CORNELL 
 
 UNIVERSITY 
 
 LIBRARY 
 
 FROM 
 
 Mrs.O.Gtierlac 
 
Cornell University Library 
 RE 30.U6H87 
 
 The development of ophthalmology in Amer 
 
 3 1924 012 164 558 
 
The original of tliis book is in 
 tlie Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924012164558 
 
I, I 
 
 UA 
 
 DE. GEORGE PRICK (1793-1870), THE FATHER OF AMERICAN 
 OPHTHALMOLOGY. 
 
The Development of 
 
 Ophthalmology in America 
 
 1800 to 1870 
 
 A Contribution to Ophthalmologic 
 History and Biography 
 
 AN ADDRESS DELIVERED IN 
 ABSTRACT BEFORE THE SEC 
 TION OF OPHTHALMOLOGY 
 OF THE AMERICAN MEDICAL 
 ASSOCIATION, JUNE 4, 1907. 
 REVISED AND ENLARGED. 
 ILLUSTRATED BY SELECTED 
 PORTRAITS AND CUTS. 
 
 ALVIN A. HJjpELL, M.D., Ph.D., 
 
 PROFESSCpt^^&T CLINICAL OPHTHALMOLOGY IN 
 
 THE UNIVERSITY OF BUFFALO, ETC., 
 
 BUFFALO. NEW YORK. 
 
 CHICAGO 
 
 AMERICAN MEDICAL ASSOCIATION PRESS 
 
 190S 
 
 A) 
 
Copyright, 1907, 
 
 BY 
 
 ALVIN A. HUBBELI,, M.D. 
 
CONTENTS. 
 
 PAGE 
 
 PREFACE 7 
 
 INTRODUCTION 9 
 
 FACTORS OF DEVELOPMENT— INSTITUTIONS AND 
 
 SURGEONS 16 
 
 BIOGRAPHICAL SKETCHES— FRICK, HAYS, LITTELL 
 
 AND OTHERS 40 
 
 AMERICAN OPHTHALMOLOGIC LITERATURE TO 
 
 1850 96 
 
 SPECIAL AMERICAN CONTRIBUTIONS 110 
 
 TRANSITION PERIOD FROM THE OPHTHALMOLOGY 
 OF THE PHYSICIAN AND SURGEON TO THE 
 OPHTHALMOLOGY OF THE SPECIALIST 138 
 
 THE PIONEER SPECIALISTS 140 
 
 AN ERA OF RAPID CHANGE AFTER 1850 150 
 
 OTHER FACTORS OF ADVANCEMENT 174 
 
 THE NEW AMERICAN OPHTHALMOLOGY 193 
 
 CONCLUSION 196 
 
PREFACE. 
 
 Through the earnest solicitations oi numerous es- 
 teemed confreres, I have been induced to republish in 
 book form the address which I had the honor to present 
 to the Section of Ophthalmology of the American Med- 
 ical Association at Atlantic City, N. J., June 4, 1907. 
 In doing this I have availed myself of the opportunity 
 to revise the text throughout, to rewrite portions of it, 
 to make several additions to it, and to incorporate a 
 number of cuts and selected portraits. These portraits 
 are of men who have distinguished themselves more or 
 less in ophthalmology during the period which I have 
 reviewed. Some of them have never before been given 
 to the public, and it is only through the extreme courtesy 
 of professional and other friends that T am enabled to 
 publish them now. Those who have been especially 
 helpful to me in this regard are Drs. B. Joy Jeffries, 
 Hasket Derby, Edward Eeynolds and Edwin H. Bing- 
 ham, of Boston ; Mr. Charles P. Fisher, librarian of the 
 College of Physicians of Philadelphia; Mr. John S. 
 Brownne, of the New York Academy of Medicine, and 
 Dr. Herman Knapp, of New York; Dr. Walter S. 
 Steiner, of Hartford, and Drs. Samuel Theobald and 
 Harry Eriedenwald, of Baltimore. This collection of 
 portraits, only two of which are of living men, viz.. 
 Dr. Derby and Dr. Knapp, adds interest, it seems to 
 
8 PREFACE. 
 
 me, to the biographical slcetches, and also serves to 
 reveal in their physiogomy something of the character 
 of the men v^ho have been instrumental in establishing, 
 advancing and dignifying ophthalmology as a specialty 
 in America. 
 
 I can not let this little volume go forth v^ithout virarn- 
 ing my readers that it is not intended to embody a com- 
 plete survey of American ophthalmology from 1800 to 
 1870. It simply sketches the principal factors, of its 
 development — the men who have been most conspicu- 
 ous in connection with it, and the institutions, in their 
 beginnings, which have become perpetual fountains of 
 ophthalmologic knowledge and experience, as well as 
 harbingers of relief to the suffering and blind. I realize 
 that almost any one subject herein touched upon merits 
 in itself a more detailed consideration — a chapter if not 
 a volume ; but I trust that even the outlines and incom- 
 plete sketches which I have given will not be entirely 
 devoid of historical interest, and that they may at least 
 serve as landmarks to , guide some future historian into 
 a wider field of study. 
 
 The story of the progress of ophthalmology from 1870 
 to the present time is an interesting one, as I know 
 from the material which I have collected and which I 
 had hoped to use when I was first invited to deliver this 
 address. Whether or not it is to be told in the future 
 depends largely on the Judgment which is passed upon 
 this first installment. A. A. H. 
 
 212 Franklin Street, Buffalo, N. Y. 
 
THE DEVELOPMENT OF OPHTHALMOLOGY IN 
 AMERICA: 1800 TO 1870.* 
 
 I. 
 INTRODUCTION. 
 
 In undertaking to indicate the factors that have con- 
 tributed to the development of ophthalmology in Amer- 
 ica, I have found it obligatory to limit my study to 
 Canada and the United States. This has been necessary 
 because of lack of time and readily available resources 
 to go farther, and also because our interests in American 
 ophthalmology center in these two great nations. 
 
 An important question has also arisen in this connec- 
 tion, viz., who are they, in this restricted sense, that are 
 Americans? Are they those alone who were reared and 
 educated in one of those two countries? Or should 
 thos© be included who, although foreign born and for- 
 eign educated, have eome to these lands to live, and who 
 have identified themselves with these peoples, their 
 thought, their work, their purposes and their institu- 
 tions? America, in the sense above indicated, and in 
 which I shall hereafter use the word, is essentially cos- 
 mopolitan, and every man is an American who sub- 
 scribes to the laws of the country, makes himself an in- 
 / 
 
 * I haTe taken tlie liberty of changing the title which the officers 
 of the Section of Ophthalmology of the A. M. A. assigned to me 
 at the time I was honored by an invitation to deliver this address. 
 The subject suggested was "What America Has Contributed to the 
 Advancement of Ophthalmology." 
 
10 OPHTHALMOLOGY IN AMERICA. 
 
 tegral part of its national life, and labors hand in hand 
 with others for the common weal, whatever may have 
 been his birthplace or in whatever country he may have 
 received his education and scientific training. Herman 
 Knapp and Ferdinand C. Hotz, for example, are to-day 
 as truly American in sentiment and spirit, and through 
 ties of scientific interests and affiliations, as are Hasket 
 Derby or G. C. Savage ; and it is both my pleasure, pride 
 and duty to recognize them as Americans, and their 
 labors here, as American, and all who, like them, have 
 adopted America as their own. I thus define what I 
 mean by America and American that there may be no 
 misconception of these terms for the purpose of this 
 occasion. 
 
 OPHTHALMOLOGIC ADVANCEMENT. 
 
 In its evolution, ophthalmology has advanced at times 
 very slowly and at other times almost by bounds. With 
 the announcement of Maitre-Jan and Brisseau of the 
 true nature of cataract in 1706 to 1709,"'with Cheselden's 
 operation for artificial pupil in 1728, with Daviel's pub- 
 lication in 1752 of a new method of curing cataract by 
 extracting it, with the discovery of sulphuric ether 
 anesthesia in 1846, with von Helmholiz's invention of 
 the ophthalmoscope in 1851, with von Graefe's newly- 
 found surgical relief for glaucoma in 1857, with Bon- 
 ders' revelations in regard to the refraction of the eye 
 and its anomalies in 1859 to 1864, with Lister's teach- 
 ings of antisepsis and the protection of operative wounds 
 from the invasion of germs in 1867, with Koller's an- 
 nouncement of ocular anesthesia by cocain in 1884, 
 ophthalmology took tremendous leaps. Other advances, 
 such as those pertaining to anatomy, physiology, path- 
 
OPHTEALMOLOGY IN AMERICA. 11 
 
 ologj' and therapeutics, have made slower pace, but 
 nevertheless they have been effective, and by a gradual 
 and cumulative accretion have united with the more 
 rapid advances to bring to a higher degree of perfection 
 the special department of medicine, whose interests it 
 is our accredited privilege to promote. 
 
 Not only, therefore, is some new and marvelous dis- 
 covery in ocular pathology and therapeutics a contribu- 
 tion to the advancement of ophthalmology, but so is 
 every well-studied and well-reported case; so is every 
 well-planned and well-executed experiment having for 
 its purpose and result the corroboration of previous 
 findings or the establishing of new facts, the importance, 
 however, varying inversely as the substantiated verity of 
 past conclusions or the need of new and additional facts 
 decrease or increase. Dr. Osier has said^ that "truth 
 grows, and its general evolution may be traced from 
 the tiny germ to the mature product." So it is with 
 ophthalmology. Out of the germinating stages of the 
 dim and distant past it has emerged as a vital part of 
 the great body of medicine, and, like the majestic trunk 
 to which it belongs, it has gradually grown and extended, 
 sometimes opposed by the most blighting influences of 
 ignorance and cupidity and sometimes sustained by the 
 invigorating accessions supplied by intelligence and 
 genius; but always has it grown by the accretion and 
 assimilation of countless experiences, for the most part 
 trifling and unnoticed, seldom striking and far-reaching, 
 until to-day it has attained a degree of perfection, a 
 proportion of completeness that are the pride, if not the 
 wonder, of our whole profession. Not alone, then, has 
 
 1. Brit. Med. Jour., Oct. 27. 1906, p. 1077. 
 
12 OPHTHALMOLOGY IN AMERICA. 
 
 the genius of Daviel, of von Helmholtz, of Bonders and 
 others brought ophthalmology to its present proportions, 
 but the thousands on thousands of lesser and often most 
 trivial observations, devices, inventions, suggestions and 
 experiments of the past have also been essential factors 
 in its growth and permanency. 
 
 I agree with Dr. C. A. Oliver, who says, in a private 
 letter, that "it seems to me that each man, in accord- 
 ance with his opportunities, contributes his mite; that 
 each institution gives its fruits in direct relationship 
 with those in charge, and that he who now may be the 
 least known and the most humble in American ophthal- 
 mology may be really the greatest." 
 
 If ophthalmology has not developed as rapidly in 
 America as in Europe, it must be remembered that 
 there have been sufBcient reasons. With few exceptions 
 the medical institutions of America, both clinical and 
 teaching, have been the outgrowth of private enterprise 
 and supported by private gain. The exceptions have 
 been the few instances where, through the foundation of 
 state university organizations, provisions have been 
 made for medical teaching and hospital facilities. 
 Physicians and surgeons have seldom been paid for 
 teaching or for serving a hospital, except, perhaps, either 
 directly through the proceeds of private patronage of 
 the institutions which they may have been serving, or 
 indirectly through the increased private practice which 
 they may have obtained by the publicity given them 
 through their medical school affiliations. The result has 
 been, therefore, that, without such a living salary as is 
 paid to those attached to the government schools and 
 hospitals of Europe, our American medical teachers and 
 
Ol'HTHALMOLOaY IN AMERICA. 13 
 
 hospital attendants have had to earn their living out- 
 side in private practice, and in doing this it has con- 
 sumed nearly or quite all of their time and energy. 
 
 Besides this, there has been the insufficient qualifica- 
 tion of our medical men, incident to the free develop- 
 ment of our medical institutions. The great liberty 
 that has been allowed in their organization, the envious 
 and often bitter strife that superfluous numbers of them 
 has engendered and the lamentable lack of government 
 restrictions and oversight in their operations, have pro- 
 duced from the beginning a gradual lowering of medical 
 standards, both for entrance and graduation of students, 
 and for license to practice, until in the '60s these were 
 reduced to the most meager proportions, or to nothing. 
 Our countr}', therefore, became flooded with ill-prepared, 
 incompetent and often fraudulent practitioners, who 
 had been sent out by these inferior, ill-equipped private 
 medical schools. It was they who, in turn, obtained 
 positions in our hospitals, or created hospitals of their 
 own, and who became, in large part, our teachers. I do 
 not wish to be understood as putting all institutions or 
 all practitioners into these classes. Their proportionate 
 numbers were simply in excess. Many young men be- 
 gan the study of medicine with better qualifications 
 than were demanded. Some faculties, with a high 
 sense of responsibility, rose above their environment 
 and had ideals higher than private gain. These formed 
 a residuum of professional men whose ability, whose 
 skill, whose intellectual attainments, whose moral 
 breadth and depth made them ornaments and an honor 
 to our ranks and maintained the dignity and the sanc- 
 tity of the high and noble principles of our profession. 
 
14' OPHTHALMOLOGY IN AMERICA. 
 
 Such men saved us from utter disgrace; and in their 
 struggle they were greatly aided by such movements as 
 the organization of the American Medical Association 
 and of the American Medical College Association, by the 
 special initiative of the State of Illinois in establishing 
 a state board of health with powers to demand higher 
 standards on the part of those who would practice in 
 that state, and by the creation of state boards of medi- 
 cal examiners in Kew York, Pennsylvania and other 
 states, which made it incumbent on those who would 
 practice- in those states to possess certain qualiiications 
 preliminary to entering a medical school, which required 
 medical colleges to maintain certain standards and 
 courses of study, and which finally required the appli- 
 cants for license to pa^s specific examinations in the 
 principal subjects of medicine. A great revolution in 
 professional standards and qualifications has followed 
 since the various states have thus taken the licensing to 
 practice out of the hands of medical faculties; and this 
 progress, too, has gone on in spite of the continued pri- 
 vate character of most of our medical institutions. 
 
 The necessity, however, of relying on private gain or 
 private aid to meet present and future demands of re- 
 search and teaching has not ceased. It has been, and 
 still is, the great obstruction that impedes our medical 
 progress in America, notwithstanding that our medical 
 men, on the average, have to-day just as well-endowed 
 brains, just as astute and resourceful minds as medical 
 men in Europe. In fact, they arc of European stuff. 
 They simply lack opportunity. And this condition must 
 continue till some government scheme prevails by which 
 the living of our medical teachers and investigators is 
 
OPHTHALMOLOGY IN AMERICA. Ig 
 
 made secure without consuming all of their time and 
 energy in practice for this purpose. But our ophthal- 
 molpgists are alive to the importance of research work, 
 and, in spite of the environment, they are making com- 
 mendable progress, and their rewards are growing richer 
 and richer. 
 
11. 
 
 FACTORS OF DEVELOPMENT. 
 
 The factors that have contributed to the development 
 of ophthalmology in America are found in our special 
 ophthalmologic institutions; in the eye clinics of gen- 
 eral hospitals and dispensaries; in the observations and 
 clinical teachings of our pioneer laborers in the ophthal- 
 mologic field of practice, and, in a more limited way, 
 of our great surgeons ; in the writings of these men, and 
 in the literature, both American and foreign, which 
 they have disseminated throughout the profession; and 
 in inventions and discoveries bearing on ophthalmologic 
 science and practice. This review must, necessarily, be 
 most incomplete, barely taking a glimpse here and there, 
 and merely noting a few of the beginnings, some of the 
 special claims, and a few of the most enlightening ob- , 
 eervations and suggestions. 
 
 THE FIRST EYE INSTITUTIONS. 
 
 In regard to institutional and clinical eye work, our 
 special institutions take first rank, and their origin and 
 development are of deepest interest. 
 
 THE NEW LONDON BYE INEIEMAEY. 
 
 The first effort to establish an institution for the 
 treatment of diseases of the eye in this country was 
 that of the New London Eye Infirmary. 
 
 In a biographic sketch of Elisha North,^ it is stated 
 
 2. Biography of Eminent Am. Phys. and Surg., by R. F. Stone, 
 1892, p. 356. 
 
OPHTHALMOLOGY 1\ AMERICA. 17 
 
 that he established in New London, Conn., the first 
 eye infirmary in this country. He did this in 1817. 
 His institution was in active operation in 1819, as 
 is shown by an advertisement in The Connecticut Gor- 
 zette, a New London newspaper, in which Dr. North 
 says : "I had the pleasure to prevent total blindness and 
 restore sight to twelve or thirteen persons during the last 
 three years. These would now probably be moping about 
 in total darkness and would be a burden to society and 
 themselves had it not been for my individual exertions." 
 How long his "infirmary" continued to exist is un- 
 known, but it is possible that it'was still alive as late as 
 1829, ae Dr. North at that time added to his name, on 
 the title page of the book later referred to, the words 
 "Conductor of an Eye Infirmary." I include it in the 
 historical sketches of those whose history we know, with- 
 out regarding it as one of especial importance. 
 
 NEW YORK EYE INFIEMAKY. 
 
 The next attempt to provide an institution for the 
 relief of the poor, afflicted with diseases of the eye, was 
 in New York City in 1830. The motive of this effort 
 can beet be described by quoting one of its founders and 
 one of its first physicians, the late Dr. Edward Dela- 
 field,^ of that city. 
 
 Some time in the year 1816 two young men, recent gradu- 
 ates in medicine of the College of Physicians and Surgeons of 
 this city, who had spent together the previous year in the 
 New York Hospital, one as house physician and the other as 
 house surgeon, sailed for Europe. Their object was to im- 
 prove themselves in the icnowledge of the profession of their 
 choice. . . . They thought then that they understood the 
 
 3. Address delivered by Dr. Delafleld at the dedication of the 
 new building of the New York Bye Infirmary, April 25, 1856. 
 
18 OPHTHALMOLOGY IN AMERICA. 
 
 nature and treatment of diseases of the eye as well as any 
 part of surgery; and when they sought abroad for additional 
 knowledge, it was "with no especial view of learning more on 
 this subject than any other in medicine. 
 
 With these impressions they arrived in the city of London, 
 where they had determined to pursue their studies, and among 
 other public medical charities were induced to become pupils 
 of the London Eye Infirmary, then recently founded by Mr. 
 Saunders. 
 
 And here they soon made a discovery which is the best pre- 
 lude to all study, that they were profoundly ignorant of the 
 surgery of the eye, and that what they had been taught on 
 that subject was almost of no value. Knowing at the same 
 time that they learned from the same sources as the rest of 
 their countrymen, they drew the inference, which the result 
 proved true, that ophthalmic surgery was comparatively un- 
 known in America. The thought flashed on them that here 
 was an open field in which they might walk, and with the 
 ardor of youth they devoted themselves to this new branch of 
 knowledge. 
 
 On their return to their country in the year 1818, the sub- 
 ject of diseases of the eye engaged their earnest attention, and 
 they soon came to the resolution that they would establish 
 in our city for the first time in America, an infirmary for cur- 
 ing diseases of the eye. 
 
 . . . To demonstrate the good to be derived from such 
 an institution, they agreed, unaided and alone, to make the 
 experiment, and to call for no public assistance, until they 
 could already show results of a character and number suflicient 
 to prove how many poor suffered under diseases of the eye, 
 and how much could be done for their relief. 
 
 Accordingly, two rooms were hired in the second story of a 
 building in Chatham Street, then in a central situation, and 
 the few articles provided the humble institution required. 
 Some students of medicine volunteered to perform in rota- 
 tion the duty of apothecary, and the landlord from whom the 
 rooms were rented acted as superintendent. Small as was the 
 scale' on which our infirmary started, it had everything essen- 
 tial to a public charity; except, indeed, money, and little of 
 
OPHTHALUOLOGY IN AMERICA. 
 
 19 
 
 that was required, as nobody was paid for his services. It 
 was made publicly known that all poor persons applying at 
 No. 45 Chatham Street, on certain days and hours of each 
 week, with diseases of the eye, would be gratuitously treated, 
 and the necessary medicines and appliances furnished them. 
 
 A single week proved that our infirmary would succeed, for 
 immediately many poor persons, thus suffering, applied for 
 relief, and in a short time our small apartments were crowded 
 with them, and the labor of earing for so many proved far 
 greater than was anticipated. 
 
 XEW YORK EYE AND EAR INFIRMARY, ERECTED. 1856. 
 
 The undertaking was commenced in the month of August, 
 1820, and in a period somewhat less than seven months 436 
 patients had applied and received the care and treatment of 
 the surgeons of the infirmary. . . . 
 
 . . . Having, then, in this manner, demonstrated that 
 an infirmary for curing diseases of the eye would be a great 
 boon to the suffering poor of our city and country, it was de- 
 
20 OPHTHALMOLOGY IN AMERICA. 
 
 termined to bring the subject before the public, and appeal to 
 them for the means of founding and continuing a public char- 
 ity for the cure of diseases of the eye in the city of New 
 York. 
 
 Of the two young men who thus adventured on an experi- 
 ment whose success is this day demonstrated, one was the 
 late Dr. John Kearney Eodgers, and the other now addresses 
 you — abundantly rewarded for all the labor he has bestowed 
 in founding and continuing this charity, by the satisfaction 
 of meeting you in this admirable building, erected and now 
 to be dedicated for the New York Eye Infirmary . 
 
 The first oiBcers and directors of the institution were 
 elected April 21, 1821, and were William Pew, presi- 
 dent; Henry I. WyckofE, first vice-president; John 
 Hone, second vice-president; John Delafield. Jr., treas- 
 urer; James I. Jones, secretary; Nathaniel Eichards, 
 Benjamin L. Swan, William Howard, Henry Brevoort, 
 Jr., Joshua Jones, William Howell, James Boggs, Isaac 
 Pierson, Jeromus Johnson. Isaac Collins, Cornelius 
 Heyer, Henry Rankin, Benjamin Strong, Samuel P. 
 Lambert, Edward W. Laight, Gideon Lee; consulting 
 surgeons, Drs. Wright, Post, Samuel .Borrowe ; surgeons, 
 Drs. Edward Delafield, J. Kearney Eodgers. 
 
 Thus through the public spirit and sagacity of two 
 young men began the now celebrated New York Eye and 
 Ear Infirmary, in the month of August, 1820. Its be- 
 ginnings were small, but its needs were manifest, and 
 from time to time receiving the financial support of the 
 public and the active cooperation of the medical pro- 
 fession it developed into one of the largest and most 
 philanthropic institutions of the world. 
 
 During the year ending Sept. 30, 1906, 2,789 persons 
 were treated in the wards of the infirmary and 40,311 
 cases were treated in the out-patient department. The 
 
OPHTHALMOLOGY IN AMERICA. 21 
 
 daily average number of all cases treated in both the 
 out-patient and in-patient departments was 502. 
 
 The records of the infirmary show that since its open- 
 ing in August, 1830, with the exception of three months 
 during the prevalence of an epidemic fever in 1833, the 
 doors of the infirmary have never been closed to patients. 
 From the month of August, 1830, to Sept. 30, 1906, 
 there have been treated at the infirmary a total of 
 1,051,893 patients. This number includes ear, nose 
 and throat, as well as eye patients. Its further history 
 must be told at another time. 
 
 INSTITUTION FOR THE DISEASES OF THE EYE AND EAR, 
 PHILADELPHIA. 
 
 The next movement toward the establishment of an 
 institution for the treatment of diseases of the eye was 
 in Philadelphia in 1831. It seemed to be the outcome 
 of the energy and public spirit of Dr. George McClel- 
 lan of that city, a young and ambitious man, then 35 
 years old, who was just entering on his career as sur- 
 geon, and who afterward greatly distinguished himself 
 as such. 
 
 Early in 1831 a notice was published in a Philadel- 
 phia medical journal* of an intention to start such an 
 institution in the following words : 
 
 Dispensary for Diseases of the Eye.-^Vor the increasing 
 number of indigent blind people in the city of liberties, a 
 number of gentlemen have been contemplating the institution 
 of a society to aflford gratuitous relief; and though circum- 
 stances at present prevent more than a limited foundation, 
 they indulge reasonable expectations of being able, in the 
 course of a few months, to establish a much more extensive 
 charity. 
 
 4. Am. Med. Recorder, April 14. 1821. iv. 402. 
 
22 OPHTHALMOLOGY IN AMERICA. 
 
 The otject of this communication is to notify those who, 
 afflicted with any diseases of the eyes, can not compensate 
 medical services, that arrangements have been made with Dr. 
 MeCIellan for surgical attendance, and with Mr. Marshall, 
 Chestnut Street, for medicines, which will be afforded -gratui- 
 tously. Application to be made at Dr. McClellan's office, 
 Swanwick Street, near Walnut, above Sixth. 
 
 In the spring of 1833 a further publication was 
 
 raade,^ stating that : 
 
 The Institution for the Diseases of the Eye and Ear had, 
 during the past year, been conducted in the form of a, dis- 
 pensary, and the poor have been supplied with medicines and 
 attendance, at the expense of a few subscribers, from the office 
 of Dr. McOlellan in Swanwick Street. The operations which 
 were performed for cataracts, etc., on a respectable number of 
 blind people, proved so successful, that considerable interest 
 has been excited, and we are happy to announce that' the 
 institution has in consequence recently been extended into a 
 hospital. We understand that more than one hundred of the 
 most influential citizens of Philadelphia have associated them- 
 selves together to support this interesting .establishment, that 
 a charter has been obtained from the Supreme Court and 
 attorney-general, and that in a few days it will go into regu- 
 lar operation as an organized hospital, for the relief of dis- 
 eases of the eye and ear. 
 
 The following prominent citizens composed the first 
 board of managers: Hon. Chief Justice Tilghman, Eight 
 Rev. Bishop White, Hon. Judge Duncan, John B. Brin- 
 ton, Edward S. Burd, John W. Condy, James C. Fisher, 
 Paul Beck, Hon. Benjamin R. Morgan, Eichard H. Bay- 
 ard, Thomas Kittera, John M. Scott and Benjamin 
 Tilghman. 
 
