  were  so  many  I  couldn't  possibly  name  them,  but  they 
were  a  representative  group. 

Hughes:     Why  is  one  appointed  to  the  Board? 

Scheie:       The  Board  members  decided  that  they  would  like  him  on  the  Board, 
that  he'd  be  a  fair  examiner,  and  I  hope  for  reasons  of  balance, 
interest  in  education,  and  ability.  Occasionally  a  member  was 
elected  because  of  special  knowledge  in  a  subject,  such  as  pathology, 
but  that  was  not  the  rule. 

Hughes:     Of  course,  you  had  been  through  the  process  from  the  other  side 

when  you  became  a  diplomate  in  1940.  Do  you  have  any  memories 
of  the  exams? 

Scheie:       Yes,  and  to  me  it  was  a  rather  enjoyable  experience.  I  was  able  to 
meet  some  of  the  leaders  in  ophthalmology  who  were  examiners. 

The  highlight  was  my  pathology  exam.  My  examiner  was  Dr.  C.S. 
O'Brien  from  the  University  of  Iowa,  who  had  a  brusque  manner. 
Even  we  examinees  knew  that  he  had  a  reputation  for  being 
somewhat  caustic.  He  was  not  the  examiner  I  would  have  selected. 
You  would  be  given  a  half  hour  to  examine  three  or  four  slides  and 
then  you  were  quizzed  about  the  slides.  It  happened  that  I  had  a 
bad  microscope  with  prisms  that  were  out  of  adjustment,  and  after 
half  the  time  of  my  half-hour  with  the  slides  was  up,  I  noticed  that  I 
was  beginning  to  be  nauseous.  By  the  time  Dr.  O'Brien  came  to 
examine  me,  I  was  perspiring,  pale  as  a  ghost,  and  experiencing  a 
feeling  akin  to  seasickness-this  because  of  the  muscle  imbalance 
induced  by  the  microscope.  I  hadn't  realized  it  until  I  became  ill. 
O'Brien  came,  took  one  look  at  me,  and  asked  me  about  one  slide, 
patted  me  on  the  back,  and  tried  to  reassure  me  by  saying,  "Don't 
be  so  excited."  He  thought  that  I  was  suffering  from  nervous 
tension  but  told  me  my  examination  was  over  and  to  relax.  So  I 
think  my  becoming  ill  from  the  microscope  probably  passed  me. 
[laughter]  I  was  never  the  greatest  pathologist  in  the  world.  It  was 
a  weird  experience,  but  I  always  had  a  special  affection  for  Dr. 
O'Brien  as  a  result.  I  had  learned  that  he  was  truly  a  kind  person 
beneath  his  brusque  manner. 

Hughes:     Were  there  any  other  well-known  examiners? 


297 


Scheie:       I  remember  William  L.  Benedict  was  one  of  the  examiners  and 
another  was  John  Dunnington. 

Hughes:     How  and  what  had  you  studied  for  the  Boards? 

Scheie:       As  I  recall,  I  did  little  studying  for  the  Boards.  I  felt  as  I  did  about 
any  of  my  licensing  examinations,  that  I  ought  to  know  enough  to 
pass.  That  was  true  for  my  national  medical  board  and  state  board 
examinations.  Once  you  go  through  a  respectable  training 
program,  whether  it's  medical  school  or  a  residency,  I  don't  think 
you  should  necessarily  have  to  cram. 

Hughes:  How  soon  were  you  told  the  results  of  the  Board  exams? 

Scheie:  I've  forgotten,  really.  It  was  so  long  ago. 

Hughes:  You  sailed  through,  didn't  you? 

Scheie:  I  had  no  problems. 

Hughes:  Anything  more  about  the  American  Board  of  Ophthalmology? 

Scheie:       No,  I  think  they  were  an  outstanding  group  to  work  with.  I  did 
enjoy  it,  except  sensing  the  stress  of  the  examinees  and  shaking 
their  clammy  hands.  It  was  a  job  that  I  took  seriously  because  it 
meant  so  much  to  each  individual. 

American  College  of  Surgeons 

Hughes:     You  became  a  fellow  of  the  American  College  of  Surgeons  in  1946. 

You  were  second  vice-president,  1961-1962,  and  then  you  were  on  the 
Board  of  Regents  from  1963-1972,  and  also  on  some  committees.* 
Was  it  unusual  at  that  time  for  an  ophthalmologist  to  be  a 
vice-president  of  the  American  College  of  Surgeons? 

Scheie:       I  think  that  I  may  have  been  the  first. 

Hughes:     What  was  ophthalmology's  standing  in  the  American  College  of 
Surgeons? 

Scheie:       Well,  there  has  been  considerable  discussion  within  ophthalmology 
about  the  American  College  of  Surgeons.  Some  very  prominent 
ophthalmologists  never  joined  the  College,  thinking  that 
ophthalmology  had  not  been  sufficiently  emphasized,  I  suspect.  I 
never  did  agree  with  that  and,  in  fact,  I  was  very  enthusiastic  about 
the  College  and  proud  of  my  fellowship. 


*        Dr.  Scheie  also  served  on  the  Graduate  Training  and  Credential  Committees. 


298 


I  have  never  belonged  to  a  medical  organization  that  was  more 
idealistic  and  dedicated  to  good  patient  care  than  the  American 
College  of  Surgeons.  There  is  less  internal  politics  than  any 
organization  that  I  have  been  involved  with,  including  academia. 
The  terms  of  office  are  strictly  limited,  usually  no  more  than  three 
years.  The  election  process  is  open  and  fair.  I've  served  at  various 
levels  in  the  College  and  I  have  never  heard  anything  discussed 
that  didn't  pertain  to  the  best  care  of  the  surgical  patient.  In  my 
opinion,  it  is  a  great  organization.  While  I  was  a  regent,  I  exerted 
considerable  effort  to  promote  ophthalmologic  membership  and  it 
did  increase  significantly  during  those  years. 

Hughes:     How  did  you  go  about  increasing  the  membership  in  ophthalmology? 

Scheie:       Well,  with  the  approval  of  the  College,  I  had  informational  material 
sent  to  ophthalmologists  around  the  country.  I  also  sponsored  and 
supported  social  events  for  ophthalmologists  attending  the  annual 
congress.  The  program  committee  arranged  excellent  programs  at 
the  annual  congress  for  the  eye  section  which  were  well  attended. 

Hughes:     I  believe  you  also  took  a  stand  in  the  American  College  of  Surgeons 
against  ophthalmologists  dispensing  glasses. 

Scheie:  Yes,  and  it  was  the  way  that  I  had  always  felt  and  had  advocated  as 
an  officer  of  the  Section  on  Ophthalmology  of  the  American  Medical 
Association.  I've  always  been  opposed  as  a  matter  of  principle.  The 
question  of  ethics  and  profits  on  glasses  are  up  to  the  individual. 

Hughes:     Did  you  make  enemies  because  of  that  stand? 

Scheie:       I  don't  know,  but  I'm  sure  that  some  people  were  opposed  to  my 
point  of  view. 

I've  been  asked  why  an  ophthalmologist  should  bother  with  either 
the  College  or  the  American  Medical  Association.  I  think  we're 
seeing  more  and  more  reason  because  of  the  growing  impact  of 
governmental  and  third  parties  on  medicine.  I  have  always  felt 
that  we  should  not  isolate  ourselves  from  the  activities  of  general 
medical  organizations,  such  as  the  College  and  the  AMA.  Certainly, 
I  prize  my  membership  in  the  College  and  continue  to  attend  the 
meetings.  Specialties  need  the  strength  of  our  national  general 
organizations  to  help  provide  a  united  front  and  lend  greater 
strength  in  confronting  our  common  problems. 

Hughes:     Were  ophthalmologists  welcomed  on  the  same  level  as  any  other 
specialty? 

Scheie:       Yes,  indeed.  Each  specialty  had  its  own  regent-neurosurgery, 

otolaryngology,  urology,  and  others.  I  am  quite  certain  that  many  of 
the  prejudices  by  ophthalmologists  against  the  college  stem  from 


299 

resentment  of  the  staff  structure  in  some  medical  schools,  especially 
in  the  old  days,  when  ophthalmology  was  usually  part  of  the 
department  of  surgery  and  under  the  administration  of  that 
chairman.  I  believe  that  any  lack  of  influence  in  the  College  by 
ophthalmology  is  because  of  our  lack  of  participation. 

I  have  always  believed  in  being  a  part  of  general  medical 
organizations,  including  one's  own  medical  school  or  hospital  staff. 
Certainly,  as  a  regent  I  never  felt  left  out.  During  my  last  two  years 
on  the  board  of  regents,  I  served  on  the  executive  committee  of  the 
group.  However,  a  feeling  of  resentment  on  the  part  of  some 
ophthalmologists  has  unfortunately  existed,  and  I  believe 
mistakenly,  which  has  kept  some  ophthalmologists  from  becoming 
members. 

Hughes:     Was  it  prestigious  to  be  on  the  board  of  regents'? 

Scheie:       I  felt  that  it  was  and  also  an  opportunity  to  be  associated  with  some 
of  the  finest  surgeons  in  the  world,  as  well  as  the  most 
accomplished  and  dedicated.  Again,  it  was  always,  "What  is  best 
for  the  patient?" 

The  college  was  the  prime  motivator  in  originating  the  Joint 
Committee  on  Hospital  Accreditation.  It  always  has  been  an 
opponent  of  fee-splitting,  which  was  one  of  the  original  goals  of  the 
college.  If  a  violation  comes  to  its  attention,  the  surgeon,  if  a 
member,  is  disciplined.  And  the  college  takes  disciplinary  actions 
for  other  reasons  as  well. 

Hughes:     Is  that  not  true  of  other  medical  organizations? 

Scheie:       Not  usually. 

Itinerant  surgery  is  also  a  target  of  the  American  College  of 
Surgeons.  The  sort  of  thing  that  some  ophthalmologists  are 
probably  guilty  of  in  their  relationship  with  optometrists,  where  the 
ophthalmic  surgeons  operate  and  then  permit  the  optometrist  to 
give  postoperative  care.  But  the  number  of  surgeons  who  operate  in 
different  cities,  for  example,  and  then  do  not  give  postoperative  care 
to  the  patient,  is  certainly  diminishing.  A  member  of  the  College 
would  face  disciplinary  action.  In  my  opinion,  the  College  is  a  fine 
and  idealistic  organization. 

Both  the  American  College  of  Surgeons  and  the  American  Academy 
of  Ophthalmology  are  interested  in  education  as  well  as  in  high 
standards  of  practice  and  ethics.  Their  annual  meetings  are 
outstanding.  Both  include  a  high  standard  of  papers  on  a  broad 
variety  of  subjects  by  excellent  teachers.  In  fact,  they  are  both  fine 
organizations. 


300 


Section  on  Ophthalmology,  AMA 

Hughes:     We've  talked  a  little  about  the  AMA  but  not  specifically  about  the  fact 
that  you  were  chairman  of  the  Section  on  Ophthalmology  in  1960. 
Could  you  say  something  about  your  accomplishments  as  chairman? 

Scheie:       Well,  I  would  say  that  I  contributed  much  more  to  the  Section,  by 
way  of  accomplishments,  when  I  was  secretary  from  1954  to  1959. 
The  organization  was  such  that  the  secretary  largely  ran  the 
section,  formulated  the  program,  and  prepared  for  the  annual 
section  meeting.  The  position  was  quite  autonomous. 

## 
Hughes:     What  do  you  mean  by  autonomous1? 

Scheie:       The  AMA  gave  the  section  great  leeway  in  its  programs,  and  the 
secretary  was  permitted  considerable  freedom  to  use  his  own 
judgment.  He  was  really  an  administrator. 

Hughes:     That's  not  true  nowadays1? 

Scheie:       It  doesn't  exist  anymore.  The  scientific  sections  of  the  AMA  have 
been  terminated. 

Hughes:     Do  you  remember  when  that  was1? 

Scheie:       It  was  a  gradual  process  in  the  late  1960s  and  early  1970s.  When 
the  specialty  organizations  grew  larger  and  stronger,  support  for 
specialty  sections  dwindled  and  were  finally  terminated. 

Hughes:     Was  there  a  pecking  order  amongst  the  sections'? 

Scheie:       I  never  sensed  it. 

While  I  was  secretary,  a  program  committee  assisted  me  with 
soliciting  papers  and  the  programs  were  excellent,  the  scientific 
program  running  for  three  half-days. 

Hughes:     Were  you  trying  to  attract  larger  support  from  ophthalmologists'? 
Scheie:       Yes,  and  the  section  did  grow  significantly  during  that  time. 

Hughes:     What  was  the  section's  role  within  ophthalmology  in  comparison  to 
some  of  the  other  American  ophthalmological  societies'? 

Scheie:       I  would  say  that  we  tried  to  have  excellent  scientific  programs  and 
included  some  economic  problems,  like  dispensing  of  glasses, 
optometric  problems,  and  others.  We  had  representation  in  the 
House  of  Delegates  where  we  could  be  represented  for  general 
problems  and  to  obtain  trustee  support  for  some  of  our  problems.  It 


301 


might  be  medical,  legal,  political,  or  whatever  came  up.  However, 
the  American  Academy  of  Ophthalmology  for  many  years  has  had 
more  impact  than  other  ophthalmological  societies. 

Hughes:     The  position  of  chairman,  then,  was  largely  a  titular  one? 

Scheie:       I  think  largely  consultation  and  presiding  at  the  annual  section 
meeting. 

Hughes:     I  believe  you  had  something  to  do  with  initiation  of  the  Knapp 
awards? 

Scheie:       Yes,  I  believe  it  was  while  I  was  secretary  that  the  Knapp  Fund  was 
approached  for  financial  support  for  the  Section  on  Ophthalmology. 
We  appealed  to  them  to  give  a  prize  for  the  best  paper  and  the  best 
exhibit  at  the  section  meeting  each  year. 

Hughes:     Did  that  become  a  prestigious  award? 

Scheie:       A  monetary  prize  was  involved  [laughter]  and  definitely  a  certain 
amount  of  prestige.  We  also  had  the  prestigious  Howe  Medal  to 
award  to  an  ophthalmologist  who  had  contributed  significantly  to 
ophthalmology  or  to  the  section. 

Hughes:     You  were  representative-at-large  from  June  1970  to  November  1977. 
What  were  your  responsibilities? 

Scheie:       I  could  go  to  the  delegates'  meetings  or  have  access  to  the  trustees 
should  there  be  some  problem  that  we  wanted  to  bring  up.  It 
wasn't  a  very  active  assignment. 

Hughes:     Did  you  ever  do  either  of  those  things? 
Scheie:       Yes,  I  did. 

American  Ophthalmological  Society 

Hughes:     You  became  a  member  of  the  American  Ophthalmological  Society  in 
1948.  That  was  on  the  basis  of  your  thesis  on  scrub  typhus? 

Scheie:       Yes. 

Hughes:     Were  there  additional  requirements  for  becoming  a  member? 

Scheie:  You  had  to  be  proposed.  The  membership  was  limited.  You  were 
not  eligible  until  you'd  been  in  ophthalmology  for  ten  years,  and  I 
was  just  under  the  wire  because  I  had  started  my  residency  in  1937. 

Hughes:     Who  proposed  you  ? 
Scheie:       Dr.  Adler  did. 


302 


Hughes:     It  was  common  knowledge? 

Scheie:       Oh,  yes,  it's  listed  in  the  Transactions.  We  had  to  have  a  seconder 
also,  and  I  don't  know  who  that  was,  but  I  believe  it  was  Dr.  Wilfred 
Fry.  He  was  a  member  of  the  faculty  in  our  department  of 
ophthalmology  at  Penn. 

Hughes:     You  were  a  council  member  (1965-1970)  and  president  (1970)  of  the 
council. 

Scheie:       Yes,  members  serve  a  five-year  term  and  the  last  year  you 
automatically  become  president  of  the  council. 

Hughes:     What  did  you  do  in  those  positions? 

Scheie:       Well,  the  affairs  of  the  society  are  analyzed  and  discussed  by  the 
council,  and  recommendations  for  membership  on  committees  and 
for  officers  are  presented  at  the  annual  meeting,  where  they're 
voted  upon.  The  council  can  make  some  decisions,  but  in  general 
problems  go  before  the  membership  for  discussion  and  vote  at  the 
business  section. 

Hughes:     What  are  the  particular  interests  of  the  AOS? 

Scheie:       I  would  think  to  stimulate  ideals,  education,  [to  provide]  a  forum  for 
discussion,  and  [to  offer]  social  activities. 

Hughes:     Do  they  have  any  disciplining  function? 

Scheie:       I've  not  known  of  a  disciplining  function. 

Hughes:     A  member  has  never  been  dropped  to  your  knowledge? 

Scheie:       The  membership  is  not  the  type  that  might  have  disciplinary 
problems.  I  don't  know  the  by-laws  that  well,  and  I  suppose 
someone  could  be  expelled,  but  I've  just  never  known  anyone  to  be. 
Turned  down  for  admission,  yes.  It  would  be  unusual  for  a  member 
to  propose  anyone  who  was  questionable.  Presenting  an  acceptable 
thesis  is  a  real  challenge. 

Hughes:     People  are  turned  down  on  the  basis  of  their  thesis? 

Scheie:       Yes,  that's  not  unusual.  By  the  way,  AOS  is  the  oldest  eye  society  in 
the  country.  It's  celebrating  125  years  in  1989. 

Hughes:     Does  it  continue  to  have  the  prestige  that  it  did  when  you  first  joined? 

Scheie:       Probably  not,  and  partly  because  the  Academy  has  become  so 
influential.  It's  an  honor  to  be  elected  to  AOS  but  as  a  force  in 
organized  medicine,  the  society's  influence  is  minimal.  Its  purpose 


303 

is  both  scientific  and  social,  and  from  that  vantage  point,  as  well  as 
in  its  traditions,  it  is  elite. 

Hughes:     You  joined  at  thirty-nine.  Isn't  that  young  for  membership  in  the 
AOS? 

Scheie:       I  think  not.  Dr.  E.  Gerard  DeVoe  of  New  York  City  became  a 

member  the  year  I  did,  and  he's  almost  as  young.  He  was  born  on 
the  same  day,  the  same  year,  [laughterl 

Hughes:  Is  one  of  the  functions  of  a  council  member  to  read  the  theses? 

Scheie:  No,  we  have  a  thesis  committee  of  three  people  for  that  purpose. 

Hughes:  Were  you  ever  on  it? 

Scheie:  No. 

Hughes:     The  burden  of  the  thesis  committee  is  to  judge  the  thesis  on  academic 
merit? 

Scheie:       Yes,  and  originality.  It  must  be  an  original  piece  of  work. 
Hughes:     Is  membership  based  solely  on  acceptance  of  the  thesis? 

Scheie:  No,  you  have  to  be  voted  in,  and  you  remain  an  associate  member 
until  after  your  thesis  is  accepted.  You  have  two  years,  I  think,  to 
prepare  your  thesis.  But  you  can  be  voted  down. 

Hughes:  Can  you  be  voted  down  for  reasons  other  than  acceptability  of  your 
thesis? 

Scheie:       I  would  hope  that  if  there  is  anything  questionable  about  your 

reputation  or  your  background  that  you  wouldn't  be  proposed.  I'm 
not  certain  of  this,  but  I  think  the  council  approves  candidates  for 
membership  before  they're  voted  on  by  the  general  body. 

College  of  Physicians  of  Philadelphia 

Hughes:     The  College  of  Physicians  of  Philadelphia. 

Scheie:       That  is  the  oldest  medical  organization  in  the  United  States,  but  its 
impact  is  largely  local.  It  is  prestigious,  especially  in  Philadelphia. 
It  has  specialty  sections  and  holds  meetings  at  the  College  of 
Physicians  building  periodically,  the  frequency  depending  upon  the 
section.  The  eye  section  used  to  meet  every  month,  except  for  June, 
July,  and  August,  but  they  meet  less  frequently  now. 