 The surgeon's first report was in part as follows, bear- 
 ing date of March 36, 1833 : 
 
 5. Am. Med. Recorder, 1822, v, 393. 
 
OPHTHALMOLOGY IN AMERICA. 23 
 
 Gentlemen: — In the month of March, 1821, an association 
 of ten individuals was formed in this city for the purpose of 
 establishing an institution for the relief of diseases of the eye. 
 By the gentlemen who composed that association, S. Badger, 
 Esq., was elected treasurer, with power to make all necessary 
 purchases; Mr. Marshall, in Chestnut Street, apothecary, and 
 I was honored with the appointment of surgeon. On the 14th 
 of April, 1821, an advertisement was inserted, by a committee 
 appointed for that purpose, in the Medical Recorder and in 
 some of the daily prints of this city, announcing the formation 
 of the institution, and inviting the poor to partake of its 
 benefits. Since that period many physicians and other respect- 
 able citizens have recommended poor persons aiflicted with dis- 
 eases of the eye to my care, and in no instance has any 
 patient so recommended, or in any other way introduced, been 
 refused the charities of the institution. 
 
 The report was signed, "George McClellan."' 
 Then follows an abstract of the cases treated during 
 the year, together with a detailed report of some cases 
 operated on. There had been ten cataract operations, 
 two of which were by extraction and eight were by 
 "division" or by "depression." Bight other cases of 
 cataract had not yet been operated on. The total num- 
 ber of cases of all kinds was fifty-one, twenty-five of 
 which had applied and been registered during the "pres- 
 ent month." 
 
 The American Medical Recorder (vol. vi, p. 382) next 
 takes notice of this institution in 1833 by announcing 
 "by request" that the "distinguished and public spir- 
 ited" managers of the new "Philadelphia Hospital for 
 Diseases of the Eye and Ear have so far organized the 
 institution under the provisions of the charter as to pro- 
 vide for the gratuitous treatment of patients from every 
 part of the country." It adds that Dr. McClellan, sur- 
 geon of the institution, invites his professional brethren 
 
24 OPHTHALMOLOGY IN AMERICA. 
 
 to send poor patients. This will "confer a favor on the 
 managers and will forward the interests of science." 
 
 This institution seemed to start anspicionsly, but for 
 unknown reasons, perhaps some higher personal aspira- 
 tions on the part of its promoter, such as the founding 
 of Jefferson Medical College, which was consummated 
 in 1835, and in which he was the moving spirit, it was 
 short-lived, as little or nothing is heard of it after 1824. 
 It is possible, also, that rivalry had something to do 
 with its decline, as another Philadelphia institution was 
 organized at about the same time as this, and was backed 
 by a strong professional support, and also appealed with 
 equal and probably greater force to the public. 
 
 PENNSYLVANIA INFIRMARY FOR DISEASES OF THE EYE 
 AND EAR. 
 
 This fourth organization in the United States, and the 
 rival of Dr. McClellan's "Hospital," had its beginning 
 in 1822. I am indebted to the interesting account pub- 
 lished by Dr. Charles A. Oliver'^ for the principal facts 
 which I here present in regard to it. 
 
 Several gentlemen in Philadelphia met on Feb. 8, 
 1822, for the purpose of organizing an infirmary for 
 treating the poor afflicted with diseases of the eye and 
 oar, when, as appears from the first address to the public 
 in which the constitution was included, with the names 
 of the ofiScers, the following managers were chosen : 
 James Gibson, William Meredith, Charles N. Baucher, 
 Manuel Eyre, Eobert M. Patterson,. M.D., Clement C. 
 Biddle, William Mellvaine and Eichard C. Wood. Mr. 
 
 6. A Brief Account of the PennsyWania Infirmary for Diseases 
 of the Eye and Ear, established in the City of Philadelphia in the 
 year 1822. Medical Library and Historical .Journal, New York. 
 April, 1003. 
 
OPHTHALMOLOGY IN AMERICA. 25 
 
 James Gibson was made chairman of the meeting, Dr. 
 Isaac Hays, secretary, and Mr. Eichard C. Wood, treas- 
 urer. Drs. George B. Wood, Isaac Hays, John Bell and 
 Robert E. Griffith were appointed surgeons, and Drs. 
 Phillip S. Physick and William Gibson, consulting sur- 
 geons. The surgeons were ex ofjiciis members of the 
 board of managers. Among other transactions of the 
 meeting, a resolution was passed constituting the sur- 
 geons a committee "with authority to procure a room for 
 an infirmary and to make arrangements for carrying 
 into effect the objects of the institution." The commit- 
 tee was also instructed to prepare an address to the pub- 
 lic, to have two hundred and fifty copies of it and a 
 constitution printed in pamphlet form, and to frame a 
 system of by-laws, all of which was to be reported on at 
 the next meeting of the board. 
 
 A managers' meeting was held twelve days later at 
 which Mr. William Meredith presided. The committee 
 reported a second-story room at No: 4 South Seventh 
 street at one hundred dollars a year, that it had made 
 arrangements with Messrs. A. M. and E. L. Cohen to 
 furnish medicines at a reasonable rate, and that it had 
 prepared an address and a constitution and had them 
 printed, as authorized, in pamphlet form. A body of 
 by-laws was also adopted at this meeting, and certain 
 forms and methods for carrying on the work of the in- 
 stitution were agreed on. 
 
 The original "address to the public" of 1833, with the 
 constitution omitted as published by Dr. Oliver, is as 
 follows : 
 
 The Pennsylvania Infirmary for Diseases of the Eye and Ear. 
 Established at Philadelphia. 
 In calling the attention and soliciting the patronage of the 
 
26 OPHTHALMOLOGY IN AMERICA. 
 
 public to an institution which is to embrace the relief of a 
 class of diseases having so important a bearing on, individual 
 happiness and social comfort, we need but advert to the suc- 
 cess which has attended similar ones in Europe, more particu- 
 larly those established at London and Vienna. In these cities 
 thousands have been anually relieved and cured of diseases of 
 the eye and ear, who otherwise would have lost the use of these 
 all-important organs, and proved a burthen to themselves and 
 to society. Like benefits have resulted from institutions of the 
 same nature in some of our own cities, and we may now con- 
 fidently hope that the citizens of Philadelphia, distinguished 
 for their zeal and liberality in the support of whatever tends 
 to usefulness and charity, will not suffer the present oppor- 
 tunity to escape without testifying their approbation of the 
 institution already organized, and prepared to commence its 
 beneficial operation, as will be seen from the subjoined con- 
 stitution, adopted at a respectable meeting of the contributors 
 on Friday last. 
 
 It is interesting to note in this connection that pro- 
 vision was made in the constitution "that clinical in- 
 struction may be given under such regulations as shall 
 be provided by the by-laws." 
 
 It will be seen by this "address" that these managers 
 entirely ignored Dr. McClellan's institution, although 
 it had already been in operation for a year, and although 
 they must have known of its existence. 
 
 The Pennsylvania Infirmary had somewhat of a strug- 
 gle to live, but it was kept in more or less successful 
 operation for at least seven or eight years. It was not 
 incorporated, however, till early in 1826. Dr. Oliver 
 says that the last meeting of the board that he can find 
 recorded was held on May 1, 1839. But at that meeting 
 a committee was authorized to collect subscriptions, and 
 other actions were taken looking toward its continued 
 support and work. In 1829 Dr. Isaac Hays, in an article 
 
OPHTHALMOLOGY IN AMERICA. 27 
 
 of much detail and interest on "Diseases of the Cor- 
 nea/"' subscribed himself as one of the "Surgeons of the 
 Pennsylvania Infirmary for Diseases of the Bye and 
 Ear," showing that he was still active in the institution, 
 and not ashamed of it. How long it lived after 1829 or 
 1830 I can not say. Perhaps it did so till James Wills' 
 legacy became effective in 1834, when place and means 
 were provided for the work of the staff of surgeons, and 
 for lack of which this was made difiBcult, and without 
 the desired efficiency. 
 
 MASSACHUSETTS CHARITABLE EYE AND EAR INFIRMARY. 
 
 The fifth institution that was organized in this coun- 
 try and which, unlike the first and last two above re- 
 ferred to, has lived to the present time, and has been 
 both a credit and pride to American opththalmology and 
 to the medical profession. This was the Massachusetts 
 Charitable Bye and Ear Infirmary of Boston, which was 
 founded in 1834. Like the New York Eye Infirmary, 
 it had its beginnings through the enterprise of two young 
 Boston physicians. Dr. Edward Eeynolds and Dr. John 
 Jeffries. I can not do better in introducing this brief 
 historical sketch than to quote from an address of one of 
 its founders. Dr. Eeynolds, delivered at the dedication of 
 its new building, on July 3, 1850. Among other things. 
 Dr. Eeynolds said : 
 
 As the London Eye Infirmary owes its origin to the Insti- 
 tution at Vienna, so the Massachusetts Infirmary, where we 
 are this day assembled, must claim its parentage from that. 
 The valuable work of Saunders, published in 1816, and the 
 occasional reports of the infirmary of which it was the first 
 fruits, began to excite a spirit of inquiry among several emi- 
 
 7. American Medical Recorder, xiii, 324. 
 
28 OPHTHALMOLOGY IN AMERICA. 
 
 nent individuals in our country. But no general movement 
 vpas made in its favor until 1821 (1820) ; vphen the first eye 
 infirmary in America was established by Dr. John Kearney 
 Rodgers and Dr. Edward Delafield, two of the most distin- 
 guished physicians and surgeons in New York, who may be 
 called the fathers of American ophthalmology. Filled with the 
 spirit first received at the London institution, and finding on 
 their return from Europe a great number of poor people 
 aiflicted with diseases of the eyes, they were desirous of ex- 
 tending a similar blessing to their native city. Accordingly, at 
 the request of several of the senior members of the profession, 
 they founded the New York Eye Infirmary. 
 
 Two (four) years after, in the latter part of 1824, the 
 example was followed in Boston, and the first effort made, 
 whose noble result we are this day assembled to celebrate. 
 Perhaps, on this occasion, I may be pardoned in saying that 
 the Massachusetts Charitable Eye Infirmary partly originated 
 in the fact that one of its founders had the happiness of 
 restoring a beloved father (Edward Reynolds, Esq.) to sight 
 by the operation of cataract. The tender relation in this case 
 of surgeon and patient, becoming extensively known among 
 the small population then composing our community, brought 
 to his observation a large number of ophthalmic patients; and 
 soon revealed the fact that the poor and laboring classes are 
 peculiarly liable to these diseases — a fact now familiar to 
 every one acquainted with the results of these institu- 
 tions. . . . 
 
 . . . In the month of November, 1824, the speaker, in 
 conjunction with Dr. John Jefl'ries, hired a room in Scollay's 
 buildings; fitted it with such conveniences as their limited 
 means enabled them to procure; and invited the poor, afflicted 
 with diseases of the eye, to come there for gratuitous aid. 
 After having continued their daily attendance for the period 
 of sixteen months, it was found that during this time, al- 
 though the population of the city did not exceed 50,000, no 
 less than 886 persons had applied at the rooms. . . . 
 
 Having thus satisfactorily tested the experiment, the sur- 
 geons now thought the time had arrived which authorized 
 them to present the claims of this large class of the poor to 
 
OPHTHALMOLOGY IN AMERICA. 29 
 
 the attention of the public. Accordingly, a meeting was 
 called on March 13, 1826, at which the Hon. John Wells pre- 
 sided. The report was read. Its simple statement of facts 
 impressed all the gentlemen present with a conviction of the 
 usefulness and importance of the institution, and determined 
 ' them to give it a more perfect trial as a public charity. In 
 accordance with a vote there passed, a subscription was com- 
 menced. By the personal exertions of one gentleman, Mr. 
 Lucius Manlius Sargent, more than two' thousand dollars were 
 
 MASSACHUSETTS CHARITABLE EYE AND EAR INFIRMARY, 
 BOSTON. ERECTKD 1850. 
 
 collected in one week, as a permanent fund; and nearly three 
 hundred dollars in annual subscriptions. 
 
 The first meeting of the subscribers who had thus promptly 
 replied to the call of the committee, was held at the Exchange 
 Coffee House, on the evening of March 20, 1826. Mr. Richard 
 D. Tucker presided. The result of Mr. Sargent's efforts being 
 made known by Mr. Brj'ant P. Tilden, was regarded as a spon- 
 taneous expression favorable to the establishment of the in- 
 stitution. Accordingly, it was then regularly organized under 
 the title of the Boston Eye Infirmary by the election of a board 
 of officers, composed of the following gentlemen: Edward 
 
30 OPHTHALMOLOGY IN AMERICA. 
 
 Tuckerman, president; Lucius M. Sargent, vice president; 
 William B. Reynolds, secretary; Bryant P. Tilden, treasurer; 
 Richard A. Tucker, Edward H. Robins, Robert G. Shaw, Henry 
 Sargent, Henry Rice, Nathaniel G. Snelling, James C. Dunn, 
 Thomas C. Amrory, and Rev. John Codman, managers. 
 
 In February of the following year it was incorporated 
 by the legislature of Massachusetts under the title of the 
 Massachusetts Eye and Ear Infirmary. 
 
 Prom this time till the fall of 1836 the infirmary was 
 "housed" in different places, and was used only as a dis- 
 pensary, serious cases being cared for by the staff else- 
 where. The requirements for hospital accommodations 
 became so imperative that a building, the Gore House 
 on Green street, was then purchased, and was remodeled 
 and adapted to both dispensary and hospital purposes. 
 This building was opened for admission and treatment 
 of patients on July 19, 1836. The number of patients 
 registered during this year is recorded as 689. It rapidly 
 increased to such an extent that additional room and 
 facilities were found necessary, and once more an effort 
 was made to provide larger quarters, which resulted suc- 
 cessfully in the purchase of a lot on Charles street in 
 1848, and the erection of a new building which was com- 
 pleted in 1850 and dedicated on July 3 of that year, the 
 dedicatory address above quoted from being delivered 
 by one of its founders. From that year the number of 
 patients increased from 2,004 to nearly 30,000 in 1895. 
 The building of 1850 had thus become inadequate for the 
 needs of the institution and it was decided to purchase 
 adjoining land and to erect a new building. This was 
 done, and the new hospital was built, and was ready for 
 occupancy in 1899. In connection with this a ward for 
 contagious diseases of the eye was provided in an adjoin- 
 
DR. GEORGE A. BETHUNB (1812-1896). 
 
OPHTHALMOLOGY IN AMERICA. 33 
 
 ing building, and is the first of its kind to be erected in 
 this country. The infirmary building to-day is, like that 
 of the New York Eye and Ear Infirmary, a model of its 
 kind. According to the -last annual report, 1906, the 
 number of patients of all kinds treated at the infirmary 
 during the preceding year was 35;319. 
 
 Ophthalmic clinics in the institution were begun as 
 early as 1836, and both Dr. John Jeffries and Dr. E. 
 Eeynolds and later Dr. George A. Bethune gave regular 
 courses on the diseases of the eyes. At the present time 
 clinical instruction is given to the students of Harvard 
 and Tufts medical colleges. 
 
 BALTIMOEE DISPENSARY EOR THE CUKE OF DISEASISS OF 
 THE EYE. 
 
 In 1823 Dr. George Frick, of Baltimore, published 
 "A Treatise on Diseases of the Bye." In the preface 
 Dr. Frick says that "opportunity has been considerably 
 augmented since his (the authors) return to his native 
 countr}', by his appointment to the Baltimore Dispensary 
 for the Cure of Diseases of the Eye." Dr. Isaac Hays, 
 of Philadelphia, in reviewing Dr. Frick's work in a 
 Philadelphia medical journal,^ says that "with respect 
 to the institution at Baltimore he has but little informa- 
 tion to communicate. It is attached to the Baltimore 
 Dispensary and is committed to the author of this 
 (Frick's) work." Dr. Cordell says, in his "History of 
 the University of Maryland," that the foundation of the 
 Baltimore Dispensary was laid in 1823 and patients 
 were received the same year. There were four wards, of 
 which "one was reserved for eye cases, instruction in 
 
 8. rhila. Jour, lletl. and Thys. Sci,, 1825, pp. 4D9 to 427. 
 
34 OPHTHALMOLOGY IN AMERICA. 
 
 ophthalmic surgery forming a prominent featwre. in the 
 course." This being in the time of Prick's early activity, 
 this prominence given to ophthalmology was probably 
 due to him, and it was he who delivered the lectures re- 
 ferred to. 
 
 Dr. Harry Frieden-qrald® says that on Dr. Prick's re- 
 turn from Europe, about 1819, "to engage in the practice 
 of ophthalmology, he was appointed surgeon to the Bal- 
 timore General Dispensary, where he established the first 
 eye dispensary in Baltimore in 1834." This dispensary 
 must, however, have been started before 1834, if Dr. 
 Prick's own statement above quoted from his book be 
 correct, for his work was published in 1833, and also 
 according to Cordell's statement, which I have above 
 quoted. 
 
 I can obtain no further record of the Baltimore insti- 
 tution, and it is even doubtful if it had an organization 
 independent of the general dispensary. Being a first 
 effort; however, at establishing a special eye clinic in 
 Baltimore contemporaneously with the beginnings of 
 eye infirmaries in New York, Philadelphia and Boston, 
 it is worth mentioning. 
 
 WILLS EYE HOSPITAL. 
 
 In following up the historical references to the early 
 institutions for the treatment of diseases of the eye which 
 have contributed in various ways to the advancement of 
 ophthalmology, the next in chronological order is the 
 Wills Eye Hospital of Philadelphia. This institution was 
 created by the benevolence of a wealthy Philadelphian, 
 
 9. The Early History of Ophthalmology and Otology in Balti- 
 more (1800-1850), reprint from Johns Hopliins Hospital Bulletin, 
 Baltimore, 1897. 
 
OPHTHALMOLOGY IN AMEIllCA. 
 
 35 
 
 James Wills, who was born in England in 1760 and died 
 in Philadelphia in 1830. His fortune was in part by in- 
 heritance and in part from his own business in Philadel- 
 phia, where he was an honored member of the Society of 
 Friends. At his death he left a will providing for the 
 founding of a "hospital for the indigent blind and 
 lame." A question arose as to the legality of his be- 
 
 OLD WILLS EYE HOSPITAL, PHILADELPHIA. 
 
 quest, and for some time it was in process of litigation. 
 The decision of the court, however, upheld the provisions 
 of the will, and, after satisfying other bequests, there 
 was a sum of $108,396.35, with its accumulations, mak- 
 ing a total of $123,548.57, available for the purchase of 
 a lot and the erection of a building in compliance with 
 the .wishes of the benefactor. The place selected by the 
 officers of the organization was on Eaee street, between 
 
36 OPHTHALMOLOGY IN AMERICA. 
 
 Eighteenth and Nineteenth streets, on which was erected 
 a building, the foundations of which were laid on April 
 ■3, 1832. On March 3, 1834, the hospital was opened for 
 the reception of patients. On the completion of the 
 building, all expenses had been paid, and there was a 
 residue of $65,344.88 for the future support of the in- 
 stitution. The first surgeons were appointed in 1834, 
 and were Drs. Isaac Parrish, Squier Llttell, Isaac Hays 
 and George Pox. Those entitled to the privileges of the 
 hospital were persons in indigent circumstances, and on 
 application they were expected to give satisfactory evi- 
 dences of respectable character. Since the erection of 
 the first building many alterations and additions have 
 been made, until now it is provided with offices, oper- 
 ating and clinic rooms and one hundred beds for interne 
 patients. , 
 
 From the earliest days of the hospital, eye diseases 
 were most prominent among the patients who applied 
 for assistance. As early as May, 1834, two operations 
 were performed for cataract by couching and, to quote 
 the report of the visiting committee, "these eases were 
 watched with the utmost interest as to the outcome of 
 the operations." At first the full capacity of the house 
 was twenty patients, and the physicians and surgeon* 
 attended but once or twice a week. The institution was 
 then known as "Wills Hospital for the Blind and 
 Lame.'' The character of the cases became more and 
 more limited to eye diseases, until in November, 1837, 
 it was reported that there were no medical cases for 
 treatment. A few years later the office of attending 
 physician was abandoned. Almost witlrout a single mo- 
 ment's hesitation has the institution received kindly rec- 
 
OPHTHALMOLOGY IN AMERICA. 37 
 
 ognition and a helping hand. It has been so well sup- 
 ported by state and private benefaction that the work 
 has steadily grown from sixty eases the first year to over 
 sixteen thousand annually at the present time. 
 
 The present building is most suitably arranged for the 
 proper treatment of diseases of the eye, and has all the 
 modern improvements and facilities. 
 
 THE MONTREAL EYE AND EAR INSTITUTION. 
 
 In this connection I may properly mention the Mon- 
 treal Eye and Ear Institution of Montreal, Canada, the 
 organization of which was undoubtedly inspired by Mr. 
 Henry Howard, of that city, and which began its exist- 
 ence in or before 1846. Information is not at hand 
 which will enable me to give any definite account of this 
 institution and its duration. 
 
 I have thus taken the time to briefly outline the origin 
 of these early institutions, because those that have sur- 
 vived have been the greatest of the sustaining and devel- 
 oping forces of American ophthalmology. But it must 
 still be borne in mind that these have been reinforced by 
 the organization from time to time of ophthalmic serv- 
 ices in connection with general hospitals and general dis- 
 pensaries by men more or less interested in diseases of 
 the eye. The Baltimore Dispensary, in which Dr. Prick 
 took an active part as early as 1823, and to which I have 
 already referred, was one. Another, the Philadelphia 
 Dispensary, a charity said to have been organized by 
 Benjamin Eush, always had a certain proportion of 
 patients with eye diseases, and they were attended to by 
 the physicians on service. The Philadelphia Hospital 
 and the Pennsylvania Hospital of Philadelphia, the New 
 
38 OPETHALMOLOQY IN AMERICA. 
 
 York Hospital, the Massachusetts General Hospital of 
 Boston, the Baltimore Hospital, and others throughout 
 the United States had their surgeons who were more or 
 less skilled in ophthalmic operations. 
 
 SOME OF THESE EARLY SURGEONS. 
 
 Some, of the early surgeons of Philadelphia who were 
 thus skilled were Thomas Bond (1713-1784), who, with 
 Benjamin Franklin, founded the Pennsylvania Hospital 
 in 1752 (the first of its kind in America) ; William 
 Shippen, Jr. (1736-1808), Philip Syng Physick (1768- 
 1837), William Gibson (1788-1868), John Syng Dorsey 
 (1784-1818), nephew of Physick; George McClellan 
 (1796-1847), Jacob Eandolph (1796-1848), and George 
 Fox (1806-1882). In Few York there were such dis- 
 tinguished surgeons as John Jones (1729-1791), later 
 of Philadelphia, Wright Post (1766-1823), Samuel Bor- 
 rowe, J. Kearney Eodgers (1793-1857), Valentine 
 Mott (1785-1840), Gurdon Buck (1807-1877), Willard 
 Parker (1800-1884), and Alfred C. Post (1806-1886). 
 In Boston there were John Warren (1753-1815), his son 
 John Collins Warren (1778-1856), George Hayward 
 (1791-1868), and John Jeffries (1796-1876) ; in Balti- 
 more, John Beale Davidge (1769-1829), Horatio G. 
 
 Jameson (1778-1855), John Harper ( 1831), 
 
 Granville Pattison (1791-1851), and Nathan E. Smith 
 (1797-1877) ; at Dartmouth and Yale, Nathan Smith 
 (1762-1829), the father of the Baltimore surgeon, and 
 himself a great physician as well as surgeon of his day; 
 in Chicago, Daniel Brainard (1813-1866) ; in Transyl- 
 vania, Ky., Benjamin Winslow Dudley (1785-1870), 
 and so on in all large towns throughout the country, 
 
OPHTHALMOLOGY IN AMERICA. 39 
 
 of which the above is a very incomplete list and does not 
 incltide those surgeons of a little later period who were 
 more or less celebrated for their skilful operations on 
 the eye. 
 
 Those who stood out more exclusively for ophthalmol- 
 ogy were George Friek of Baltimore, Isaac Hays and 
 Squier Littell of Philadelphia. Edward Delafield, of 
 New York, served the New York Bye Infirmary many 
 years, but was actively engaged in other departments of 
 practice. Dr. J. K. Eodgers was also faithful to the same 
 institution, but his service was incidental to his surgical 
 work. John Jeffries, George A. Bethune, John H. Dix, 
 Eobert W. Hooper and Edward Eeynolds, in Boston, 
 who attended the Massachusets Charitable Eye and Ear 
 Infirmary, were also general practitioners. Samuel D. 
 Gross, Philadelphia, was a great surgeon, and he also 
 did eye surgery. The same is true of D. Hays Agnew, 
 also of Philadelphia. 
 
 The lives of some of these men deserve further record 
 in this connection and I shall, therefore, give sketches 
 of them very briefly. 
 
III. 
 
 BIOGRAPHICAL SKETCHES. 
 
 George Feick^ Baltimore, was the first in America 
 to undertake to restrict his professional work almost 
 exclusively to ophthalmology. He was born in Balti-, 
 more in 1793. After completing his medical studies and 
 graduating from the University of Pennsylvania in 
 1815, he was licensed to practice in his native city in 
 1817. He visited Europe, where he became a favorite 
 pupil of the celebrated Vienna ophthalmologist. Beer. 
 He came to feel deeply the dearth of knowledge of dis- 
 eases of the eye in America and set himself to work to so 
 qualify himself under the great master that he might 
 return to his home and give some enlightenment and a 
 scientific uplift to a neglected department of medicine. 
 After a prolonged period of study, and enthused by the 
 example of Beer as an exclusive specialist, he returned 
 to Baltimore in 1818 and undertook in a measure to fol- 
 low his teacher's example. He at once began his plans 
 for ophthalmologic work. He organized a special eye 
 clinic in connection with the Baltimore Dispensary and 
 established a course of lectures on the eye in the Uni- 
 versity of Maryland. He was naturally retiring in dis- 
 position, and without demonstration he undertook this 
 innovation. There is sufficient evidence extant to show 
 that his work as an ophthalmologist was approved in 
 Baltimore, and had it not been for a frail physique and 
 the infirmity of deafness he would undoubtedly have left 
 a more impressive and lasting record than he has. 
 
DE. ISAAC HATS (1796-1879.) 
 
OFHTHALMOLOGY IN AMERICA. 43 
 
 i!^evertheless, his clinical work in ophthalmology be- 
 came an inspiration to others, and his ophthalmologic 
 ■contributions to the American Medical Recorder of Phil- 
 adelphia and his "Treatise on the Eye" (1833) are 
 enduring monuments to his learning. Unfortunately, 
 as his infirmity increased, and having tastes for other 
 pursuits, he was led to abandon his profession so well 
 begun. He finally repaired to Dresden, where he died 
 in 1870, at 77 years of age. (For these facts regarding 
 Dr. Frick's life I am indebted to Dr. Harry Friedeo- 
 wald's "Early History," etc., above cited.) 
 
 Isaac Hays. — The next who did much credit to early 
 ■ophthalmology was the distinguished Isaac Hays, who 
 was born in Philadelphia in 1796 and died there in 
 1879, spending the whole of his life in that city in most 
 arduous and productive labor. He graduated in medi- 
 cine from the University of Pennsylvania in 1820, and, 
 unaided by friends or by the patronage of the great and 
 influential of his city, he began the world's struggles, 
 and at once won the confidence of the most distinguished 
 physicians with whom he came in contact. Fitted by 
 Xature and by training for literary work, he neverthe- 
 less took a deep interest in ophthalmology, both scien- 
 tifically and practically, and so far as he practiced medi- 
 cine at all it was chiefly in this field. He began the 
 practice of ophthalmology early in life, and when the 
 Pennsylvania Infirmary for Diseases of the Eye and 
 Ear was founded in 1822, undoubtedly as a rival to Dr. 
 McClellan's hospital, he was one of its first surgeons. 
 His services there were faithful and efficient, and it was 
 also to his influence and energy that it was kept alive 
 till the time when James Wills died in 1830 and left a 
 
44 OPHTHALMOLOGY IN AMERICA. 
 
 bequest, whereby there would be means to support an 
 institution in which charitable work of this kind could 
 be done in accordance with higher ideals and with less 
 worry over insufficient financial support. At the open- 
 ing of the Wills Hospital for the Blind and Lame in 
 1834, Dr. Hays became one of its surgeons. Here his 
 masterful influence greatly dominated its work, and 
 here, too, he built up an enviable reputation as a skilled 
 and progressive ophthalmologist. In the meantime he 
 contributed numerous learned articles on ophthalmologic 
 subjects to the journal with which he became identified 
 when a young man, viz., the Journal of the Medical and 
 Physical Sciences, afterward the American Journal of 
 the Medical Sciences, a journal which has come down to 
 our own time, and which has ever been the pride of our 
 profession and an honor to its editors and its publishers. 
 Dr. Hays' service at the Wills Hospital continued till 
 1854, a period of twenty years, when the pressure of lit- 
 erary work led him to resign. During all of those years 
 of institutional work, from, 1823 to 1854, the knowledge 
 which he acquired of ophthalmology, both practical and 
 theoretical, was most efficiently and advantageously re- 
 flected to the public in the lectures which he gave in Dr. 
 Godman's private school and at the eye hospitals with 
 which he was connected; in the editorial work of his 
 journal; in his original articles, and in the notes which 
 he discriminatingly added to his American edition of T. 
 Wharton Jones' "Principles and Practice of Ophthalmic 
 Surgery," and to his two editions of Lawrence's "Treat- 
 ise on Diseases of the Eye." 
 
 Dr. Hays, besides contributing many articles of great 
 value to his journal, made important devices in ophthal- 
 
DK. SQUIER LITTKLL (1S03-1S80). 
 
OPHTHALMOLOGY IN AMERICA. 47 
 
 inic instruments, occupied many positions of trust, and 
 kept alive the newer and more progressive ideas touching 
 the science and practice of ophthalmology. The extent 
 and value of his lahors in this field alone can not be 
 measured. 
 
 On withdrawing from the Wills Hospital, he also 
 withdrew from the practice of ophthalmology; but as 
 long as he lived his interest in the subject was never 
 lost. Although he did not endeavor to make it an ex- 
 clusive department of practice, th€ world will always 
 claim him as the great American editor-ophthalmologist 
 of the first half of the nineteenth century, whose learn- 
 ing and skill were the admiration and inspiration of the 
 practitioners of that period. 
 
 Squier Littell. — A third name that stands out in 
 bold relief in the same historical period is that of Squier 
 Littell. He was born in Burlington, Vt., in 1803 and 
 died in Philadelphia in 1886. He was one of a family 
 who was endowed with literary tastes. It was his 
 brother who founded that old and still popular maga- 
 zine, "Littell's Living Age." Dr. Littell also possessed 
 a strong religious nature, and his literary predisposition 
 was shown both in medicine and in religion. After 
 studying medicine with Dr. Joseph Parrish of Phila- 
 delphia, he graduated from the University of Pennsyl- 
 vania in 1834. He then entered into general practice, 
 making his first attempt at this in South America, but 
 returning to Philadelphia in 1826, where he remained 
 the rest of his life. His retiring and modest disposition, 
 his consequent lack of aggressiveness, contributed to a 
 slow acquirement of practice. The death also of his 
 young and charming wife, who left to him a little daugh- 
 
48 OPHTHALMOLOGY IN AMERICA. 
 
 ter and an infant son, so overwhelmed him with grief 
 from which he did not recover in years, that it in a great 
 measure stifled his ambition and diverted him into chan- 
 nels of thought and labor, which, to say the least, did 
 not contribute to enviable success in general practice. 
 Not to dwell, however, on these or on his literary labors 
 in medical journalism and in religious publications, it 
 should be mentioned that he early contributed several 
 important papers on general medicine and was esteemed 
 a physician and medical writer of merit. In 1834, on 
 the organization of the Wills Hospital, and perhaps 
 through the kind offices of Dr. Parrish, his preceptor 
 and friend, he was appointed one of its surgeons. He 
 was a faithful and conscientious attendant to this insti- 
 tution for thirty years, resigning in 1864. He disclaimed 
 any title to being a specialist, and regarded himself sim- 
 ply as .a general practitioner, and yet his attachment to 
 an eye hospital had more or less effect in making his oph- 
 thalmic practice disproportionately the larger part. His 
 experience in the Wills Hospital and in private practice 
 bore good fruit, for, while Dr. Littell did not write ex- 
 tensively, his best contributions were in the interests 
 of an advanced ophthalmology. His "Manual on Dis- 
 eases of the Eye," 1837, was his most conspicuous and 
 helpful production. In 1853 he edited the first Ameri- 
 can edition of H. H. Walton's "Treatise on Operative 
 Ophthalmic Surgery," adding some useful notes. 
 
 The first article which the doctor published in a' med- 
 ical journal was in 1881 and the last was in 1873, 
 numbering in all about twenty. Of these only three or 
 four were on the eye. On the discovery of the ophthal- 
 moscope Dr. Littell at once recognized its value and its 
 
OPHTHALMOLOGY IW AMERICA. 49 
 
 practical application to diagnosis and treatment. He, 
 although conservative by nature and slow to adopt new 
 methods, at once devoted himself to mastering the diffi- 
 culties of the new instrument p.nd used it habitually and 
 intelligently in his practice. 
 
 Dr. Littell, having had a good constitution and having 
 led a regular and temperate life, had kept comparatively 
 young to advanced age. As he approached his eightieth 
 year his sight began to fail him from a chorioidal affec- 
 tion and was one of the severe trials of his old age, but 
 he made no complaint, and to the last, as his blindness 
 increased, he adapted himself to his privation. 
 
 Like Dr. Hays, this pioneer ophthalmologist portrayed 
 those qualities of mind and heart which should stand as 
 an example to all young men in generations to come. 
 
 THE THREE PIONEERS. 
 
 These three men, Frick, Hays and Littell, unlike all 
 others in the iirst half of the last century, almost com- 
 pletely divorced themselves in practice, though not in 
 theory, from other departments of medicine. Each one 
 was modest and conservative by nature, each was refined 
 and cultured, and each was endowed with literary tastes. 
 Each was full of the feeling of the great responsibility 
 of his work, and each had an unselfish desire to better 
 the ophthalmic practice of his time and to lead others 
 to a higher plane of ophthalmologic knowledge. They 
 practiced according to the best information and e.xpe- 
 rience available, and they opened their clinics to those 
 who would come. In ophthalmology they stood above all 
 others in the extent of their practice, in their self-sacri- 
 ficing devotion to their wort and in the literary contri- 
 
50 OPHTHALMOLOGY IN AMERICA. 
 
 butions which were the outgrowth of their knowledge 
 and experience, and which served so effectually to ad- 
 vance the science in America and to enlighten the pro- 
 fession on a neglected subject. 
 
 OTHEE SKETCHES. 
 
 There were others, however, who were the contem- 
 poraries of Prick, Hays and Littell, or who came later, 
 who did less writing, but who did most important service 
 in ophthalmology. Their careers should also be briefly 
 noted. 
 
 Elisha North (1771-1843), of New London, Conn., 
 attempted to make ophthalmology more or less promi- 
 nent in his practice, even earlier than did either of the 
 three men whose lives I have sketched. He was the son 
 and grandson of physicians, and studied medicine in 
 Hartford, and subsequently in Philadelphia under Ben- 
 jamiin Eush. After being admitted to practice he settled 
 in his native town, Goshen, Conn., and engaged in the 
 pursuit of his profession until 1812, when he removed to 
 New London, Conn. He was a man of progress and was 
 among the earliest to practice vaccination in the United 
 States, being the first to introduce vaccine matter in New 
 York City, sending it to Dr. Edward Miller of that town. 
 In New London he devoted special attention to diseases 
 of the eye, and in 1817 established there the first eye in- 
 firmary in this country. According to information fur- 
 nished me by Dr. Walter E. Steiner, of Hartford, Conn., 
 Dr. North in 1839 published a book entitled "The 
 Science of Life." In it he refers to his work and insti- 
 tution as follows : "We had attended to eye patients be- 
 fore that time (1817), but it occurred to us then that 
 we might multiply the number of cases of that descrip- 
 
BLISHA NORTH (1771-1843). 
 
OPHTHALMOLOGY IN AMEBWA. 53 
 
 tion and hereby increase our knowledge, advertising the 
 public in regard to an eye institution. This was done, 
 and ^^'e succeeded, although not to our wishes in a pe- 
 cuniary view of the case. Our success or exertions prob- 
 ably hastened in this country the establishment of larger 
 and better eye infirmaries (i. e., for larger cities). '^ Lit- 
 tle is really known of Dr. North's institution or his oph- 
 thalmic practice, but the fact that he was thus interested 
 in ophthalmology is worthy of record here. 
 
 Philip Stng Physick. — In making special note of 
 the early general surgeons who should be remembered 
 in connection with the development of ophthalmology 
 the name of Philip Syng Physick should, perhaps, come 
 first. He was born in Philadelphia in 1768 and died 
 there in 1837. He received a collegiate education from 
 the University of Pennsylvania, where he graduated in 
 arts in 1785. He studied medicine with a physician in 
 his native town for three years, and went to London in 
 1789, where he became the private pupil of John Hun- 
 ter, with whose family he lived. He was a great favorite 
 of Hunter, and received many attentions and consider- 
 ations from him. It was through Hunter's influence 
 that he was appointed to the house staff of St. George's 
 Hospital, London, in 1790. In 1791 he went to Edin- 
 burgh, and in 1792, after one course of study in the 
 University of Edinburgh, he graduated in medicine. 
 He then returned to Philadelphia and began practice 
 under most favorable conditions. In 1794 he was ap- 
 pointed surgeon to the Pennsylvania Hospital, which he 
 served for many years. In 1800 he was taken into the 
 medical department of the University of Pennsylvania, 
 first as lecturer, and in 1805 as professor of surgery. In 
 
54 OPHTHALMOLOGY IN AMERICA. 
 
 1818 he was transferred to the chair of anatoiay, which 
 he occupied till 1830. 
 
 Dr. Ph3'sick is said to have been a man of medium 
 height, with "pale classic features," reserved and rather 
 forbidding in his manner, pessimistic in his tempera- 
 ment, and devoid of the sense of humor. In his teach- 
 ing he was precise and emphatic and commanded the 
 profoundest deference from his pupils. He was not a 
 ready speaker, and for the most part read his lectures 
 to his classes. As a surgeon he was skilful and accurate 
 in operating, and always conservative. He was not a 
 "man of books," neither writing much nor reading much. 
 Dr. Gross has said of him that he had no books worth 
 mentioning, either medical or non-professional. In his 
 practice he was essentially an empiric, apparently being 
 guided altogether by the light of experience. He had 
 no theories of his own, and was intolerant in his teach- 
 ing and practice of the theories of others. He possessed, 
 however, one of the richest endowments of a profes- 
 sional man, namely, strong common sense, and this was 
 his great bulwark in every situation. Although cold and 
 unsocial, yet at heart he was full of sympathy for suffer- 
 ing humanity. 
 
 It was he who originated the idea of the use of animal 
 ligatures as I shall elsewhere note, and he is said to 
 have been the first to wash out the stomach, in cases 
 of poisoning, with a gum-elastic catheter and syringe. 
 He devised many new surgical appliances and instru- 
 ments, and in many ways advanced surgical practice. 
 He was an expert operator on the eye, especially for cat- 
 aract and artificial pupil, as is made evident by Dorsey, 
 his nephew, in the first volume of Dorsey's "Elements 
 
DR. PHILIP SYNG PHYSICK (1768-1837). 
 
OPHTHALMOLOGY IN AMERICA. 57 
 
 of Surgery.-" Among the original devices of Dr. Physiek 
 for ophthalmic operations is a forceps-punch (see illus- 
 tration) for removing a piece of iris for artificial pupil. 
 Dr. Physiek wrote scarcely anything for publication, 
 yet, fortunately, his work and memory have been per- 
 petuated, at least partially, through the writings of oth- 
 ers, particularly of his distinguished nephew, John Syng 
 Dorsey, and of his son-in-law. Dr. Jacob Eandolph. Dr. 
 Physick's surgical originality and genius have won for 
 him the distinction of being regarded as "the father of 
 American surgery." 
 
 Physick's punch-forceps foi' making artificial pupil. 
 
 William Gibson, another eminent surgeon who 
 thought and acted for himself and who contributed ma- 
 terially to ophthalmologic knowledge and practice, was 
 the successor to Physiek in the chair of surgery in the 
 University of Pennsylvania, to whicli he was called in 
 1819. He was born in Baltimore in 1788 and died in 
 Savannah, Ga., in 1868. He graduated in arts in 1806 
 from Princeton College with high rank as a classical 
 scholar. He then repaired to Edinburgh, where he 
 studied medicine under John Bell, graduating in medi- 
 cine from the university of that city in 1809. From 
 there he went to London, where he studied for some time 
 under Sir Charles Bell. From London Dr. Gibson re- 
 turned to Baltimore, and was soon in successful prac- 
 tice. He was appointed professor of surgery in the med- 
 
•58 OPHTHALMOLOGY IN AMERICA. 
 
 ical department of the University of Maryland in 1813. 
 He occni])icd this position till he removed to Philadel- 
 phia in 1819. His connection with the University of 
 Pennsylvania continned until 1855, when he resigned. 
 Dr. Gibson was the first to ligate the common iliac artery 
 in 1812, but his greatest feat, a feat which made his 
 name widely known, both in Europe and in this coun- 
 try, was the performance of the Cesarean section twice 
 on one woman, saving mother and child in both in- 
 stances. His reputation as an expert operator extended 
 far and wide, and while at times his ill temper betrayed 
 him into unkind expressions, yet he never failed to 
 command the highest respect of most of his confreres. 
 He was an able and impressive teacher, his character- 
 istic qualities being clearness, accuracy and earnest- 
 ness. He made no pretentions to eloquence. Dr. Gross 
 in his sketch of him says : "He handled his knife with 
 great skill and was one of the foremost operators of his 
 day." Dr. Gibson made many contributions to the prac- 
 tice and literature of general surgery and some to the 
 surgery of the eye. His most noted literary production was 
 his "Institutes and Practice of Surgery," the first edi- 
 tion of which was published in 1834, the last, the eighth, 
 in 1850. The first volume of this work contains an ex- 
 cellent resume of the diseases of the eye and their treat- 
 ment, in which is embodied the undoubted results of the 
 experience and study of a man versed in the ophthal- 
 mology of his time. His discussion of cataract is es- 
 pecially authoritative. He was the first surgeon to : per- 
 form the operation for convergent strabismus, which 
 was afterward made so popular by Dietlenbach. Unfor- 
 tunately, he did not record his operation in time to re- 
 
III:. UEOHOE McCLELLAN (1700-1847). 
 
OPHTHALMOLOGY 7.Y AMERICA. (U 
 
 ceive due credit for priority. This subject is reviewed 
 elsewhere in this paper. I have also detailed on other 
 pages some of his procedures and instruments for opera- 
 tions of the eye, showing the originality and resource- 
 fulness of his intellect. Gibson will long remain a 
 prominent iigure in the history of ophthalmology as well 
 as surgery. 
 
 George JIcClellan^ — As I have in the preceding 
 pages briefly rehearsed Dr. George McClellan's effort to 
 establish an eye hospital in Philadelphia in 1821, it 
 seems appropriate to add a few words in regard to the 
 man himself. He was born in Woodstock, Conn., in 
 1796 and died in Philadelphia in 1847, 51 years of 
 age, from an ulcerative perforation of the small intes- 
 tine. He graduated in arts from Yale College in 1815, 
 and began the study of medicine with Dr. Thomas Hub- 
 bard, of Pomfret. Conn. He afterward became the 
 pupil of the celebrated Philadelphia surgeon. Dr. John 
 Syng Dorsey. He graduated in medicine from the Uni- 
 versity of Pennsylvania in 1819. After receiving his 
 M.D. degree he began the practice of his profession in 
 Philadelphia, where he labored during the remainder 
 of his life. Immediately after locating in Philadelphia 
 he began to teach anatomy and surgery, privately, and 
 his lecture room soon became a rallying point for many 
 pupils. It may be said that Dr. McC^lellan's private 
 school, which grew into great popularity, was the germ 
 from which the Jefferson Medical College sprang later. 
 In 1835, with the assistance of other Philadelphia physi- 
 cians, particularly John Eberle, he organized the Jef- 
 ferson Medical College, in which he became the professor 
 of surgery, a position which he occupied till 1838, when 
 
62 OFHTHALMULOOY IS AUERIGA. 
 
 he was compelled to withdraw. Immediately after this 
 change he, with others, founded the medical departnient 
 of the Pennsylvania College of Gettysburg m 1839. The 
 department was closed, however, after four annual 
 
 courses of lectures, and he then retired to private prac- 
 tice. 
 
 Dr. McClellan as a young man was aspiring and ag- 
 gressive, and both in the "Institution for Diseases of the 
 Bj'e" and in the Jelferson Medical College he was, as 
 Dr. Gross says, the "master genius." His teaching in 
 the medical college included both anatomy and surgery, 
 and his. vivacit}' and fluency of speech attracted large 
 classes. His lectures wore "extemporaneous" and they 
 achieved a popularity and produced an eilect seldom 
 equaled. He was full of energy and enthusiasm, but 
 utterly without system. Every student was strongly 
 attracted to him, and "Mac" was the name by which he 
 was generally designated. As an operator he was showy 
 and at times brilliant, but it was claimed by his adherents 
 that he lacked judgment and patience. McClellan wrote 
 and published very little. A posthumous work on the 
 "Principles and Practice of Surgery" was published by 
 his son, the late Dr. John H. B. McClellan, which, how- 
 ever, attracted indifferent attention. I have already 
 shown that Dr. McClellan was especially interested in 
 ocular surgery, and no doubt this interest was lessened 
 only by being overshadowed by that in general surgery It 
 appears that he had similar "troubles and tribulations," 
 however, in this branch of surgical art to those which 
 frequently befall ophthalmologists and surgeons of the 
 present day, for in 1828 a suit for malpractice was 
 brought against him on account of alleged want of skill 
 
DR. JOHN KEAENEY RODGERS (1793-1851). 
 
OPHTHALMOLOGY IN AMERICA. 65 
 
 in a case of cataract, in which a verdict of $500 was 
 rendered in favor of the plaintiff. i)r. Gross has re- 
 minded us that "the suit, as most frequently happens, 
 had been instigated by professional enemies." Notwith- 
 standing the criticisms and inuendos which his enemies 
 in the profession saw fit to make, he was recognized as 
 a practical surgeon of high rank. The school which 
 he founded has contributed through its graduates many 
 eminent surgeons and teachers. He is also to be re- 
 membered as the father of Gen. George B. McClellan, 
 of Civil War fame, and grandfather of George B. 
 McClellan, the present mayor of the city of New York. 
 John Kearney Eodgees was born in New York City 
 in 1793 and died there in 1851, his death being caused by 
 "phlebitis of the liver followed by peritonitis." He ob- 
 tained his classical education at Princeton College, and 
 afterward studied medicine under Dr. Wright Post, who 
 was a distinguished New York surgeon. He graduated 
 from the College of Physicians and Surgeons in 1816. 
 After his graduation he and Dr. Edward Delafield went 
 to London, where they pursued their studies at the hos- 
 pitals of that city under the famous masters of the me- 
 tropolis, giving special attention to diseases of the eye. 
 In 1818. soon after his return to New York, Dr. Eod- 
 gers was appointed demonstrator of anatomy in the col- 
 lege from which he graduated. Four years afterward 
 he was made surgeon to the New York Hospital, an 
 office which he much coveted and which he retained up 
 to the time of his death — a period of thirty years. He 
 was a practitioner of great eminence, and with Dr. 
 Delafield, was the founder of the New York Bye In- 
 firmary, in 1820, which institution he served for many 
 
06 OPHTBALMOLOGY IN AMERICA. 
 
 years. He was especially noted for his sterling integ- 
 rity, his active and generous mind, and for his adroit- 
 ness and ease as an operator. It has been said that as 
 an operator he had no superior in this country, except, 
 perhaps, Valentine Mott, who so long wielded the scep- 
 ter on the American continent. The principal opera- 
 tion which gave him great honor throughout the sur- 
 gical world, and for all time, was the ligation of, the left 
 subclavian artery within the scaleni muscles, in 1845, 
 on account of a large aneurism of that vessel, a feat 
 which up to that time was universally regarded as im- 
 practicable. In consultations he was the wise counselor, 
 and under all circumstances he was the sympathizing 
 and trusted friend and physician. His cQijtributions to 
 medical literature were not numerous, and it is to be re- 
 gretted that the record of his vast experience has been so 
 insufficient. Meager as his contributions w6re they, how- 
 ever, leave a mark which will not be easily erased. 
 
 Edward Delafield was during his whole life a prom- 
 inent figure in New York professional circles. He was 
 energetic, skilful and courteous and occupied many posi- 
 tions of trust. He had a very large practice, and was 
 for a long time professor of obstetrics and diseases of 
 women and children in the College of Physicians and 
 Surgeons. He was born in 1795 and died in 1875. He 
 graduated in arts at Yale College in 1812 and in medi- 
 cine at the College of Physicians and Surgeons of Kew 
 York in 1815. After a period of service as interne in 
 the New York Hospital, he and Dr. John Kearney Eodg- 
 ers went to Europe for special study. Soon after re- 
 turning Dr. Delafield, with Dr. Eodgers, organized the 
 New York Eye Infirmary in 1820, as above detailed. 
 
DR. EDWARD DELAFIELD (1705-1875). 
 
OPHTHALMOLOGY IN AMERICA. 69 
 
 He acted as surgeon and gave clinical lectures there on 
 diseases of the eye for many years. He was one of 
 the active promoters of the organization of the Ameri- 
 can Ophthalmological Society in 1864 and was unani- 
 mously elected its first president, a fitting acknowledge- 
 ment of what he had done by his example and labors 
 during many years to make ophthalmology an honor- 
 able department of medical practice in the estimation 
 of the public and profession. Clinical teaching at the 
 New York Eye Infirmary was early instituted by Dr. 
 Delafield and was carried on by himself and associates 
 for many years. He wrote and published very little. 
 His ophthalmologic writings were chiefly reports of ex- 
 periences from his practice in the infirmary, a few of 
 which will be found in the early transactions of the Oph- 
 thalmological Society, and his notes to his American 
 edition of "Travers on the Eye," to be referred to later. 
 Dn. Edward Eeynolds was born in Boston, Mass., 
 in Pebruar}^, 1793, and there closed his long life in 
 1881. He graduated in arts at Harvard College in 1811, 
 and afterward for several j'ears was a private pupil in 
 medicine of Dr. John Collins Warren. He then availed 
 himself of the very great advantage of three years of 
 training abroad. In London he studied under Aber- 
 nethy and Astley Cooper, and at Paris with Bichat and 
 Dupuytren. He also followed, at London, the lectures 
 of Sir William Lawrence on diseases of the eye, and 
 with his fellow-students was carefully taught, among 
 other things, to perform ophthalmic operations, using 
 sheep's eyes set in a mask. It was perhaps owing to the 
 influence of his European teachers that he acquired a 
 preference for surgery, and especially for ophthalmic 
 
70 OPHTHALMOLOGY IN AMERICA. 
 
 surgery, although he always enjoyed an extensive gen- 
 eral practice. During Dr. Eeynold's lifetime modern 
 specialization of the medical profession was not known, 
 and he never lost his interest in the pursuit of gen- 
 eral professional work. 
 
 After returning from abroad, he found his father, at 
 60 years of age, blind with cataracts in both eyes. He 
 had the rare courage to perform the depression of the 
 two lenses at one sitting. Happily the operation proved 
 a complete success. It had never before been under- 
 taken in Boston and, becoming widely known, formed 
 the foundation for a reputation which made him the 
 leading surgeon in diseases of the eye in Boston and 
 throughout New England for many years. 
 
 In 1824 he and Dr. John JefEries, son of the fa- 
 mous aeronaut and man of science of that name, es- 
 tablished a dispensary which developed into the well- 
 Imown Massachusetts Charitable Eye and Ear Infirmary 
 above referred to. After the withdrawal of Dr. Jef- 
 fries, Dr. Eeynolds long continued to be the senior sur- 
 geon of the infirmary, training for it a staff of able 
 men, devoted to ophthalmic practice. His connection 
 with the institution, first as surgeon and later as teacher, 
 lasted until 1870, but his interests in 'it continued un- 
 abated to the end of his days. 
 