You  must  be  elected  to  membership  in  the  college.  It  is  somewhat 
selective,  but  its  membership  is  really  a  cross  section  of 
Philadelphia  medicine,  surgery,  and  the  specialties.  A  general 
physician  is  eligible  for  membership.  The  Philadelphia  medical 


304 

schools  utilize  the  college,  particularly  its  library,  which  is  one  of 
the  best  medical  libraries  in  the  country.  It  also  has  a  museum  of 
medical  history,  the  Mutter  Museum,  with  an  outstanding 
ophthalmology  collection.  It  serves  a  significant  community 
purpose  and,  of  course,  has  a  legendary  historical  background 
dating  back  to  colonial  days. 

Hughes:     Benjamin  Rush  was  one  of  the  early  members,  wasn't  he? 

Scheie:       Yes,  and  some  of  the  founders  of  the  University  of  Pennsylvania 
Medical  School,  which  is  the  oldest  school  in  the  country.  We  also 
have  the  oldest  hospital,  Pennsylvania  Hospital. 

Hughes:     Does  the  college  ever  meet  as  a  whole? 

Scheie:       Yes,  it  has  general  meetings. 

Hughes:     You  were  chairman  of  the  finance  committee. 

Scheie:       Yes,  for  a  few  years.  The  college  is  a  private  organization,  financed 
through  dues,  gifts  and  bequests.  The  job  of  the  finance  committee 
is  first  of  all  to  see  that  budgets  balance,  to  help  draw  up  to 
budgets,  and  also  to  supervise  investments. 


Editorial  Work 


Hughes:     Well,  you've  been  on  several  editorial  boards.  Perhaps  we  could  talk 
about  your  work  with  the  Archives  of  Ophthalmology.  You  were  on 
the  board  from  1954  through  1964.  Was  that  a  prestigious  position? 

Scheie:       I  considered  it  an  honor  to  be  on  the  editorial  board.  The  Archives 
is  one  of  the  two  most  respected  ophthalmology  journals  in  our 
country.  Dr.  Adler  was  the  editor  at  the  time  I  was  named  associate 
editor.  The  term  was  for  ten  years.  He  appointed  the  editorial 
board  as  more  or  less  of  a  consultant  group.  My  niche  was  to  read 
and  accept  or  decline  papers  for  publication  on  surgical  subjects  and 
particularly  surgical  techniques. 

Hughes:     Was  that  time  consuming? 

Scheie:       Not  really. 

Hughes:     Can  you  comment  on  your  rejection  rate? 

Scheie:       I  can't.  I  kept  no  data.  We  accepted  the  papers  that  we  believed  to 
be  publication  worthy. 

Hughes:     The  journal  that  you  seemed  to  favor  in  terms  of  your  own 
publications  is  the  Archives.  Is  there  a  reason  for  that? 


305 


Scheie:       I  guess  loyalty  to  the  AMA  and  Dr.  Adler. 

Hughes:     Do  the  major  journals  in  ophthalmology  have  certain  emphases  that 
are  well  known  to  potential  authors'? 

Scheie:       I  think  the  American  Journal  of  Ophthalmology  and  the  Archives 
were  the  two  major  publications  in  general  ophthalmology  in  this 
country  and  published  papers  with  a  broad  range  of  interest.  They 
were  equally  prestigious  but  always  friendly  competitors. 

Hughes:     Does  one  or  the  other  have  a  more  clinical  as  opposed  to  research 
emphasis? 

Scheie:       No,  I  think  they're  quite  equal  and  have  been  for  some  years. 

Dr.  Derrick  Vail  and  Dr.  Adler-Dr.  Vail  was  editor  of  the  American 
Journal  of  Ophthalmology-were  very  close  friends.  Through  my 
professional  lifetime,  I  was  close  to  Dr.  Adler  and  particularly 
during  those  days  when  I  was  growing  up  in  ophthalmology  with 
him  and  the  department  at  Penn  and  in  his  private  practice.  I  used 
to  be  a  participant  in  an  occasional  discussion  between  Dr.  Vail  and 
Dr.  Adler,  and  they  were  always  friendly  competitors.  I'm  sure  that 
the  relationship  of  Frank  Newell  and  Morton  Goldberg  is  equally 
friendly  today. 

There  is  a  research  journal,  ARVO,  published  by  the  Association  for 
Research  in  Vision  and  Ophthalmology,  that  comes  out  monthly.  It 
publishes  scientific  papers,  especially  those  given  at  the  annual 
meeting  of  the  Association  for  Research. 

Hughes:     Has  the  rise  of  the  Academy  as  an  association  within  ophthalmology 
meant  an  increase  in  prestige  of  the  Transactions  of  the  Academy? 

Scheie:  Yes,  it  has  and  particularly  the  newest  journal. 

Hughes:  You  mean,  Ophthalmology? 

Scheie:  Yes,  and  it  is  an  enjoyable  and  informative  journal. 

Hughes:  Anything  more  to  be  said  about  editorial  work? 

Scheie:  No,  I  don't  think  so. 


306 


Honors 

## 

Hughes:     Dr.  Scheie,  let's  select  some  of  your  many  awards.*  The  first  one  I 
have  listed  is  your  honorary  membership  in  the  Order  of  the  British 
Empire. 

Scheie:       That  was  given  because  of  my  care  for  the  British  and  American 
troops  of  the  Southeast  Asia  Command  during  World  War  II, 
including  Lord  Mountbatten.  The  award  came  as  a  complete 
surprise  to  me  and  was  awarded  after  I'd  returned  to  practice  with 
Dr.  Adler  in  1946.  Arrangements  were  made  for  it  to  be  presented 
at  the  British  Embassy  in  Washington  by  the  then  ambassador  to 
the  United  States,  Lord  Halifax.**  Unfortunately,  Lord  Halifax 
was  just  recovering  from  an  attack  of  chicken  pox  during  the  week 
of  the  presentation  but  was  still  quite  weak  and  unable  to  stand 
during  the  formal  ceremony,  for  which  he  apologized.  That  was 
probably  the  highlight  of  that  presentation,  [laughs]  However,  it 
was  very  generous  of  him  to  appear  personally  under  those 
circumstances.  The  order  was  signed  by  Queen  Mary. 

Hughes:     The  Lindback  Teaching  Award  from  the  University  of  Pennsylvania? 

Scheie:       The  Lindback  Teaching  Award  is  given  for  excellence  in  teaching 
medical  students  at  the  University  of  Pennsylvania.  I  believe  it's 
also  given  at  some  other  schools.  I'm  not  sure  that  the  University  of 
Minnesota  doesn't  give  Lindback  awards.  Two  were  given  each  year 
at  Penn,  and  I  was  given  one  this  particular  year,  1964. 

Hughes:     Who  nominates  for  the  award? 

Scheie:       I  believe  the  students  do  so. 

Hughes:     The  Howe  Award  in  Ophthalmology  from  the  AM  A  (1964)? 

Scheie:       The  Howe  Award  was  given  by  the  Section  on  Ophthalmology.  I 
think  it  was  given  to  me  the  year  after  I  was  chairman  of  the 
Section,  because  of  my  activities  with  the  Section. 

Hughes:     In  1964  you  received  a  second  Howe  Award,  from  the  University  of 
Buffalo. 

Scheie:       How  the  selection  was  made  for  that  Howe  Medal,  I  do  not  know. 


A  list  entitled  "Decorations  and  Awards"  comprises  one-and-a-half  pages  of  Dr.  Scheie's 
curriculum  vitae. 

**      Edward  Frederick  Lindley  Wood,  First  Earl  of  Halifax. 


307 


Hughes:     It  wasn't  for  specific  research? 

Scheie:       I  think  it  was  for  general  accomplishments,  if  that's  a  good  word  in 
this  instance. 

Hughes:     You  received  a  third  Howe  Award  in  1984. 

Scheie:       I  am  the  only  ophthalmologist  to  have  received  three  Howe  Medals. 
This  one  was  given  by  the  American  Ophthalmological  Society.  It  is 
a  prestigious  award  voted  by  AOS  members  and  I  was  extremely 
proud  to  receive  it.  The  medal  was  presented  by  Dr.  Sam 
McPherson  in  a  nice  ceremony  spiced  with  Sam's  tasteful,  dry 
humor. 

Hughes:     Was  it  awarded  for  anything  specific1? 

Scheie:  Nothing  specific.  A  member  is  selected  to  receive  the  Howe  Medal 
because  of  his  contributions  to  ophthalmology.  It's  not  necessarily 
given  each  year. 

Hughes:     Is  there  a  variation  in  prestige  of  each  of  these  Howe  Medals? 
Scheie:       I  would  think  the  most  prestigious  would  be  that  of  the  AOS. 

Hughes:     In  1968,  you  received  an  honorary  doctorate  of  medical  science  from 
Villanova  University. 

Scheie:       Yes,  and  I  would  think  that  was  given,  again,  because  of 

contributions  in  ophthalmology  at  the  University  of  Pennsylvania 
and  in  the  community.  Their  board  of  trustees  and  the  president  of 
Villanova  University  made  the  decision.  At  the  same 
commencement,  Eugene  Ormandy  was  given  an  honorary  degree, 
as  was  Senator  [Daniel  Patrick]  Moynihan  and  [pause]  Ramsey 
Clark.  That  name  came  "slow  freight."  Anytime  Senator  Grundy 
couldn't  immediately  remember  something,  and  in  a  minute  or  two 
when  it  came  to  him,  he  would  say,  "By  slow  freight,  doctor." 

Hughes:     An  Outstanding  Achievement  Award  from  the  University  of 
Minnesota  in  1968. 

Scheie:       That  was  probably  because  I'd  been  active  in  several  different  ways 
at  the  university,  but  particularly  with  the  Minnesota  Medical 
Foundation  where  I  had  been  a  trustee  for  several  years.*  I  hope 
that  my  professional  life  may  have  had  something  to  do  with  it  also. 

Hughes:     An  honorary  doctor  of  law  degree  from  the  University  of 
Pennsylvania  in  1978. 


Dr.  Scheie  served  two  terms,  1966-70  and  1970-74. 


308 


Scheie:       The  University  of  Pennsylvania  has  a  faculty  trustee  committee 
that  makes  these  decisions,  and  I  was  selected  as  one  of  eight 
recipients  of  an  honorary  degree  at  the  spring  commencement.* 

Hughes:     Then  in  1980,  the  Derrick  T.  Vail  Gold  Medal  of  the  International 
Eye  Foundation. 

Scheie:       Yes,  Dr.  Harry  King  and  his  committee  invited  me  to  give  the  Vail 
Lecture  and  to  receive  the  medal  at  the  IVth  World  Congress  in 
Nairobi  of  the  Society  of  Eye  Surgeons.  Following  the  lecture,  I  was 
presented  with  the  Vail  Medal  by  the  president  of  the  Republic  of 
Kenya,  President  Daniel  Arap  Moi. 

Hughes:     Is  that  a  prestigious  medal? 


Scheie:       It  is  the  highest  honor  bestowed  by  that  society. 

Hughes:     In  1982  the  Harold  G.  Scheie  Research  Professorship  was 

established  at  the  University  of  Pennsylvania.  Who  was  behind  that? 

Scheie:       The  dean  and  the  faculty  were  behind  it.  It  was  done,  I  guess, 
because  of  my  efforts  at  the  University  of  Pennsylvania  over  so 
many  years  and  whatever  I  might  have  done  for  the  department  of 
ophthalmology. 

Hughes:     The  last  award  I've  singled  out  to  discuss  is  the  Harold  G.  Scheie 
Research  Chair  in  Ophthalmology  at  the  University  of  Minnesota. 

Scheie:       Yes.  I've  remained  close  to  the  University  of  Minnesota,  and  I  have 
contributed  to  their  annual  giving  program  each  year,  as  well  as 
being  supportive  of  the  Minnesota  Medical  Foundation  and  a 
trustee.  A  friend  had  left  some  money  to  be  used  for  eye  research 
and  this  helped  to  support  the  establishment  of  the  chair. 

Hughes:     Anything  more  to  be  said  about  awards? 

Scheie:       We've  said  too  much.  It's  almost  embarrassing.  Life  has  been  good 
to  me. 


Miscellaneous 

Hughes:     I  wonder  if  to  advance  to  positions  of  power  and  prestige  in 
ophthalmology,  it  is  an  advantage  to  be  a  surgeon? 


The  other  recipients  were  Julius  H.  Comroc,  Jr.,  Pierre  Emmanuel,  Hans  Frauenfelder,  Patricia 
Roberts  Harris,  Theodore  M.  Hesburgh,  Gordon  N.  Ray,  and  John  H.  Ware,  III. 


309 


Scheie:       I  don't  think  so.  Look  at  people  like  Frank  Walsh,  Arnall  Patz, 

Jonas  Friedenwald,  and  David  Cogan.  Dr.  Adler  did  surgery  but  it 
wasn't  his  driving  interest.  I  don't  know  how  much  surgery  Dr. 
Phillips  Thygeson  did,  but  I  would  think  it  wasn't  a  priority  of  his. 
You  could  go  on  and  on. 

Retirement 

Hughes:     You  retired  as  chairman  of  the  department  and  director  of  the 
institute  in  1975.  Would  you  comment  on  the  adjustments  that 
retirement  must  have  required? 

Scheie:       The  adjustments  weren't  great  for  me  because  I  am  the  type  of 
person  who  is  always  involved  in  one  activity  or  another.  More 
than  that,  I  have  the  capacity  to  relinquish  and  withdraw  when  my 
responsibility  ends.  As  an  example,  when  I  retired  from  the  army,  I 
terminated  my  contacts.  I  did  the  same  when  giving  up  my  position 
as  chairman  of  the  department  of  ophthalmology  and  director  of  the 
eye  institute. 

Because  of  my  somewhat  "take  charge"  personality,  people  felt  that 
I  would  always  be  about  and  attempting  to  run  both  the  army  unit 
and  later  the  eye  institute  behind  the  scenes.  But  like  the  army,  I 
have  not  intervened  in  affairs  of  the  institute  and  I  have  avoided 
any  participation  in  the  administration  or  of  setting  policy.  That 
would  only  have  caused  resentment.  Furthermore,  my  successor 
should  be  able  to  make  the  changes  he  might  wish  within  the  limits 
approved  by  the  university  administration. 

Hughes:     So  you  gave  it  up  in  1986? 

Scheie:       I  think  about  1986  I  saw  my  last  patients.  Actually,  I  stopped 
surgery  in  1983  because  I'd  had  heart  surgery.  I  began  to  ask 
myself,  "Why  continue  operating?"  I  was  working  very  hard,  with 
long  hours,  and  I  did  continue  an  office  practice  for  three  more 
years. 

Hughes:     For  a  very  active  person,  a  very  energetic  person,  it  must  have  been 
difficult  to  limit  your  activities.  You  had  been  engaged  in  many 
different  facets  of  ophthalmology.  Did  you  throw  yourself  more 
actively  into  fund  raising? 

Scheie:       No,  not  any  more  actively.  I  continued  with  it  and  I  did  travel  more 
widely  in  my  fund-raising  efforts,  which  were  fairly  successful.  I 
developed  contacts  around  the  country,  some  of  them  through 
patients  and  friends  as  far  away  as  Washington,  Florida,  and 
Arizona.  I  usually  visited  them  myself  at  least  once  a  year.  I  have 
never  cared  for  fund-raising  dinners  although  we  have  an  annual 
ball,  called  the  Odyssey  Ball,  which  has  been  generously  supported. 


310 


Dr.  Scheie,  Greek  dancers  and  Mrs.  Scheie 

Hughes:     How  has  it  been  to  work  in  and  raise  money  for  an  institution, 

namely  the  Scheie  Eye  Institute,  of  which  you  are  founding  director1? 

Scheie:       Well,  everyone  knows  I'm  very  supportive  and  that  I  feel  strongly 
about  endowment  funds.  It's  fine  to  say,  "Obtain  government 
grants."  But  if  I  were  a  young  man  planning  to  come  into  a 
department  to  do  full-time  research  and  to  depend  upon  it  for  my 
living,  I  would  want  to  know  that  there  was  money  to  pay  my 
salary,  whether  I  had  a  grant  or  not.  That  is  just  one  example  of 
the  need  for  endowment  funds.  Obviously  no  one  knows  when  the 
political  climate  and  government  financing  might  change. 

Hughes:     Have  you  found  it  difficult  to  sit  back  and  watch  others  take  over  the 
positions  you  once  held1? 

Scheie:       Yes.  There's  no  doubt  of  that. 

The  Hotel  Fire,  Norway,  September  1986* 

Scheie:       A  long  story  is  involved  in  visiting  my  relatives.  My  wife  and  I  flew 
into  Norway  from  Switzerland  on  Friday,  September  4,  1986.  We've 
vacationed  in  Switzerland  on  several  occasions  for  a  couple  of 
weeks,  especially  enjoying  the  mountain  area  of  Crans. 
Switzerland,  I  might  add,  is  a  favorite  of  ours.  We  had  decided  to 
visit  Norway  on  the  way  home.  We  arrived  at  Kristiansand,  which 
is  at  the  southern  tip  of  Norway  and  a  key  shipping  city. 


This  section  was  moved  from  a  position  earlier  in  the  transcript. 


311 


The  area  is  called  the  Florida  of  Norway  because  people  go  there  in 
the  winter  to  avoid  the  severe  winters  of  the  north.  We  arrived  at 
our  hotel,  had  a  late  dinner,  and  went  up  to  our  room  to  sleep.  At 
4:30  a.m.  we  were  awakened  by  a  fire  alarm.  We  immediately 
popped  out  of  bed,  and  shortly  all  communications  and  electricity 
were  cut  off  by  the  fire,  which  had  started  on  the  first  and  second 
floors.  The  room  was  rapidly  filling  with  smoke  so  I  looked  out  in 
the  corridor,  which  was  pitch  dark,  as  was  our  own  room.  Due  to 
the  tremendous  amount  of  smoke  and  no  lights,  I  told  my  wife  that 
we  could  not  possibly  leave  the  room  to  escape  through  the 
corridors.  We  decided  to  put  on  street  clothes  with  the  idea  that  we 
would  soon  be  evacuated,  but  the  soon  proved  to  be  three  hours 
later. 

Hughes:     What  was  your  state  of  mind  during  that  period? 

Scheie:       Well,  I  am  a  positive  person  and  continued  to  believe  that  we'd  be 
evacuated  soon.  However,  our  room  continued  to  fill  with  smoke 
coming  under  the  doors  and  through  the  ventilators,  which  was 
really  worrisome.  I  tried  to  break  one  window  for  air  and  failed.  I 
then  went  to  another  and  using  a  heavy  oak  chair  on  about  the 
third  swing  was  able  to  shatter  the  glass.  We  removed  the  broken 
edges,  enabling  us  to  lean  out  of  the  window  for  air.  We  couldn't  get 
to  the  bathroom.  I  guess  it  was  somewhat  continental,  being  an 
anteroom  between  us  and  the  corridor,  and  it  was  as  smoke-filled  as 
the  corridor.  We  were,  therefore,  unable  to  moisten  towels  through 
which  to  breathe  or  to  block  vents.  I  was  able  to  pull  a  mattress 
cover  off  the  bed.  It  was  porous  so  that  we  were  able  to  breathe 
through  it  as  a  filter.  So  Polly  and  I  held  that  over  our  mouths  and 
soon  our  tears  and  saliva  moistened  the  cover,  producing  an  even 
better  filter  which  helped  us  no  end.  However,  with  no 
communications,  we  were  completely  isolated. 

This  was  the  first  fire  of  this  severity  in  Norway  in  forty  years,  and 
I  think  they  probably  were  inadequately  prepared.  We  were  on  the 
tenth  floor  where  the  firemen's  ladders  could  not  reach  us.  They 
extended  only  to  the  ninth  floor.  One  man  jumped  out  a  window 
and,  of  course,  to  his  death.  Two  different  cranes  were  brought  in, 
but  the  first  one  was  too  short.  We  could  view  all  of  this  but  with  no 
communication,  not  even  a  bullhorn,  had  no  reassurance  whatever 
of  any  plans  for  rescue.  When  city  officials  later  sent  a  critique  for 
us,  we  strongly  suggested  that  at  least  bullhorns  be  available. 
Sending  the  critique  to  us  was  a  nice  gesture. 

After  about  two  hours  the  fire  broke  through  the  walls  of  the  two 
lower  floors  and  smoke  began  to  threaten  us  from  the  outside,  as 
well  as  continuing  from  the  inside.  The  outside  smoke  was  very 
irritating,  probably  due  to  plastics  burning.  Daybreak  was  now 
approaching.  The  wind  would  come  in  puffs  which  provided 
relatively  clear  air  between  puffs.  Also  at  about  this  time,  Polly 


312 


was  discouraged  enough  to  say  good-bye  to  me.  "Thank  you,"  she 
added,  "We've  had  a  good  life  together."  I  responded  that  the  Lord 
wouldn't  have  us  and  the  Devil  didn't  want  us,  so  we  were  safe, 
[laughter] 

At  about  that  time,  a  very  tall  rescue  crane  was  brought  in  from  a 
high-rise  building  project.  Adjacent  to  our  hotel  was  a  building 
lower  than  ours,  possibly  three  stories  high.  When  the  crane  was 
extended  toward  us,  the  ledge  of  the  building  below  prevented  the 
crane  from  reaching  our  window.  The  crane  was  then  removed  and 
that's  when  Polly  said  good-bye. 

The  fire  was  probably  caused  by  sabotage  because  NATO  troops, 
including  American,  were  on  maneuvers  in  southern  Norway,  and  it 
was  about  the  time  of  the  Paris  bombings.  The  military  had  sent  in 
a  helicopter  to  remove  the  two  or  three  people  who  had  been  able  to 
reach  the  roof.  There  were  about  ninety  to  one  hundred  people  in 
the  hotel  of  whom  sixteen  died,  most  of  them  from  smoke  inhalation 
in  the  corridors.  At  this  time,  with  the  second  crane  removed  and 
with  no  explanation  at  all  [from  the  rescuers],  Polly  gave  up. 
However,  unknown  to  us,  the  crane  was  being  moved  to  the  opposite 
side  of  the  hotel  where  they  gained  access  to  the  windows  on  the 
side  opposite  us. 

We  were  surprised  about  a  half-hour  later  when  we  heard  a 
banging  on  our  door  by  three  or  four  firemen  breaking  into  our  room 
with  axes.  They  had  masks  and  had  just  come  up  in  the  crane.  We 
were  taken  across  to  the  other  side  of  the  hotel  where  the  crane  was 
waiting,  put  in  the  pod,  and  rescued.  We  had  become  shaky  that 
last  hour  and  our  thinking  was  definitely  affected.  I  could  recognize 
my  state  because  I've  had  general  anesthesia  several  times  for 
surgery,  and  I  realized  that  I  was  becoming  foggy  and  felt  unsteady. 
Actually  they  put  me  on  a  litter,  which  Polly  escaped.  We  were 
taken  in  a  military  ambulance  to  the  local  hospital  for  first  aid. 
They  asked  for  identification  and  we  had  my  army  I.D.  card,  as  well 
as  our  passports.  We  were  driven  to  a  lovely  nearby  area  where  the 
Norwegian  military  hospital  was  located.  We  were  released  by 
midafternoon.  The  personnel  was  very  good  to  us,  and  a  chaplain's 
assistant  was  even  sent  to  see  us  and  later  the  senior  chaplain. 

There  is  no  full-time  military  establishment  in  Norway,  and  the 
system  resembles  that  of  Switzerland.  It  is  interesting  that  the 
senior  military  chaplain  is  also  the  chaplain  for  the  Norwegian  civil 
churches. 

So  back  to  the  story:  We  still  planned  to  go  to  Eiken  but  at  that 
moment  didn't  know  quite  how.  In  the  meantime,  a  new  hotel  was 
found  for  us.  The  one  that  we  had  been  in  was  demolished.  The 
senior  chaplain,  Colonel  Ole  Askvig  Ogaard,  came  to  see  us  at  our 
new  hotel  toward  the  end  of  the  day.  When  he  learned  of  our  desire 
to  visit  Eiken,  he  offered  to  take  us  there.  He  knew  some  people  in 
Eiken  and  was  well  acquainted  with  the  local  minister.  On 


313 


Saturday  the  hotel  management  bought  new  clothing  for  us.  Ours 
was  very  smoky  and  dirty.  Fortunately  they  had  not  burned  since 
the  fire  did  not  reach  our  room  but  they  had  to  be  professionally 
cleaned.  This  took  until  Monday,  but  in  the  meantime  we  had  our 
new  outfits.  My  jacket  was  made  in  Finland  and  a  pair  of  trousers 
made  in  Denmark. 

The  chaplain  arrived  on  Sunday  morning  to  take  us  to  Eiken,  which 
proved  to  be  about  a  forty  mile  drive.  I  was  amazed  nearing  Eiken 
to  see  that  there  was  a  village  by  the  name  of  Skeie.  The  area  was 
lovely  and  peaceful,  with  mountains  on  one  side  and  a  beautiful 
fjord  on  the  other.  We  drove  on  through  Skeie  village  to  a 
centuries-old  church. 

When  we  arrived,  they  were  in  the  middle  of  their  service.  The 
chaplain,  therefore,  took  us  through  the  old  cemetery  where  we  saw 
a  good  many  of  my  relatives'  graves,  including  one  who  had  been  a 
chief  justice  of  the  Norwegian  supreme  court.  Near  the  end  of  the 
service,  our  chaplain  host  escorted  us  into  the  church  and  talked  to 
the  minister,  whom  he  knew.  After  a  short  conversation,  the 
minister  introduced  us  to  the  congregation  and  explained  our 
mission.  I  was  asked  to  say  a  few  words  and,  of  course,  thanked 
them  and  told  them  how  proud  I  was  to  be  a  Norwegian.  Then  the 
chaplain  asked  any  of  our  relatives  in  the  audience  to  come  forward, 
and  three  or  four  did  so.  One  was  a  most  attractive  and  energetic 
person,  Anna  Rossevatn,  who  as  it  turned  out  was  doing  a  book  on 
the  history  of  our  family. 

Hughes:     In  Norwegian? 

Scheie:       Could  be,  she  is  a  teacher.  Whether  it  will  be  in  Norwegian  or 

English,  I  cannot  say.  Most  Norwegians  are  bilingual.  It  is  nice  for 
an  American  to  travel  in  Norway  because  of  this.  Everyone  we 
encountered  spoke  English. 

Anna  was  very  excited  about  taking  us  around  the  area  and 
introducing  us  to  other  relatives.  She  was  indefatigable.  She 
arranged  with  some  relatives  to  serve  luncheon  for  us,  after  which 
she  toured  with  us  the  entire  afternoon  until  I  felt  sorry  for  the  poor 
chaplain.  There  he  was  a  captive,  so  to  speak,  on  this  grand  tour. 
It  was,  however,  an  interesting  and  rewarding  day.  So  that's  Eiken 
and  the  Scheie  family. 

Controversies  in  Ophthalmology 

Hughes:     We've  mentioned  some  stands  that  you've  taken  in  the  course  of  your 
career.  Is  there  anything  more  to  be  said  about  controversies  in 
ophthalmology  with  which  you've  been  associated? 

Scheie:       Well,  not  being  particularly  a  medico-political  animal,  I  haven't 

been  involved  in  too  many  controversies.  I  certainly  have  opinions 


314 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


Hughes: 
Scheie: 


about  many  matters  and  express  them  if  I  feel  they  would  be 
constructive. 

Did  you  have  any  particular  role  in  the  issue  of  fee-splitting? 

Only  as  a  member  of  the  Board  of  Regents  of  the  American  College 
of  Surgeons.  The  college  is  adamantly  opposed  to  fee-splitting. 
They  do  discipline  members  and  even  expel  them.  I  am  opposed  to 
fee-splitting  in  any  form  and  especially  in  ophthalmology. 

Have  you  never  been  involved  in  policy  decisions  in  these  various 
organizations? 

Yes,  to  some  extent.  A  problem  now  is  our  relationship  with 
optometrists.  One  of  the  temptations  might  occur  after  a  patient  is 
referred  by  an  optometrist  for  surgery.   Should  he  be  sent  back  to 
the  optometrist  for  postoperative  care  and  refraction?  Is  that  really 
ethical  and  proper?  Those  questions  are  being  asked.  I  think  it  is 
wrong,  but  the  world  seems  to  be  changing. 

Advertising  on  the  part  of  the  physician  is  another  issue  that  I 
certainly  can't  approve  of.  Hospital  advertising  has  not  been  a  good 
example  for  physicians. 

Have  you  said  so  in  public? 

Well,  I've  said  this  at  meetings.  There  is  no  doubt  that  people  know 
where  I  stand. 

Subspecialization  in  Ophthalmology 

What  is  your  opinion  about  subspecialization  within  ophthalmology? 

I  think  it's  fine,  certainly  in  centers  where  the  subspecialist  has 
enough  patients  to  make  it  attractive  and  worthwhile.  However,  it 
would  be  impossible  in  a  small  community  where  it  is  not  practical, 
nor  does  the  average  patient  require  the  degree  of  subspecialization 
that  we  are  developing.  I  think  the  average  competent 
ophthalmologist  should  be  able  to  encompass  and  practice  most 
segments. 

For  example,  I  think  any  ophthalmologist  who  has  had  good 
training  should  be  able  to  treat  glaucoma  patients.  He  might  wish 
to  refer  some  of  the  surgery,  as  has  always  been  done.  General 
ophthalmologists,  in  my  opinion,  should  be  able  to  operate  cataracts 
and  do  most  glaucoma  surgery.  I  think  any  ophthalmologist  who 
has  had  good  training  should  be  able  to  care  for  children's  eyes. 
Obviously  there  may  be  special  situations  where  you  would  desire  a 
consultation  with  a  subspecialist. 


315 


Hughes:     Is  the  philosophy  in  most  of  the  ophthalmology  residency  programs 
in  this  country  to  turn  out  general  ophthalmologists, 
ophthalmologists  with  a  facility  in  all  of  the  subspecialties? 

Scheie:       Well,  we  try  to  train  our  residents  to  be  excellent,  well-trained 
ophthalmologists.  But  how  many  people  should  be  trained  to  do 
retina  surgery,  which  is  certainly  a  justifiable  subspecialty,  I  don't 
know.  Now,  retina  I  feel  is  a  true  specialty.  It  is  a  very  complex, 
highly  skilled  phase  of  our  work.  I  gave  up  operating  retinas  myself 
nearly  sixteen  years  ago,  feeling  that  other  people  could  do  them 
better.  I  had  felt  that  my  work  was  acceptable  or  I  wouldn't  have 
been  doing  the  surgery.  However,  many  complex  technological 
advances,  both  medical  and  surgical,  were  being  made  and  I 
thought  they  went  beyond  the  scope  of  the  general  ophthalmologist. 

Hughes:     You  wouldn't  put  glaucoma  in  the  same  category? 

Scheie:       Well,  it  is  considered  to  be  a  specialty  by  many,  but  I  feel  that  a 
general  ophthalmologist  should  be  able  to  manage  a  glaucoma 
patient  and  do  glaucoma,  cataract,  muscle,  and  simple  eyelid 
surgery  if  he  wishes. 

Hughes:     Is  it  the  technical  difficulty  of  retinal  detachment  surgery  that 
warrants  it  being  a  specialty? 

Scheie:       Yes,  it  is  very  technical,  and  being  a  retina  specialist  involves  much 
more  than  retinal  detachments.  There  are  many  complex 
conditions  involving  the  retina  that  require  intricate  studies,  such 
as  injecting  dyes,  interpretations,  various  types  of  laser  therapy, 
and  many  other  ramifications  that  qualify  it  as  a  specialty. 

I  did  a  great  deal  of  pediatric  ophthalmology,  with  probably  as  much 
or  more  congenital  cataract  surgery  and  glaucoma  surgery  as 
anyone  in  the  country.  I  also  did  a  great  many  crossed  eyes. 
Probably  because,  as  my  mother  predicted  that  I  would  never  grow 
up,  I  did  get  along  well  with  the  children-and  most  of  the  time  with 
their  mothers. 

Thomas  D.  Duane* 

Hughes:     Well,  if  you're  satisfied  with  the  discussion  of  glaucoma,  I  have  one 
question  on  an  entirely  different  topic.  You  are  listed  as  one  of  the 
key  ophthalmic  researchers  in  the  U.S.  who  was  interviewed  in 
depth  by  Dr.  Duane  in  1963  in  connection  with  his  Ophthalmic 
Research:  USA.** 


* 
** 


This  section  on  Dr.  Duane  was  moved  from  the  transcript  of  the  session  recorded  on  June  14,  1988. 

A  National  Survey  Report  by  T.D.  Duane,  M.D.,  Ph.D.  Initiated  and  sponsored  by  Research  to 
Prevent  Blindness,  Inc.,  1965.  For  more  on  this  subject,  see  the  forthcoming  interview  in  this 
series  with  Dr.  Duane. 


316 


Scheie:       Jules  Stein  engaged  Tom  to  do  a  review  of  research  going  on  in 

ophthalmic  departments  around  the  country.  Tom  and  I  did  talk  at 
some  length  and  with  good  reason,  because  we  had  the  same  goals 
and  were  good  friends.  He  had  referred  much  of  his  surgery  to  me 
when  he  practiced  in  the  Bethlehem  [Pennsylvania]  area  and  we 
had  shared  many  patients  in  consultation.  Dr.  Gaylord  Ojers,  who 
practiced  with  him,  and  I  had  the  same  relationship.  Tom  knew  me 
well  and  we  talked  about  research  and  many  other  subjects.  I  am 
afraid  he  exaggerated  when  he  referred  to  me  as  one  of  the  key 
ophthalmic  researchers  in  the  United  States. 

Hughes:     Do  you  remember  anything  about  the  interview1? 

Scheie:       Not  really,  except  that  I  knew  Tom  as  a  very  sincere  person  who  had 
done  an  excellent  job  at  the  Johnsville  Naval  Air  Development 
Center.  He  had  a  Ph.D.  degree  in  physiology  and,  as  I  said,  I 
appointed  him  director  of  research  [1960-1962]  in  our  department  of 
ophthalmology  with  the  idea  that  he  would  build  a  fine  research 
department  for  us. 

We  compared  notes  about  directions  we  thought  ophthalmic 
research  might  take.  I  was  never  a  basic  scientist  but  I  do  know 
that  a  basic  scientist  is  going  to  find  the  answers  to  glaucoma  and 
many  other  unsolved  problems. 

Governmental  Intervention  in  Medicine 

Hughes:     Did  you  take  any  particular  stand  on  the  Medicare- Medicaid  issue 
in  the  1960s? 

Scheie:       No,  I  approved  it  but  had  reservations  about  the  probability  of  it 
being  a  step  toward  third-party  and  socialized  medicine. 

I  am  very  concerned  about  the  extent  of  third-party  intervention  at 
the  moment.  DRGs  [Diagnostic  Related  Groups]  and  other 
governmental  interventions  have  not  improved  patient  care.  In 
fact,  it  begins  to  taste  more  and  more  like  socialized  medicine, 
which  has  left  a  great  deal  to  be  desired  in  countries  where  now 
practiced.  I've  never  been  a  good  socialist. 

Disseminating  Information  in  Ophthalmology 

Hughes:     What  do  you  believe  is  the  most  effective  means  of  disseminating 
information  in  ophthalmology? 

Scheie:       You  mean  after  residency  training?  I  think  our  journals  do  a 

tremendous  job.  That  is  number  one.  The  television  tape  systems 
and  computerized  sources  of  medical  information  offer  promise. 
The  Academy  instructional  programs  are  also  high  on  any  list. 


317 


Hughes:     Well,  when  you  were  pushing  ahead  the  frontiers  of  glaucoma 

surgery,  journal  publication  would  have  taken  too  much  time.  The 
time  interval  between  writing  a  paper  and  publishing  it  is  months  at 
least.  How  did  you  keep  in  touch  with  what  was  happening  in  the 
glaucoma  field  across  the  country  and  internationally  other  than 
through  publications? 

Scheie:  Meetings  and  various  publications.  In  fact,  most  of  the  papers  that 
anyone  writes  and  ideas  that  he  has  developed  have  been  presented 
at  instruction  courses  and  other  meetings  held  around  the  country. 

Hughes:     Would  you  ever  get  on  the  telephone  to  a  colleague  to  discuss  what 
you  were  doing  and  what  he  was  doing? 

Scheie:       Yes. 

Hughes:     Did  you  ever  feel  it  necessary  to  withhold  information  until  you  had 
time  to  publish  it? 

Scheie:       Well,  I  guess  that  wouldn't  occur  to  me. 
Writing  Papers 

Hughes:     Could  you  say  something  about  how  you  went  about  writing  a 

medical  paper?  There  are  various  approaches.  Some  people  simply 
write  up  their  conclusions.  Others  look  upon  the  writing  process  as  a 
very  creative  one  and  develop  ideas  about  their  research  through  the 
process  of  writing.  Could  you  characterize  your  style  of  medical 
writing? 

Scheie:       Well,  I  think  what  I  did  was  coordinate  pertinent  literature  on  the 
subject,  before  and  while  working  on  my  tables  or  illustrations,  to 
present  a  subject  in  an  organized  way.  Then  I  would  begin  to  write. 
I  usually  made  an  outline  and  worked  from  there.  But  my  data  had 
been  prepared  and  the  material  collected  for  the  bibliography  before 
I  wrote  the  paper.  After  that  I  wrote  and  rewrote. 

My  first  secretary  after  World  War  II,  Mrs.  Betty  Eckert,  is  a  very 
talented  person  who  writes  under  a  pseudonym  and  has  published 
poetry  and  short  stories.  She  works  with  Dr.  Ewing  now.  She  had 
typed  and  helped  me  with  several  papers  that  I  had  written  and 
rewritten.  Finally,  after  countless  retypings  of  a  paper,  she  said  in 
disgust,  "Dr.  Scheie,  I  think  you  would  try  to  revise  Shakespeare!" 
[laughter]  I  did  write  painfully. 

Hughes:     Was  it  more  stylistic  revision  than  content? 

Scheie:       Well,  sequence,  changing  wording,  and  proper  continuity. 

Hughes:     Your  ideas  before  you  sat  down  to  write  the  paper  were  fixed? 


318 


Scheie:       I  always  had  made  an  outline  of  what  I  thought  I  should  write. 

After  I  had  written,  I  would  then  delete  and  change.  I  think  Mrs. 
[Charlotte]  Beurer  did  my  current  paper  on  mucopolysaccharidosis 
at  least  eight  times. 

Hughes:     Did  you  have  a  method  for  determining  the  order  of  authors  on  the 
paper? 

Scheie:       Yes,  I  felt  the  senior  author  should  be  the  person  who  originally  had 
the  idea  for  the  project  and  who  guided  it.  That  is  a  rule  I  nearly 
always  followed  when  I  was  chairman.  I  rarely  had  my  name  on  a 
paper  that  I  wasn't  actively  involved  with.  Supplying  the  money  to 
support  the  work  is  not  justification  for  being  a  coauthor. 

Hughes:     What  importance  did  you  give  to  publication? 

Scheie:       I  started  writing  papers  when  I  was  an  intern.  It  was  something  I 
emphasized  as  head  of  the  department  to  stimulate  research  and 
clinical  projects.  Encouraging  research  was  one  of  my 
responsibilities  in  an  academic  environment.  However,  material 
should  be  worthwhile  and  have  some  originality. 

Movies  and  Videotapes 

Hughes:     I  know  you've  made  a  number  of  movies  of  your  operations.  Do  you 
have  any  idea  how  many  and  which  operations? 

Scheie:       I  have  no  idea  of  how  many  and  they  would  include  videotapes, 
particularly  since  we've  recorded  so  much  surgery  on  our 
closed-circuit  television.  I've  learned  a  great  deal  in  years  past 
from  editing  surgical  movies.  It  calls  attention  to  easily  overlooked 
details. 

Hughes:     Of  course,  you  used  those  films  for  teaching,  as  well. 

Scheie:       Oh,  yes.  They  were  mainly  teaching  films,  and  I've  shown  both 

movies  and  TV  at  numerous  different  meetings.  They  were  part  of 
a  lecture  or  series  of  lectures. 

Hughes:     They're  now  no  longer  used? 

Scheie:       Well,  most  procedures  have  changed  and  improved  over  the  years. 
The  films  have  become  history. 

Hughes:     Did  you  submit  exhibits  for  medical  meetings? 