 He was one of the founders of the well remembered 
 Tremont Medical School, and was for many years its 
 professor of general surgery. During a prolonged ab- 
 sence of Dr. Warren in Europe he also taught anatomy 
 and surgery at the Harvard Medical School. As an 
 eye surgeon his fame was such that in 1864, on the or- 
 ganization of the American Ophthalmological Society, 
 he was made an honorary member. 
 
DR. BDWAKD REYNOLDS (1793-lSSl). 
 
DR. JOHN JEFFRIES (1796-1S76). 
 
OPHTHALMOLOGY IN AMERICA. 75 
 
 Phj'sically he was a giant among men. His fine and 
 commanding presence, his always genial humor, and the 
 ready generosity of his character made for him a host of 
 friends and followers in his community. There was 
 an entire absence of professional Jealousy in him, and 
 he was as kind as he was unselfish. Pie lived to be for 
 many years the Nestor of the local profession and, except 
 for an increasing deafness, retained all his faculties and 
 capacity for the enjoyment of life to within a few 
 months of his death, which occurred at the end of hia 
 eighty-ninth year.* 
 
 John Jeffkies, who with Dr. Edward Eeynolds, 
 founded the Massachusetts Charitable Eye and Ear In- 
 firmary, was born in Boston in 1796 and died in 1876. 
 He was the son of a distinguished surgeon of revolu- 
 tionary times. Dr. John Jeffries. In 1815 he graduated 
 in arts from Harvard College, and in 1819 received from 
 the same institution the degree of doctor of medicine. 
 He was one of Boston's most distinguished practitioners, 
 and from the foundation of the Massachusetts Chari- 
 table Eye and Ear Infirmary in 1824 until 1841 he was 
 one of its surgeons. "While he was recognized only as a 
 general practitioner, his ophthalmologic practice, never- 
 theless, was large. He was universally respected and 
 beloved as a citizen and as a physician. 
 
 Horatio Gates JAMESOisr was an early Baltimore 
 surgeon whose work included the treatment of diseases 
 of the eye. He was born in York, Pa., in 1788, and 
 died in Baltimore in 1855. He graduated in medicine 
 from the University of Maryland in 1813, and inune- 
 
 * From information Isindly furnished me by his grandson, Dr. 
 Edward Eeynolds, of Boston, and to whom also I am indebted for 
 the accompaning portrait. 
 
76 OPHTHALMOLOGY /X AMERICA. 
 
 diately located in Baltimore, where he soon attained 
 high rank as a surgeon and physician. He was the 
 founder in 1837 of the Medical Department of Wash- 
 ington College (afterward the Washington University 
 School of Medicine), Washington, Pa., and was its pro- 
 fessor of surgery from the time of its organization to 
 1835. Besides being a practical surgeon, he made numer- 
 ous contributions to surgical literature. Perhaps one 
 of the most important of these was the prize essay of 
 1827, on "Observations upon Traumatic Hemorrhage, Il- 
 lustrated by Experiments upon Living Animals," in 
 which he demonstrated anew the use and value of animal 
 ligatures. His teaching, however, on this subject, al- 
 though sustained by the authority of Dr. Physick, was 
 not appreciated by contemporary surgeons, and it was 
 forgotten until after the method became popular as one 
 of the features of antiseptic surgery. 
 
 Jameson, besides being an excellent surgeon, was also 
 a journalist of considerable note and was the author 
 of several books and papers on medical subjects which 
 received high commendation. 
 
 Although a distinguished general surgeon and prac- 
 titioner, it is his contributions to early American oph- 
 thalmology that especially concern us here, as he ap- 
 pears to have been much interested in diseases of the 
 eye. He undoubtedly included them in his surgical 
 practice and teaching and wrote some instructive pa- 
 pers pertaining to them. Dr. Harry Priedenwald^" cites 
 some of them which were published in Jameson's own 
 journal, The Maryland Medical Recorder. One was on 
 
 10. The Early History of Ophthalmology and Otology in Balti- 
 more (1800-1850), .Johns Hopkins Hospital Bulletin, August-Sep- 
 tember. 1897. 
 
OPHTHALMOLOGY IN AM-ERIGA. 77 
 
 the "Pathological Sympathy between the Bye and the 
 Larynx ;"^^ another was on "A Case of Enlargement of 
 the Eye Following the Entrance of Steel into the Bye/'^^ 
 probably panophthalmia; another was one describing 
 "Two Cases of Ossification of the Lens with Luxation 
 Through the Pupil/'^^ and anotlier was on "Amaurosis 
 Associated with Inordinate Thirst."^'' He also pub- 
 lished^^ another paper giving an account of the success- 
 ful removal of "An Encysted Tumor of the Orbit." 
 
 John Mason Gibson was another Baltimore man 
 who aspired to do ophthalmologic work and evidently 
 to make it an exclusive practice. He waf admitted into 
 the "Faculty" of Maryland in 1825. Very little is re- 
 corded of his life, but his ambition was made apparent 
 by the publication of a book entitled "Condensation of 
 Matter upon the Anatomy, Surgical Operations and 
 Treatment of Diseases of the Eye," in 1833. I shall 
 refer to this book elsewhere. 
 
 John Hakpek. — Still another surgeon of Baltimore 
 
 was John Harper ( 1831). He is mentioned by 
 
 Dr. Harry Priedenwald and also by Dr. E. M. Eeese 
 in his American edition of "Cooper's Dictionary of Prac- 
 tical Surgery" as one of the most successful surgeons in 
 this country. He was a native of Ireland and graduated 
 at Glasgow. He died in Baltimore in 1831. The Mary- 
 land Medical Recorder (vol. ii, p. 179) refers to him as 
 "well-known as an oculist." He was one of the early 
 surgeons who, according to Dr. Eeese,^" operated fre- 
 
 11. Maryland Sled. Recorder, 1831, il, 117. 
 
 12. Ibid., p. 601. 
 
 13. Ibid., p. 6'08. 
 
 14. Ibid., p. 664. 
 
 15. The American Medical Recorder of Philadelphia, xii, 340. 
 
 16. Cooper's Surg. Dictionary, 1842, i, 272. 
 
78 OPHTHALMOLOGY IX AMERICA. 
 
 quently for cataract. He seldom adopted any other 
 operation for it than the laceration of the capsule and 
 lens substance, repeated "as often as necessary on the 
 same eye." 
 
 Kathan E. Smith was another notable Baltimore 
 surgeon and teacher who was also eminent as an ophthal- 
 mic surgeon. He was born in Concord, N. H., in 1797 
 and died in Baltimore in 1887. He was the son of 
 the great physician and surgeon, Nathan Smith, of 
 New Haven, and received both his classical and medical 
 education at Yale, in which his father was one of the 
 professors. He graduated in medicine from that insti- 
 tution in 1833. Dr. Smith was successively attached to 
 medical schools in Philadelphia, Lexington, Ky., and 
 Baltimore, the principal part of his professional career 
 having been spent in the last mentioned city. He had an 
 inventive mind and added considerably to the instru- 
 mental and operative improvements of both surgery and 
 ophthalmology. Some of his ophthalmologic instru- 
 ments will be referred to later. Dr. Smith was the 
 grandfather of our distinguished colleague, Dr. Samuel 
 Theobald of Baltimore. 
 
 Samuel D. Gross. — It would be quite unjust to limit 
 my references entirely to those whom I have already 
 considered. Certain other surgeons of a little later 
 period were so active in this department of practice that 
 some mention should be made of them also. I wish 
 first to take note of Samuel D. Gross, who was not only 
 one of the greatest surgeons of his time, but practiced 
 ophthalmology and contributed to ophthalmologic liter- 
 ature from the earliest periods of his professional life 
 almost to the time of his death. In fact, at the time of 
 
DR. NATHAN E. SMITH (1707-1887). 
 
DR. SAMTJEL D. GROSS (1805-1884). 
 
OPHTHALMOLOGY IN AMERICA. 83 
 
 his graduation Ms thesis had for its subject "The Nature 
 and Treatment of Cataract," to the composition of which 
 he devoted unusual care and labor. In his autobiography 
 (toI. i, p. 39) he says: "I had seen many cases of this 
 disorder during my Philadelphia pupilage. ^^ It is a 
 subject which during my prolonged professional life has 
 deeply interested me." So prominent was he in ocular 
 surgery at the close of the first half of the nineteenth 
 century that he was elected one of the delegates from the 
 United States to the first international ophthalmologic 
 congress, held in Paris in 1857, and contributed to it an 
 important paper in regard to the prevailing eye diseases 
 of this country. He was also one of the first to operate 
 for strasbismus, and he wrote a valuable paper on the 
 subject, which was published in the Western Journal of 
 Medicine and Surgery in 1842. One of his cotemporaries 
 said that this article "abounded in discriminating criti- 
 cisms on popular errors on the subject and furnished the 
 best statistics on the subject anywhere to be found."^^ 
 
 Dr. Gross was born in 1805 and died in 1884. He 
 was a student of medicine of the celebrated Dr. George 
 McClellan, to whom I have already made reference, and 
 graduated from the JefEerson Medical College in 1838. 
 The first period of his career was in the then West (Cin- 
 cinnati and Louisville). He finally took up his resi- 
 dence in Philadelphia, and in 1856 M'as made professor 
 of surgery in the college from which he received his 
 medical degree. He was a voluminous writer, but one 
 of the most charming, clear and systematic of medical 
 authors. He will, of course, be especially remembered 
 
 17. Probably under Dr. McCleUan. 
 
 18. Dr. Beese in Cooper's Surgical Dictionary, Am. Ed., 1842, 
 p. 128 of supplement. 
 
84 OPHTHALMOLOGY IN AMERICA. 
 
 for his "System of Surgery," the first edition of which 
 appeared in 1859. A man of his versatility, of his sur- 
 gical judgment and skill and of his diversified practice 
 will never be forgotten; and, inasmuch as he was so 
 distinguished in ophthalmologic practice, our own "cult" 
 should show him special homage. 
 
 Alfred C. Post. — Still another practitioner who con- 
 tributed to the advancement of ocular surgery was 
 Alfred C. Post, who lived and practiced in New York 
 City. He was born in 1806 and died in 1886. He grad- 
 uated in arts from Columbia College in 1822 and from 
 the College of Physicians and Surgeons in medicine in 
 1827. He afterward continued his medical studies in 
 Paris, Berlin, Vienna and London, returning to New 
 York in 1829, where he began the practice of surgery. 
 As a teacher of surgery he served first the College of 
 Physicians and Surgeons, and afterward the Medical De- 
 partment of the University of the City of New York. As 
 a surgeon he was attached, at different times, to the New 
 York Hospital, the Presbyterian Hospital, St. Luke's 
 Hospital and others. He achieved great fame in sur- 
 gery, being noted for precision and dexterity in his 
 operations. He also exercised much mechanical inge- 
 nuity in devising instruments and methods of operating, 
 laboring, particularly to improve plastic surgery, both 
 generally and in the region of the eye. His first case 
 of blepharoplasty was reported as early as 1842, in a pa- 
 per entitled "Blepharoplastic Operations for the Cure 
 of an Aggravated Case of Ectropion."" He also read an 
 important paper on the same subject before the American 
 
 19. Xew Yoik Medical Gazette, vol. ii, 1842, p. 23. 
 
DR. ALFKED C. POST (1800-1S86). 
 
OPHTHALMOLOGY IN AMERICA. 89 
 
 Medical Association in 1878.^" His deep interest in 
 ocular surgery was manifest on various occasions and 
 should not be forgotten. His principal writings were 
 published in medical periodicals, with the exception of 
 a small volume on strasbismus, which was issued in 1841. 
 Dr. Post was the son of Joel Post and was born in New 
 York, where he lived during his whole life. 
 
 John H. Dix. — Belonging to this period was John H. 
 Dix. He was born in Boston in 1813 and died there in 
 1884. He graduated in arts from Harvard College in 
 1833, and in medicine from Jefferson Medical College, 
 Philadelphia, in 1836. He at once began the practice of 
 medicine in his native town, giving especial attention 
 to diseases of the eye. In 1846 he visited Europe, where 
 he continued his study of this subject. At home he was 
 one of the most active workers in that field, and was a 
 frequent contributor to the ophthalmologic literature of 
 his time. He was always alert to the latest discoveries 
 and was the first-^ in America to follow the example of 
 DiefEenbach in the operation for strabismus, reporting 
 his case in September, 1840. He again operated Oct. 16, 
 1840, in the presence of Drs. Eeynolds, Jeffries, Hooper, 
 Bethune and Charles Ware.^^ He is said to have been 
 a skilful operator and a very close and discriminating 
 observer. 
 
 D. Hates Agnew. — Only a brief sketch can be given 
 here of this great surgeon, although, like others to whom 
 I have similarly referred, he is worthy of a more de- 
 tailed presentation and study. He came into surgical 
 
 20. Transactions of the American Medical Association, vol. xxzix, 
 1878, p. 353. 
 
 21. Boston Medical and Surgical Journal, Sept. 30, 1840. 
 
 22. Medical Examiner, Philadelphia, 1840, iii, 760. 
 
90 OPHTHALMOLOQY IN AMERICA. 
 
 prominence soon after Dr. S. D. Gross had risen to liis 
 zenith. He, too, practiced ophthahnolog)' in connection 
 with general surgery. He was born in Nobleville (now 
 Christiana), Lancaster County, Pa., in 1818, and died 
 in Phihidelphia in 1892. His father was a ph3rsician 
 of local renown and Ijelonged to the family of Agnews, 
 who have been more or less distinguished both in Europe 
 and America since the iSTorman conquest of England. 
 Young Agnew received a good classical education, al- 
 though he never took a degree in arts. He studied med- 
 icine witli his father, and in 183G entered the Medical 
 Department of the University of Pennsjdvania, from 
 which he graduated in 1838. He then returned home 
 and for five years practiced with his father, after which 
 he endeavored to establish himself elsewhere in different 
 places, but without success. Between the years 1844 
 and 1847 he undertook a business enterprise, which re- 
 sulted in failure. He then returned again to the prac- 
 tice of his profession, first in the country and afterward 
 in Philadelphia. He removed to that city in 1848 and 
 at once began a career of teaching and practice which 
 culminated in his being one of the most famous sur- 
 geons in the United States. It would be untimely for 
 me to take note of the various steps which led up to such 
 renown. In a general way I may say that his profes- 
 sional relations to hospitals were numerous. His pop- 
 ularity as a teacher, both in his private schools and in 
 the University of Pennsylvania, was unrivaled. As a 
 writer he contributed many papers and monographs to 
 the literature of surgery of much value. The great 
 work, howevei'. of his life and that which will stand as 
 an enduring monument to his memorv was tlie "Prin- 
 
DI!. D. HAYES AGNEW (1818-1802). 
 
OfUTHALMOLOGY IN AMERICA. 93 
 
 ciples and Practice of Surgery," in three volumes, the 
 first being published in 1878 and the last in 1883. 
 Immediately after its publication Dr. Gross was asked 
 what he thought of it, and in his impressive style 
 he said : "I sat up nearly the whole of the night 
 before last reading this work, and I will venture to as- 
 sert that 'Agnew's Surgery' will be read and consulted 
 by the medical world long after the dust has settled for- 
 ever on the covers of similar works." To an added in- 
 quiry, "How do you think it compares with your own 
 work ?" Dr. Gross modestly replied : "Why, sir, mine 
 is in comparison a pigmy." In a letter to Dr. Agnew 
 later Dr. Gross said : "You have produced a great and 
 noble work, one creditable alike to yourself, your pro- 
 fession and your country." The subject of diseases of 
 the eye was carefully and fully considered, and the sec- 
 tion devoted to it gives ample evidence of the author's 
 familiarity with it. It is a most creditable production. 
 
 Dr. Agnew's personality was impressive and attrac- 
 tive. He was tall, like his ancestors. It is said that 
 his father, who was the shortest of seven brothers, had 
 a height of six feet and two inches, the tallest of the 
 seven being six feet and seven inches.. As a man and 
 physician (and he practiced "internal medicine" as well 
 as surgery to the end of his life) he was greatly honored. 
 He was never morose, never discouraged, always calm 
 exteriorly. Although reticent and undemonstrative, he 
 was always cheerful. He had no jealousies and was ever 
 ready to assist the weak and struggling practitioner. 
 He did not attain his preeminent position in surgery 
 suddenly. The first fifteen years of his professioital 
 
94 OPHTHALMOLOGY IS AMERICA. 
 
 life seemed to him fruitless and unsatisfactorj', but by 
 patient industry and tireless application, wise judgment, 
 thorough knowledge, consummate skill, honest ' purpose 
 of word and act, he rose to a distinction in the profes- 
 sion seldom attained. 
 
 Dr. Agnew took great interest in ophthalmic surgery 
 and was one of the surgeons to Wills Eye Hospital from 
 1864 to 1868. ,He was an expert operator on the eye, 
 and his thorough knowledge of the subject is made evi- 
 dent by the manner in which he has presented it in his 
 "Surgery." 
 
 William Clay Wallace. — A man who will long be 
 remembered, not for his eminence in the profession, 
 but for a work on the comparative anatomy of the eye. 
 and especially of the ciliary muscle of that organ, includ- 
 ing its physiology, is William Clay Wallace of New York 
 City, who styled himself "oculist." It is because of Dr. 
 Wallace's work on the ciliary muscle, which included 
 original and careful dissections, and his theory of the 
 accommodation of vision to different distances, that I 
 hereby refer to his name. I am, however, unable to ob- 
 tain a sketch of his life. I shall refer to his work in 
 another connection. 
 
 That Dr. Wallace had a recognized standing is proved 
 by the fact that Dr. Eeese included him in his list of 
 American surgeons who were his collaborators in pro- 
 ducing the American edition of "Cooper's Surgical Dic- 
 tionary" in 1843. 
 
 Me. Heney Howard — In the history of the ophthal- 
 mology of Montreal I find one man who early undertook 
 to limit his practice exclusively to the treatment of dis- 
 
OPHTHALMOLOGY IN AMERICA. 95 
 
 eases of the eye. This man was Mr. Henry Howard. He 
 studied this subject undoubtedly with a great deal of 
 care under the instruction of the distinguished Professor 
 Arthur Jacob of Dublin Ireland, and he was found en- 
 gaged in this special practice in Montreal for several 
 years beginning in 1846. 
 
IV. 
 
 THE AMERICAN LITERATURE OS OPHTHALMOLOGY 
 DURING THE FIRST HALF OF THE NINE- 
 TEENTH CENTURY. 
 
 The books that were published during this period by 
 American authors were few and their merits varied. 
 Some were excellent both in subject matter and style and 
 others were inferior. Several English works were re- 
 published in this country with the revisions and addi- 
 tions of our best men. I will speak of this literature 
 very briefly. 
 
 THE FIRST AMBEICAig- BOOK ON" DISEASES OF THE BYE. 
 
 The first American book on ophthalmology was that 
 of Dr. Prick entitled : "A Treatise on the Diseasei of the 
 Eye, Including the Doctrines and Practice of the Most 
 Eminent Modern Surgeons, and Particularly those of 
 Professor Beer. By George Prick, M.D., Ophthalmic 
 Surgeon to the Baltimore General Dispensary. With 
 an engraving. Baltimore : Fielding Lucas, Jun., 1823." 
 
 This is an octavo volume of xx-320 pages, with one 
 plate illustrating instruments for operation for cataract. 
 
 The book is a precious souvenir of the early ophthal- 
 mology of America, first, because it was the first Ameri- 
 can treatise on diseases of the eye, and, second, because it 
 was the production of a young man who had had un- 
 excelled training and a diversified experience under the 
 tutelage of Dr. George Beer of Vienna, the greatest 
 ophthalmologist that the world had then ever known. 
 
Ol-MTHALUOLOGy IN AMERICA. 97 
 
 The author says in the introduction that the volume is 
 little more than the abstract of a course of lectures 
 which he had prepared on diseases of the eye and repre- 
 sents the teaching of Dr. Beer, to which "he has en- 
 deavored to add what he has conceived most important 
 from the experience and practice of others, together with 
 such remarks as his own observations have supplied.'^ 
 
 The arrangement "is founded on the variety of tex- 
 tures which enter into the structures or composition of 
 the eye, and is comprehended under four general divi- 
 sions. The first includes the various forms of inflam- 
 mation of the eye; the second the effects of sequelae of 
 this inflammation; the third comprehends the various 
 diseases of the appendages, and the fourth such diseases 
 as attack at the same time several or all of the tissues of 
 the organ." 
 
 Dr. Prick laments "that the pathology of the eye has 
 not kept progress with the advanced state of pathologic 
 science in general, and this is attributable, no doubt, to 
 the circumstances that this branch of the healing art has 
 been confined for so long a time to exclusive oculists," 
 and also that diseases of the eye have "obtained but a 
 small share of the attention of the profession." The 
 work is a model, from the literary standpoint, and is 
 clear and concise in expression. 
 
 I can not dwell on the contents of this book, but I 
 wish to call particular attention to his chapter on, cat- 
 aract. After describing, with the utmost clearness, the 
 nature of cataract and the different methods of its treat- 
 ment, including its extraction and absorption, he comes 
 to the following conclusion : 
 
98 OPHTHALMOLOGY IN AMERICA. 
 
 We may lay it down, as a general rule, to extract in all such 
 cases where the cataract occurs in a healthy subject, without 
 any complication of other disease, and is of the species denom- 
 inated dura, where the eye remains firm and quiet under the 
 knife, where the pupil is large and dilated, and where the 
 anterior chamber is large and full. These are on the whole 
 the most favorable eases for any operation, (p. 214.) 
 
 On page 175 he defines tlie most important proper- 
 ties of a good knife, and such a knife, it seems to me, 
 would meet the most refined requirements of those who 
 to-day perform the flap operation. His description of 
 the operation represents also the ideal of mechanical 
 technic. 
 
 He says that in extraction "many circumstances may 
 occur to mar the success of the operation. The most 
 important of these is a section of the cornea of insuf- 
 ficient magnitude to admit of the easy escape of the 
 lens." Operators of to-day all agree with Dr. Prick in 
 this regard. 
 
 On the whole, our first American treatise on the eye 
 was a fine example of what a manual should be, and for 
 many years it was the leading text-book on the subject 
 in this country and was recommended by teachers and 
 surgeons. 
 
 His work was so well thought of in England that it 
 was republished there in 1826 with notes by Eichard 
 Welbank. 
 
 THE WORK OF JOHN MASON GIBSON. 
 
 "A Condensation of Matter on the Anatomy, Surgical 
 Operations and Treatment of Diseases of the Eye, To- 
 gether with Eemarks. Embellished with Twelve Litho- 
 graphic Plates, Illustrative of the Anatomy and Morbid 
 Appearance. By John Mason Gibson, Member of the 
 
OPHTHALMOLOGY IN AMERICA. 99 
 
 Medical and Chirurgical Faculty of Maryland. Balti- 
 more : Published by W. E. Lucas, 1833." 
 
 This was the second- American book on the eye and its 
 diseases. It is a small quarto volume of 204 pages, be- 
 sides the plates and the descriptions of them. As a con- 
 tribution to ophthalmologic literature it was practically 
 a failure. It was badly written, illy arranged, in many 
 cases incorrect as to facts, and the illustrations were 
 very inferior. It is a book that is scarcely ever heard of, 
 and deserves oblivion. 
 
 littell's manual. 
 
 "A Manual of the Diseases of the Eye. By S. Lit- 
 tell, Jr., M.D., one of the surgeons of the Wills Hospital 
 for the Blind and Lame ; Fellow of the College of Physi- 
 cians of Philadelphia, etc. Published by John S. Littell, 
 Philadelphia, 1837." 
 
 In 1846 a second American edition was published by 
 Hogan and Thompson, of Philadelphia, under the title, 
 "A Manual of the Diseases of the Eye : Or, Treatise on 
 Ophthalmology." 
 
 This manual of Dr. Littell was not a compilation 
 merely, but it represented, especially in the last edition, 
 the results of the large experience of himself and his 
 colleagues in the Wills Hospital. It not only received 
 the highest commendation in this country, but also in 
 Great Britain. The British and Foreign Medico-Ohi- 
 rurgical Review, at the time of its publication, said : 
 
 It is no small triumph to Dr. Littell to be able to say that 
 he has introduced almost all that is valuable and everything 
 absolutely necessary to the student within a compass of 250 
 pages. ... It is replete with information, yet so terse in 
 style and compressed in bulk, as at once to entice and repay 
 perusal. 
 
100 OPHTHALMOLOGY IN AMERICA. 
 
 It was thought so well of in London that the first 
 edition was revised and enlarged by Hugh Houston, 
 Member of the Royal College of Surgeons, London, and 
 published there by John Churchill in 1838. 
 
 WORK OF HENKT HOWARD. 
 
 "The Anatomy, Physiology and Pathology of the 
 Eye. By Henry Howard, M.E.C.S., Surgeon to the 
 Montreal Bye and Ear Institution. London: John 
 Churchill. Montreal: Armour and Eameey. 1850." 
 
 This is an octavo volume of xii-518 pages, and is 
 a good compilation, representing, without great detail, 
 the ophthalmology of the last part of the first half of 
 the nineteenth century. Mr. Howard had been a stu- 
 dent of the celebrated Dr. Arthur Jacob, of Dublin, and 
 "for the last four years, as surgeon to the Montreal 
 Eye and Ear Institution, has devoted his labors exclu- 
 sively to the treatment of diseases incident to these or- 
 gans." The work is well arranged, is clearly written, 
 and, although not containing anything new, is a cred- 
 itable production. It covers the ground indicated by its 
 title, and due proportion is preserved throughout in its 
 various divisions. 
 
 WILLIAM CLAY WALLACE'S BOOKS. 
 
 Another small book which attracted much attention 
 was by William Clay Wallace. It was first published in 
 1836. The second edition, 1839, which is in my posses- 
 sion, was entitled, "A Treatise on the Eye, Containing 
 the Discoveries of the Cause of Near and Par Sighted- 
 ness, and of the Affections of the Eetina, with Eemarks 
 on the Use of Medicines as Substitutes for Spectacles." 
 This edition was a 12mo volume of about ninety pages, 
 
OPHTHALMOLOGY IN AMERICA. 101 
 
 and dealt with the anatomy of the eye of both man and 
 some of the lower animals. The last chapter of this 
 volume was reprinted from an article read before the 
 New York Medical and Surgical Society, Oct. 31, 1837. 
 The volume has very little intrinsic merit. In 1841 a 
 third edition was issued, somewhat modified, and with 
 the title, "Wonders of the Vision: A Treatise on the 
 Eye." Illustrated. This edition I have not seen. 
 