Scheie:       Yes,  I've  had  exhibits  on  glaucoma  and  other  surgery,  especially 
during  the  years  that  Jean  Wolfe  was  our  department  artist.  Her 
work  was  beautiful. 


319 


Life  Style 

Hughes:     You  have  the  reputation  for  being  a  hard-driving  and  very  successful 
specialist.  Has  this  life  style  taken  any  toll? 

Scheie:       Possibly  on  people  around  me.  [laughter] 
Hughes:     But  not  on  you ? 

Scheie:       Well,  from  the  time  I've  been  a  youngster,  I've  been  very  active, 

hard  working  and  striving  to  do  my  best.  That  includes  everything 
from  hard  labor  to  being  a  physician  and  running  a  department.  I 
carried  this  into  athletics.  I  was  quite  athletic  when  I  was  a 
youngster  and  even  at  the  University  of  Minnesota. 

Major  Advances  in  Ophthalmology  and  the 
Basic  Sciences 

Hughes:     Would  you  comment  about  what  you  consider  to  be  the  major 

advances  in  ophthalmology  in  the  years  that  you've  been  involved  in 
the  specialty? 

Scheie:       There  are  so  many  areas  where  advances  have  been  made  that  I 
hardly  know  where  to  begin.  I  think  the  introductions  of 
chemotherapy  and  antibiotics  have  been  two  of  the  greatest 
advances.  I  often  recall  a  fellow  intern  who  incurred  a  gonorrhea! 
eye  infection  from  a  patient  during  the  first  year  of  my  internship 
(July  1935).  He  lost  one  eye  and  nearly  lost  the  other.* 

Very  significant  advances  in  the  management  of  glaucoma  resulted 
from  knowledge  gained  through  Barkan  and  gonioscopy.  We 
learned  to  recognize  two  main  types  of  primary  glaucoma, 
narrow-angle  and  open-angle  (chronic),  each  with  a  different 
therapeutic  approach.  I  can  remember  our  abysmal  ignorance 
regarding  mechanisms  of  glaucoma  before  gonioscopy  concepts  were 
accepted. 

A  revolution  in  cataract  surgery  has  occurred  with  the  adoption  of 
extracapsular  cataract  extraction  with  posterior  chamber  implant 
lenses.  When  I  was  an  intern  on  Dr.  Holloway's  service,  I 
remember  debate  as  to  whether  it  was  worthwhile  to  operate 
retinal  detachments  because  the  results  were  so  poor.  Now,  the 
cure  rate  is  over  ninety  percent. 

Hughes:     What  was  the  operation  for  retinal  detachment  when  you  first 
entered  ophthalmology? 


See  the  episode  recounted  on  pp.  44-45. 


320 


Scheie:       The  main  difficulty  was  finding  the  retinal  hole  because  the 

instruments  weren't  as  good  as  they  are  today.  The  present-day 
binocular  scope  represents  a  significant  advance  in  the  field.  At 
that  time  refined  techniques  for  sealing  the  retinal  hole  were  not 
available.  Diathermy  pins  of  various  types  were  used  and  I 
remember  the  Walker  and  the  Pischel  pins.*  These  recollections 
come  from  the  days  of  my  internship  between  1935  and  1937. 

Finding  the  hole  and  localizing  it  are  still  the  keys.  Scleral 
resection,  buckles,  and  various  implants  to  produce  contact  between 
the  choroid,  the  outer  layer  of  the  retina,  and  the  detached  retina 
are  helpful  adjuncts,  as  well  as  is  intravitreal  gas.  I  think  those  are 
the  highlights. 

Of  course,  there  have  been  even  more  spectacular  advances  in  basic 
sciences,  which  have  contributed  to  medicine,  surgery,  and  all 
specialties.  My  fifty-four  years  in  medicine  have  been  the  best 
years,  the  golden  years  of  medicine,  and  the  future  seems 
unlimited.  The  prognosis  for  most  infectious  diseases  has  been 
transformed.  Thoracic  surgery,  heart  surgery,  and  organ 
transplantations-heart,  kidney  and  others-are  phenomenal.  These 
have  been  wonderful  years  to  be  in  medicine,  but  now  it  is  upsetting 
to  see  some  of  the  developments  in  the  socioeconomic  area  and  the 
related  political  problems. 

Dr.  Scheie's  Greatest  Contribution 

Hughes:     Well,  one  final  question,  Dr.  Scheie.  What  do  you  consider  to  be  your 
greatest  contribution1? 

Scheie:       I  didn't  know  that  any  were  great. 
Hughes:     I  think  people  would  disagree  with  you. 

Scheie:       Well,  I've  had  much  satisfaction.  I  couldn't  have  been  a  happier 
person  nor  a  busier  one.  Possibly,  the  creation  of  the  eye  institute 
and  being  able  to  build  up  its  research  endowment  funds  could  be 
considered  significant.  It  should  be  a  rewarding  place  for  both 
clinical  and  research-oriented  ophthalmologists  to  work. 

## 

Taking  over  a  department  that  had  almost  no  financial  support 
motivated  me  to  devote  considerable  time  to  development  work  and 
financing.  I  believe  that  I  did  accomplish  a  great  deal,  but  my 
successors  must  continue  the  effort. 


For  more  on  these  pins,  see  the  interview  in  this  series  with  Dr.  Dohrmann  Pischel. 


321 


Hughes:     Anything  else  you  care  to  say  on  any  subject? 

Scheie:       You're  wonderful. 

Hughes:     [laughs]  Thank  you,  Dr.  Scheie. 


1983 


323 


APPENDICES 


325 


CURRICULUM  VITAE 

Name  Harold  G.  Scheie,  MD 

Date  of  Birth     March  24, 1909 

Place  of  Birth    Brookings  County,  South  Dakota 

Nationality        U.S.  Citizen 

Education Degree Year 

University  of  Minnesota  B.S.  1931 

University  of  Minnesota  M.B.,  M.D.  1935 

University  of  Pennsylvania  Hospital  Internship  1935-1937 

University  of  Pennsylvania  Hospital  Residency  1937-1940 

University  of  Pennsylvania  D.Sc.  1940 

Professional  Experience 

Private  Practice  limited  to  diseases  of  the  eye,  1946-1987 
Founding  Director  of  the  Scheie  Eye  Institute,  1977- 

Emeritus  William  F.  Norris  &  George  E.  de  Schweinitz  Professor  of 
Ophthalmology,  University  of  Pennsylvania  School  of  Medicine,  1977- 

Visiting  Professor  -  Hahnemann  Medical  College  &  Hospital  of 
Philadelphia,  1975-1983 

Director,  Scheie  Eye  Institute,  Presbyterian-University  of  Pennsylvania 
Medical  Center,  1975-1983 

University  Associate,  Division  of  Ophthalmology,  Department  of  Surgery, 
Children's  Hospital  of  Philadelphia,  1972 

Courtesy  Staff  in  Ophthalmology,  Presbyterian-University  of  Pennsylvania 
Medical  Center,  1960-1972 

Chief  of  Ophthalmology  Service  and  Consultant,  VA  Hospital,  1954-1975 

Chief  of  Ophthalmology  Service,  Children's  Hospital  of  Philadelphia, 
1960-1972 

Chief  of  Ophthalmology  Service,  Philadelphia  General  Hospital,  1960-1975 


326 

Chairman  of  Department  of  Ophthalmology,  University  of  Pennsylvania 
School  of  Medicine,  1960-1975 

William  F.  Norris  &  George  de  Schweinitz  Professor  of  Ophthalmology, 
University  of  Pennsylvania  School  of  Medicine,  1960-1977 

Professor  of  Ophthalmology,  University  of  Pennsylvania  School  of  Medicine, 
1953-1960 

Associate  Professor  of  Ophthalmology,  University  of  Pennsylvania  School  of 
Medicine,  1949-1953 

Assistant  Professor,  University  of  Pennsylvania  School  of  Medicine, 
1945-1949 

Instructor  in  Ophthalmology,  University  of  Pennsylvania  School  of  Medicine, 
1940-1945 

Professor  of  Ophthalmology,  University  of  Pennsylvania  Graduate  School  of 
Medicine,  1956- 

Associate  Professor  of  Ophthalmology,  University  of  Pennsylvania  Graduate 
School  of  Medicine,  1952-1956 

Assistant  Professor  of  Ophthalmology,  University  of  Pennsylvania  Graduate 
School  of  Medicine,  1946-1952 

Instructor  in  Ophthalmology,  University  of  Pennsylvania  School  of  Medicine, 
July  1946  -  October  1946 

Consultant  Appointments 

Consultant  in  Ophthalmology,  Camden  City  Municipal  Hospital,  NJ, 
1950-1975 

Consultant  in  Ophthalmology,  Crozier-Chester  Medical  Center,  PA, 
1966-1975 

Consultant  in  Ophthalmology,  Skin  and  Cancer  Hospital,  PA,  1949-1960 
Consultant  in  Ophthalmology,  Children's  Hospital  of  Philadelphia,  1972- 

Civilian  Consultant  to  Ocular  Research  Unit,  Walter  Reed  Army  Hospital 
and  Medical  Center,  Washington,  DC,  1951-1964 

Consultant  in  Ophthalmology,  VA  Hospital,  Philadelphia,  1953-1975 
Consultant  in  Ophthalmology,  Valley  Forge  General  Hospital,  PA,  1946-1975 
Consultant  in  Ophthalmology,  Philadelphia  Home  for  Incurables 

Central  Office  Chief  Consultant  in  Ophthalmology,  VA,  Washington,  DC, 
1951-1959 

Medical  Advisory  Board,  VA,  Washington,  DC,  1956-1959 

Consultant  to  the  Chronic  Disease  Program  of  the  Public  Health  Service, 
1956-1960 

Consultant  in  Ophthalmology,  Children's  Heart  Hospital,  PA,  1942-1955 

Consultant,  Health  and  Welfare  Council,  Inc.,  Committee  for  Services  and 
Facilities  to  the  Blind,  1960-1063 


327 


Consultant-Lecturer,  US  Naval  Hospital,  PA,  1967-1975 

Consultant,  HEW  Public  Health  Service,  Out-Patient  Clinic,  1964-1975 

Consultant,  Frankford  Hospital,  PA,  1965-1977 

Consultant,  Alcon  Laboratories,  Inc.,  Fort  Worth,  TX,  1960-1970 

Consulting  Surgeon,  Pennsylvania  Hospital,  Philadelphia,  1973- 

Memberships 

Academia  Ophthalmologica  Internationalis,  1975-1984 

Emeritus  member  1984- 

American  Academy  of  Ophthalmology  and  Otolaryngology,  1940 

First  Vice  President,  1960-1961 

Committee  for  Ophthalmology  of  the  Teachers'  Section 

American  Association  for  the  Advancement  of  Science,  1951 

American  Association  of  Ophthalmology 

Treasurer  and  Trustee,  1959-1960 

Committee  on  Eye  Care  in  the  Armed  Services,  1963-1964 

Committee  on  Member  Liaison  and  Federal  Services,  1966 

Third  Vice-President,  1970 

American  Board  of  Ophthalmology,  Diplomate  1940 

Board  of  Examiners,  1959-1966 

American  College  of  Surgeons,  Fellow,  1946 

Graduate  Training  Committee 

Second  Vice-President,  1961-1962 

Board  of  Regents,  1963-1972 

Credentials  Committee,  1972-1976 

American  Medical  Association,  1938 

Secretary  of  Section  on  Ophthalmology,  1954-1959 

Chairman  of  Section  on  Ophthalmology,  1960 

Representative  at  Large,  Section  on  Ophthalmology,  1970-1977 

American  Medical  Writers'  Association,  1962 

American  Ophthalmological  Society,  1948 

Council  Member  1965-1970 

President  of  Council,  1970 

American  Trauma  Society,  Founding  Member,  1973 

Advisory  Council  of  Reserve  Affairs  to  the  Surgeon  General,  1955 

Alpha  Omega  Alpha,  Medical  Honor  Society,  1936 

Association  for  Military  Surgeons  of  the  US,  1950 


328 

Association  for  the  Multiple  Impaired  Blind,  Advisory  Board,  1977 

Association  of  the  United  States  Army 

Advisory  Board  of  Directors,  1966-1969 

William  Penn  Chapter  of  AUSA,  Philadelphia 

Member  of  Board  of  Advisors 

Association  of  University  Professors  of  Ophthalmology,  1966-1975 

Australian  College  of  Ophthalmology,  Honorary  Member,  1968 

Bausch  &  Lomb  Soflens  Division  Fellowships,  Selection  Committee, 
1975-1977 

Benjamin  Franklin  Associates  of  University  of  Pennsylvania 

First  President,  Life  Member,  Burma  Star  Association  (American  Branch), 
1979 

Central  Illinois  Society  of  Ophthalmology  and  Otolaryngology,  1965 

College  of  Physicians  of  Philadelphia,  Fellow,  1941 

Chairman,  Section  on  Ophthalmology,  1958-1959 

Chairman,  Finance  Committee,  1964-1965 

Consultant  to  Armed  Forces  Society,  1950 

Deutsche  Ophthalmologische  Gesellschaft,  1966 

Editorial  Board,  Contemporary  Surgery ,  1971 

Editorial  Board,  Journal  of  Archives  of  Ophthalmology ,  1954-1964 

Editorial  Board,  Glaucoma,  1978 

Editorial  Board,  Journal  ofPediatric  Ophthalmology 

Episcopal  Academy,  Board  of  Trustees,  1968-1974 

Emeritus  Trustee,  1974- 

Eye  Research  of  the  Retina  Foundation,  Friends  Committee,  1976 

Friends  of  Eye  Research,  Honorary  Member,  1982 

Excerpta  Medica,  Editorial  Board,  1976 

International  Editorial  Advisory  Committee,  1982 

Guild  of  Prescription  Opticians  of  America,  Inc.,  Committee  for  Guild 
Fellowship  Program 

Historical  Society  of  Pennsylvania,  1982 

Hospital  of  St.  John  of  Jerusalem  (ASMVO),  Associate  Officer,  1974 

International  Eye  Foundation,  Advisory  Board,  1966 

International  Glaucoma  Congress,  Board  of  Governors,  1979 

Irish  American  Ophthalmological  Society,  1988 

John  Archer  Society  of  University  of  Pennsylvania 

John  Morgan  Society  of  University  of  Pennsylvania,  1948 


329 

Jules  Gonin  Society,  1970 

Juvenile  Diabetes  Foundation,  Board  Member,  1974-1975 

Juvenile  Diabetes  Foundation  International,  Board  Member,  1982-1983 

Medcom  Editorial  Board,  1968 

Medic  Alert  Foundation  International,  Advisory  Committee,  1966 

Medical  and  Biological  Sciences,  Advisory  Panel  Member  DDR&E 

Chairman,  Medical  Board  of  Hospital  of  University  of  Pennsylvania, 
1967-1969 

Medical  Club  of  Philadelphia,  1948 

Medico,  National  Committee 

Minnesota  Alumni  Association,  1935 

Minnesota  Medical  Foundation,  Board  of  Trustees,  1966 

Motility  Foundation,  Advisory  Board,  1977 

Nacional  Institute  de  Investigaciones  Oftalmologican,  Advisory  Board,  1970 

National  Council  to  Combat  Blindness,  Inc. 

National  Retinitis  Pigmentosa  Foundation,  Advisory  Board,  1973 

National  Society  for  the  Prevention  of  Blindness,  Inc. 

Board  of  Directors,  1968-1983 

Executive  Committee,  1970 

Vice-President,  1972-1976 

Ophthalmic  Club  of  Philadelphia,  1939 

Ophthalmic  Research  Foundation,  Member,  Scientific  Advisory  Council,  1979 

Ophthalmological  Society  of  the  UK 

Oxford  Ophthalmological  Congress,  1967 

Pacific  Coast  Oto-Ophthalmological  Society,  1964 

Pan-American  Ophthalmological  Society,  1948 

Pan-Pacific  Surgical  Association 

Pennsylvania  Academy  of  Ophthalmology  and  Otolaryngology,  1951 

Vice  President,  1959-1960 

President  Elect,  1967 

President,  1968 

Pennsylvania  Diabetes  Institute,  Board  of  Directors,  1975-1976 

Pennsylvania  Medical  Society 

Pennsylvania  State  Impartial  Medical  Testimony  Plan 

Phi  Rho  Sigma  (Theta  Tau  Chapter) 

Philadelphia  Chapter  of  Reserve  Officers  Association 

Philadelphia  Council  (Boys  Scouts  of  America),  1979- 


330 

Philadelphia  County  Medical  Society,  1938 
Chairman,  Strittmatter  Award  Committee,  1969 
Investment  Advisory  Committee,  1970-1977 
Professional  Relations  and  Grievance  Committee,  1977-1978 
Physiological  Society  of  Philadelphia,  1940 

Presbyterian-University  of  Pennsylvania  Medical  Center,  Honorary  Member 
of  Board  of  Trustees,  1978 

Steering  Committee  -  12th  Decade  Renewal  Fund,  1979 

Project  Orbit,  1973 

Reserve  Officers  Association,  1946 

Rudolphy  Home,  Advisory  Committee,  1977 

Sigma  XI,  University  of  Pennsylvania,  1939 

Society  of  Contemporary  Ophthalmology,  Board  of  Governors,  1970 

Society  of  Eye  Surgeons,  Board  of  Directors,  1981 

Society  of  Medical  Consultants  to  the  Armed  Forces 

Society  of  Military  Ophthalmologists,  1967 

Washington  Crossing  Foundation,  Board  of  Trustees,  1983-1986 

United  World  Colleges,  Life  Member 

Army  Service  and  Assignments 

Commissioned  1st  Lieutenant,  Medical  Corps  ORC,  US  Army,  1936 

Promoted  to  Captain,  ORC,  1940 

Active  Duty,  1942-1946 

Promoted  to  Major,  AUS,  1944 

Promoted  to  Colonel,  USAR,  1950 

Promoted  to  Brigadier  General,  USAR,  1954 

(Retired)  Brigadier  General,  1964 

Chief,  Section  of  Ophthalmology,  20th  General  Hospital,  1942-1943 

Chief,  Section  on  Ophthalmology  and  Otorhinolaryngology, 
China-Burma-India,  20th  General  Hospital,  1944-1945 

Assistant  Chief  of  Ophthalmology,  Crile  General  Hospital,  1946 

Deputy  Commander,  Attached  Headquarters,  303rd  Hospital  Center  for 
USAR  Training,  1950-1951 

Comanding  General,  HQS  303rd  Hospital  Center,  1951-1964 
Comanding  General  of  Hospital  Center  to  ANADUTRA,  1951-1963 

Honors 

American  Campaign  Service  Medal 


331 

Asiatic  Pacific  Service  Medal  -  two  Campaign  and  Battle  Bronze  Stars 

Victory  Medal,  WWII 

Armed  Forces  Reserve  Medal 

Honorary  Member  of  the  Military  Order  of  the  British  Empire,  1946 

Zentmayer  Award  in  Ophthalmology,  College  of  Physicians,  1946, 1948 

VA  Certificate  of  Commendation,  1963 

US  Army  Legion  of  Merit,  1964 

Association  of  the  United  States  Army  Certificate  of  Appreciation,  1964 

Certificate  of  Achievement,  HDQ,  2nd  United  States  Army,  1964 

Personal  Medal  from  British  Minister  of  Defense,  Lord  Mountbatten  of 
Burma,  1964 

Honorary  Kentucky  Colonel,  1964 

Honor  Award  from  American  Academy  of  Ophthalmology  and 
Otolaryngology,  1964 

Lindback  Teaching  Award,  University  of  Pennsylvania,  1964 

Resolution  of  the  Senate  of  Pennsylvania,  1964 

Howe  Award  in  Ophthalmology  from  American  Medical  Association,  1964 

Howe  Gold  Medal,  University  of  Buffalo,  1964 

Association  of  the  United  States  Army  Certificate  of  Achievement,  1964 

Election  of  Honor  to  the  Royal  Scientific  and  Humanistic  Society  of 
Gothenburg,  1966 

Outstanding  Civilian  Service  Medal,  United  States  Army,  1967 
Honorary  Member  of  the  Institute  Barraquer,  1967 

"Man  of  the  Year",  National  Council  of  Auxiliaries  of  the  American  Medical 
Center  at  Denver,  1968 

Honorary  Doctorate  of  Medical  Science,  Villanova  University,  1968 
Irving  S.  Cutter  Medalist,  1968 

Medal  from  Egyptian  Ophthalmological  Society,  acknowledging  contributions 
to  ophthalmology,  1968 

Outstanding  Achievement  Award,  University  of  Minnesota,  1968 

Pennsylvania  Award  for  Excellence,  1969 

Honorary  Member,  Irish  Ophthalmological  Society,  1971 

Honor  Award,  Ophthalmological  Society  of  the  Republic  of  China,  1972 

The  Penn  Club  Award,  1972 

Honorary  Member  of  "M"  Club,  University  of  Minnesota,  1973 

Honorary  Award,  Pennsylvania  Society  of  Dispensing  Opticians,  1974 

Award  for  Distinguished  Achievement  from  Modern  Medicine,  1974 


332 

Honorary  Member  of  Institute  Nacional  de  Investigaiones  Oftalmologicas, 
1974 

Distinguished  Service  Award,  Pennsylvania  Academy  of  Ophthalmology  and 
Otolaryngology,  1974 

Louis  Braille  Award,  Philadelphia's  Center  for  the  Blind,  1974 

Horatio  Alger  Award,  American  Schools  &  Colleges  Association,  Inc.,  1974 

Medical  Achiever  Award,  Wheels,  Inc.,  Philadelphia,  1974 

Golden  Plate  Award,  American  Academy  of  Achievement,  1975 

Golden  Slipper  Club  Bicentennial  Award,  Philadelphia,  1976 

Strittmatter  Award,  Philadelphia  County  Medical  Society,  1976 

Americanism  Award,  China-Burma-India  Veterans'  Association,  1976 

1977  Distinguished  Pennsylvanian,  Greater  Philadelphia  Chamber  of 
Commerce 

Duke  Elder  Award,  1978  International  Glaucoma  Congress  Gold  Medal 
Honorary  Doctorate  of  Law,  University  of  Pennsylvania,  1978 

Saunders  Award,  Presbyterian-University  of  Pennsylvania  Medical  Center, 
1978 

Humanitarian  Award,  The  Chapel  of  Four  Chaplains,  1979 
Super  Achiever  Award,  Juvenile  Diabetes  Foundation,  1979 
John  Wanamaker  Award,  Pennsylvania  Council  of  the  Blind,  1979 

Red  Jacket  Award,  The  Bogie  Busters,  Wright  State  University  Medical 
Center,  1979 

Derrick  T.  Vail  Gold  Medal,  International  Eye  Foundation,  Society  of  Eye 
Surgeons,  1980 

1982  Resolution  of  Appreciation,  Council  of  the  City  of  Philadelphia 
The  Harold  G.  Scheie  Research  Professorship  established  at  the 
University  of  Pennsylvania,  1982 

"Distinguished  Achievements  in  the  Field  of  Ophthalmology"  Special  Award, 
National  Exhibit  for  Blind  Artists,  Inc.,  1983 

The  Lucien  Howe  Medal,  American  Ophthalmological  Society,  1984 
Honorary  Member,  Portugese  Ophthalmology  Society,  1984 

Honored  for  50  Years  of  Medical  Staff  of  Hospital  of  the  University  of 
Pennsylvania,  1985 

Certificate  of  Merit,  Society  of  Illustrators,  1986 

Harold  G.  Scheie  Chair  in  Ophthalmology,  University  of  Minnesota,  1987 

Charles  E.  Shaffrey,  S.J.  Award,  St.  Joseph's  University  Medical  Alumni 
Award,  1989 

Honorary  Degree,  Doctor  of  Humane  Letters,  University  of  Minnesota,  1989 


333 


BIBLIOGRAPHY 


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JAMA  109:413-414  (Aug)  1937. 

2.  Scheie  HG,  Collins,  LH,  Jr.:  The  use  of  rabbit  antipneumococcus  serum  in  the  treatment  of 
ulcus  serpens.  JAMA  112:2130  (May)  1939. 

3.  Scheie  HG,  Reber  J:  Bilateral  Endophthalmitis  complicating  pneumococci  septicemia.  Arch 
Ophthalmol  21:731-734  (May)  1939. 

4.  Scheie  HG:  Site  of  disturbance  in  Adie's  Syndrome.  Arch  Ophthalmol  24:225-237  (May) 
1940. 

5.  Schcie  HG,  Adler  FH:  The  site  of  the  disturbance  in  tonic  pupils.  Trans  Amer  Ophthalmol 
Socpp  183- 192, 1940. 

6.  Schcie  HG,  Souders  BF:  Penetration  of  sulfanilamide  and  its  derivatives  into  aqueous 
humor  of  the  eye.  Arch  Ophthalmol  25:1025-1031  (June)  1941. 

7.  Scheie  HG,  Adler  FH:  Aplasia  of  the  optic  nerve.  Arch  Ophthalmol  26:61-70  (July)  1941. 

8.  Scheie  HG,  Adler  FH,  Moore  E:  Chemical  equilibrium  between  blood  and  aqueous  humor. 
Arch  Ophthalmol  27:317-329  (Feb)  1942. 

9.  Scheie  HG,  Leopold  IH:  Penetration  of  sulfathiazole  into  the  eye.  Arch  Ophthalmol 
27:997- 1004  (May)  1942. 

10.  Scheie  HG,  Leopold  IH:  Studies  with  microcrystalline  sulfathiazole.  Arch  Ophthalmol 
29:8 11-8 17  (May)  1943. 

1 1.  Schcie  HG,  Moore  E,  Adler  FH:  Physiology  of  aqueous  in  completely  iridectomizcd  eyes. 
Arch  Ophthalmol  30:70-74  (July)  1943. 

12.  Schcie  HG,  Hodes  PJ:  Injection  of  oxygen  into  Tenon's  Capsule.  Arch  Ophthalmol  35:13-14 
(Jan)  1946. 

13.  Scheie  HG,  Freeman  N:  Vascular  disease  associated  with  angioid  streaks  of  retina  and 
pscudoxanthoma  elasticum.  Arch  Ophtahlmol  35:241-250  (Mar)  1946. 

14.  Scheie,  HG:  Ocular  changes  in  scrub  typhus.  Bull  of  the  US  Army  Med  Dept  4:423-428 
(Apr)  1946. 

15.  Scheie  HG,  Crandall  AS,  Henie.W:  Kcratitis  associated  with  lymphogranuloma  venereum. 
JAMA,  135:333-339  (Oct)  1947. 

16.  Scheie  HG:  Ocular  changes  in  scrub  typhus:  A  study  of  451  patients.  Trans  Am 
Ophthalmol  Soc  45:637 -677,  1947. 

17.  Scheie  HG,  Owens  WC,  Frank  JJ,  Leahey  B,  Meisser  PE,  Vincent  BR,  Wadsworth  JAC, 
Stansbury  FC:    Symposium:  Corneal  Transplantation  -  V.  Results.  Am  J  Ophthalmol 
3 1:1394- 1399  (Nov)  1948. 

18.  Scheie  HG:  Symposium:  Primary  glaucoma:  III-The  treatment  of  primary  glaucoma  by 
medical  means.   Trans  Am  Acad  Ophtahlmol  Otolaryngol  186-212  (Jan-Fcb)  1949. 

19.  Scheie  HG,  Jerome  B:  Electrocoagulation  of  the  sclera:  Reduction  in  ocular  volume  and 
pathologic  changes  produced.  Am  J  Ophtahlmol  32:6  60-78,  Part  II,  (June)  1949. 

20.  Scheie  HG,  Adler  FH,  Dennis  R:  Thyrotropic  exophthalmos  from  the  viewpoint  of  the 
ophthalmologist.    J  Mich  State  Med  Soc  48:852-857  (July)  1949. 


334 

21.  Scheie,  HG:  Goniotomy  in  treatment  of  congenital  glaucoma.  Arch  Ophthalmol  42:266-282 
(Sept)  1949. 

22.  Scheie  HG,  Ojers,  GW:  Choice  of  a  miotic  agent  following  retrobulbar  anesthesia.  AmJ 
Ophthalmol  32:10  1369-1375  (Oct)  1949. 

23.  Scheie,  HG,  Dennis  RH,  Ripple  RC,  Calkins  LL,  Buesseler  JA:  The  effect  of  low-voltage 
roentgen  rays  on  the  normal  and  vascularized  cornea  of  the  rabbit.  Am  J  Ophthalmol  33:4 
549-571  (Apr)  1950. 

24.  Scheie,  HG,  Ojers  GW:    The  effects  of  procaine  and  cocaine  when  applied  locally  to  the  iris. 
Am  J  Ophthalmol  33:1543-1551  (Oct)  1950. 

25.  Scheie  HG,  Blazer  HA:  Pseudoglaucoma.  Arch  Ophthalmol  44:499-513  (Oct)  1950. 

26.  Scheie,  HG,  Frayer  W:  Ocular  hypertension  induced  by  air  in  the  anterior  chamber.  Arch 
Ophthalmol  44:691-702  (Nov)  1950. 

27.  Scheie  HG:  Goniopuncture  -  a  new  filtering  operation  for  glaucoma.  Arch  Ophthalmol 
44:76 1-780  (Dec)  1950. 

28.  Scheie  HG:  Glaucoma:  A  review  of  the  literature,  1949-1950.  Arch  Ophthalmol  44:883-908 
(Dec)  1950. 

29.  Scheie,  HG:  ACTH  and  keratoplasty:  A  discussion.  Clin  ACTH  Conf  Proc  Philadelphia, 
Blakiston  Co,  pp354,  1950. 

30.  Scheie  HG,  Tyner  G,  Buesseler  JA,  Alfano  JE:  Adrenocorticotropic  hormone  (ACTH)  and 
cortisone  in  ophthalmology.  Arch  Ophthalmol  45:301-316  (Mar)  1951. 

31.  Scheie  HG:  Management  of  congenital  glaucoma.  Trans  PAAcad  Ophthalmol  Otolaryngol 
4:3  48-54  (Oct)  1951. 

32.  Scheie  HG:  Glaucoma:  A  review  of  the  literature,  1950-51.  Arch  Ophthalmol  46:677-709 
(Dec)  1951. 

33.  Scheie  HG:  Retinal  changes  associated  with  hypertension  and  arteriosclerosis.  IL  Med  J 
101:126- 129  (Mar)  1952. 

34.  Scheie  HG,  Tyner  GS,  LaMotte  WO,  Jr:  Treatment  of  rctrolental  fibroplasia  with  vitamin 
E,  corticotropin  (ACTH)  and  cortisone.  Arch  Ophthalmol  47:556-569  (May)  1952. 

35.  Scheie  HG:  Traumatic  surgery  of  the  eye.  Presented  March  11,  1952,  Symp  on  "Teatment  of 
Trauma  in  the  Armed  Forces",  Army  Medical  Service  Graduate  School,  Walter  Reed  Army 
Med  Ctr,  Washington  DC. 

36.  Scheie  HG,  Gammon  GD,  Ojers  GW,  Tyner  GS,  King  G:  The  effect  of  ACTH  and  cortisone 
on  certain  demyelinizing  diseases  of  the  central  nervous  system.  Trans  Am  Neural  Assoc 
pp39-41,  77th  Annual  Meeting,  (May)  1952. 

37.  Scheie  HG,  Hedges  TR:  Thyrotropic  exophthalmos.  New  Orleans  Med  Surg  J  104:481-85 
(June)  1952. 

38.  Scheie  HG:  Research  in  Ophthalmology.  PA  Fed  of  the  Blind,  We,  The  Blind  (Oct)  1952. 

39.  Scheie  HG,  Haas  JS:  Peripheral  iridectomy  in  narrow  angle  glaucoma.  Trans  Am  Acad 
Ophthalmol  Otolaryngol,  pp  589-95  (July-Aug)  1952. 

40.  Scheie  HG:  Cyclodiathermy  in  the  treatment  of  glaucoma.  West  J  Surg,  Obgyn  60:322-326 
(July)  1952. 

41.  Scheie  HG:  Lacerations  of  the  eye  and  adnexa.  Am  J  Ophthalmol  35:1096-1102  (Aug)  1952. 

42.  Scheie  HG,  Ellis  RA:  Regression  of  metastatic  lesions  of  breast  carcinoma  following 
sterilization.  Arch  Ophthalmol  48:455-59  (Oct)  1952. 

43.  Scheie  HG:  Postoperative  complications  of  keratoplasty.  Am  J  Ophthalmol  35:11, 
pp  1697-98,  (Nov)  1952. 

44.  Scheie  HG:  Congenital  glaucoma.  Sight-Saving  Review  22:4  pp!97-201,  (Winter)  1952. 

45.  Scheie  HG:  Gonioscopy.  Trans  Ind  Acad  ofOphtalmol  Otolaryngol  35th  Annual  Meeting, 
pp71-90,  1952. 

46.  Scheie  HG:  Cyclodiathermy.  Trans  Ind  Acad  of  Ophthalmol  35th  Annual  Meeting, 
pp!09-127, 1952. 


335 

47.  SchcieHG:  Glaucoma:  A  Review  of  the  Literature,  1951-52.  Arch  Ophthalmol  48:752-782 
(Dec)  1952. 

48.  Scheie  HG:  Evaluation  of  ophthalmoscopic  changes  of  hypertension  and  arteriolar  sclerosis. 
Arch  Ophthalmol  49:117-138  (Feb)  1953. 

49.  Scheie  HG,  Ojers  GW,  Yasuna  JM:  Cortisone  in  experimental  homologous  keratoplasty  in 
the  rabbit.  Am  J  Ophthalmol  36:120-126  (June)  1953. 

50.  Scheie  HG,  Ellis,  RA:  Long  lasting  aneshetic  agents  in  ophthalmic  surgery.  AMA  Arch 
Ophthalmol  50:2  pp252-254  (Oct)  1953. 

51.  Scheie  HG,  DeLong  SL:  Dibenamines:  An  experimental  and  clinical  study.  Arch 
Ophthalmol  50:3  pp289-298  (Sept)  1953. 

52.  Scheie  HG,  Day,  RMcC:  Simulated  progression  of  visual  field  defects  of  glaucoma.  Arch 
Ophthalmol  50:4  pp4 18-433  (Oct)  1953. 

53.  Scheie,  HG,  Tyner,  GS:  The  mechanism  of  the  miotic  resistant  pupil  with  increased 
intraocular  pressure.  Arch  Ophthalmol  50:4  pp572-579  (Nov)  1953. 

54.  Scheie  HG:  Gonioscopy  in  the  diagnosis  of  tumors  of  the  iris  and  ciliary  body  (emphasis  on 
intraepithelial  cysts).  Trans  Am  Ophthalmol  Soc  pp3 13-331,  1953. 

55.  Scheie  HG:  Gonioscopy  in  the  diagnosis  of  tumors  of  the  iris  and  ciliary  body  (emphasis  on 
intraepithelial  cysts).  Arch  Ophthalmol  51:3  pp288-300  (Mar)  1954. 

56.  Scheie  HG,  Yasuna  JM,  Ojers  GW,  Prayer  WC:  An  experimental  study  of  the  effect  of 
cortisone  on  the  eye.  Am  J  Ophthalmol  37:923-31  (June)  1954. 

57.  Scheie  HG,  Alpcr  MC:  Treatment  of  herpes  zoster  ophthalmicus  with  cortisone  or 
corticotropin.  Arch  Ophthalmol  53:38-44  (Jan)  1955. 

58.  Scheie  HG:    Symposium:  Retrolental  Fibroplasia.  Trans  Am  Acad  Ophthalmol  Otolaryngol 
pp  15-24  (Jan-Feb)  1955. 

59.  Scheie  HG,  Ellis  RA,  Eckenhoff  JE,  Spencer  RW:  Long-lasting  local  anesthetic  agents  in 
ophthalmic  surgery.  Arch  Ophthalmol  53:177-190  (Feb)  1955. 

60.  Scheie  HG,  Frayer  WC,  Spencer  RW:  Cyclodiathery  -  a  clinical  and  tonographic  evaluation. 
Arch  Ophthalmol  53:839-846  (June)  1955. 

61.  Scheie  HG,  Spencer  RW,  Dripps  RD:  Anterior  chamber  injection  in  the  rabbit  as  a  method 
for  determining  irritancy  of  local  anesthetics.  J  Pharm  and  Exper  Therap  113:421-430  (Apr) 
1955. 

62.  Scheie  HG:  Symposium:  Congenital  glaucoma  -  diagnosis,  clinical  course  and  treatment 
other  than  goniotomy.  Trans  Am  Acad  Ophthalmol  Otolaryngol  pp309-321  (May-June) 
1955. 

63.  Scheie  HG,  Spencer  RW,  Helmick  ED:  Tonography.  Arch  Ophthalmol  54:4  pp515-527  (Oct) 
1955. 

64.  Scheie  HG,  Hedges,  TR  Jr:  Visual  field  defects  in  exophthalmus  associated  with  thyroid 
disease.   Arch  Ophthalmol  54:885-892  (Dec)  1955. 

65.  Scheie  HG:  Discussion  of  organization  for  the  management  of  mass  casualties.  Miltary 
Med  118:4  pp434-435  (Apr)  1956. 

66.  Scheie  HG:  A  method  of  cataract  extraction  following  filtering  operations  for  glaucoma. 
Arch  Ophthalmol  55:818-829  (June)  1956. 

67.  Scheie  HG:  Continuous  retrobular  anesthesia.  Trans  Am  Acad  Ophthalmol  Otolaryngol 
pp389-395  (May-June)  1956. 

68.  Scheie  HG:  What  the  general  practitioner  should  know  about  ocular  surgery.  Med  Clinics 
of  North  Am  W.B.  Saunders  Co  pp!689-1714  (Nov)  1956. 

69.  Kinsey  VE  et  al:  Retrolental  fibroplasia.  Arch  Ophthalmol  56:481-543  (Oct)  1956. 

70.  Scheie  HG,  Spencer  RW,  Helmick  ED:  Tonography  in  the  clinical  management  of  glaucoma. 
Arch  Ophthalmol  56:797-818  (Dec)  1956,  Trans  AOS  53:265-299,  1956. 

71.  Scheie  HG,  Hicks  JD:  Mooren's-like  ulcer  in  a  corneal  graft.  Am  J  Ophthalmol  43:385-388 
(Mar)  1957. 


336 

72.  Scheie  HG:  New  scissors  for  cataract  extraction.  Arch  Ophthalmol  58:135  (July)  1957. 

73.  Scheie  HG:  Width  and  pigmentation  of  the  angle  of  the  anterior  chamber.  Arch 
Ophthalmol  58:510-512  (Oct)  1957. 

74.  Scheie  HG,  Hogan  TF  Jr:  Angioid  streaks  and  generalized  arterial  disease.  Arch 
Ophthalmol  57:855-868  (June)  1957. 

75.  Scheie  HG,  Williams  NS:  Comparative  studies  on  anesthetic  properties  of  Primacaine  HCL. 
Arch  Ophthalmol  (Jan)  1958. 

76.  Scheie  HG,  Fleischauer  HW:  Idiopathic  atrophy  of  the  epithelial  layers  of  the  iris  and 
ciliary  body.  Arch  Ophthalmol  59:6  pp2 16-228  (Feb)  1958. 

77.  Scheie  HG:  Retraction  of  scleral  wound  edges:  As  a  fistulizing  procedure  for  glaucoma.  Am 
J  Ophthalmol  45:4  Part  II  pp220-228  (Apr)  1958. 

78.  Scheie  HG:  Guides  to  the  evaluation  of  permanent  impairment  -  the  visual  system.  JAMA 
(Sept)  1958. 

79.  Scheie  HG:  Peripheral  iridcctomy  with  scleral  cautery  for  glaucoma.  Arch  Ophthalmol 
61:139-291,  146-298  (Feb)  1959. 

80.  Scheie  HG:  Incision  and  closure  in  cataract  extraction.  Arch  Ophthalmol  61:431-452. 

81.  Scheie  HG:  The  management  of  infantile  glaucoma.  Arch  Ophthalmol  62:35-54  (July)  1959. 

82.  Scheie  HG,  McLellan,  TG  Jr:  Treatment  of  herpes  zoster  ophthalmicus  with  corticotropin 
and  corticosteroids.  Arch  Ophthalmol  63:579-587  (Oct)  1959. 