 In 1850 Dr. Wallace published another book of thir- 
 ty-six pages in duodecimo form, entitled "The Accom- 
 modation of the Eye to Distances." Xew York: John 
 Wiley, publisher. While containing some of the subject 
 matter and illustrations of the previous volumes, this, 
 on the whole, was an entirely different work. The au- 
 thor says : "The substance of the following essay has al- 
 ready appeared in Silliman's Journal for 1835, the Lon- 
 don Medical Gazette for 1842, and the Boston Medical 
 andSurgical Journal for 1844." The distinctive features 
 of this essay are the description of the structure of the 
 ciliary body based on the author's own dissections, and 
 contains his theory of its functions and of the "accom- 
 modation of the eye to distances." The current opinion 
 of his work in 1839 was expressed by Professor Knight, 
 of Yale College, as follows : 
 
 "He has made interesting discoveries which throw 
 much light on hitherto obscure points in the physiology 
 ef vision." 
 
 Professor Silliman said : "I have been very f avorabl}' 
 impressed by his various communications on the eye and 
 topics relating to that organ." 
 
 Sir David Brewster, at the eighth meeting of the 
 British Association for the Advancement of Science, 
 
102 OPHTHALMOLOGY IN AMERICA. 
 
 laid before the meeting a series of preparations of the 
 eye made by Dr. Wallace which, he said, were calculated 
 to establish some important points in the theory of vision. 
 
 JAMES W. POWELL OK THE EYE. 
 
 "The Eye: Its Imperfections and Their Prevention," 
 published by the author, 1847. 
 
 This is a §mall octavo volume of 140 pages, pub- 
 lished, probably, more for the purpose of advertising 
 the author than of enlightening the profession. It deals 
 in the most meager manner with the "anatomy and 
 physiology of the organ of vision, rules for the preven- 
 tion, improvement and restoration of sight, with re- 
 marks on near sight and aged sight, on optics, and the 
 uses and abuses of spectacles, with directions for their 
 selection." The author signs himself a member of the 
 College of Surgeons of Ireland and "oculist and aurist," 
 and says his hours of attendance at his residence and 
 office, 261 Broadway, New York, are from 9 to 4. At 
 the conclusion of the book he wishes, also, to inform per- 
 sons residing at a distance that they may obtain his 
 "opinion on various affections of the eye and ear by 
 writing a description of their case and enclosing a fee 
 of three dollars." Dr. Powell was a pupil of the cele- 
 brated Dr. Arthur Jacob, of Dublin, whose lectures, 
 and those of others, he attended from 1838 to 1833. 
 Undoubtedly Dr. Powell was a well-informed man, but 
 his book shows that a commercial spirit dominated cer- 
 tain physicians half a century ago, as well as in our own 
 time. 
 
 VrOEKS ON STRABISMUS. 
 
 As soon as Dr. Dieffenbach, of Berlin, had published 
 his operation for strabismus, the profession of the world 
 
OPHTHALMOLOGY IN AMERICA. 103 
 
 was very much aroused over a procedure which appar- 
 ently gave such marvelous results. As has always been 
 the case, American surgeons caught the enthusiasm and 
 many were the reports of operations made by them 
 throughout the United States, and many were the im- 
 provements that were suggested. A number of "treat- 
 ises" were also soon published. It is the latter that I 
 desire to chronicle in this connection. 
 
 As I have already stated, Dr. John H. Dix, of Boston, 
 is said to have been the first to perform DiefEenbach's 
 operation in the United States. In 1841 he published a 
 small book covering the causes, symptoms and operative 
 treatment of strabismus.- It is entitled "A Treatise on 
 Strabismus, or Squinting, and the New Mode of Treat- 
 ment." 
 
 In the same year, 1841, Alfred C. Post, of New York, 
 published a small 16mo volume on the same subject, 
 with excellent colored plates, illustrating the anatomy 
 of the muscles involved, the instruments used, and the 
 methods of operation. It was entitled "Observations on 
 the Cure of Strabismus, with an Appendix on a New 
 Operation for the Cure of Stammering." 
 
 Following the small works of Dix and Post was that 
 of James Bolton, of New York, in 1843, which he enti- 
 tled "A Treatise on Strabismus, With a Description 
 of New Instruments Designed to Improve the Oper- 
 ation for Its Cure, in Simplicity, Ease and Safety." 
 This was a small octavo volume treating the subject of 
 strabismus very much as the others had done. Bolton 
 was a young man and had undoubtedly been attending 
 the clinics at the New York Eye Infirmary, and, 
 through one of his teachers. Dr. John Kearney Eodgers, 
 
104 OPHTHALMOLOGY IN AMERICA. 
 
 to whom he dedicated the Tolume, he had hecome very 
 much interested in the subject, had studied it carefully, 
 and embodied in his "treatise" the best conclusions of 
 the time. 
 
 Four years after the works of Dix and Post, Dr. 
 Frank H. Hamilton, at that time professor of surgery 
 in Geneva Medical College, Geneva, N. Y., published a 
 very small 16mo volume, entitled "A Monograph on 
 Strabismus, with Cases." Buffalo, N. Y., 1845. It was 
 scarcely more than a bound pamphlet, which, he stated, 
 was for the use Of his medical students. 
 
 WEAKNESS OE SIGHT. 
 
 Another small book which attracted considerable at- 
 tention was one by John H. Dix, of Boston, entitled 
 "Treatise on the Nature and Treatment of Morbid Sen- 
 sibility of the Eetina, or Weakness of Sight." Boston, 
 1849. This little book was the republication of an 
 essay which gained the Boylston prize for 1848, and, 
 from the standpoint of ophthalmologic knowledge then, 
 it was esteemed an important contribution. 
 
 Aside from the binding into book form of a few 
 papers of minor importance, no other ophthalmologic 
 books than those above mentioned were written by 
 Americans having a professional standing during the 
 first half of the nineteenth century. 
 
 AMEHICAN EDITIONS OE ENGLISH WORKS ON DISEASES OF 
 THE EYE. 
 
 I will now supplement the above notices of American 
 works on the eye by a list of English works which were 
 republished in this country under the editorial super- 
 vision of American practitioners. Several works were 
 
Ol'UTHALMOLOGY IN AMERICA. 105 
 
 also republished here, besides the ones that I shall men- 
 tion, such as the works of Saunders, Vetch, and early 
 editions of Lawrence and Mackenzie, but without Amer- 
 ican revision. The first in the list was Delafield's edi- 
 tion of Travers' work: "A Synopsis of the Diseases of 
 the Bye and Their Treatment, to Which Are Prefixed a 
 Short Anatomical Description and a Sketch of the 
 Physiology of That Organ, by Benjamin Travers, 
 F.E.S.; surgeon to St. Thomas' Hospital, with notes 
 and additions by Edward Delafield, M.D., surgeon to 
 the New York Eye Infirmary and lecturer on diseases 
 of the eye. First American from the third London 
 edition. Published by E. Bliss and E. White, New 
 York, and H. C. Carey and I. Lea, Philadelphia, 1835," 
 8vo, pp. xxi-474. 
 
 This book was brought out by Dr. Delafield in this 
 country not long after he and Dr. Eodgers organized 
 the New York Bye Infirmary. In its English form, 
 the work was a very desirable maniaal, but its value was 
 materially enhanced by the numerous additions and 
 notes, as well as illustrations, which Dr. Delafield incor- 
 porated. 
 
 "A Treatise on Diseases of the Bye, by William 
 Lawrence, E.E.S. A new edition, with many modifica- 
 tions and additions, and the introduction of nearly two 
 hundred illustrations by Isaac Hays, M.D." 8vo, pp. 
 900. Philadelphia : Lea & Blanchard, 1847. 
 
 William Lawrence's work on the eye was encyclopedic 
 in character, and in its revised and enlarged form it was 
 cordially received by the American profession. 
 
 "Principles and Practice of Ophthalmic Medicine and 
 Surgery, by T. Wharton Jones, F.E.S., etc., with 102 
 
106 OPHTHALMOLOGY IN AMERICA. 
 
 illustrations. Edited by Isaac Hays, M.D., surgeon to 
 Wills Hospital." 12mo, pp. 510. Philadelphia Lea & 
 Blanchard, 1849. 
 
 This work of Mr. Jones was issued by the same pub- 
 lishers and under the same editorial supervision as that 
 of Lawrence. It was more concise and was intended to 
 serve the profession in another way. In the words of 
 the editor, "it was one of the series of manuals in- 
 tended for students. By its conciseness and systematic 
 arrangement the author was enabled to embody such ma- 
 terial as would be suitable for the student within a 
 small compass." 
 
 "Spectacles: Their Uses and Abuses in Long and 
 Short Sightedness, and the Pathologic Conditions Ee- 
 sulting from Their Irrational Employment, by J. 
 Sichel, M.D. Translated from the French by permis- 
 sion of the author by Henry W. Williams, M.D. Bos- 
 ton : Phillips, Sampson & Co., 1850." 
 
 This was not a republication of an English author, 
 but was a translation of an excellent French work by the 
 learned Dr. Sichel, which gave the latest views on the 
 abnormal refractive conditions of the eyes, several of 
 which, he believed, were caused by the abuse of spec- 
 tacles. While these views have radically changed since 
 that time by the teachings of Donders, yet the book ha? 
 a recognized historical value. 
 
 PUBLICATIONS IN MEDICAL PERIODICALS. 
 
 From the very beginning of the last century our 
 American medical periodicals have always been more or 
 less alive to the importance of that department of medi- 
 cine pertaining to diseases of the eye. The American 
 Medical Recorder, the Journal of the Medical and Phys- 
 
OPHTHALMOLOGY IN AMERICA. 107 
 
 ical Sciences^ and the successor to both of these, The 
 American Journal of the Medical Sciences, of Philadel- 
 phia, and the contemporary New England Journal of 
 Medicine and Surgery, of Boston, and several medical 
 journals that were started at about the same time in New 
 York and the West, all contain articles of more or less 
 ophthalmologic interest. 
 
 Dr. Flick, of Baltimore, in 1821, 1832 and 1823, 
 contributed, each year, to the American Medical Re- 
 corder (Philadelphia). His articles were on the sub- 
 jects of conjunctivitis, cataract and the various modes 
 of operating, and on modes of operating for artificial 
 pupil. They were in reality an extended summary of 
 what was known in regard to those subjects at that 
 time, and to the medical historian are to-day of much 
 interest. Since Prick published his book, little or noth- 
 ing is found written by him. 
 
 The writings of Dr. Isaac Hays were almost without 
 exception published in the journals in which he had an 
 editorial interest. As early as 1826 and 1827 we find 
 long and well written articles on inflammation of the 
 conjunctiva and of the sclera, in 1828 on the diseases of 
 the cornea and their treatment. From that time to 
 1850 he published many valuable and interesting papers, 
 abstracts and discussions on various ophthalmologic sub- 
 jects. 
 
 Dr. Littell was not a prolific writer. The few arti- 
 cles, however, that he did write were published in the 
 same journals as those of Hays, and were meritorious. 
 The most frequent contributors in Boston to medical 
 journals were John Jeffries (a few reports), John H. 
 Dix with great frequency, and later George A. Bethune. 
 
108 OPHTHALMOLOGY IN AMERICA. 
 
 The ophthalmologic contributors in New York, Balti- 
 more, Louisville, Cincinnati and other cities were less 
 numerous, ' but after the announcement, through the 
 medical journals, of Dieffenbach's operation for strabis- 
 mus, the periodical literature on that subject became 
 quite voluminous and was widelj^ scattered throughout 
 America. In fact, there was so much of it that I shall 
 not undertake to review it. 
 
 Many reports on rare eases of diseases of the eye, 
 many experiences and different views on ophthalmologic 
 subjects were published here and there in the numerous 
 medical periodicals of the United States. These are 
 so diversified in character and the authors so many that 
 they, too, cannot be specifically referred to. One feature 
 of medical journalism in this country, embodied espe- 
 cially in The American Journal of the Medical Sciences, 
 was reports of the progress of the medical sciences, with 
 a department given up exclusively to ophthalmology. I 
 believe it is impossible to measure the good that Dr. 
 Hays did to the American profession by publishing, 
 from quarter to quarter, the essentials of the current 
 ophthalmologic contributions of the world. The ab- 
 stracts were of sufficient length to make the subjects 
 under discussion intelligible, and, through this channel 
 alone, he advanced very materially the knowledge of 
 ophthalmology in this country. At the time when this 
 was done it was impossible for any but an experienced 
 ophthalmologist, like Dr. Isaac Hays, to realize the 
 professional needs and to be able to supply them so well. 
 For this, if nothing else, ophthalmology, to-day, owes 
 this great man an undying gratitude. 
 
OPHTHALMOLOGY IN AMERICA. 109 
 
 THESES. 
 
 Besides the journalistic contributions, I find a num- 
 ber of theses, or dissertations on the eye or its diseases, 
 of special interest, and among them I may mention one 
 on cataract by Isaac Cleaver, University of Pennsylva- 
 nia, 1805 (dedicated to Dr. Phillip Syng Physick) ; 
 another on the nature and treatment of cataract, by 
 Samuel D. Gross, Jefferson Medical College, Philadel- 
 phia, 1828 (dedicated to George McClellan), and still 
 another on the same subject by Arthur B. Stout, College 
 of Physicians and Surgeons, New York, 1837 (dedi- 
 cated to Drs. Edvi^ard Delafield, John Kearney Eodgers 
 and James Edward Cornell) ; one on the eye and on 
 vision by Elisha DeButts, University of Pennsylvania, 
 1805 (dedicated to Dr. Casper Wistar) ; one on oph- 
 thalmia, by David Morre, University of Pennsylvania, 
 1807 (dedicated to Drs. John Claiborne and John 
 B. Walker, both of Virginia), and one on Iritis, by 
 Richard Kissam, College of Physicians and Surgeons, 
 New York, 1839 (dedicated to Drs. Edward Delafield 
 and John Kearney Eodgers). These essays have dis- 
 tinct merit as representing the knowledge of the times 
 in which they were written. There undoubtedly were 
 many other theses on ophthalmologic subjects, but these 
 serve to indicate that ophthalmology was by no means 
 entirely neglected in the teachings of our early medical 
 schools. 
 
V. 
 
 SOME SPECIAL AMERICAN CONTRIBUTIONS TO 
 OPHTHALMOLOaY. 
 
 In times past, as well as to-day, there have been many 
 evidences of great surgical originality and insight on the 
 part of Americans. In some instances they have been 
 shown by suggestions, in others by demonstrating im- 
 portant procedures and devices. When Dieffenbach's 
 operation, for example, had been made public, it was 
 found that the same operation had long before been 
 suggested and even performed in this country. The 
 great misfortune was that the genius of our American 
 surgeons had not always been put more fully into light 
 and recorded. 
 
 DR. INGALLS' SUGGESTION OP THE OPERATION FOR 
 STRABISMUS 
 
 was made as early as 1813, as is proved by the follow- 
 ing: 
 
 Pkovidence, Feb. 8, 1841. 
 
 To the Editors of the Medical Examiner. 
 
 Gentlemen: — I have this day received the following letter 
 from Samuel Y. Atwell, Esq., of this city, in which he gives 
 the credit of having first suggested the operation for strabis- 
 mus to Dr. William Ingalls of Boston. 
 
 Mr. Atwell is an eminent member of the legal profession in 
 this state, and his statements are worthy of the highest credit. 
 
 I think it due to Dr. Ingalls that the fact of his having first 
 suggested the operation, should be made known to the profes- 
 sion. 
 
OPHTHALMOLOGY IN AMERICA. Ill 
 
 I also send you notes of two eases of strabismus on which J 
 have operated successfully. Yoiu: obedient servant, 
 
 Henry Whbaton Riyebs, M.D. 
 
 Providence, Feb. 8, 1841. 
 
 Dear Sir: — I observe from the newspapers that you have 
 operated with great success in several eases of strabismus, or 
 squinting. I have also noticed this operation spoken of as a 
 new discovery in the art of surgery, and is said to have lately 
 originated in Germany. Now, sir, I think we should give honor 
 where honor is due. In the years 1812 and '13 I attended 
 courses of surgical and anatomic lectures delivered before the 
 Medical School of Brown University, by William Ingalls, M.D., 
 of Boston, then the professor of anatomy and surgery in that 
 institution; being subject myself to this infirmity (strabismus). 
 Dr. Ingalls took frequent opportunities to explain to me the 
 method of its surgical cure; he did this by diseecting the eye 
 itself, explaining the power and disposition of several muscles 
 appertaining to that organ, and showed me how by division 
 of one or more of them, the eye might be brought to its proper 
 place. In my own case I know he proposed to divide the 
 rectus internus. So strongly was I impressed with the prac- 
 ticability and success of this operation, that I strongly urged 
 my father to permit me to submit to the operation; but upon 
 the nature of the operation being explained to him, he de- 
 clined the permission, because he feared the eflfeet might be to 
 turn the eye the other way. 
 
 I make this statement in justice to my friend and quondam 
 master, and to show that we have surgeons in this country as 
 learned in their profession as some in Europe. Respectfully, 
 your obedient servant. Samuel Y. Atweli,. 
 
 To Henry W. Rivers, M.D., Providence, R. I. 
 
 Then follows a report of two eases successfully oper- 
 ated on by Dr. Elvers on Dec. 33, 1840, and Jan. 13, 
 1841, respectively, by dividing the rectus muscle (ex- 
 
112 OPHTHALMOLOGY IN AMERICA. 
 
 terniis, first case, divergent; internus, second case, cou- 
 vergent).^" 
 
 Soon after that William Gibson, who was then pro- 
 fessor of surgery at the University of Maryland, actual- 
 ly operated for this condition. Dr. M. D. Reese, in 
 1842, in his supplement to the "Surgical Dictionary" of 
 Samuel Cooper (p. 187), refers to the subject in thesfi 
 words : 
 
 It appears from the "Institutes of Surgery" that Professor 
 Gibson attempted the cure of strabismus by dividing the recti 
 muscles of the eye precisely as now practiced, some twenty 
 years since in Baltimore. Soon after, he repeated it unsuc- 
 cessfully, in Philadelphia, in several cases, and was induced to 
 abandon it by the unfavorable opinions expressed on the 
 operation by Dr. Physielc. He, however, inculcated the propri- 
 ety of the operation on his class many years since, and Dr. A. 
 E. Hosack of New York, then one of his pupils, distinctly 
 recollects Dr. Gibson's expressions of confidence that the opera- 
 tion would ultimately succeed. 
 
 Dr. Gibson himself in the sixth edition of his "Insti- 
 tutes of Surgery," published in 1841, describes in detail 
 the operations which he performed in 1818, and also 
 adds that on the advice of Dr. Physick he was led to 
 abandon these experiments. His reference to the sub- 
 ject will be found on page 375 of his work. 
 
 Dr. Harry Friedenwald, of Baltimore, in his "Early 
 History," etc., quotes Dr. Gibson's remarks in full. 
 
 GIBSON^S SCISSOES FOR OPERATION OF ABSORPTION OP 
 CATARACT. 
 
 William Gibson,^* then professor of surgery, TJniver- 
 -sity of Pennsylvania, in 1821, described an instrument 
 
 23. Philadelphia Medical Examiner, iv, 119. 
 
 24. Phila. Jour. Med. and Phys. Sol., 1821, ill, 192. 
 
OPHTHALMOLOGY IN AMERICA. 113 
 
 for "cutting to pieces the crystalline lens in all cases of 
 cataract." It was a pair of scissors, thus described : 
 
 So delicate as hardly to exceed, in size, the iris knife of Sir 
 William Adams, and at the same time, so strong and sharp aa 
 to cut, with ease, the most solid and compact lens and cap- 
 sule, without injuring, in the slightest degree, any part of the 
 eye. These scissors are formed on the principle of Mr. Willas- 
 ton's scissors, used for common purposes — with the edge so 
 constructed as to operate like a knife. On this account, the 
 instrument perforates the coats of the eye with the utmost 
 facility, and when introduced, the blades can be opened to a 
 certain extent so as to cut the lens to pieces without bruis- 
 ing it or any other part — the necessary effect of scissors, as 
 they are usually made. This instrument possesses another 
 advantage — the lens is supported in its natural situation dur- 
 ing the operation, by having one blade behind, and the othei/ 
 before it, so that it may be cut to pieces, in situ, and its 
 remains afterwards forced, by the shut blades, into the an- 
 terior chamber, for dissolution. 
 
 At the tiine Dr. Gibson suggested this instrument, 
 "dissolution" of cataract had become a popular method 
 of operating through the influence of Saunders and 
 Adams, of London, and the scissors were offered as a 
 substitute for needles, the use of which waa frequently 
 attended by dislocation of the lens into the vitreous 
 humor. 
 
 ANOTHER INGENIOUS METHOD OF ABSORBING CATARACT. 
 
 Dr. Gibson's originality was further illustrated by 
 another method which he adopted for the absorption of 
 cataract.^^ His. operation was described by Dr. J. 
 Eevere, of Baltimore, in a letter dated March 2, 1819; 
 It consisted in passing "a common sewing needle, slight- 
 ly curved and armed with a single thread of silk" 
 
 25. New England Journal of Medicine and Surgery, 1818, vlii, 
 119. 
 
114 OPHTHALMOLOGY IN AMERICA. 
 
 through the sclera about two lines from the cornea, 
 through the opaque lens and sclera of the opposite side 
 at a point corresponding to the one at which it was 
 introduced, the pupil having been previously dilated 
 with belladonna. "The silk being drawn through and 
 the ends cut off, a single thread was thus left passing 
 through the ball of the eye and acting on the diseased 
 lens in the manner of a seton." Dr. Gibson had oper- 
 ated in this manner on two cases. "No reaction or acci- 
 dent intervened, and at the end of ten days, in both 
 eases, the diseased lens had disappeared." The silk 
 was then withdrawn and in a few days the vision was 
 restored. In a third case in which this operation was 
 performed "it failed in consequence of the iris being 
 wounded" and the thread was withdrawn at an early 
 period because of inflammation. The wound of the 
 iris was attributed to not using belladonna. 
 
 hoknee's opeeation foe ecxeopion of the lower 
 
 LID. 
 
 Dr. Horner, like many others, devised a very ingen- 
 ious operation for ectropion of the lower lid which he de- 
 scribed in the American Journal of the Medical Sciences, 
 1837, vol. xxi, p. 105. It deserves to be remembered 
 as an original and effective method of correcting this 
 deformity. Dr. Horner had .performed it as follows : 
 "An incision, two inches in length and down to the 
 bone, was made parallel with and at the inferior margin 
 of the orbicularis muscle. The whole thickness of the 
 eyelid was then dissected up from the adjoining bones. 
 From about the middle of that incision started another, 
 of an incli in length, downward toward the angle of 
 the Jaw. From the termination of the latter another 
 
OPHTHALMOLOGY IN AMERICA. 
 
 115 
 
 incision of the same length was directed toward the root 
 of tlie nose. The two last incisions consequently de- 
 fined an angle of integuments, which, being dissected 
 up as far as its base, was then turned into the begin- 
 ning of the first incision. The following diagram will 
 illustrate the operation. 
 
 Diagrams illustrating Horner's operation. 
 
 "The angle A, Figure 1, taken from the cheek was 
 inserted into the lower eyelid, as seen in Figure 2, and 
 a pin fixed at b and another at c, so as to keep the parts 
 in place. An almost immediate correction of the de- 
 formity ensued." 
 
 The ordinary dressings were applied over the eye and 
 recovery was rapid. 
 
 OPERATION FOE BLEPHAROSPASM. 
 
 Dr. George C. Blackman, a prominent surgeon of 
 New York, again illustrated the resourcefulness of our 
 American surgeons by devising a method of operating 
 for blepharospasm, which, in a modified form, has since 
 
UU OPHTHALMOLOGY ITSl AMERICA. 
 
 been widely practiced. His case was recorded in the 
 New York Lancet, 1843, vol. i, p. 410. The operation 
 was used as a last resort after every remedy which 
 seemed applicable had been unsuccessfully tried. Dr. 
 Blackman's description is as follows : 
 
 After explaining to the patient the nature of the operation 
 which I thought lilcely to raise (open) the eyelid, she readily 
 consented to its performance. With the assistance of Prof. 
 Willard Parker and Dr. Hall, I divided the musculi orbicu- 
 laris palpebrarum in the follcwing manner: The patient was 
 seated on a low stool before the window; Professor P. then 
 passed a smooth ivory handle beneath the lid, in order to pro- 
 tect the eyeball, whilst^ with a straight, narrow tenotome, a 
 puncture was mfjde near the outer margin of the lid, and mid- 
 way between the outer and the inner angle. The knife was 
 passed on towards the superciliary ridge, when, turning the 
 edge towards the muscle, and by gently pressing during the 
 act of withdrawing, its fibers were easily divided. The muscle 
 both at the inner and outer edge of the eye I 'divided in the 
 same manner, in every instance leaving the conjunctiva entire. 
 Instantly our patient remarked that she could raise the lid so 
 as clearly to distinguish objects across the street. Professor 
 P. then suggested that the division of the lower portion of the 
 muscle might relieve the entropion of the lower lid. This I 
 aivided in the manner^ before 'mentioned, and much to our 
 satisfaction, the entrppipn. immediately disappeared. . . . 
 
 Frpm the happy effects ,wJiich fpUowed the division of the 
 muscle in the lower lid, as Prof essbr^ Parker recominended, I 
 have but little doubt but that we now possess' an 'easy and 
 effectual remedy, perhaps in a majority of the cas6S 'of fhis 
 troublesome affection. G. C. Blaokman, M^D. r 
 
 New York, June 14, 1842. 
 
 BLEPHAEOPLASTT. 
 