83.  Scheie  HG,  Muirhead  JF:  Transient  myopia  after  acetazolamide.  Arch  Ophthalmol 
63:315-318  (Feb)  1960. 

84.  Scheie  HG:  Aspiration  of  congenital  or  soft  cataracts:  A  new  technique.  Am  J  Ophthalmol 
50:1048-1056  (Dec)  1960. 

85.  Scheie  HG:  Goniopuncture:  An  evaluation  after  eleven  years.  Arch  Ophthalmol  65:38-48 
(Jan)  1961. 

86.  Scheie  HG,  Ashley  BJ  Jr,  Weiner  A:  The  treatment  of  total  hyphema  with  fibrinolysin 
(Plasmin).  A  preliminary  report.  Arch  Ophthalmol  66:226-231  (Aug)  1961. 

87.  Scheie  HG:  Elsom  KA,  Beebe  GW,  Sayen  JJ,  Gammon  G,  Wood  FC:  Scrub  typhus:  A 
follow-up  study.  Ann  Int  Med  55:5  pp784-795  (Nov)  1961. 

88.  Scheie  HG:  Surgery  is  still  primary  in  glaucoma  management.  Surg  World  pp7  (Dec)  1961. 

89.  Scheie  HG:  In  consultation.  Med  Trib  pp9  (Dec)  1961. 

90.  Scheie  HG:    What  the  general  practitioner  should  know  about  glaucoma.  J  Med  Assoc  AL 
31:10  pp317-322  (Apr)  1962. 

91.  Scheie  HG:  Filtering  operations  for  glaucoma:  A  comparative  study.  AJO  53:4  pp571-590 
(Apr)  1962. 

92.  Scheie  HG,  Hambrick  GW  Jr:  Studies  of  the  skin  in  Hurler's  Syndrome.  Arch  Derm 
85:455-471  (Apr)  1962. 

93.  Scheie  HG,  Hambrick  GW  Jr,  Harness  LA.  A  newly  recognized  form  fruste  of  Hurler's 
Disease  (Gargoylism).  Am  J  Ophthalmol  53:753-769. 

94.  Scheie  HG:  The  inflammed  eye.  Consultant  (SK&F)  (June)  1962. 

95.  Scheie  HG,  Ashley  BJ  Jr:  Ocular  injuries  and  the  general  practitioner.  J  Med  Assoc  AL 
31:12  pp392-397  (June)  1962. 

96.  Scheie  HG,  Muirhead  JF:  Cataract  extraction  after  filtering  operations.  Arch  Ophthalmol 
68:37-41  (July)  1962. 

97.  Scheie  HG:  Results  of  peripheral  iridectomy  with  scleral  cautery  in  congenital  and  juvenile 
glaucoma.  Arch  Ophthalmol  69:13-22  (Jan)  1963. 

98.  Scheie  HG,  Ashley  BJ  Jr,  Burns  DT:  Treatment  of  total  hyphema  with  Fibrinolysin.  Arch 
Ophthalmol  69:147-153  (Feb)  1963. 

99.  Scheie  HG,  Frayer  WC:  Cure  of  narrow  angle  glaucoma  by  iris  atrophy:  A  report  of  two 
patients.  Am  J  Ophthalmol  55:335-338  (Feb)  1963. 


337 

100.  Scheie  HG:  Disorders  of  childrcns' eyes  -  notes  on  the  early  recognition.  Clin  Fed  2:2  (Fob) 
1963. 

101.  Scheie  HG:  Ocular  symptomatology.  Consultant  (SK&F)  (Apr)  1963. 

102.  Scheie  HG,  Albert  DM:  Nevus  of  Ota  with  malignant  melanoma.  Arch  Ophthalmol 
69:774-777  (June)  1963. 

103.  Scheie  HG:  Editorial  "Surgical  Techniques".  Arch  Ophthalmol  70:45-46  (July)  1963. 

104.  Scheie  HG:  Indications  for  surgery  in  infantile  and  juvenile  glaucoma.  Trans  Am  Acad 
Ophthalmol  Otdaryngol  pp458  (July-Aug)  1963. 

105     Scheie  HG,  Yanoff  M,  Prayer  WC:  Ocular  findings  in  a  patient  with  13-15  Trisomy.  Arch 
Ophthalmol  70:372  (Sept)  1963. 

106.  Scheie  HG:  Ophthalmology  as  a  specialty.  Ganka  6:1  (Jan)  1964. 

107.  Scheie  HG,  Rubenstein  RA,  Albert  DM:  Congenital  glaucoma  and  other  ocular 
abnormalities  with  idiopathic  infantile  hypoglycemia.  J  Fed  Ophthalmol  pp45  (Jan)  1964. 

108.  Scheie  HG,  Ashley  BJ  Jr,  Yanoff  M:  Medical  ophthalmology  hpcrtcnsion  and 
arteriosclerosis.  The  New  Phys,  JStudAMA  -  Follow-Up  1:1  (Mar)  1964. 

109.  Scheie  HG,  McFarlane  JR,  Popkin  A:  Medical  ophthalmology  endocrine  diseases,  blood 
dyscrasias,  dysproteinemias  and  geriatrics.  The  New  Phys,  JStudAMA  -  Follow-Up  1:2 
(Apr)  1964. 

1 10.  Scheie  HG,  Rubenstein  RA,  DeLong  SI:  Medical  ophthalmology  collagen  diseases  and 
heritable  diseases  of  connective  tissue.  The  New  Phys,  J  Stud  AMA  -  Follow-Up  1:3  (May) 
1964. 

111.  Scheie  HG,  Simco  WC,  Burns  WP:  Primary  glaucoma.  The  New  Phys,  J  Stud  AMA  - 
Follow-Up  1:4  (June)  1964. 

112.  Scheie  HG:  The  surgical  management  of  primary  glaucoma.  Trans  Pac  Coast 
Oto-Ophthalmol  Soc  pp215, 1964. 

113.  Scheie  HG:  Complications  of  cataract  extraction.  Trans  Pac  Coast  Oto-Ophthalmol  Soc 
pp!97, 1964. 

1 14.  Scheie  HG:  The  management  of  glaucoma  and  cataracts  in  children.  Sight-Saving  Review 
34:2  (Summer)  1964. 

115.  Scheie  HG,  Yanoff  M:  Argyrosis  of  the  conjunctiva  and  lacrimal  sac.  AMA  Arch  Ophthalmol 
72:58  (July)  1964. 

116.  Scheie  HG,  Connell  MM,  Poley  BJ:  Pediatric  ophthalmology.  The  New  Phys,  J  Stud  AMA  - 
Follow-Up.  1:5  (Sept)  1964. 

1 17.  Scheie  HG,  Poley  BJ,  Rubenstein  RA:  Pediatric  ophthalmology.  The  New  Phys,  J  Stud 
AMA  -  Follow-Up  1:6  (Oct)  1964. 

118.  Scheie,  HG:  Infantile  glaucoma  and  the  pediatrician.  Clin  Ped  3:9  pp525  (Sept)  1964. 

1 19.  Scheie  HG,  Burns  DT,  Popkin  AB:  External  diseases  and  ocular  injuries.  The  New  Phys,  J 
Stud  AMA  -  Follow-Up  1:7  (Nov)  1964. 

120.  Scheie  HG,  Yanoff  M,  Frayer  WC:  Carcinoma  of  sebaceous  glands  of  the  eyelid.  AMA  Arch 
Ophthalmol  72:800  (Dec)  1964. 

121.  Scheie  HG,  Latics  AM,  Eggleston  TF,  Newas  HJ:  Neuro-ophthalmology.  The  New  Phys,  J 
Stud  AMA  1:8  (Dec)  1964. 

122    Scheie  HG:  Iridectomy  with  scleral  cautery  -  current  status.  Trans  Ophthalmol  Soc  UK  84, 
1964. 

123.  Scheie  HG,  Rubenstein  RA,  Katowitz  JA:  Ophthalmic  ointment  bases  in  the  anterior 
chamber:  Clinical  and  experimental  observations.  AMA  Arch  Ophthalmol  73:36  (Jan)  1965. 

124.  Scheie,  HG:  A  career  in  ophthalmology.  J  Phi  Rho  Sigma  60:2  ppl  (Fob)  1965. 

125.  Scheie  HG,  Edwards  DL,  Yanoff  M:  Clinical  and  experimental  observations  using  Alpha 
Chymotrypsin.    Am  J  Ophthalmol  59:3  pp469  (Mar)  1965. 


338 

126.  Scheie  HG:  Stripping  of  descement's  membrane  in  cataract  extraction.  Trans  Am 
Ophthalmol  Soc  1964,  Arch  Ophthalmol  73:311  (Mar)  1965. 

127.  Scheie  HG,  Yanoff  M,  Tsou  KG:  Inhibition  of  Alpha  Chymotrypsin  by  aqueous  humor. 
AMA  Arch  Ophthalmol  73:399  (Mar)  1965. 

128.  Scheie  HG,  Brill  H,  DeLong  SL:  Phenothiazines,  skin  pigmentation  and  related  eye 
findings.  Am  J  Psych  122:3  (Sept)  1965. 

129.  Scheie  HG,  Laties  AM:  Adie's  Syndrome:  Duration  of  methacholine  sensitivity.  AMA  Arch 
Ophthalmol  74:458  (Oct)  1965. 

130.  Scheie  HG,  Albert  DM,  Burns  WP:  Severe  orbitocranial  foreign  body  injury.  Am  J 
Ophthalmol  60:6  (Dec)  1965. 

131.  Scheie  HG:  Management  of  ocular  injuries.  Trans  Ind  Acad  Ophthalmol  Otolaryngol  ppl-6, 
1965. 

132.  Scheie  HG:  Techniques  of  procedures  for  everyday  ophthalmic  surgery.  Trans  Ind  Acad 
Ophthalmol  Otolaryngol  pp33-44, 1965. 

133.  Scheie  HG,  Albert  DM:  Distichiasis  and  trichiasis:  Origin  and  management.  Am  J 
Ophthalmol  61:4  pp7 18-720  (Apr)  1966. 

134.  Scheie  HG:  Present  concepts  in  glaucoma  surgery.  Proc  Course  in  Military  Ophthalmol, 
Walter  Reed  Gen  Hosp  (Apr)  1966. 

135.  Scheie  HG:  Ocular  trauma  and  glaucoma.  Proc  Course  in  Military  Ophthalmol,  Walter 
Reed  Gen  Hosp  (Apr)  1966. 

136.  Scheie  HG,  McCurdy  DK,  Schneider  B:  Oral  Glycerol:  The  mechanism  of  intraocular 
hypotension.  Am  J  Ophthalmol  61:5  pp304-309,  Part  II  (May)  1966. 

137.  Scheie  HG,  Rubenstein  RA,  Albert  DM:  Ocular  complications  of  hemophilia.  Arch 
Ophthalol  76:229  (Aug)  1966. 

138.  Scheie  HG,  McFarlane  JR,  Yanoff  M:  Toxic  retinopathy  following  sparsomycin  therapy. 
Arch  Ophthalmol  76:532-540  (Oct)  1966. 

139.  Scheie  HG,  Albert  DM:  Ophthalmology  at  the  University  of  Pennsylvania:  A  chronology. 
Trans  &  Studies  Coll  Phys  ofPhila  34:2  (Oct)  1966. 

140.  Scheie  HG,  Yanoff  M:  Fibrosarcoma  of  orbit:  Report  of  two  patients.  Cancer  19:11 
pp!711- 1716  (Nov)  1966. 

141.  Scheie,  HG:  Changing  trends  in  the  surgical  management  of  advanced  open  angle 
glaucoma.  Trans  PA  Acad  Ophthalmol  Otolaryngol  pp79-81  (Fall)  1966. 

142.  Scheie  HG,  Rubenstein  RA,  Kent  RB:  Aspiration  of  congenital  or  soft  cataracts:  Further 
experience.  Trans  Am  Ophthalmol  Soc  64  pp319-331,  1966,  Am  J  Ophthalmol  63:3  (Jan) 
1967. 

143.  Scheie  HG,  Yanoff  M:  Pseudomelanoma  of  the  ciliary  body.  Arch  Ophthalmol  77:81-83 
(Jan)  1967. 

144.  Scheie  HG,  Schaffer  DB,  Plotkin  SA,  Kertesz  ED:  Congenital  rubella  cataracts:  Surgical 
results  and  virus  recovery  from  intraocular  tissue.  Arch  Ophthalmol  77:440  (Apr)  1967. 

145.  Scheie  HG,  Albert  DM,  Rubenstein  RA:  Tumor  metastasis  to  the  eye:  Part  I.  Incidence. 
Am  J  Ophthalmol  63:723  (Apr)  1967. 

146.  Scheie  HG,  Albert  DM,  Rubenstein  RA:  Tumor  metastasis  to  the  eye:  Part  II.  Clinical 
study.  Am  J  Ophthalmol  63:727  (Apr)  1967. 

147.  Scheie  HG,  Plotkin  SA,  Cochran  W,  Lindquist  JM,  Cochran  GC,  Schaffer  DB,  Furukawa  T: 
Congenital  Rubella  Syndrome  in  late  infancy.  JAMA  220:6  pp35-441  (May)  1967. 

148.  Scheie  HG,  Vucicevic  ZM,  Burns  WP,  Nazarian  IH,  Edwards  DL:  Clinical  and 
pathohistological  evaluation  of  different  scleral  implants  in  detachment  surgery.  Trans  Ger 
Ophthalmol  Soc  1967-1968. 

149.  Scheie  HG,  Vicicevic  ZM,  Tsou  KC,  Nazarian  IH,  Burns  WP:  A  new  approach  to  laser 
coagulation  of  ciliary  body.  Trans  Ger  Ophthalmol  Soc  1967-1968. 


339 

150.  Scheie  HG,  Yanoff  M:  Malignant  lymphoma  of  the  orbit-difficulties  in  diagnosis.  Survey  of 
Ophthalmol  12:2  pp!35-140  (Fall)  1967. 

151.  Scheie  HG:  An  evaluation  of  iridoctomy  with  scleral  cautery.  Trans  Meet  Ohthalmol  Soc 
Australia  XXVL44,  1967. 

152.  Scheie  HG:  Rubella  syndrome  and  cataracts.  Trans  Meet  Ophthalmol  Soc  Australia. 
XXVL44, 1967. 

153.  Scheie  HG:  Is  delayed  cataract  surgery  for  rubella.  Clinical  Trends  pp3  (Jan-Fcb)  1968. 

154.  Yanoff  M,  Scheie  HG:  Cytology  of  human  lens  aspirate:  Its  relationship  to  phacolytic 
glaucoma  and  phacoanaplylactic  endophthalmitis.  Arch  Ophthalmol  80  (Aug)  1968. 

155.  Scheie  HG:  Closed  fistula  and  reoperations  for  glaucoma.  Highlights  of  Surg  XI:  1  1968 
Series. 

156.  Scheie  HG,  Ashley  BJ  Jr,  Yanoff  M:  Medical  ophthalmology:  Hypertension  and 
arteriosclerosis.  Mod  Med  36:24  (Nov  18)  1968. 

157.  Yanoff  M,  Schaffer  DB,  Scheie  HG:  Rubella  ocular  syndrome  clinical  significance  of  viral 
and  pathologic  studies.  Trans  Am  Acad  Ophthalmol  Otolaryngol  72  (Nov-Dec)  1968. 

158.  Vucicevic  ZM,  Scheie  HG,  Burns  WP,  Nazarian  IH,  Edwards  DL:  Klinische  und 
pathohistologische  beurteilungder  verscheidenen  skleralplomben,  angewandt  in  dor 
netzhautchirurgie,  Toil  I:  Silikone  und  Haut.  Klinische  Monatsblatter  fur  Augenheilkunde 
153:194-202, 1968. 

159.  Scheie  HG:  Shingles.  Lance*  2:109  (July)  1968. 

160.  Scheie  HG:  Challenges  in  ophthalmology.  J Phi  Rho  Sigma  64:3  (Fob)  1969. 

161.  Vucicevic  ZM,  Tsou  KG,  Nazarian  IH,  Scheie  HG,  Burns  WP:  A  cytochcmical  approach  to 
the  laser  coagulation  of  the  ciliary  body.  Mod  Prob  Ophthalmol  8:467-478,  1969. 

162.  Vucicevic  ZM,  Nazarian  IH,  Scheie  HG,  Burns  WP:  Clinical  and  histopathologic  evaluation 
of  preserved  fascia  lata  implants.  Surg  Forum  XX  1969. 

163.  Tsou  KG,  Vicicevic  ZM,  Miller  EE,  Scheie  HG,  Rhoads  JE:  A  cytochemical  approach  to  ruby 
laser  microsurgery:  Preliminary  study  in  tissue  culture  and  rabbit  eye.  Surg  Forum  XX 
1969. 

164.  Scheie  HG,  McFarlane  JR,  Popkin  AB:  Medical  ophthalmology:  Endocrine  diseases,  blood 
dyscrasias,  dysprotcincmias,  and  geriatrics.  Mod  Med  37:6  (Mar  24)  1969. 

165.  Scheie  HG:  An  evaluation  of  iridectomy  with  scleral  cautery.  Reprinted  Trans  Ophthalmol 
Soc  Australia  XXVL44  1967,  Doctor's  Digest  (July)  1969. 

166.  Scheie  HG,  Rubenstein  RA,  DcLong  SL:  Medical  ophthalmology:  Collagen  diseases  and 
heritable  diseases  of  connective  tissue.  Mod  Med  37:17  (Aug  25)  1969. 

167.  Vucicevic  ZM,  Scheie  HG,  Ralston  J:  Ultrasonic  evaluation  of  osmotic  agents  (urea,  manitol, 
and  glycerol).  3rd  International  Symposium  on  Ultrasonic  Diagnostics  in  Ophthalmology. 
SIDUO  III  Vienna  1969. 

168.  Scheie  HG,  Simcoe  CW,  Burns  WP:  Primary  glaucoma:  Current  concepts.  Mod  Med  (Fcb 
23) 1970. 

169.  Scheie  HG:  Cataract  surgery  in  children.  Proc  XXI  Internal  Cong  Mexico  DF  (March  8-14) 
1970.  Reprinted  Ex  Medica  Internal  Cong  Series  222. 

170.  Scheie  HG,  Kozart  DM:  Spontaneous  cysts  of  the  ciliary  epithelium.  Trans  Am  Acad 
Ophthalmol  Otolaryngol  74  (May-June)  1970. 

171.  Scheie  HG,  Conncll  MM,  Poley  BJ:  Pediatric  ophthalmology.  Mod  Med  (June  15)  1970. 

172.  Yanoff  M,  Scheie  HG:  Melanomalytic  glaucoma  -  Report  of  a  case.  Arch  Ophthalmol  84 
(Oct)  1970. 

173.  Scheie  HG:  Surgical  management  of  black  ball  hyphema.  Discussion  of  M.L.  Scars'  paper. 
Trans  Am  Acad  Ophthalmol  74:826-827,  1970. 

174.  Scheie  HG:  Management  of  congenital  cataracts.  Discussion  of  G.K  von  Noorden  et  al's 
paper.  Trans  Am  Acad  Ophthalmol  74:356-358,  1970. 


340 

175.  Laties  AM,  Scheie  HG:  Sarcoid  granuloma  of  the  optic  disk:  Evolution  of  multiple  small 
tumors.  Trans  Am  Ophthalmol  Soc  68,  1970. 

176.  Scheie  HG:  Herpes  zoster  ophthalmicus.  Trans  Ophthalmol  Soc  of  UK  XC,  1970. 

177.  Scheie  HG,  Poley  BJ,  Rubenstein  RA:  Pediatric  ophthalmology.  Mod  Med  39:2  (Jan  25) 
1971. 

178.  Scheie  HG,  Gray  son  MC:  Ocular  manifestations  of  systemic  diseases.  Disease-a-Month 
(Feb)  1971. 

179.  Scheie  HG,  Burns  DT,  Popkin  AB:  External  diseases  and  ocular  injuries.  Mod  Med  (Apr 
19)  1971. 

180.  Scheie  HG,  Shannon  RE,  Yanoff  M:  Onchocerciasis  (Ocular).  Ann  Ophthalmol  3:7  (July) 
1971. 

181.  Glass  R,  Scheie  HG,  Yanoff  M:  Conjunctival  amyloidosis  arising  from  a  plasmacytoma. 
Ann  Ophthalmol  3:8  (Aug)  1971. 