 Alfred C. Post was probably the first in America to 
 successfully perform iplastic operaitions to correct de- 
 formities of the lids resulting from cicatrices. His first 
 
OPUTHALMOLOGY IN AMERICA. 117 
 
 aceoTint was published in the New York Medical Ga- 
 zette, Jan. 19, 1842. His example was soon imitated 
 by Dr. J. Mason Warren of Boston, Dr. George McClel- 
 lan and Dr. Mutter of Philadelphia and others. Dr. 
 Horner's method, which was reported in the American 
 Journal of the Medical Sciences for 1837, was entirely 
 different in its..principles. 
 
 INSTRUMENTS AND OPERATION FOR LACHRYMAL 
 STRICTURE. 
 
 Dr. Nathan E. Smith, the eminent Baltimore surgeon, 
 early devised a knife for dividing strictures of the nasal 
 duct. His instrument is figured in vol. iii, p. 161, of 
 Norris and Oliver's System of Diseases of the Eye. The 
 operation which he performed antedated Stilling's by 
 many years, having been done as early as 184G at least. 
 Dr. Smith also used gold lachrymal canulse of his own 
 device, which were an improvement on the old forms.-" 
 
 ABSCISSION OF THE CORNEA. 
 
 Prof. L. A. Dugas, of Augusta, Ga., was an eminent 
 surgeon of the South who also gave much attention to 
 diseases of the eye. In 1840 he practiced an operation 
 on the eye in certain conditions of corneal staphyloma, 
 which has since met with much favor by experienced 
 ophthalmologists. The operation was the abscission of 
 the cornea, which he did "by passing a tenaculum 
 through the cornea and excising it with the straight 
 bistoury without touching the sclerotica." Dr. Dugas 
 seems to have used proper discrimination in his cases 
 and preferred this method to the excision of the whole 
 
 26. Norris and Oliver's System, iii, 157. 
 
118 OPHTHALMOLOGY IN AMERICA. 
 
 eyeball. The deformity resulting from his operation 
 was greatly diminished, while the removal of the cornea 
 was attended with no danger.^' 
 
 CHLORID OF SODIUM IN PURULENT OPHTHALMIA. 
 
 Dr. L. A. Dugas, of Augusta, Ga., published a paper 
 in the Southern Medical and Surgical Jo-urnal for 1837 
 on "Purulent Ophthalmia," in which he related several 
 cases, all of which were successfully treated by a solu- 
 tion of ehlorid of sodium as a wash, one-half ounce to a 
 quart of water. 
 
 If there were no medicinal properties in ehlorid of 
 sodium, it served the purpose of cleanliness at least, 
 and it is possible that effectual cleanliness in purulent 
 conjunctivitis is better than the indiscriminate use of 
 some of the strong drugs which have, during later years, 
 been so popular. 
 
 POTASSIUM lODID IN DISEASES OF THE EYE. 
 
 As early as 1842 Dr. Isaac Parrish,^^ of Philadelphia, 
 recommended this drug in certain ophthalmic diseases, 
 in doses of from two to six grains, three times a day. 
 He believed it had potency in relieving inflammatory 
 affections "involving the deep tunics of the eye." 
 
 HOENEE's MUSCLE. 
 
 In 1824 Dr. William E. Horner (1790-1853), of 
 Philadelphia, who was an excellent anatomist and very 
 painstaking and minute in his dissections, described^" 
 a muscle which he believed to be separate from the or- 
 
 2Y. Eeese : Cooper's Surgical Dictionary, Supplement, 1842, 
 p. 75. 
 
 28. Medical Examiner, April 16, 1842. 
 
 L".). Phila. Jour, of Med. and Pliys. Sci., 1824, vili, 70. 
 
DR. WILLIAM E. HORNER (1790-1853 1 
 
OPHTHALMOLOGY IN AMERICA. 121 
 
 bicularis of the eyelids and which extended along the 
 course of the lachrymal canals of the lids from the crest 
 of the lachrymal bone to the lachrymal puncta. The 
 article was entitled "Description of a Small Muscle of 
 the Inner Commissure of the Eyelids." He said that a 
 "compend of the foregoing description was published 
 two years ago" (p. 72). The function of this muscle 
 he believed to be to "apply the puncta lachrymali'a to 
 the ball of the eye." This muscle has from that time 
 been called "Horner's muscle" in almost all of the ana- 
 tomic descriptions of the eye, and has been regarded by 
 physiologists as having the special function, noted by 
 Dr. Horner himself, of facilitating the excretion of the 
 tears. While it is a structure of small size, yet it de- 
 serves the attention that it has received, and has a use- 
 ful function in the "economy" of the eye. Horner will 
 be remembered for many generations as its discoverer. 
 
 FIFST CASE OP ASTIGMATISM IN THIS COUNTRY FOE 
 WHICH CYLINDEICAL GLASSES WERE MADE. 
 
 Isaac Hays, in his American edition of Lawrence on 
 "Diseases of the Eye," of 1854, p. 669, and Dr. Henry 
 D. ISToyes, of New York, in the American Journal of the 
 Medical Sciences, 1873, vol. Ixvii, p. 355, both described 
 the case of Eev. Mr. Goodrich, who had deficiency of 
 sight, which he called "near sighted," because he was 
 obliged to approach nearer to objects to see them than 
 most persons. This man had noticed that in looking at 
 lines, or br-ajiches of trees, or the rigging of a ship, that 
 those objects having a vertical direction were more dis- 
 tinct than those having a horizontal direction. In 1838 
 he consulted a skilled optician, Mr. John McAllister, of 
 
122 OPHTHALMOLOGY IN AMERICA. 
 
 Philadelphia. After studying the case and making 
 tests, McAllister had a glass ground, "plane on one side 
 and to a section of a cylinder on the other." This cor- 
 rected the irregular refraction and the vision was much 
 improved. Mr. Goodrich later became chaplain of the 
 New York State Lunatic Asylum at Utica, and Dr. 
 Noyes came into possession of the glasses. Dr. Noyes 
 says: "They were given to me in a piece of writing 
 paper on which, in the owner's handwriting, was in- 
 scribed the following memorandum: 'Number 7, 
 French number, cylinder cone, got of McAllister, May, 
 1828.' " 
 
 Dr. Noyes stated that they were plano-concave cylin- 
 ders of seven inches' focus, with axes horizontal, and 
 were mounted in a spectacle frame with oval rims. It 
 is believed that these were the first of the kind made 
 in this country, and, according to Dr. Noyes, "they have 
 become historical." 
 
 DISLOCATION OP THE LENS. 
 
 It is said that Dr. J. C. Warren was the first to de- 
 scribe a case of accidental dislocation of the crystalline 
 lens.^° He also called the attention of the profession to 
 "rheumatic inflammation of the eye, now universally 
 recognized, but then little was known of its diagnosis."^^ 
 
 "■inverted" VISION. 
 
 It is very interesting in this connection to note that 
 perhaps the first case on record of so-called "inverted" 
 vision was reported by Dr. John D. GrodmaUj of Phila- 
 delphia, in 1837."^ His article is headed, "Note of an 
 
 30. New England Med. Jour., 18H. 
 
 31. Reese's Supplement to Cooper's Surgical Dictionary, p. 75. 
 
 32. American Journal of the Medical Sciences, 1827, i, 183. 
 
OPHTHALMOLOGY IN AMERICA. 123 
 
 Interesting Fact Connected with the Physiology of 
 Vision," which he reports as follows : 
 
 The following instance communicated to me by Reuben 
 Peale, Esq., the uncle of the young man, is the only one with 
 which we are at present acquaintecj, where the inyersion of 
 objects on the retina was productive of inacci^ijacy of judg- 
 ment as to position, notwithstanding all the other senses were 
 in their ordinary condition, and the individual had arrived at 
 the age of 7 years. 
 
 When his father, who was a distinguished artist, began to 
 give him lessons in drawing, he was very much surprised to 
 find that whatever object he attempted to delineate, he uni- 
 formly inverted. If ordered to make a drawing of a candle and 
 candlestick set before him, he invariably drew it with the 
 base represented in the air and the iiame downwards. If it 
 was a chair or table he was set to copy, the same result was 
 the consequence ; the feet were represented in the ' air, and 
 the upper part of the object, whatever it might be, was turned 
 to the ground. His father, perplexed at what he considered 
 the perverseness of the boy, threatened, and even did punish 
 him for his supposed folly. When questioned on the subject 
 the youth stated that he drew the objects exactly as he saw 
 them, and as his drawings were in other respects quite accu- 
 rate, there was no reason to doubt his statement. Whenever 
 an object was inverted previous to his drawing it, the draw- 
 ing was made to represent it in its proper position, showing 
 that the sensations he received from the eye were exactly 
 correspondent with the inverted pictures formed on the retina. 
 This condition of his vision was observed to continue for more 
 than a year, when his case gradually ceased to attract atten- 
 tion, which was when he was about 8 years old. Since that, 
 time he has imperceptibly acquired the haoit of seeing things 
 in their actual position. 
 
 COLOR BLINDNESS. 
 
 This visual defect received attention in this country 
 long before the publication of George Wilson's book in 
 
124 OPHTHALMOLOGY IN AMERICA. 
 
 Edinburgh in 1855. As early as 1840'^ Dr. Isaac Haj's 
 reports the case of a young woman who was unable to 
 distinguish certain colors. Supplementing this report,, 
 he discusses the subject quite fully, and gives references 
 to the literature from the time of Dalton, in 1794, to 
 the time of the writing of this article. He believed the 
 imperfection to be a very curious one, and finds that it 
 occurs in persons whose vision is natural and who can 
 see minute objects, often with perfect distinctness. He 
 also found it to be hereditary, "or, at least, to prevail in 
 certain families." The various theories which had been 
 previously put forward, he thought, did not explain the 
 phenomenon. He believed the condition to be incurable. 
 The subject was again taken up by Dr. Pliny Earle, 
 of Philadelphia, in 1845.^^ Dr. Earle's article is a 
 most learned one and treats of : 
 
 1. Cases heretofore unpublished. 
 
 2. Peculiarities heretofore observed: (a) the inability to 
 distinguish colors is hereditary; (b) when thus entailed it 
 sometimes overleaps one generation or more; (c) males are 
 more frequently affected than females. 
 
 3. Peculiarities heretofore unnoticed: (st) the power of 
 accurately distinguishing colors varies at different times in the 
 same individual; (b) the inability to distinguish colors is not 
 infrequently connected with, or accompanied by a defective 
 power of discriminating between musical notes. 
 
 He concludes by referring to "the several theories 
 promulgated by different authors as explanatory of the 
 inability to distinguish colors," and said that "they may 
 be resolved into -two classes : first, those which place the 
 cause of the defect in the apparatus of vision, and, 
 second, those which suppose it to be in the organ of 
 
 33. Am. Jour. Med. Sci., 1840, xxvi, 277. 
 .•?4. Am. Jour. Med. Sci., N. S., ix, 346. 
 
OPHTHALMOLOGY IN AMERICA. 125 
 
 perception," adding that "we are disposed to give pref- 
 erence to the latter, but we have nothing on the subject 
 to add to the excellent treatise of Dr. Hays." Probably 
 up to the time of these papers nothing more enlightening 
 had been written on the subject. 
 
 "neomacropia." 
 
 In 1849^^ the late Prof. Chester Dewey, of Eochester, 
 N. Y., published a brief but interesting paper entitled, 
 "On an Unnoticed Kind of Abnormal Vision." Ex- 
 pressing himself according to the knowledge of that 
 time, he said that there were two well-known kinds of 
 abnormal vision in eyes not diseased, "the far sighted 
 and the near sighted." He then adds : 
 
 There is a kind of abnormal vision, different from either of 
 these, which is not farsighted or nearsighted, but in which small 
 near objects, or larger distant objects, are not seen with distinct- 
 ness. This imperfection occurs in children and young persons and 
 is remedied by convex spectacles which are suited to the eyes 
 of persons from 65 to 70 years of age. The younger eyes re- 
 quire the older glasses and with advancing years less convex 
 glasses are required. At the age of 45, or more, this kind of 
 abnormal vision becomes mvich diminished. As the young use 
 glasses of the farsighted, -this kind may be called neo-macropia. 
 It is evident that convex glasses produce that change in the 
 rays of light which fits such eyes to see distinctly small and 
 large objects at varying distances. This fact proves that 
 JJiere is Jio defect in the adjusting power of the eyes. The 
 cause, then, is to be sought in the structure of the eye. 
 
 Professor Dewey said this "abnormal vision" had not 
 attracted attention, for he had found but one allusion 
 to it in authors on optics, although it was relatively 
 common. In New England and New York more than 
 fifty instances had come to his knowledge. A child of 
 
 35. American Journal of Science and Arts, 1849, viii, 443. 
 
126 OPHTHALMOLOGY IN AMERICA. 
 
 15 was enabled for the first time to see distinctly by 
 using his grandfather's glasses. A young man of 18 
 required glasses of ten-inch focus. Poor progress of 
 children in study occurred because they were not able 
 to see distinctly, and this defect had not been sus- 
 pected. "Knowledge of this subject will make spec- 
 tacles a still greater benefit to our race." 
 
 ACCOMMODATION OF THE EYE ACCOEDING TO DK. HOSACK, 
 
 1794. 
 
 The mechanism of the adjustment of vision to dif- 
 ferent distances has always been an interesting problem, 
 and it was one to receive scholarly attention in this 
 country in 1813 by Dr. David Hosack (1769-1835), 
 who was one of our most celebrated physicians. Pre- 
 vious to his time, Descartes had expressed the opinion 
 that accommodation of the eye was effected by the ac- 
 tion of the ciliary processes on the crystalline lens in 
 such a way as to make it more or less convex; Kepler, 
 Zinn and Porterfield, that it was done by the lens being 
 moved nearer to the cornea; La Chariere, Brisseau, 
 Perault, by being moved nearer to the retina; while 
 others held that the change was made by variations in 
 the size of the pupil. 
 
 Thomas Young had endeavored to prove that the ad- 
 justment was produced by a change of the curvature of 
 the crystalline lens through muscle-tissue existing in it. 
 Mr. Young's paper was published in the Philosophical 
 Transactions of London in 1793. In 1794 Dr. Hosack 
 followed up the discussion by a paper in the same trans- 
 actions for that year, in which he took issue with all 
 opinions previously expressed. In April, 1813, he re- 
 
OPHTHALMOLOGY IN AMERICA. 127 
 
 published his paper in the American Medical and 
 Philosophical Register, New York, under the title, "Ob- 
 servations on Vision." It is an extended experimental 
 study in which he endeavors to prove that the change 
 of focus of the eye is effected by the action of the exter- 
 nal recti muscles, and to disprove all the theories tliat 
 had been presented up to that time. His paper con- 
 cludes with the following summary : 
 
 I have thus endeavored, first, to point out the limited action 
 of the iris, and of consequence, the insuiBcieney of this action 
 for explaining vision. Secondly, to prove that the lens pos- 
 sesses no power of changing its form to the different distances 
 of objects. Thirdly, that to see objects at different distances, 
 corresponding- changes of distance should be produced between 
 the retina and the anterior part of the eye, as also in the re- 
 fracting powers of the media through which the rays of light 
 are to pass. And fourthly, that the combined action of the 
 external muscles is not only capable of producing these effects, 
 but that from their situation and structure they are also pecu- 
 liarly adapted to produce them. 
 
 THE THEORY OP ACCOMMODATION ACCOEDING TO DE. H. 
 MOETON^ 1831. 
 
 A discussion on this subject was again renewed in 
 this country by Dr. H. Morton, of New York City, in 
 1831, in a paper, "On the Adaptive Powers of the 
 Bye.'""' This was a laborious effort to invalidate all the 
 experiments and conclusions before advanced, and every 
 available argument was used to show that the focal 
 adjustment of the eye was produced by the action of the 
 iris in dilating and contracting the pupil : 
 
 The iris, by its contraction and dilatation, admits the requis- 
 ite number of visual rays to pass through that portion of the 
 
 36. Am. Jour. Med. Sci., 1831, ix,, 53. 
 
128 OPHTHALMOLOGY IN AMERICA. 
 
 crystalline lens which will cause them to reach the retina at 
 their proper foci, while at the same time it excludes in the 
 most efTectual manner all unnecessary light, and all collateral 
 or direct rays. 
 
 THE MECHANISM OF ACCOMMODATION OE DR. WALLACE. 
 
 The next conspicuous study of the accommodation of 
 the eye was made by William C. Wallace, of New York, 
 already referred to. By his numerous dissections of the 
 eye and his minute study of the ciliary body, both in 
 man and animals, beginning in 1835, he came to the 
 conclusion that the adjustment of vision to different 
 distances was accomplished by the action of the ciliary 
 muscle and by the "erection" of the ciliary processes in 
 such a way as to change the position of the crystalline 
 lens farther from or nearer to the retina. I will quote 
 him in full : 
 
 We have, then, the ligament by which the ciliary body is 
 attached to the sclerotica; the outer ciliary muscle to contract 
 the vessels returning from the ciliary processes; the ciliary 
 processes, which are attached by the filaments of Ammon to 
 the ciliary zone and crystalline capsule, to become erect and 
 draw forward the crystalline body; and the inner ciliary mus- 
 cle, aided by the elasticity of the membrane of the vitreous 
 humor, to draw it backwards. 
 
 The functions of the various parts of the ciliary body are 
 evident from: 1, Its entire absence when there is another in- 
 strument for adjustment; 2, its structure; 3, there is no 
 other arrangement by which adjustment can be explained, . or 
 by which we can account for the sudden occurrence of near 
 and far-sightedness. 
 
 If, when the ej^e is adjusted to a remote object, we direct 
 it by the external muscles to one which is near, an indistinct 
 image of the latter is formed on the retina; the impression is 
 communicated to the sensorium by the optic nerve; a reflex 
 affection of the third, from which the ciliary nerves in part 
 
OPHTHALMOLOGY IN AMERICA. 129 
 
 proceed, causes the ciliary muscle to contract, the processes to 
 become erect, and the crystalline body to be drawn forward 
 until a distinct image of the object is formed on the retina. 
 
 The following facts show that the eye, in a perfectly passive 
 state, is adjusted for the discernment of distant objects: 1, 
 An effort is necessary to look at near objects without fatigue; 
 2, as age advances, the ability to see near objects becomes 
 lessened, while distant objects can be seen as plainly as ever; 
 and, 3, when under the relaxing power of belladonna, the eye 
 loses the power of seeing near objects distinctly. 
 
 By the graduating power of the ciliary processes and ciliary 
 muscles, together with the elasticity of the membranes of the 
 vitreous body, the crystalline may be drawn not only back- 
 wards and forwards, but its inclination may be changed so as 
 to throw the image on another part of the retina. As the 
 upper and outer portion of the ciliary body is the broadest, 
 that margin of the crystalline will advance the furthest, and 
 thus facilitate the vision of near objects with both eyes at the 
 same time." 
 
 Had Wallace accompanied his otherwise intelligent 
 experiments with a study of the catoptric images from 
 the surfaces of the lens and noted their curvature- 
 changes, he would undoubtedly have anticipated von 
 Helmholtz by many years and arrived at the correct 
 mechanism of accommodation, which does consist in the 
 action of the ciliary muscle on the crystalline lens, but 
 to change its surface curvatures, and not to change its 
 position. 
 
 OPHTHALMOLOGY SHARES WITH GENEEAL SURGERY IN 
 MANY IMPROVEMENTS AND DISCOVERIES. 
 
 While ophthalmology, both from the scientific and 
 practical standpoints, has been simultaneously advanced 
 by the numerous discoveries and greatly increased 
 
 37. The Accommodation ot the Bye to Distances, 1850, p. 23. 
 
130 UFUTHALMOLOaY IN AMERICA.. 
 
 knowledge in general siirgerj', j'et I will take the time to 
 refer to but two American contributions wMch were 
 made previous to 1850, and which have proved to be so 
 advantageous in ophthalmic surgery and in its advance- 
 ment. My first reference is to 
 
 AKIMAL LIGA]?DEES. 
 
 I need not discuss the value of animal ligatures in 
 certain operations on the eye and its appendages. All 
 will agree that it is very great. The credit of suggest- 
 ing and demonstrating the advantages of such ligatures 
 in surgical practice belongs to an American surgeon, 
 Dr. Phillip Syng Physiek, of Philadelphia. The story 
 of Dr. Physick's adoption of the use of animal ligatures 
 is best told by Dr. Frederick P. Henry*** as follows : 
 
 In the Eclectic Repertory, 1816, vol. vi, p. 389, there is a 
 letter from Dr. Physiek, in which he speaks of the delay in 
 the healing of \YOunds because of the ligatures in use. He 
 says: "Several years ago, recollecting how completely leather 
 straps, spread with adhesive plaster and applied over wounds, 
 for the purpose of keeping their sides in contact, were dis- 
 solved by the fluids discharged from the wound, it occurrjd 
 to me that ligatures might be made of leather, or of some 
 other animal substance, with which the sides of a blood ves- 
 sel could be compressed for a sufficient time to prevent hemor- 
 rhage, and that such ligatures would be dissolved after a, few 
 davs and would be evacuated with the discharge from the 
 cavity of the wound." He requested Dr. Dorsey to try such a 
 ligature on a horse, and the result justified his anticipations. 
 The letter goes on to say that, acting on Dr. Physick's sugges- 
 tion, Dr. Hartshorne had used ligatures made of parchment on 
 some of the arteries, after an amputation of the thigh, and 
 they were found dissolved at the first dressing. Dr. Dorsey, 
 
 38. Standard History of the Medical Profession of Pliiladelphia, 
 1897, p. 436. 
 
OPHTHALMOLOGT IN AMERICA. 131 
 
 with Dr. Physiek's assistance, used French kid ligatures with 
 success in several cases. He experimented with different sub- 
 stances to ascertain which would withstand the solvent power 
 of the pus for the longest time, by applying the material over 
 the surfaces of ulcers. Buelcskin and kid dissolved first, then 
 parchment, lastly the catgut. Fearing that the leather might 
 dissolve too soon in tj'ing large vessels, he intended to re- 
 quest Dr. Dorsey to use leather impregnated with the varnish 
 used in making elastic catheters. In his letter he makes the 
 suggestion that perhaps tendon would be found more durable 
 than any of the materials above mentioned. 
 
 Further historical details are given in the American 
 Medical Recorder, 1819, vol. ii, p. 488, and the Philadel- 
 phia Journal of the Medical and Physical Sciences, 1831, 
 vol. ii, p. 4. 
 
 GENERAL ANESTHESIA. 
 
 The other contribution, and undoubtedly the most 
 important to surgery, is general anesthesia. This, too, 
 is emphatically of American origin. The history has 
 been so often told that I need only refer to a few facts 
 in connection with it at this time. The first man to 
 use sulphuric ether as an anesthetic was Dr. Crawford 
 W. Long of JefEerson, Jackson County, Ga., in March, 
 1842. He had graduated from the University of Penn- 
 sylvania in 1839, and had spent one year after this in 
 a New York Hospital. His use of ether was the out- 
 come of the knowledge of effects derived from its in- 
 halation as a matter of amusement. His experiments, 
 which were prosecuted in a perfectly scientific manner, 
 demonstrated that the operations which he performed 
 under its influence were done without pain or disagree- 
 able reaction to the patient. His first operation was 
 performed on March 30, 1842, and consisted in the re- 
 moval of a small cystic tumor of the jaw. His second 
 
132 OPHTHALMOLOGY IN AWERICA. 
 
 operation was on tlie same patient on June 6, 1842, for 
 the removal of another small tumor. His third case was 
 that of a negro boy who had a disease of a toe which 
 rendered its amputation necessary, and the operation 
 was done on July 3, 1843. Dr. Long continued to use 
 sulphuric ether anesthesia in surgical operations, but, 
 unfortunately, he does not seem to have realized what a 
 vast benefit this discovery would prove, and, being a 
 modest country practitioner, he did not publish his ex- 
 perience until 1849.^" In 1853 he read a paper on the 
 subject before the Georgia Medical Society, in which he 
 again detailed his experience with ether as an anesthetic. 
 His claims to priority of the discovery were publicly ad- 
 mitted by Dr. Charles T. Jackson in 1861 in the Boston 
 Medical and Surgical Journal of April 11, that year. 
 
 Another claimant for the early administration of sul- 
 phuric ether as an anesthetic, according to Professor 
 Lyman in his work on "Anesthesia," (p. 6) was the late 
 Dr. W. E. Clark, of Chicago, 111., who, while a student 
 in Dr. E. M. Moore's office, Eochester, N. Y., in the 
 winter of 1842, administered ether to a young woman 
 for the extraction of a diseased tooth, which w&s done 
 with the patient in an unconscious state. Dr. Moore 
 believed, however, that the unconsciousness was hyster- 
 ical, and advised his pupil to make no more experi- 
 ments in that direction, and the advice was unfortu- 
 nately followed. 
 
 It remained for Dr. W. T. G. Morton, later, to redis- 
 cover the anesthetic properties of sulphuric ether and to 
 bring the agent to the attention of the public in the 
 form of a proprietary preparation which he named 
 
 39. Southern Medical Surgical Journal, December, 1849. 
 
DR. W. T. C. MORTON (1819-18ff8). 
 
DR. JOHN COLLINS WARREN (1778-1856). 
 
OPBTHALMOLOOY IN AMERICA. 137 
 
 "letheon ;"' and, so far as the professional world is con- 
 cerned, sulphuric ether anesthesia had its real birth in 
 the Massachusetts General Hospital on Oct. 16, 1846, 
 at the hands of its originator. Dr. W. T. G. Morton, 
 and under the knife of that progressive and distinguished 
 Boston surgeon. Dr. John Collins Warren. As is well 
 known, the news of this demonstration of sulphuric ether 
 anesthesia spread rapidly throughout the world. It led 
 Sir James Y. Simpson to use chloroform anesthesia at 
 Edinburgh the following year, and from that time till 
 now general anesthesia has been a priceless boon and a 
 most powerful factor in that surgical advancement in 
 which ophthalmology has taken a proportionate share. 
 The extent of the progress which it has furthered can not 
 be measured or even imagined. I need not undertake to 
 picture any of the benefits which operative and experi- 
 mental ophthalmology has derived from it. It will suf- 
 fice to say that America would have glorified herself in 
 ophthalmology as well as in general surgery had this 
 been her onlv contribution. 
 
VJ. 
 