182.  Scheie  HG,  Laties  AM,  Egglcston  TF,  Nevyas,  HJ:  Neuro-ophthalmology.  Mod  Med  39:19 
(Sept  20)  1971. 

183.  Constantopoulos  G,  Dekaban  AS,  Scheie  HG:  Heterogeneity  of  disorders  in  patients  with 
corneal  clouding,  normal  intellect,  and  mucopolysaccharidosis.  Am  J  Ophthalmol  72:6 
ppll06-1117  (Dec)  1971. 

184.  Scheie  HG,  Yanoff  M:  Peter's  anomaly  and  total  posterior  coloboma  of  retinal  pigment 
epithelium  and  choroid.  Arch  Ophthalmol  87:525-530  (May)  1972. 

185.  Scheie  HG:  Glaucoma  and  ocular  injuries.  Revista  de  la  Soc  Colombiana  de  Oflalmol  111:2 
pp75-82  (June)  1972. 

186.  Scheie  HG:  Surgical  management  of  primary  glaucoma.  (Abstract)  5th  Afro-Asian  Cong  of 
Ophthalmol,  Tokyo  (July)  1972. 

187.  Laties  AM,  Scheie  HG:  Evolution  of  multiple  small  tumors  in  sarcoid  granuloma  of  the 
optic  disk.  Am  J  Ophthalmol  74:1  pp60-67  (July)  1972. 

188.  Scheie  HG,  Morse  PH:  Rubeola  retinopathy.  Arch  Ophthalmol  88:341-344  (Sept)  1972. 

189.  Vucicevic  ZM,  Scheie  HG,  Yanoff  M,  Ralston  J:  Evaluation  of  different  preservatives  of 
biological  sclcral  implants.  Mod  Probl  Ophthalmol  10:148-152  (Karger,  Basel)  1972. 

190.  Scheie  HG,  Morse  PH,  Aminlari  A:  Incidence  of  retinal  detachment  following  cataract 
extraction.  Arch  Ophthalmol  89:293-295  (Apr)  1973. 

191.  Morse  PH,  Scheie  HG,  Aminlari  A:  Light  flashes  as  a  clue  to  retinal  disease.  Arch 
Ophthalmol  91:179-180  (Mar)  1974. 

192.  Fine  BS,  Yanoff  M,  Scheie  HG:  Pigmentary  "Glaucoma"  -  A  histologic  study.  Trans  Am 
Acad  Ophthalmol  Otolaryngol  78:314-325  (Mar-Apr)  1974. 

193.  Scheie  HG,  Morse  PH:  Shallow  anterior  chamber  as  a  sign  of  nonsurgical  choroidal 
detachment.  Ann  Ophthalmol  6:4  (Apr)  1974. 

194.  Morse  PH,  Scheie  HG:  Prophylactic  cryoretinopcxy  of  retinal  breaks.  Arch  Ophthalmol 
92:204-207  (Sept)  1974. 

195.  Scheie  HG:  Retinal  detachment  (correspondence).  Arch  Ophthalmol  92:269  1974. 

1%.    Scheie  HG:  Cryoextraction  of  cataract  through  round  pupil  with  no  assistance.  Klin  Mbl 
Augenheilk  165:21-24,  1974. 

197.  Morse  PH,  Aminlari  A,  Scheie  HG:  Spontaneous  vitreous  hemorrhage.  Arch  Ophthalmol 
92:297-298  (Oct)  1974. 

198.  Vucicevic  ZM,  Scheie  HG,  Berry  A,  Yaros  M,  Fraucnhoffcr  C:  The  importance  and  accuracy 
of  the  water  drinking  test  and  tonography.  Ann  Ophthalmol  7:39-45  (Jan)  1975. 

199.  Perry  HD,  Yanoff  M,  Scheie  HG:  Rubeosis  in  Fuchs  hcterochromic  iridocyclitis.  Arch 
Ophthalmol  93:337-339  (May)  1975. 

200.  Allen  HF,  Scheie  HG:  Common  eye  disorders:  treat  or  refer?  (In  consultation).  Med  World 
News  pp39-50  (June  16)  1975. 


341 

201.  Morse  PH,  Schcic  HG:  Rhegmatogenous  retinal  detachment  in  patients  age  40  years  or 
less.  Trans  Ophthalmol  Soc  UK  1975. 

202.  Scheie  HG:  Glaucoma:  1874-1974.  Trans  &  Stud  Coll  Phys  Phila  43:1  ppl-12  (July)  1975 
(Deschwinitz  Lecture). 

203.  Scheie  HG,  Yanoff  M:  Iris  Nevus  (Cogan- Reese)  syndrome  -  A  cause  of  unilateral  glaucoma. 
Arch  Ophthalmol  93:93  pp963-970  (Oct)  1975. 

204.  Scheie  HG,  et  al:  Discussion  -  Problems  in  the  treatment  of  glaucoma.  Ann  Inst  Barraquer 
XII:3  1975-76. 

205.  Scheie  HG:  What  type  of  surgery  for  cataract  in  patients  with  glaucoma?  JAMA  236:3 
pp304-305  (July  19)  1976. 

206.  Scheie  HG,  Yanoff  M,  Kellogg  WT:  Essential  iris  atrophy.  Arch  Ophthalmol  94:8 
pp  13 15- 1320  (Aug)  1976. 

207.  Yanoff  M,  Scheie  HG,  Allman  Y,  Marian  I:  Endothelialization  of  filtering  bleb  in  iris  nevus 
syndrome.  Arch  Ophthalmol  94  (Nov)  1976. 

208.  Scheie  HG,  Laties  AL:  2076  in  ophthalmology,  Philadelphia  a  medical  panorama  of  200 
years  -  1776-1976.  Phila  County  Mod  Soc.  Phila  Med  (Fall)  1976. 

209.  Scheie  HG,  Yanoff  M,  Sassani  JW:  Inverted  follicular  keratosis  clinically  mimicking 
malignant  melanoma.  Ann  Ophthalmol  9:8  (Aug)  1977. 

210.  Scheie  HG,  Barraquer  J,  Francois  J,  Hcnkind  P,  Podos  S:  Managing  glaucoma  -  the  experts 
speak.  The  Lederle  Internal  Bull  5:2  (Fall)  1977. 

211.  Scheie  HG,  Pitts  E,  Martin  FJ:  Management  of  persistent  filtering  cicatrix  following 
cataract  extraction.  Arch  Ophthalmol  95:10  pp!835-1838  (Oct)  1977. 

212.  Scheie  HG:    Surgical  therapy  for  glaucoma.  Ann  Ophthalmol  9:10  pp!311-1313  (Oct)  1977. 

213.  Scheie  HG,  EwingMQ:  Aspiration  of  soft  cataract.  Internal  Ophthalmol  Clin  17:4  (Winter) 
1977. 

214.  Scheie  HG:  Operative  therapie  des  glaukoms.  Klin  Mbl  Augenheilk  171:7  (Dec)  1977. 

215     Scheie  HG,  Crandall  AS,  Karp  LA:  Senile  entropion:  Modified  schimek.  Ann  Ophthalmol 
10:1  (Jan)  1978. 

216.  Scheie  HG,  EwingMQ:  Aphakic  glaucoma.  Trans  Ophthalmol  Soc  UK 98:111-117,  1978. 

217.  Scheie  HG,  Guehl  JJ:  Surgical  management  of  overhanging  blebs  after  filtering  procedures. 
Arch  Ophthalmol  97  (Feb)  1979. 

218.  Yanoff  M,  Scheie  HG:  Melanomalytic  glaucoma,  in  Albert  MD  Puliafito  CA  (ed):  Found 
Ophthal  Pathol  Applcton-Century  Crofts,  pp418-420  1979. 

219.  Scheie  HG,  Schnitzer  JI:  Bilateral  posterior  lentiglobus  associated  with  spontaneous 
rupture  of  the  lens  capsule.  Ann  Ophthalmol  12:1  (Jan)  1980. 

220.  Stone  RA,  Scheie  HG:  Periorbital  sclerodcrma  associated  with  heterochromia  iridis.  Am  J 
Ophthalmol  90:858-861  1980. 

221.  Perry  HD,  Scheie  HG:  Superficial  reticular  degeneration  of  koby.  Brit  J  Ophthalmol 
64:841-844  (Fall)  1980. 

222.  Scheie  HG:  Iridectomy  with  sclcral  cautery.  Reprinted  Internal  Ophthalmol  Clin  - 
Glaucoma  Surgery,  Little,  Brown  &  Co,  21:1  (Spring)  1981. 

223.  Scheie  HG,  Cameron  JD:  Pigment  dispersion  syndrome:  A  clinical  study.  Brit  J 
Ophthalmol  65:264-269  (Apr)  1981. 

224.  Karp  LA,  Scheie  HG:  Results  of  1000  consecutive  intracapsular  cataract  extractions.  Ann 
Ophthalmol  13:10  (Oct)  1981. 

225.  John  T,  Yanoff  M,  Scheie  HG:  Eyelid  fibrous  histiocytoma.  Ophthalmol  88:12  (Dec)  1981. 

226.  Scheie  HG:  Management  of  primary  narrow  angle  glaucoma.  Trans  Asia  Pac  Acad 
Ophthalmol  Thailand,  VIII  (Fall)  1981. 

227.  Bloom  LH,  Scheie  HG,  Yanoff  M:  The  warming  of  local  anesthetic  agents  to  decrease 
discomfort.  Ophthal  Surg  15:7  (July)  1984. 


342 


INTERVIEWER  BIOGRAPHY 

Sally  Smith  Hughes 

She  graduated  from  the  University  of  California,  Berkeley,  in  1963  with  an 
A.B.  degree  in  zoology,  and  from  the  University  of  California,  San  Francisco, 
in  1966  with  an  M.A.  degree  in  anatomy.  After  completing  a  dissertation  on 
the  history  of  the  concept  of  the  virus,  she  received  a  Ph.D.  degree  in  the 
history  of  medicine  from  the  Royal  Postgraduate  Medical  School,  University  of 
London,  in  1972. 

Her  previous  positions  have  been  postgraduate  research  histologist,  the 
Cardiovascular  Research  Institute,  University  of  California,  San  Francisco, 
1966-1968,  and  medical  historian  conducting  the  NEH-supported  History  of 
Medical  Physics  Project  for  The  Bancroft  Library,  1978-1980. 

She  is  presently  an  interviewer  on  medical  and  scientific  topics  for  the 
Regional  Oral  History  Office,  and  the  author  of  The  Virus:  A  History  of  the 
Concept. 


343 


INDEX 


Academia  Ophthalmologica  Internationalis  294 

Adie's  syndrome  (tonic  pupil)  44,  48-51, 133,  235,  278 

Adler,  Francis  H.  35,  36,  37-39,  40,  41,  44,  49-50,  52,  53-58,  59,  60,  81,  87,  130-132, 142, 149, 

163-175  passim,  191,  203-204,  225,  229,  233,  236,  285,  301-309  passim 
Adler,  Louis  54 

advances  in  ophthalmology  319-320 
advertising  by  physicians  314 
Albert,  Daniel  M.  9, 169,  191-192,  294 
Alcon  Laboratories  161-162 
Aldrich,Winthropll2 

American  Academy  of  Ophthalmology  205,  234,  294-295,  299,  301,  303,  305,  317 
American  Association  of  Ophthalmology  295 
American  Board  of  Ophthalmology  178,  184-185,  295-297 
American  College  of  Surgeons  66, 151,  297-299,  314 
American  Journal  of  Opthalmology  305 
American  Medical  Association  239,  295,  300 

Section  on  Ophthalmology  127,  238,  295,  298,  300,  305,  306 
American  Ophthalmological  Society  24,  49-50,  94,  247,  301-303, 307 
Anderson,  H.  K.  278 
Anderson,  J.  Ringland  232 

anesthesia,  anesthesiologists  46,  80, 142-144, 191,  202,  271,  272-273,  274,  277-279 
angioid  streaks  of  the  retina  95-98, 198 
antibiotics  46-47,  161,  273,  274-275 
aqueous  humor 

in  glaucoma  229-230,  231-232,  253,  255,  257,  259 

physiology  of  59-60 
Archives  of  Ophthalmology  304-305 
Armed  Forces  Institute  of  Pathology  79,  94,  96 
Armstrong,  George  107 
Arnold,  Henry  Harley  (Hap)  102 
Asher,  Chester  72,  75 
Ashley,  B.  John,  Jr.  193 

Association  for  Research  in  Vision  and  Ophthalmology  305 
At-Tabari  219 
Axenfeld  syndrome  238 


B 


Baldwin,  Air  Marshall  102 
Banister,  Richard  219,  260 
Barkan,  Otto  111,  220,  222,  224,  225,  226,  227,  228,  231,  232-233,  239,  244,  246,  248,  249, 

258,  293,  319 
Barnard,  Christiaan  20, 170 


344 

Barnes,  Albert  D.  46 

Barness,  L.  A.  195 

Barnes-Hind  Pharmaceutical  46 

Barraquer,  Joaquin  276 

Beausang,  John  88 

Becker,  Bernard  247,  248,  249,  250 

Becton  and  Dickinson  Company  204,  267 

Bedell,  Arthur  J.  255 

Bell,  Elexious  Thompson  96 

Bellanti,  J.A.  290 

Bellows,  John  C.  62 

Bellows,  John  257,  294 

Benedict,  William  286,  297 

Benson,  John  24 

Benson  Optical  Company  24 

Bergan,  James,  81,  86,  87,  89,  90 

Berrang,  Elizabeth  54 

Berthold  Indian  Reservation  3 

Beurer,  Charlotte  163, 175,  201n 

Birch,  Prank  26,  27 

Bjerrum,  Janik  P.  223 

Black,  Paul  69 

Blodi,  Frederick  C.  294 

Blough,  Herbert  174,  216 

Board  of  City  Trusts  151,  254 

Boatner,  Hayden  86 

Bodine,  William  166 

Boeder,  Paul  52, 133 

Boone,  Joel  T.  159 

Borowik,  Alice  175 

Brav,  Ernest  67 

Brisseau,  Michael  219 

Bruno,  M.  249 

buccaneers  in  ophthalmology  38,  206-207,  265 

Burns,  William  P.  167 


Cabot,  Margaret  83,  86 

Cairns,  J.  E.  240-241 

Camden  City  Municipal  Hospital  155 

Camp  Anza  71-72 

Camp  Claiborne  69-71 

Carlson,  Anton  J.  170 

Cassidy,  Leora  7,  9,  20 

Castroviejo,  Ramon  251-252 

cataract 

alpha-chymotrypsin  275-277 

and  glaucoma  279-282 

aspiration  48,  204,  266-269,  285,  286,  288,  292 

capsulotomy  115,  286,  292 

causes  of  269 

complications  of  surgery  for  273-274 

congenital  153,  260,  262-263,  267,  269,  285,  286,  287,  290,  293 

couching  219,  260 

criteria  for  operating  for  269-270 


345 


discission  operation  260-261,  268 

extracapsular  extraction  114-115,  261-262,  286,  319 

headhunter  113-1 16 

historical  background  219,  260-262 

incision  and  closure  in  surgery  for  282-284,  285-286 

intracapsular  extraction  261-262,  276 

intraocular  lenses  263-265,  268,  319 

iridectomy  261,  271 

linear  extraction  285 

phacoemulsification  262-263,  268,  269 

postoperative  care  273-275 

radiation  137-138 

ripening  265-266,  267,  268, 286 

rubella  153,  269,  286,  287-291 

Scheie  operating  procedure  for  202-203,  258,  270-272 

scissors  for  incisions  204 

sites  for  the  incision  279-282 
Celsus  219 

Center  for  the  Blind  218 
Chandler,  Paul  234,  235 
Chiang  Kai-shek  106 
Chiang  Kai-shek,  Madame  108 
Children's  Heart  Hospital,  Philadelphia  161 

Children's  Hospital  of  Philadelphia  152-154,  155, 172, 177,  181,  274,  287,  288 
Chinese  troops,  medical  problems  of  78-80,  82-84,  91-92, 105 
Chronic  Disease  Program,  U.S.  Public  Health  Service  161 
Churchill,  Winston  101 
Clauson,  Myrtle  W.  and  Earl  C.  2 
Cleveland  Clinic  122 
Cogan,  David  G.  309 

College  of  Physicians  of  Philadelphia  278,  303-304 
Columbia  Presbyterian  Eye  Institute  33,  36,  41 
Committee  for  Services  and  Facilities  to  the  Blind  161 
Comroe,  Julius,  H.,  Jr.  44-45,  46,  51,  53,  319 
Cook,  Thomas  70,  71 
Cooley,  Elias  69,  84,  98 
Cooper,  Liz  290 
corneal  grafts  137 
Costenbader,  Frank  174 
Cowan,  Alfred  35 
Coward,  Noel  112-1 13 
Crandall,  Alan  129, 130 

Crile  Army  Hospital  Eye  Center  48,  70, 120-124 
Critchett,  George  220 
Croll,  Leo  121 

Crozer-Chester  Medical  Center  155 
Curran,  E.  J.  224 
Custodis,  Ernst  146 
Cutler,  Elliott  C.  67 
cyclodiatherny  250-252 


D 


Dale,  Henry  H.  275 

Daviel,  Jacques  219,  260,  261,  285 

Davis,  Charles  118 


346 

de  Mendoza,  Suarez  283 

de  Schweinitz,  George  35,  36,  37, 134, 163-164 

de  Vincentiis,  Carlo  231 

de  Wecker,  Louis  220 

Desmarres,  Louis  August  283 

DeVoe,  E.  Gerard  303 

diabetic  retinopathy  292 

Diagnostic  Related  Groups  214,  273,  274,  316 

diathemy  in  eye  surgery  136 

disseminating  information  in  ophthalmology  316-317 

Bonders,  Pranciscus  C.  220 

Dripps,  RobertD.  143, 150, 151,  272-273 

Duane,  Thomas  D.  151, 166-167,  254,  315-316 

Duke-Elder,  Stewart  60, 109-111, 120,  226,  228, 235-236 

Dunnington,  John  H.  234,  235,  297 

E 

Eckenhoff,  James  E.  142 

Eckert,  Betty  175,  317 

Edwards,  David  L.  277 

Edwards,  Lt.  Col.  72 

82nd  Airborne  Division  70, 123 

Elsom,  Kendall  A.  67 

Esposito,  Louis  149 

Ethicon  48,  205 

Ewing,  Madeline  Q.  35,  75, 173,  174, 175, 187,  202,  242,  255,  258,  268,  270,  271,  272,  317 


Falls,  Harold  52, 133, 174,  295 

fee-splitting  299,  314 

Fewell,  Alexander  G.  35-36,  38 

fibrinolysin  193-194 

Fitts,  William  68,  95 

Fitz-Hugh,  Thomas,  Jr.  67,  82 

Fleischhauer,  Hans  146 

Forrester,  James  96 

Frayer,  William  C.  162, 166,  167,  170, 174,  243,  253,  254 

Freeman,  Norman  E.  67,  96 

Friedenwald,  Jonas  S.  94,  234,  235,  309 

Fry,  Wilfred  E.  39,  40,  302 

Fulton,  Dan  103, 104 


G 


Galen  219 

Gammon,  George  42-43 

Gibson,  William  266,  268,  285 

glaucoma 

Academy  symposium  on  (1948)  234-236 

and  cataract  extraction  279-282 

and  iris  atrophy  253-254 

aqueous  humor  in  135,  147,  215,  221,  222,  225-226,  227,  229-230,  231-232,  237,  253,  255, 
257, 259 

classification  227-228 

congenital  227,  231,  232,  233,  238 

criteria  for  operating  for  258-259 


347 

filtering  operations  135,  221,  224,  227,  230,  231,  236-239,  240-241,  243,  279,  280-281,  292 

gonioscropic  approach  to  111,  220,  224,  226,  228-229,  230,  233,  234,  235 

goniotomy  190,  231-233,  237,  238,  239,  293 

historical  background  219-222,  224-226 

instrumentation  for  222-224 

iridectomy  220,  224-231  passim,  237,  245-246,  253-254,  256,  259,  293 

iris  nevus  and  255-256 

laser  use  in  230-231,  292-293 

low  tension  226,  236 

medical  treatment  of  221,  229,  231,  234,  235,  278 

narrow-angle  219,  225-231  passim 

neurovascular  approach  to  111,  222,  226,  228-229,  230,  235,  245 

open-angle  225-233  passim 

pigmentary  146-147,  256-258 

pediatric  153-154 

perimetry  223 

pseudoglaucoma  242-243 

Scheie  procedure  240-242 

secondary  220,  227,  230 
Gleason,  Philip  47,  80-81 
gloves,  surgical  44 
Goldberg,  Morton  305 
Goldmann,  Hans  222 
Gonin,  Jules  241 

gonioscopy  246,  250,  259,  293,  319.  See  also  glaucoma. 
Go  warty,  Mary  201 

Graduate  School  of  Medicine.  See  under  University  of  Pennsylvania. 
Graduate  Hospital  39,  147,  207 
Graefe,  Albert  von  220,  225,  226 
Grant,  Morton  229,  247,  248,  249 
Grant,  Harold  101 
Gregg,  Norman  289 
Groff,  Robert  68 
Grooms,  Robert  171 
Grundy,  Joseph  R.  40,  163,  207,  307 
Grundy,  Margaret  M.  207,  216 
Gullstrand,  Allvar  223 
Gundersen,  Trygve  123 


H 


Haas,  Joseph  245-246 

Hambrick,  George  196 

Hammarskjold,  Dag  112 

Hansen.ErlingW.26,295 

Harnwell,  Gaylord  P.  134, 179, 180, 181 

Harris,  John  52, 133 

Harvard  University  41 

Hatch,  Larry  C.  31-32,  53-54 

headhunter  113-116,  200 

Hearn,  Thomas  108 

Hedges,  Thomas  144 

Helmholtz,  Hermann  von  220,  259 

Helmick,  Ernest  D.  247 

herpes  zoster  118-119, 139-141 

Hippocrates  2 19 


348 

Hodes,  Phillip  J.I  19 

Hoffman,  George  115 

Hogan,  Thomas  98 

Holloway,  Thomas  B.  32-34,  37,  44-45 

Holmquist,  Gamelius  9 

Holth,  Soren  221 

Hoover,  Herbert  C.  106 

Hopkins,  Henry  118-119, 140 

Hopkins,  Johns,  University  41 

Horstman,  D.  M.  290 

Howe  awards  301,  306-307 

Hruby,  Karl  206 

Hughes,  William  137 

human  volunteers  in  research,  use  of  189-190 

Hurler's  syndrome  194-198 

Hurley,  Patrick  J.  106-107 

hyphema  193-194 


Inglis  House  (Philadelphia  Home  for  Incurables)  158-159 

Institute  of  Ophthalmology,  Columbia  University  170 

intensive  care  wards  91 

International  Eye  Foundation  308 

intinerant  surgery  299 

intraocular  lenses  263-265,  268,  319 

intravenous  solutions  83 

iridencleisis  221 

iridotasis  220 


Jackson,  Clarence  M.  21 

Jefferson  Hospital  207 

Jefferson,  Thomas  Medical  College  15,  28, 150, 151,  152,  166, 167, 177,  254 

Jerome,  Bourne  135,  240 

Johnson,  Julian  67 

Johns ville  Naval  Air  Development  Center  316 

Joint  Committee  on  Hospital  Accreditation  299 

Jules  Stein  Institute  208 


K 


Karp,  Louis  169,  202 
Kaufman,  Martin  L.  39 
Kelman,  Charles  D.  262,  263 
Kern,  Richard  46 
Kertesz,  Elsa  D.  174,  288 
Kessler,  William  149 
Khatani,  Mahin  216 
King,  John  Harry  156,  294,  308 
Kinsey,  V.  Everett  145 
Kling,  Vincent  181,  209,  210 
Klingensmith,  Paul  68 
Knapp,  Arnold  261 
Knapp  awards  301 
Koelle,  George  174 
Kozart,  David  174 


349 


Krawicz,  Theodorus  275 
Kries,  Max  221 
Krol,  Colonel  107 
Kronfeld,  Peter  234,  235,  245 
Krukenberg's  spindle  147 
Krupin,  Theodore  215,  257 
Kurz,  George  170 


Lakenau  Hospital  210 

Laqueur,  Ludwig  221 

laser  uses  in  ophthalmology  40,  152, 168, 198,  215,  224,  251,  259,  291-293 

Laties,  Alan  M.  50-51, 166, 169,  172, 174, 177,  215-216 

Ledo  Road,  China-Burma-India  Theatre  (WWII)  77,  86-87 

leeches  124 

Leopold,  Irving  H.  39,  41,  42,  51, 129, 130, 132,  164, 173 

Lewis,  John  F.  40 

Lien  Tien  Wu  84-86 

light  coagulator  168,  291-292 

Lindback  Teaching  Award  306 

Lindner,  Karl  136,  206,  241 

Litzenberg,  J.  C.  23 

Livongood,  Clarence  S.  67-71,  83 

Loeb,  Jacques  22 

Loewi,  Otto  278 

Loucks,  Roger  14 

Lucke,  Baldwin  96 

Lyon,  Elias  Potter  14-15,  20,  21,  22,  23,  25,  27,  29, 170 


M 


Mac  Arthur,  Douglas  106 

MacKenzie,  William  219,  221 

Maddox,  General  104 

Maklakov,  Alexander  N.  222 

malaria  77-78 

Mandan  (Indian)  tribe  3 

Manson,  M.  N.  290 

Mao  Tse-tung  106-107 

Marden,  Philip  A.  67,  80,  81 

Marfan's  syndrome  198 

Markle  Foundation,  John  and  Mary  R.  59 

Massachusetts  Eye  and  Ear  Infirmary  169,  208 

Maumenee,  Edward  294 

Maumenee,  Irene  294 

Mayo  Clinic  23,  24,  51, 170 

McCarthy,  Colonel  108 

McCurdy  D.  K.  255 

McDonald,  P.  Robb  157 

McGavic,  John  157 

McKusick,  Victor  195,  196, 197 

McLean,  John  283 

McMillan,  David  13 

McNally,  Vincent  92 

McPherson,  Sam  307 

McQuarrie,  Irvine  23-24 


350 


Medicare-Medicaid  316 

Meller,  Joseph  191 

Menjou,  Adolphe  106 

Merck,  Sharp  and  Dohme  194 

Merrill,  Frank  D.  98 

Merrill's  Marauders  77,  98 

Meyer-Schwickerath,  Gerd  292 

Miami  Medical  College  221 

Minnesota  Medical  Foundation  307,  308 

miotics  221,  252-253,  259,  277-279 

Moi,  Daniel  A.  308 

Moore,  Eleanor  38,  59,  60 

Morse,  Peter  198 

Moses,  Robert  249 

Mountbatten,  Edwina  105, 111-112 

Mountbatten,  Louis  99-105, 106,  109, 112, 193,  208,  306 

Movies  and  videotapes  318 

Moyhihan,  Daniel  P.  307 

Mucopolysaccharidosis  153, 194-198 

Mucopolysaccharidosis,  First  International  Congress  on  197-198 

Mueller,  Leopold  283 

Muller,  Heinrich,  220 

Mullett,  Col.  72,  75 

mustard  gas  research  41-42 

Mutter  Museum  304 

Myer,  Louis  68 

Myrin,  Mabel  210 


Nason  and  Cullen  Builders  209,  210 

Neigh,  John  272 

Nemir,  Paul  51 

Newburger,  Frank  78,  105 

Newell,  Frank  P.  192,  294,  305 

Nichols,  Charles  174 

Nicholson,  Edward  E.  19 

Norris,  William  F.  37,  41,  164,  221 

North,  John  Paul  98 

Norton,  Edward  W.  D.  294 


O 


O'Brien,  C.  S.  296 

Ogaard,  Ole  A.  312 

Ojers,  Gaylord  277,  316 

101st  Airborne  Division  70, 123 

Ophthalmic  Research:  USA  315-316 

Ophthalmology  305 

optometrists,  optometry  69,  123, 159,  160,  295,  299,  300,  314 

Ormandy,  Eugene  24,  307 

Orphans'  Court  of  Philadelphia  151 

outpatient  surgery  214-215,  273-274,  284 

Oxygen  injection  into  the  eye  119-120 


Paget's  disease  95,  96,  07 


351 


Parks,  Marshall  174 

Patton,  Margaret  175 

Patz,  Arnall  309 

Peking  Union  Medical  College  15 

Pendergrass,  Eugene  P.  34,  45, 90 

Penfield,  Wilbur  13 

Penfield,  Wilder  21 

penicillin  124 

Pennsylvania  Hospital  28,  304 

Pepper,  O.  H.  Perry  46 

Pepper,  William  27-28,  29,  46 

perimetry  233,  252 

Perkins,  Ralph  R.  163 

Peter,  Luther  39, 132 

Pew  Charitable  Trusts  208 

Pew  family  159,  179, 180, 181,  208,  209,  210 

Pew,  Joseph  N.,  Ill,  Mrs.  159 

phacoemulsification  262-263,  268,  269,  291,  292 

pharmaceutical  companies,  relationship  with  ophthalmology  161-162 

Philadelphia  General  Hospital  28,  30, 148, 154-155, 177 

Philadelphia  Home  for  Incurables  (Inglis  House)  158-159 

Phillips  Contact  Therapy  Apparatus  137 

Pick,  Louis  86-87 

pilocarpine  221,  230 

Pischel,  Dohrmann  K.  136 

plastic  surgery  120, 156, 157-158,  207 

Plotkin,  Stanley  A.  287-288 

Popkin,  Arnold  B.  174 

Poticher,  Jane  175 

Pownall,  Henry  99 

Presbyterian  Medical  Center,  Philadelphia  178, 179, 180,  213,  216,  217-218 

prostigmin  in  myasthenia  gravis  42-44,  49 

pseudoxanthoma  elasticum  95-97, 198 

ptosis  167-158 


R 


radiation  of  the  cornea  137-138 

Raeder,  J.  G.  224 

Ramsey,  Earle  G.  88 

Rasmussen,  Andrew  T.  21 

Rasmussen,  Theodore  21 

Rasmussen,  Waldemer  21 

Ravdin,  Isidor  S.  42,  66,  67,  68-69,  73,  80,  91,  92,  98,  100, 112, 118, 119,  125, 150-151 

Red  Cross  111 

Reese,  Algernon  B.  234 

Reimann,  Hobart  15-16,  94 

resident  training  program.  See  University  of  Pennsylvania. 

Retina  Foundation  208 

retinal  detachment  surgery  135-136, 168,  291,  292,  315,  319-320 

retinal  changes  in  hypertension  and  arteriosclerosis  141-142 

retinal  pins  136,  320 

retrolental  febroplasia  144-146, 153 

Richards,  Alfred  N.  37-38,  59,  68 

Ridgeway,  Matthew  B.  70, 123 

Ridley,  Harold  264 


352 

Ripple,  Richard  C.  137 

Riva,  Charles  152,  215 

Roberts,  Brooke  193, 194 

Rockey,  John  216 

Roenne,  Henning  223 

Rogers  Will(iam)  P.  A.  107 

Rommel,  Erwin  74 

Roosevelt,  Franklin  D.  101, 106 

Rosengren,  Bengt  224 

Rossevatn,  Anna  313 

Royster,  Henry  157 

rubeola  retinopathy  198-199 

Rucker,  E.  Wilbur  24,  26 

Ruedemann,  Albert  D.  48, 122, 137 

Rufus  219 

Rush,  Benjamin  304 

Rychener,  Ralph  295 


Safar,  Karl  136 

Salzmann,  Maximilian  224 

Sams-ad-Din  219 

Samuel,  Mayor  54 

Scammon,  Richard  21 

Schaffer,  David  B.  152-153, 288 

Scheie,  Ella  Mae  Ware  1-2,  5-6, 10, 11,  20 

Scheie,  Eric  17 

Scheie,  Ethel  20 

Scheie  Eye  Institute 

affiliations  of  217-218 

and  Wills  Eye  Hospital  150-151 

cornea  service  136 

design  81, 117, 172,  209-215 

executive  committee  216-217 

funding  159, 179, 186,  207-209,  216-217,  309-310,  320 

glaucoma  section  215 

Ophthalmology  Teaching  and  Research  Endowment  Grant  217 

research  169, 174,  215-216 

retina  service  292 

site  selection  178-182 
Scheie,  Harold  (son)  76 
Scheie,  Harold  Glendon 

Deputy  Commander  and  Commanding  General,  31st  Hospital  Center  Headquarters 
125-127 

family  background  and  education  1-11 

Norway  hotel  fire  310-313 

private  practice  41,  53-58, 117,  129, 132, 134,  153, 163,  164,  165,  166,  167,  203-204 

U.  S.  Army  Medical  Corps  (WWII)  65-125 
Camp  Anza  71-72 
Camp  Claiborne  69-71 

Crile  Army  Hospital  Eye  Center  48, 120-124 
Ledo,  India  47-48,  75-117 
nursing  staff  86-87 

University  of  Minnesota 
medical  student  15-27 


353 

undergraduate  11-14 
University  of  Pennsylvania 

assistant  and  chief  medical  officer  31,  53-54,  65-66 

chairman,  department  of  ophthalmology  127, 141,  162-178,  213 

consultancies  147-149, 152-162 

controversies  in  ophthalmology  313-314 

director,  Scheie  Eye  Institute  127, 178-182,  207-218 

doctor  of  medical  science  48,  50,  51,  53, 133 

editorial  work  304-305 

fundraiser  134, 172,  207-209,  216-217 

greatest  contribution  320 

honors  218,  306-308 

instructor,  Graduate  School  of  Medicine  132-134 

intern  20-21,  27-33 

medical  fees  188-189 

medical  organizations  127,  293-304 

patient  care  132,  175,  186, 187-188,  200,  309 

research.  See  specific  topics. 

resident  33-40,  54, 133 
retirement  131, 132,  309-310 
surgeon  56, 185-186,  199-204,  214-215,  258,  263,  270-272,  272,  284,  309.  See  also  cataract, 

glaucoma,  retinal  detachment. 

teacher  130, 155,  172-173,  176-178, 179, 182-186,  201,  202,  318 
textbooks  173, 190-193 
writing  method  317-318 
Scheie,  John  3,  5, 10, 11 
Scheie,  Lars  O.  2 

Scheie  Lars  T.  2,  3,  5-6,  8-9, 10, 11, 19-20 
Scheie,  Mary  Ann  (Polly)  89, 105, 113,  208,  311-313 
Scheie,  Simon  O.  2 
Scheie  Syndrome  194, 196, 198 
Scheie  test  48-51 
Schepens,  Charles  136 
Schiotz,  Njalmar  A.  222 
Schneider,B.255 
Schoening,  Harry  13 
Schull,  William  174 

Schwegman,  Cletus  65,  80,  82,  83,  91-92 
scrub  typhus  77,  79,  91,  92-94, 110,  301 
Seagrave,  Gordon  77,  99 
Seidel,  Erich  223 
72nd  Station  Hospital  73 
Shaffer,  Robert  248,  249 
Shumway,  Norman  E.  20, 170 
silvernitrate  45,  46 
Skin  and  Cancer  Hospital  155-156 
skin  diseases  83-84 
Sleight,  James  121 
Slim,  William  102 
Smith,  Priestly  222 
Smith,  Henry  261 
Society  of  Surgeons  308 
Soong  Mei-ling  108-109 
Soong  Ching-ling  108-109 
Souders,  Benjamin  F.  39,  62 


354 

Spackman,  E.  W.  119 

Spaeth,  Edmund  B.  39,  51, 132 

Spencer,  Robert  W.  247 

Spencer,  Steven  90 

Spivey,  Bruce  E.  294 

St.  John's  Nursing  Corps  111 

Stein,  Jules  316 

Stemmler,  Edward  J.  162, 172 

Stengel,  Alfred  46 

steroids  in  ophthalmology  124, 138-141 

Stevenson,  Mary  V.  54 

Stilwell,  Joseph  W.  77,  92,  99, 102, 107-108 

Straatsma,  Bradley  R.  294 

Streptomycin  124 

Strider,  Ken  17 

Struble,  Gilbert  121 

Stuempke,  Frank  8 

subspecialization  in  ophthalmology  169-170,  314-315 

Sugar,  Saul  294 

sulfa  drugs  41,  44-46,  60-63,  79, 100, 124-125 

Surgeon  General  of  the  Army  119, 120, 126,  206 

surgical  needles  204-205,206 

sutures  47,  204-206,  282-284 

syphilis  82-83, 116 


Tasman,  William  149 

Taylor,  Ivan  47 

Temple  University  Medical  School  150,  151, 154, 155, 177,  254 

Temple,  Esther  Scheie  and  Charles  20 

Theobald,  Georgiana  D.  94 

31st  Hospital  Care  Headquarters  87 

Thurnburn  224 

Thygeson,  Phillips  79,  139,  157,  261,  309 

tonography  189,  229,  247-250 

tonometers,  tonometry  220,  222-223 

toxoplasmosis  139 

trachoma  79 

Troncoso,  Manuel  U.  224 

Tsou,  K.  C.  277 

20th  General  Hospital  Unit  33,  41-42,  66-117, 130 

28th  National  Guard  Division  123 

Tyner,  George  S.  57,  199,  252 

U 

University  of  Minnesota 

affiliation  with  the  Mayo  Clinic  23,  51 

hospital  34 

Harold  G.  Scheie  Research  Chair  in  Ophthalmology  308 

Medical  School  21-24,  41,  197 
University  of  Pennsylvania  66, 130,  304 

basic  science  course  in  ophthalmology  51-53,  149, 184 

department  of  ophthalmology  40-41, 162-178 

Graduate  School  of  Medicine  (Division  of  Graduate  Medicine)  39-40,  51-53,  132-134 


355 

hospital  20-21,  27-33,  34,  36-37,  38-39,  41,  45,  47,  66, 117,  124,  135,  147,  148, 150, 152, 154, 

165-169, 177,  179-181,  182, 186,  205,  212,  262,  263,  282,  283 
medical  students'  curriculum  in  ophthalmology  172-173, 176 
resident  training  program  in  ophthalmology  51,  52,  56,  57,  58,  133-134,  150, 166, 169-170, 

176-178,208 
trustees  216 
Medical  Board  179 

Scheie,  Harold  G.,  Research  Professorship  308 
Upjohn  Company  142 
Upsal  Day  School  218 
uveitis  227 

V 

Vail,  Derrick  120,  234,  235,  276,  305 

Vail  Medal  308 

Valley  Forge  Army  Hospital  Eye  Center  118, 122, 156,  157 

Van  Herick,  William  250 

Veterans  Administration  Central  Office  159-161 

Veterans  Administration  Hospital  (Philadelphia)  147-149,  154,  159, 177 

Viets,  H.  R.  43 

Villanova  University  307 

visual  field  defects  144 

Vogt,  Alfred  251 


W 


Wainright,  Jonathan  M.  106 

Walker,  Arthur  68 

Walsh,  Frank  50,  309 

Walter  Reed  Army  Hospital  156 

Wangensteen,  Owen  20,  22-23, 170 

Ware,  James  1 

Weber,  Adolf  221 

Weimert,  Hisako  175 

Weiner,  Alvin  193 

Werner  224 

Wheeler,  John  33,  36,  261 

Wiener,  Meyer  190, 191 

Williams,  Henry  283 

Williams,  Walter  121 

Wills  Eye  Hospital  36,  134,  149-152,  177,  254,  262,  282 

Wilmer  Eye  Institute  137,  248 

Winstead,  Willy  88-90 

Wistar  Institute  288 

Wlodarczyk,  Terry  175 

Wolfe,  Jean  E.  171,  192,  318 

Wong  91-92 

Wood,  Francis  C.  67 

Wood,  Edward  F.  L.  (Lord  Halifax)  306 

wound  closure  282-284 


Yanoff,  Myron  162, 169, 170, 173,  174,  218,  255,  256,  277 


Ziegler,  S.  Lewis  285-286 
Zollinger,  Robert  M.  160 


ISBN  0-TEbflbb-QE-fl 


The  Foundation  of  the 

American  Academy  of  Ophthalmology