 TBE TRANSITION-PERIOD FROM THE OPHTHALMOL- 
 
 OaY OF THE PHYSICIAN AND SURGEON TO THE 
 
 OPHTHALMOLOGY OF THE SPECIALIST. 
 
 The imperfect review which I have now given of the 
 ophthalmology of America from 1800 to 1850, of its 
 institutions, of the men who were most alive to its 
 interests, of the surgeons who incidentally made it a 
 part of their teachings and practice, and of its litera- 
 ture and contributions, shows what growth can be ob- 
 tained, what developments can be made, what last- 
 ing foundations can be laid in the midst of an en- 
 vironment whose professional standards averaged low, 
 whose professional life in a new country was a struggle 
 for bread, whose professional sentiments were opposed to 
 specialism, looking upon it as disgraceful, and in which 
 a certain amount of apathy toward ophthalmology was 
 always present. 
 
 Isaac Hays and his co-workers had, notwithstanding 
 all these hindrances, supplied foreign and original liter- 
 ature which, at the opening of the second half of the 
 nineteenth century, impressed the American profession 
 with the value and respectability of this special science, 
 and the special institutional activities had demonstrated 
 its public as well as private needs and benefits. More 
 and more had a few of our physicians and surgeons in 
 our large cities been extending their practices into this 
 special field. James Edward Cornell, Mark Stephenson, 
 
OPHTHALMOLOGY IN AMERICA. 139 
 
 George Wilkes, Freeman J. Bumstead, Henry B. Sands 
 and David L. Eogers, of New York; George Hayward, 
 Robert W. Hooper, Francis P. Sprague, John H. Dix 
 and George A. Bethune, of Boston; Adinell Hewson, 
 Samuel D. Gross, William Hunt, Edward Hartshorne, 
 A. D. Hall, Thomas G. Morton, Henry H. Smith, John 
 Neill, D. Hays Agnew and E. J. Levis, of Philadelphia ; 
 Aaron Friedenwald and Nathan R. Smith, of Balti- 
 more; J. S. Hildreth and Moses Gunn, of Chicago; 
 Simon Pollak, William Dickinson, John T. Hodgen, 
 Paul F. Eve and Charles A. Pope, of St; Louis; Rob- 
 ert A. Kinloch, of Charleston; Julius F. Miner, of 
 Buffalo, and Alden March, of Albany, and probably 
 many others whom I do not recall, had been greatly 
 skilled in it, if not foremost in its practice, and their 
 prestige had so dignified it that it needed only the 
 slightest reaction from abroad to establish it as an 
 exclusive department of medicine here. This reaction 
 was imminent, and this specialism was soon to be an ac- 
 complished fact 
 
VII. 
 
 TEE PIONEER SPECIALISTS. 
 
 HENRY W. WILLIAMS. 
 
 The first American, I believe, to set himself to ex- 
 clusively special study in Europe was Dr. Henry W. 
 Williams (1831-1895), of Boston. He had begun his 
 medical studies at Harvard in 1844, but it appears that 
 before graduating he went to Europe, virhere he spent 
 three years, returning in 1849. In the same year he 
 received his M.D. degree from Harvard. While in 
 Europe he took a systematic course in ophthalmology 
 at the then famous clinics of Sichel .and Desmarres, of 
 Paris, also following the services at Vienna of Prederich 
 Jaeger and Eosas, and at London of Dalrymple, Law- 
 rence, Dixon, Critehett and Bowman. It was too early 
 to study with von Graefe, von Helmholtz and Donders, 
 for they were just entering on their life work. On his 
 return to Boston, he was appointed one of the district 
 physicians of the Boston Dispensary, and in 1850 waj 
 made its first ophthalmic surgeon. In the same year 
 he organized a class of Harvard medical students for 
 instruction in diseases of the eye, in which he was great- 
 ly aided by his lifelong friend. Dr. Charles E. Bucking- 
 ham, who for several years placed at his disposal a very 
 abundant and excellent clinical material at the "Old 
 City Institution" in South Boston. In 1864 Dr. Wil- 
 liams was made ophthalmic surgeon to the City Hos- 
 pital, a position which he held for many years. In 
 
DR. IIENKY W. WILLIAMS 11821-1893 
 
OPHTHALMOLOGY IN AMERICA. 143 
 
 1869 he was made lecturer on ophthalmology, and in 
 1871 professor of ophthalmology in Harvard Medical 
 College. It is said that his teaching was lucid and 
 practical, and was always admirably suited to the just 
 requirements of the particular class of hearers, whether 
 physicians or students, to whom it was addressed. 
 
 Through the long succession of ophthalmic internes 
 and externes under him at the City Hospital, and the 
 many classes of students taught by him at the medical 
 college, also through the numero^is editions of his books, 
 which were bought and studied by physicians, he ex- 
 erted a continuing and far-reaching influence. 
 
 As an ophthalmologist. Dr. Williams won favorable 
 recognition from the first years of his practice as a physi- 
 cian in 1850. He was identified with this specialty 
 from the beginning of a professional career which ex- 
 tended through forty-six years, and, although a special- 
 ist of high rank, he never gave up his interest in general 
 medicine or in subjects of public interest. 
 
 Throughout the whole of his professional life Dr. Wil- 
 liams showed himself at once conservative and inde- 
 pendent. A careful observer of the work of others, he 
 possessed in a high degree the faculty of discrimination 
 in respect to the relative merits of teachers and the 
 value of their particular methods. Learning from all, 
 he owed no partisan allegiance to any single master or 
 school. 
 
 The method of Daviel, as perfected by Beer, was, 
 with unimportant variations, practiced by all the great 
 masters of the art with a deftness and finish which have 
 never been rivaled. Influenced by such examples, it 
 was only natural that he should adopt extraction in 
 
144 OPHTHALMOLOGY IN AMERICA. 
 
 preference to the brilliant but uncertain operation of 
 reclination then in vogue in this country. In the per- 
 formance of extraction he was unexcelled, and it is char- 
 acteristic of the man that he never departed very widely 
 from the method which he had learned to practice so 
 well and which he believed to be, on the whole, the most 
 satisfactory in its results. He adhered to the classical 
 flap incision long after the peripheral linear section of 
 von Graefe had been generally adopted, and steadfastly 
 withstood the tidal wave of opinion in favor of iridec- 
 tomy as an integral part of the operation. He was one 
 of the first, if not the first, among ophthalmic surgeons 
 to advocate and employ etherization as a general prac- 
 tice in cataract extraction. 
 
 He was a man of large stature and strong character, 
 and was a conspicuous figure on all medical occasions. 
 He was a frequent and forcible, but persuasive, speaker 
 and an excellent presiding ofiicer. He was sturdy and 
 honest in suppressing quackery, and in a thousand ways 
 left his mark on his times and on his community.*" 
 
 ELKANAH WILLIAMS. 
 
 Elkanah Williams (1822-1888) began his profes- 
 sional life a little later. He graduated from the Uni- 
 versity of Louisville in 1850. After engaging in general 
 practice for a short time, he went abroad in 1853, with 
 the avowed purpose of studying ophthalmology. He 
 followed the same teachers as had Henry W. Williams 
 at Vienna, Berlin, Paris and London. He was a young 
 man of intelligence and ambition, and he fitted himself 
 for ophthalmologic practice as completely as possible. 
 
 40 From biographical sketch by Dr. John Green, Trans. Am. Oph. 
 Soc, 1896, vil, 479. 
 
DR. ELKANAH WILLIAMS (1822-1S88) . 
 
OPHTHALMOLOGY IN AMERICA. 147 
 
 While in Europe the newly invented ophthalmoscope 
 was the source of much experiment and discussion. He 
 acquired a knowledge of its use in its modified form and 
 was probably the first to bring an instrument to this 
 country and to teach his American colleagues its won- 
 derful revelations. It is said that he was also the first 
 to demonstrate its use to London ophthalmologists at 
 Moorfields in 1854.^^ They had previously hesitated to 
 employ it, fearing that the strong light which was re- 
 flected by it into the eye would injure the retina. To 
 illustrate the sentiment then existing in London I will 
 quote from Mr. James Dixon, who was then one of the 
 most prominent ophthalmologists in England, and who 
 was one of the surgeons to the Moorfields Eye Hospital. 
 In 1853 he said:*^ "If the praise bestowed on this in- 
 strument (the ophthalmoscope of Coccius) be allowed 
 to go forth to the professional public without strong 
 cautions and limitations, such dangerous results appear 
 to me likely to ensue that I feel it a duty to offer a 
 few remarks on the subject for the consideration of your 
 readers." The practitioner in using the ophthalmoscope 
 "may bring about the very condition (amaurosis) that 
 he is hoping to avert." Later he also said*^ that he 
 retained "a very strong opinion as to the mischief likely 
 to result from the abuse of the reflecting ophthalmo- 
 scope if it is indiscriminately resorted to by inex- 
 perienced persons for investigating cases hastily classed 
 as incipient amaurosis." 
 
 Dr. Williams,** in an article on the ophthalmoscope, 
 . 1 
 
 41. London Medical Times and Gazette, vol. Ix, p. 30, 1854. 
 
 42. The London Medical Times and Gazette, vol. vli, 1853, p. 379. 
 
 43. Ibid., vol. ix, 1854, p. 7. 
 
 44. The London Medical Times and Gazette, vol. ix, 1854, p. 30. 
 
148 OPETEALMOLOGY IN AMERICA. 
 
 contributed in 1854, modestly referred to his use of the 
 instrument in the Moorfields (Eoyal London Ophthal- 
 mic) Hospital, where he probably demonstrated its 
 harmlessness, as well as benefits, with convincing effect. 
 He said : "As examples are always more interesting and 
 instructive than general descriptions, I will give a short 
 account of some cases which I have had occasion, within 
 the last few weeks, to observe at the London Ophthalmic 
 Hospital in the presence of Mr. Dixon and Mr. Bowman, 
 who had themselves seen some of the alterations which 
 it is my object now to describe. It is with great pleas- 
 ure that I take this opportunity of thanking the eminent 
 surgeons of the institution for the kind permission they 
 have granted me of attending their extensive and inter- 
 esting practice, and especially of continuing those ob- 
 servations with the ophthalmoscope which. I had com- 
 menced at Paris with Dr. Anagnostakis, the ingenious 
 inventor of the ophthalmoscope which I use." Then 
 follows a description of the cases in which he had used 
 this instrument and of the appearances which they pre- 
 sented. 
 
 On his return to Cincinnati, in 1855, Dr. Williams at 
 once established an eye clinic, in connection with one of 
 the hospitals, which met with success. In 1860 Miami 
 Medical College, which was organized in 1852, created 
 a chair of ophthalmology, and Dr. Williams was elected 
 professor to it. This was the first time in America that 
 a medical college had thus recognized this specialty. 
 
 Dr. Williams was a lucid and impressive teacher, and 
 was greatly beloved by both physicians and students. 
 For a number of years he had editorial charge of the 
 Cincinnati Lancet and Observer, and contributed nu- 
 
OPHTHALMOLOGY IN AMERICA. 149 
 
 merous articles and reports on ophthalmologic subjects 
 to its columns. In 1885 he wrote the section on dis- 
 eases and injuries of the eye for Ashurst's International 
 Eneiycopedia of Surgery, 1884, vol. v, pp. 169-288. It 
 was concise and comprehensive; in fact, it was a com- 
 plete manual on the subject and embodied the results of 
 his own observations and experience of many years' dura- 
 tion. As a teacher, practitioner and operator he had 
 few equals. 
 
 THE INFLUENCE OF THE TWO WILLIAMSES. 
 
 These two men, Henry W. Williams, of the Bast, and 
 Elkanah Williams, of the West, inspired by the examples 
 of their famous European teachers and believing in the 
 dignity and value of specialism, dared to assert them- 
 selves in opposition to an organized and inbred senti- 
 ment against it. By their professional loyalty and up- 
 rightness, by their devotion to the interests of general 
 medicine, by their enthusiasm and consistent aggres- 
 siveness, by their learning and their skill, and by their 
 kindly and commanding personality, they won the battle 
 for the exclusive practice of ophthalmology. 
 
 With the examples and labors of these two men, and 
 with the growing interest in ophthalmology that had 
 already developed, the impulse became irresistible and 
 the time seemed to have arrived for men to build anew 
 on the foundations which a half century had made 
 secure. Other young men began to repair to the large 
 eye clinics of Europe, and they continued to bring back 
 to this country the enthusiasm of the great masters and 
 a greatly enlarged view of ophthalmology. 
 
VIII. 
 AN ERA OF RAPID CHATUGE, AFTER 1S50. 
 
 While this interest was deepening and widening in 
 this country, great changes were also taking . place 
 abroad. In 1851 von Helmholtz published his invention 
 of the ophthalmoscope; in 1854 von Graefe established 
 his Archives; in 1857 Streatfield began the publication 
 of the Royal London Ophthalmic Hospital Reports; in 
 1857 von Graefe startled the world by the announce- 
 ment of a surgical remedy for glaucoma; in 1857 to 
 1859 Bonders recorded in von Graefe's Archives his 
 marvelous researches in the refraction and accommoda- 
 tion of the eye and their anomalies. 
 
 During the '50s the important accessions to the spe- 
 cial literature were Dr. H. W. Williams' translation, in 
 1850, of Dr. Sichel's work on "Spectacles," and new 
 editions of English treatises on the eye and its diseases. 
 In 1853 Lindsay and Blakiston, of Philadelphia, issued 
 "A Treatise on Operative Ophthalmif Surgery," by H. 
 Hayes Walton, P.E.C.S.E., of London, England, edited 
 by S. Littell, M.D., of Philadelphia. It was the first 
 American, from the first London edition, in an octavo 
 volume of 599 pages, illustrated by 169 engravings. As 
 indicated by the title, the range of the work was limited 
 to operative ophthalmic surgery, and within that range 
 it was a valuable contribution to our science. It was 
 the first work on the eye to contain a chapter on general 
 anesthesia in this department of surgical practice. The 
 
DR. ADINELL HEWSON (1828-1889). 
 
OPHTHALMOLOOY IN AMERICA. 153 
 
 author preferred chloroform to sulphuric ether or any 
 other agent in producing the anesthesia. He believed 
 that it might be administered to "persons of all ages, 
 from a few -weeks or months old to extreme age." He 
 further stated that "it is scarcely possible to overrate the 
 value of a discovery which tranquilizes the mind of the 
 patient by banishing the anticipation of pain, deadens 
 the sensibility, and prevents the reality of suffering; 
 while to the operator it brings the inestimable advantage 
 of quieting the struggles of children, or of irresolute 
 adults, which are so apt to frustrate all the care, fore- 
 sight and dexterity that the most assiduous application 
 to practical surgery can command." 
 
 In 1854 another edition of the great work of Law- 
 rence was republished here, much enlarged and im- 
 proved by Dr. Hays. His notes were numerous and 
 valuable. 
 
 The next year, 1855, Dr. Adinell Hewson brought out 
 a new American edition of William Mackenzie's ency- 
 clopedic "Practical Treatise on Diseases of the Eye." 
 His additions, too, were numerous and valuable. They 
 included new suggestions, as well as recent observations, 
 and for the first time, in an American book, he de- 
 scribed the ophthalmoscope by adding a special chapter 
 devoted to it. This instrument had been entirely ignored 
 in the English edition. 
 
 In 1856 there was another, the second American, 
 edition of T. Wharton Jones' "Principles and Practice 
 of Ophthalmic Medicine and Surgery" (Philadelphia 
 Lea and Blanchard, 1856)., This time it was edited by 
 Dr. Edward Hartshorne instead of by Dr. Hays. Dr. 
 Hartshorne was a distinguished practitioner of Philadel- 
 
154 OPHTHALMOLOGY /*" AMERICA. 
 
 phia and was prominent there in ophthalmic circles. His 
 notes added materially to the value of the book. 
 
 The '60s became more prolific than ever before, at 
 least of foreign literature on the ej'e, and its influence 
 on America was deeper and more lasting. In 1864 the 
 classic work of Bonders on "Kefraction and Accommo- 
 dation" was put into English, and in 1866 and 1867 
 that of von Helmholtz on "Physiological Optics" was 
 issued both in German and in French. Immediately 
 after these publications J. Soelberg Wells, of London, 
 wrote his extended "Treatise on Diseases of the Bye," 
 accepting and incorporating the conclusions of Bonders 
 and von Helmholtz, together with the operative proce- 
 dures of von Graefe in glaucoma and cataract. Wells' 
 work epitomized, also, the new experiences and conclu- 
 sions of his English confreres, Gritchett, Bowman and 
 others. In fact, it was the reflection of all that was 
 new in ophthalmology, and at the same time embodied 
 the verities of the old. It was published in London in 
 1868 and in this country in 1869. E. Jaeger, in 1869, 
 also published that inimitable "Atlas," representing the 
 normal and pathologic fundus of the eye, the descrip- 
 tive text being in German. It was followed the next 
 year by a French edition, by de Wecker, of Paris. 
 
 Another work of great erudition and merit was that 
 of Stellwag von Carrion. It was issued in German in 
 
 1867 and was at once translated into English by Drs. 
 Eoosa, Bull and Hackley of New York and published in 
 
 1868 by William Wood & Co., New York. In the mean- 
 time translations of foreign ophthalmologic articles were 
 published in the Boston, New York and other journals, 
 either in full or in abstract, by Hasket Derby, Henry D. 
 Noyes and others. 
 
DR. EDWAKD HARTSHOENB (1S18-1885). 
 
OPHTHALMOLOGY IN AMERICA. 157 
 
 Dr. H. W. Williams in 1862 published Ms "Practical 
 G-uide to the Study of Diseases of the Bye," a 12mo of 
 351 pages. This was the fourth original work on dis- 
 eases of the eye written by an American, and in it? 
 clearness and conciseness, and yet completeness, has 
 never been excelled. Eepresenting, as it did, the oph- 
 thalmology of that time, the publication of Donders' 
 work in 1864 made it necessary to give it an early re- 
 vision. It passed through several editions, the last of 
 which was issued in 1886, and to-day, even, is a model 
 of medical authorship. In 1865 Dr. Williams was the 
 successful competitor for the Boylston prize, the subject 
 being "Eecent Advances in Ophthalmic Science." This 
 was published in uniform style with his "Practical 
 Guide," making a 12mo of 178 pages. The substance 
 of this essay was afterwards incorporated into his "Prac- 
 tical Guide," but in itself alone it was an important ad- 
 dition to the ophthalmic literature of that time. 
 
 THE OPHTHALMOSCOPE. 
 
 > Soon after the discovery of the ophthalmoscope much 
 interest was shown in this instrument in this country, 
 and numerous articles were written describing it and its 
 uses. Among the earliest of those who wrote on the 
 subject were George A. Bethune, of Boston;*^ John H. 
 Dix, of Boston:*" Adinell Hewson, of Philadelphia;*' 
 Montrose A. Fallen, then of New York,*^ and L. Turn- 
 bull, of Philadelphia.*" 
 
 4.3. Boston lied, and Surg. Jour., 1854, vol. ii. 
 
 46. Boston Med. and Surg. Jour, for 1855, 1856 and 1858. 
 
 47. Am. Ed. of Mackenzie, 1855. 
 
 48. Trans. Am. Med. Assn., 1858. 
 
 49. Phila. Sled, and Surg. Reporter, 1850. 
 
158 OI'HTHALMOLOaY IN AMEKIVA. 
 
 TWO NOTABLE ARTICLES. 
 
 Two original articles which were espeeialh* notable, 
 both by the Willianises, were published during the early 
 part of this formative period. One was by Henry W. 
 Williams "On the Treatment of Iritis Without Mer- 
 cury/' in 185G. It was a memorable essay, and is said 
 to have inaugurated a radical reform in the therapeu- 
 tics of that disease. Dr. Williams demonstrated by the 
 study of sixty-four cases that this class of cases would 
 recover by the systematic use of a strong solution of 
 atropia, the only internal remedies administered being 
 iodid of potassirrm, colchicum and iron. 
 
 The other paper was by Elkanah Williams "On the 
 Obliteration of the Lachrymal Sac by the Actual Cau- 
 tery." It was first presented in Cincinnati in 1856 
 (Cincinnati Jjoncet and Ohscrver, 1856), and again lie- 
 fore the International Congress of Ophthalmology in 
 18(i'i.'"' 
 
 TWO NEW EYE HOSPITALS. 
 
 During the same period two new institutions devoted 
 to the charitable relief of the poor afflicted with diseases 
 of the eye were added to those previously founded. 
 
 The first was the New York Ophthalmic Hospital, 
 which was incorporated April 21, 1852, and was opened 
 on May 25 of the same year. The board of directors 
 was made up of prominent citizens of New York City, 
 and Hon. C. S. Woodhull was its first president. The 
 first surgeons were Dr. David L. Bogcrs and Dr. Mark 
 Stejihenson, both of New York. It had a humble be- 
 ginning like other institutions of the kind, and tlic 
 
 50 Congi-Os rV'L-iodique Internationale d'Ophtbalmologie, 2e ses- 
 sion, 1802. Compte-i-endu, I'aris, 1803, p. 137. 
 
DK. EDWARD L. HOLMES (1828-1900). 
 
OPHTHALMOLOGY IN AMERICA. 161 
 
 purpose of its organization was said to be to accommo- 
 date the poor in districts then farther up town in that 
 city. Its first location was at No. 6 Stuyvesant Street, 
 between Second and Third Avenues. According to its 
 first report, four hundred and forty-four patients were 
 treated from May 25, 1853, to Jan. 1, 1853. From that 
 time it had a steady and healthful growth. In 1865 
 the surgical staff was constituted of Drs. John P. Gar- 
 rish, Marcus P. Stephenson, William F. Holcomb, 
 Ebenezer McFarland, Giovinni Ceccarini and John M. 
 Carnochan, with Drs. David L. Rogers, Alfred C. Post 
 and Frank H. Hamilton, consultants. Almost from 
 the outset clinical instruction on diseases of the eye was 
 given to students, and in 1865, the report states that 
 "over six hundred students have availed themselves of 
 these advantages." 
 
 In 1867 the homeopaths in some way secured posses- 
 sion of the management, and since then it has been 
 served by homeopathic practitioners. To-day it is es- 
 timated that about 15,000 patients, including eye, ear, 
 nose and throat eases, are treated there annually. 
 
 The other institution was that most active and benef- 
 icent one of Chicago, known to-day as the Illinois Char- 
 itable Eye and Ear Infirmary. 
 
 In the month of May, 1858, a number of physicians, 
 under the leadership of Dr. Edward L. Holmes, met 
 some benevolently disposed citizens of Chicago and 
 founded the Chicago Charitable Eye and Bar Infirmary, 
 electing a board of trustees and making Dr. Edward L. 
 Holmes surgeon. Its first location was in a single room 
 at the northeast corner of Michigan and North Clark 
 Streets. It remained there until 1862, when it was re- 
 
102 OPHTHALMOLOGY LN AMERICA. 
 
 moved to No. 28 North Clark Street. In 1864 Walter 
 L. Newberry, president of the institution, donated for 
 a term of ten years the lease of a lot of land, on which 
 was erected a large two-story frame building. In 1865 
 this building was raised and a brick basement con- 
 structed under it. In 1871 the State of Illinois, after 
 some preliminary legal proceedings, received it into the 
 circle of state institutions by a special act, when the 
 name of the institution was changed by the substitution 
 of the word "Illinois" for "Chicago." On Oct. 9, 1871, 
 fire swept away the old infirmary. The state at once 
 made provisions for carrying on the work of the institu- 
 tion, and as soon as possible erected the present building, 
 which was completed in 1874. The number of patients 
 of all kinds admitted to the infirmary for treatment for 
 the biennial period ending June 30, 1903 (the last re- 
 port at hand), was 31,395, making a total at that time 
 of 183,904 admitted since the opening of the institution 
 by the state in 1874. 
 
 Among the active surgeons have been Edward L. 
 Holmes, Edwin Powell, P. C. Hotz, S. J. Jones and 
 others. 
 
 OPHTHALMOLOGIC JOURNALISM. 
 
 Early in the '60s a movement was made to establish 
 an ophthalmologic journal. This deserved to be a last- 
 ing success, but it was not. There had never been an 
 ophthalmologic journal in this country, ophthalmologic 
 papers having been heretofore published in the general 
 medical journals and in the transactions of the state 
 societies and of the American Medical Association. Dr. 
 Julius Homberger, who had been a pupil of von Graefe 
 and Sichel, had just settled in New York to practice 
 
DR. FIENRY D. NOTES (1S32-1000). 
 
OPHTHALMOLOGY IN AMERICA. 165 
 
 ophthalmology. The time seemed to him auspicious for 
 establishing a special journal. In 1862, therefore, he 
 undertook to do so^ under the name. The American Jour- 
 nal of Ophthalmology. The first prospectus announced 
 that it would be a quarterly with forty-eight pages to 
 each number. The first number was issued in July, 
 1862. Six numbers were published between that date 
 and May, 1863 and constituted the first volume. The 
 second volume was begun in January, 1864, but the en- 
 terprise was apparently discontinued with the second 
 number of this volume, in April of that year. It con- 
 tained but few original articles and these were mostly 
 written by the editor. The bulk of the contents was 
 made up of translations of articles by von Graefe and 
 other German writers. The pages were closely printed 
 and the articles represented some of the best German 
 thought. 
 
 THE AMERICAN OPHTHALMOLOGICAL SOCIETY. 
 
 In point of time the next movement to create a means 
 of interchange of thought and experience on the part 
 of the few Americans who were engaging themselves 
 wholly or in part in ophthalmic study and practice was 
 instigated by two enterprising young men. Dr. Henry D. 
 Noyes, of New York, and Dr. Hasket Derby, of Boston, 
 who had then just entered on careers of specialism. They 
 were materially aided and encouraged by Dr. Freeman J. 
 Bumstead, a prominent and influential general as well 
 as ophthalmic surgeon of New York. In response to 
 several verbal invitations, a conference was held at the 
 oflSce of Dr. Noyes, 278 Fourth Avenue, New York, on 
 Jan. 9, 1864. The purposes of the conference were 
 stated to be "to consult on the best mode of promoting 
 
166 OPHTEALMOLOGY IN AMERICA. 
 
 the interests of ophthalmologjr in this country." Drs. 
 H. B. Sands, H. Althof, J. H. Hinton, F. J. Bumstead, 
 D. B. St. John Eoosa, W. P. Holcomb, H. D. l^oyes, all 
 of New York, and Hasket Derby, of Boston, were pres- 
 ent. The project of founding a Journal of ophthalmol- 
 ogy was discussed, but it was voted down.'^ A resolution, 
 however, presented by Dr. Bumstead, was passed, au- 
 thorizing the appointment of a committee "to invite 
 ophthalmic surgeons from the whole country to assemble 
 in New York at the time of the meeting of the Ameri- 
 can Medical Association." Drs. Bumstead, Noyes and 
 Derby were appointed such committee. Pursuant to a 
 call of this committee, a meeting was held at the New 
 York Eye Infirmary, Second Avenue and Thirteenth 
 Streets, on June 7, 1864. Eighteen gentlemen were 
 present. Dr. Bumstead called the meeting to order, 
 and Dr. Edward Delafield was elected chairman and Dr. 
 H. D. Noyes secretary. A constitution and by-laws 
 were adopted. 
 
 At the meeting held the next day papers were read 
 
 51. Since the above was put in type I have received the fol- 
 lowing note from Dr. Hasket Derby, of Boston, which Is self ex- 
 planatory. It will serve to indicate! the opposition that was felt 
 toward Dr. Homberger and his journal, and the actuating desire 
 of the pioneer ophthalmologists to neutralize his influence and to 
 advance ophthalmology on scientific and unselfish lines. Dr. Derby 
 says : "The actual founder of the society was Dr. Julius Homberger, 
 as I used laughingly to assert, to Dr. Noyes' great indignation. 
 About 1862, a peripatetic German adventurer of this name came 
 to New York to engage in ophthalmic practice, and started a maga- 
 zine of ophthalmology. After a few numbers this probably fell 
 stillborn, but while it lasted it disgusted reputable ophthalmologists, 
 and the meeting called by Dr. Noyes, after consultation with me, 
 was really to concert measures for the establishment of a magazine 
 that should be respectable. Eight of us came , together at 0r. 
 Noyes' office in Fourth Avenue, and after well weighing the matter, 
 decided that a society would be a better thing to found than a 
 magazine. So we issued a call for a meeting and held it (the 
 first) June 7, 1864. Thus we originated. Whatever became of 
 Homberger I have no means of khowing. The Germans have a 
 word, 'verschoUeh,' which probably applies to him." 
 
DR. BASKET DERBY. 
 
OPHTHALMOLOGY IN AMERICA. 169 
 
 and discussed and certain other business was transacted. 
 The organization was completed and named The Amer- 
 ican Ophthalmologieal Society. Dr. Edward Delafield 
 was elected president. Dr. Henry D. Noyes recording 
 secretary, and Dr. Herman Althof corresponding secre- 
 tary. As an indication as to who the principal ophthal- 
 mic surgeons were in 1864 I will here record those who 
 were present and who were made charter members, and 
 also those who were not present but who were elected to 
 membership: Present, Drs. Edward Delafield, F. J. 
 Bumstead, John Hinton, Francis Simrock, Herman Alt- 
 hof, W. F. Holcomb, D. B. St. John Eoosa, William F. 
 Carmalt, William Stimpson, Henry B. Sands, Henry 
 D. Noyes, of New York; John H. Dix, B. Joy Jeffries, 
 Hasket Derby, Francis P. Sprague, of Boston; Ezra 
 Dyer, of Philadelphia, and C. A. Eobertson, of Pough- 
 keepsie. Others elected tt) active membership were Drs. 
 Abram Du Bois, of New York; Henry W. Williams, 
 Gustavus Hay, of Boston ; J. F. Noyes, of Detroit, J. S. 
 Hildreth, of Chicago; Adinell Hewson, William Hunt 
 and Thomas G. Morton, of Philadelphia. The follow- 
 ing were elected honorary members : Drs. Edward Eey- 
 nolds, Kobert W. Hooper, George A. Bethune, John 
 Jeffries, of Boston; George Wilkes, of New York, and 
 Isaac Hayes, of Philadelphia. 
 
 Dr. John H. Dix was the first to read a paper before 
 the newly organized society. It had a double subject; 
 one part was the report of a case of "Peculiar Trans- 
 parent Neoplastic Formation in the Anterior Chamber 
 of the Eye," and the other was "On the Effects of Cal- 
 abar Bean on Paralysis of Accommodation Following 
 Diphtheria.'' 
 
170 OPHTHALMOLOGY IN AMERICA. 
 
 Thus was founded the first ophthalmological society 
 in America, if not in the world. Thus began the united 
 scientific labors of American ophthalmic surgeons, and 
 such was the personnel of its first membership. The 
 transactions of the society from 1864 to 1906 record 
 the essential results of the study and practice of these 
 and subsequent members, and in a great measure repre- 
 sent the progress of ophthalmology in this country dur- 
 ing the last forty years. 
 
 LOCAL SOCIETIES. 
 
 In 1864 the New York (City) Ophthalmological So- 
 ciety was organized, with Dr. Cornelius E. Agnew its 
 first president. It has continued in successful operation 
 to the present time. 
 
 On Feb. 1, 1870, a similar organization was started 
 in Philadelphia, the Philadelphia Ophthalmological So- 
 ciety, with Dr. Isaac Hays president and Dr. Edward 
 Hartshorne vice-president. Dr^ S. D. Eisley, of Phila- 
 delphia, in a private letter to me, says : 
 
 The names of many eminent men, some of whom are still 
 living, appear again and again in the records of the scientific 
 proceedings and in their discussions of the private business of 
 the society. Monthly meetings with full attendance were held 
 for the first year, and most of the second. Then the attend- 
 ance rapidly fell off, the leading ophthalmologists' names being 
 absent from the list of those present, only general surgeons, 
 like Levis,' Morton and others, all of whom did eye surgery 
 in conjunction with their general surgery, being habitually 
 present. The society finally died a natural death after many 
 vicissitudes, the last meeting having been held at Dr. Straw- 
 bridge's house, April 6, 1875. 
 
DR. HERMAN KNAl'P. 
 
OPHTHALMOLOGY IN AMERICA. 173 
 
 DR. KNAPP AND HIS AECHIVES. 
 
 It was apparent from the discussion at the first meet- 
 ing, held for the purpose of organizing the American 
 Ophthalmological Society, that an ophthalmologic Jour- 
 nal was regarded a desideratum, and yet it was not 
 deemed best to undertake the publishing of one at that 
 time. Perhaps the experience of Dr. Homberger was 
 a warning against it. Soon, however, a distinguished 
 and energetic Heidelberg professor, Dr. Herman Knapp, 
 came to this country and took up his residence in New 
 York. This was in 1868. In the following year he 
 established his Archives. This journal had a vigorous 
 beginning and gave assurance of perpetuity. With the 
 realization of such perpetuity, with the maintenance of 
 its high and scientific ideals and standards, it has proved 
 to be a most powerful engine of ophthalmologic progress 
 in this country. 
 
IX 
 OTHER FACTORS OF ADVANCEMENT. 
 
 At this period also medical college after medical col- 
 lege was establishing special lectureships and professor- 
 ships of ophthalmology. 
 
 Institutions for diseases of the eye were still being 
 organized. The Ophthalmic and Aural Institute was 
 
 THE FIRST MANHATTAN EYE AND EAR HOSPITAL, 
 34TH STREET. 
 
 founded by Herman Knapp in 1868 ; the Brooklyn Eye 
 and Ear Hospital by Arthur Matthewson, late of the 
 United States Army, and Homer C. Newton, late of 
 the United States Navy, assisted by Cornelius E. Ag- 
 new, in 1868; the Manhattan Eye and Ear Hospital 
 by Cornelius E. Agnew in 1869. 
 
 SOME NOTEWORTHY CONTRIBUTIONS DURING THE TWO 
 DECADES AETER 1850. 
 
 The first of these to which I wish to call attention is 
 the "needle-knife" of Dr. Hays for the operation for 
 
OPHTHALMOLOGY IN AMERICA. 
 
 175 
 
 cataract "by solution or absorption."^^ Not only did this 
 instrument admirably serve the purpose for which it 
 was designed by Dr. Hays, but it is still an excellent 
 knife for discission of "after-cataract." Dr. Hays de- 
 scribed it, in 1855, as having a total length of six-tenths 
 
 THE SECOND MANHATTAN EYE AND EAR HOSPITAL. 
 103 PARK AVENUE, NEW YORK. 
 
 of an inch "from point to bead," with a perfectly straight 
 cutting edge four-tenths of an inch long. The back was 
 also straight to near the point "where it was truncated 
 80 as to make the point stronger, but at the same time 
 
 HAYS "NEEDLE-KNIFE." 
 
 leaving it very acute." This truncated portion of the 
 back was made to cut. The rest was rounded and the 
 shank was so constructed as to fill the incision and pre- 
 
 52. Lawrence's Treatise on Diseases of the Bye, Am. Ed., 1854, 
 p. 726. and Am. Jour. Med. Sci., 1855, xxx, 81. 
 
176 OPETUALMOLOOY ly AMERICA. 
 
 vent the escape of aqueous humor. It is doubtful if any 
 discission "needle-knife" or "knife-needle" has since 
 been devised that was better than this. 
 
 Previous to and for some time after this period "ex- 
 traction of cataract was an infrequent procedure, eon- 
 fined *■© the hands of a few skilful men. Comminution 
 and depression were the common operations."^' 
 
 Levis' wire loop. 
 At about the same time Dr. E. J. Levis, a Philadel- 
 phia surgeon skilled in ophthalmic surgery, devised a 
 wire loop with which to facilitate the exit of the lens 
 in cataract extraction. This has proved to be of great 
 service in certain cases. 
 
 EXPERIMENTAL CATARACT. 
 
 In 1860 Dr. S. Weir Mitchell made some interesting 
 experiments which showed that the administration of 
 saccharine substances to frogs produced cataract in 
 them.'^* The experiments consisted in injecting "syrup" 
 subcutaneously, the effect being, among other things, to 
 produce a peculiar variety of cataract "due to mechan- 
 ical digturbances of the form and relative position and 
 contents of the component tubes of the lens." 
 
 dyer's CILIARY GYMNAStlCS. 
 
 Dr. Ezra Dyer, a careful student of Donders and an 
 astute observer, read a memorable paper before the 
 American Ophthalmologieal Society in 1865 entitled 
 "Asthenopia in Connection with Hypermetropia."°° He 
 believed that the cause of asthenopia in these cases was 
 
 53. S. D. Gross : "Century of Surgery," Am. Jour. Med. Scl., 
 1876, Ixil, 478. 
 
 54. Am. Jour. Med. Sel., 1860, xxxix, 106. 
 
 55. Trans. Am. Oph. Soc, 1865, p. 28. 
 
OPHTHALMOLOGY IN AMERICA. 177 
 
 a loss of tone of the ciliary muscle. The treatment, 
 therefore, consisted in increasing the tone or strengthen- 
 ing the ciliary muscle by systematic reading exercises, 
 or what he termed, "gymnastic exercises" of the accom- 
 modating muscle. In addition to the lack of "tone" 
 he believed that there was some disturbance of the rela- 
 tive accommodation, together with a "want of mental 
 energy, the patient having lost confidence in his power 
 to use the eye." He first changed the relation of the ac- 
 commodation to the angle of convergence of the axes of 
 the eyes by glasses. To the emmetrope he gave + 1.25 
 or + 1.00. In a myope of 4.00 D. he simply corrected 
 the myopia. In the higher grades of myopia he carried 
 the far point to ten or fifteen inches with the proper 
 concave glass. Glasses having thus been ordered in ac- 
 cordance with the given refractive condition of the eyes, 
 the patient was directed to read clear type of medium 
 size for three to fifteen minutes in the morning. If no 
 pain followed, the reading was continued a minute 
 longer at noon and increased another minute at evening. 
 This was done entirely by daylight. If pain followed 
 the first reading until the time of the second, the patient 
 should not mind it, but read a minute less than he had 
 done in the morning and a minute less at night, if it 
 still continued. In this way a point was to be found 
 when he could read a certain number of minutes without 
 pain and then the time increased a minute each day, or 
 faster if prudent, until the patient could read thirty or 
 forty minutes three times a day. Then other uses of 
 the eyes than for reading were carefully substituted. 
 When sixty to seventy minutes were reached the glasses, 
 except in the myopic class, were gradually dispensed 
 
178 OPETHALMOLOOY IN AMERICA. 
 
 with, the surgeon being guided by the nature and course 
 of the case. Dr. Dyer added: One minute increase a 
 day seems a small matter, but if a person begins with 
 an increase of time of reading one minute, three times 
 a day, at the end of a month he will be reading an 
 hour and a half a day. Dr. Dyer's gymnastic treatment 
 of asthenopia at that time was based on an experience 
 with forty cases, in thirty-eight of which the results were 
 "highly satisfactory." 
 
 UNIFORM ILLUMINATION OF TEST-TXPES. 
 
 Dr. Hasket Derby, of Boston, was probably the first 
 to urge the importance of using steady and uniform ar- 
 tificial light on test letters in examinations for ame- 
 tropia. He directed the attention of the profession to 
 this in a paper read in 1866.^^ His statement was as 
 follows : 
 
 Let the letters used as a. test be placed in a room from 
 which daylight is excluded, and let them be illuminated by a 
 steady flame, uniform in intensity of illuminating power, and 
 placed always at the same distance from the letters. 
 
 MYDRIATICS A CAUSE OF GLAUCOMA. 
 
 Dr. Hasket Derby, in 1868, was also the first to pro- 
 test against the use of mydriatics in glaucoma.^' He 
 cited two cases in which acute glaucoma had super- 
 vened on the use of atropia. He concluded that "so 
 important in glaucoma are the early ophthalmoscopic 
 sjnnptoms . . . and so frequently does it become 
 desirable to dilate the pupil in order to satisfactorily 
 determine their existence, that any facts tending to show 
 
 56. Trans. Am. Oph. Soc, 186ff, p. 116. 
 
 57. Trans. Am. Oph. Soc, 1868, p. 35. 
 
DR. FREEMAN J. BUMSTEAD (1826-1879). 
 
OPHTHALMOLOGY IN AMERICA. 181 
 
 the impropriety of the use of mydriatics would have a 
 most important practical bearing." 
 
 PRESCRIBING CYLINDRICAL GLASSES. 
 
 Dr. F. J. Bumstead and Dr. Hasket Derby were the 
 first in this country to follow Donders in the determina- 
 tion and correction of astigmatism. Dr. Bumstead re- 
 ported one case with suggestions in 1863.^^ In the same 
 year Dr. Derby reported four cases, the first of which 
 was examined by him in Boston in May, 1863. He had 
 glasses ground in Berlin for them.^' 
 
 Dr. Derby had been studying ophthalmology in Europe 
 under the great masters, Arlt, Jaeger, Von Graefe and 
 Donders from 1859 to 1862. During the latter part of 
 this period he was in Utrecht with Donders, who was 
 then working out the great problem of astigmatism and 
 its correction with cylindrical glasses. He, with his 
 companion at that time, Dyer, thus had the rare privilege 
 of acquiring at first hand the essential principles of as- 
 tigmatism and its correction from the one who scientif- 
 ically established them. Being, therefore, one of the first 
 disciples of the immortal founder of a new science, and 
 being conscious of the verity and practicability of his 
 teachings, he returned to this country to promulgate and 
 apply them. In this most difiicult and important field 
 of refraction work he was an American pioneer. 
 
 OPERATION FOR DIVERGENT STRABISMUS. 
 
 Another original contribution which is worthy of notice 
 was made by Dr. C. E. Agnew on the operative correction 
 of divergent strasbismus. His paper will be found in the 
 
 58. Am. Med. Times, 1863, Tii, 203. 
 
 59. Ibid., p. 277. 
 
182 OPHTHALMOLOGY IN AMERICA. 
 
 Transactions of the American Ophthalmological Society 
 for 1866, p. 31, entitled "A Method for Operating for 
 Divergent Squint." 
 
 Dr. Agnew described his method in substance as fol- 
 lows: 
 
 The patient being put under the influence of a general anes- 
 thetic, the eye is exposed by an eye speculum and the cornea 
 is drawn as much as possible toward the outer canthus by an 
 assistant grasping the tissues over the tendon of the external 
 rectus muscle with a pair of fixation forceps. The operator 
 then makes a horizontal opening of the conjunctiva over the 
 external rectus muscle with scissors, midway between its bor- 
 ders and extending from a point one line distant from the cor- 
 nea inward as far as the semilunar fold, thus exposing the 
 muscle without difficulty and without the occurrence of much 
 bleeding. After having found the insertion of a muscle, a stra- 
 bismus hook with an eye in its free extremity and armed with 
 a waxed silk thread is passed beneath it, from below upward 
 keeping the hook in close contact with the sclera, and carried 
 sufiieiently far back to include every straggling band or theca 
 which is to be advanced. The uplifted mass is then tied close 
 to its scleral implantation. The next step is to divide the 
 attachment of the external muscle freely through a horizontal 
 wound in the conjunctiva. The . operator now holds the liga- 
 ture, which is tied to the external rectus muscle, firmly in one 
 hand, and with scissors severs the insertion of the muscle and 
 gently breaks up any bands of connective tissue which may 
 attach it to the sclera. Having satisfied himself that there are 
 no adhesions which may obstruct the advancement of the mus- 
 cle, he now catches the scleral edge of the cut tendon of the 
 external rectus muscle, draws the cornea toward the inner 
 canthus, and while he holds up the muscle en the stretch, the 
 retentive sutures are placed. For this purpose two delicate, 
 short and sharp-curved needles are armed with fine, well-waxed 
 silk and adapted to a needle-holder. 
 
 The author's method of placing this suture is, in his own 
 words, as follows : "Having measured the extent to which the 
 eyeball must be adducted in order to correct the divergence, 
 
OPHTHALMOLOGY IN AMERICA. 183 
 
 the sutures should be passed through the muscle and its theea 
 as far from its cut end as may be necessary. The muscle 
 should be drawn well out and kept on the stretch, so that the 
 sutures may be passed through it as deeply as possible behind 
 the caruncle, to secure a firm hold, and to leave a somewhat 
 longer mass between the perforations made by the sutures and 
 the ligature on its cut end than the original divergence meas- 
 ured. The course of the sutures should be perpendicular to the 
 plane of the muscle, one passing through near its upper mar- 
 gin and the other near its lower. After the sutures have been 
 placed in the muscle the end included in the ligature should be 
 cut oflf, care being taken to leave enough to prevent their 
 tearing out. The amount cut should nearly equal the degree 
 of divergence to be corrected, allowance being made for shrink- 
 age which has followed the detachment of the muscle from the 
 sclera. The next step is to carry the sutures beneath the con- 
 junctiva above and below the cornea. It is better to place the 
 upper suture first. This also requires the curved needle. The 
 point aimed at in carrying the needle along the sclera, beneath 
 the conjunctiva, should be about a line above the cornea and 
 over the center of the line of implantation of the superior rec- 
 tus muscle, and there the suture should emerge. Before tying 
 the vipper, the lower suture should be brought out at a corre- 
 sponding point over the inferior rectus insertion. AVhile the 
 operator is cautiously tying the sutures his assistant should, 
 catching hold of the insertion of the external rectus, carry the 
 cornea toward the internal canthus as much as possible and 
 thus effect what may be considered the real intention of the 
 operator, namely, to adduct the eye strongly, and thus place 
 the end of the shortened internal rectus in coaptation with the 
 sclera at the natural line of sclerotic implantation. The exer- 
 cise of a little oare will cause the muscle to spread out and be 
 hidden beneath the horizontal pillars of the wound through 
 which the retentive sutures, have been carried, thus insuring a 
 consolidation of the wounded parts intervening between the 
 cornea and the caruncle in the ultimate result. 
 
 This operation has been followed by ophthalmic sur- 
 geons and has proved most satisfactory. 
 
184 OPHTHALMOLOGY IN AMERICA. 
 
 AGNEW'S OPEEATIOHr FOR THICKENED CAPSULE. 
 
 In 1867*° Dr. Agnew also devised an ingenious and 
 safe method for removing a thickened capsule or other 
 pupillary obstruction, which was as follows : 
 
 The pupil having been dilated by atropin, the operator 
 passes a stop needle through the cornea about one line from 
 the nasal border and transfixes the membraniform obstruction. 
 Then while holding this steady, he makes an opening in the 
 cornea about one-half line from the temporal border with a 
 knife or a broad needle. Through this opening a sharp hook 
 is introduced, and its point entered in the opening made in 
 the membrane by the stop needle. If possible, the hook is now 
 to be rotated and the membrane rolled up around it, and 
 brought out of the anterior chamber. If it can not be drawn 
 out, it should be torn. 
 
 The patient is then kept in bed two or three days 
 with the. eye bandaged. The great advantage of the stop 
 needle is that it prevents traction on the ciliary body. 
 
 CORNEAL SUTURE IN CATARACT EXTRACTION. 
 
 Dr. H. W. Williams, of Boston, was undoubtedly the 
 
 first to suggest suturing the corneal wound after cataract 
 
 extraction. His first reference to the subject was made 
 
 in 1866."^ He again described his method in the last 
 
 edition of his work on "Diseases of the Bye" (Edition of 
 
 1886, p. 292), where he says : 
 
 The use of a suture to bring together the edges of the cor- 
 neal wound was proposed by me about twenty years since. 
 Extensive further trial has proved the value of this expedient 
 in many ■ cases, whatever method of operation, is employed ; as 
 also the perfect tolerance by the cornea of the exceedingly 
 minute suture. 
 
 60. See Stellwag. Am. Editions, 1868, p. 544, and 1873, p. 643. 
 
 61. Trans. Am. Oph. Soc, 1866, p. 45. 
 
DR. CORNELIUS R. AGNBW (18S0-1888). 
 
OPHTHALMOLOGY IN AMERICA. 187 
 
 By holding the edges of the wound in contact the suture 
 promotes immediate union, and tends to lessen the danger of 
 hernia of the iris, loss of vitreous and suppuration of the 
 wound; while, by securing early restoration of the anterior 
 and posterior chambers, it removes the iris from contact with 
 the cornea, or with portions of lens substance or capsule, thus 
 preventing synechia, or inflammation of the ciliary body. In 
 my judgment, the suture deserves attention as a, means of 
 gaining quicker and better results in any mode of extraction. 
 
 The needle I use is one-fourth of an inch long, and has a 
 flattened point with cutting edges. The needle-holder should 
 not be fastened with a spring catch, but must be held with 
 the fingers, so that the needle may be instantly released, with- 
 out jar, at the proper moment. Only a single strand of the 
 finest silk, scarcely larger than a filament from a cocoon, is 
 used for the suture. One edge of the flap is taken hold of with 
 a fine-toothed forceps, and held, while the needle is passed 
 through it close to its border ; the needle may be pulled through 
 at this side before the opposite edge is seized and penetrated 
 at a corresponding point. The slight contusion of a, small 
 point of the cornea by the forceps, or the continued presence 
 of the suture, does no apparent harm. The silk may be left 
 in situ till it comes away, or may be removed in a few days 
 after the healfng is consolidated, too much haste in this re- 
 spect being avoided.^ 
 
 NEW FORM 03? LACHRYMAL PROBES. 
 
 Dr. Williams in 1867"^ also proposed a modification 
 of probes for the lachrymal passages. The modification 
 consisted in having bulbous extremities of the sizes of 
 Bowman's series, and which are slender for one-third 
 of the distance from the bnlb to the flat disc at their 
 middle. He directed that they should be made of al- 
 loyed silver so that they might have an elastic flexibility 
 
 62. Trans. Am. Oph. Soc, 1867, p. 30. 
 
188 OVllTSALMOLOGY IN AMERICA. 
 
 without being liable to bend on themselves in encounter- 
 ing obstructions, as would be the case were the silver too 
 pure. 
 
 LACHRYMAL STYLES MADE OP LEAD WIRE. 
 
 At about the same period**^ Dr. John Green, of St. 
 Louis, suggested substituting for the rigid styles of sil- 
 ver in the treatment of lachrymal obstructions those 
 made of leaden wire : 
 
 The wire should be of the purest and softest lead, and drawn 
 to sizes ranging from one to two millimeters in diameter. 
 The styles are easily cut with a penknife, and the ends are 
 carefully rounded and smoothed by scraping. They are made 
 perfectly straight, as they are more easily introduced in this 
 form, and the upper end is bent over into a hooked form by 
 means of forceps after it has been placed in position. 
 
 Since Dr. Green suggested these styles many surgeons 
 have used them with satisfaction. 
 
 TEST-TYPES FOR DETERMINIKG ACUTENESS OE VISIOIT. 
 
 The publication of the test letters of Dr. Snellen, of 
 Utrecht, Holland, in 1862, marks the beginning of the 
 systematic testing of the acuteness of vision in clinical 
 work. The principle of Snellen consisted in using 
 "block" letters whose height subtends a visual angle of 
 five minutes at given distances, and in recording the 
 
 d 
 vision in accordance with the formula, V = — , V rep- 
 
 D 
 resenting the acuteness of vision, d the distance at 
 which the letters are viewed, and D the distance at 
 which the smallest size of letter correctly named is rec- 
 ognized by an average normal eye. The first American to 
 
 63. Trans. Am. Oph. Soc, 1868, p. 31. 
 
OPETHALMOLOGY IN AMERICA. 189 
 
 appreciate the value of Snellen's principle and to intro- 
 duce into this country test letters based upon it was the 
 late Dr. Ezra Dyer, in 1862, even several months before 
 the publication of Snellen's standard test-types. After 
 a prolonged period of study in Europe, the last few 
 months of which were passed in Utrecht, Dyer, in 1863, 
 entered on the practice of ophthalmology in Philadel- 
 phia. His letters, which were of different patterns 
 placed in juxtaposition, were printed on a sheet for 
 private use and distribution among his American col- 
 leagues. The credit due to him is for his prompt recog- 
 nition of the importance of Snellen's invention and for 
 making it known in this country in advance of its gen- 
 eral promulgation in Europe."* 
 
 Soon after the publication of Donders' studies on re- 
 fraction and accommodation Dr. Green, of St. Louis, 
 became one of his pupils. He at once gave especial at- 
 tention to the detection and measurement of astigma- 
 tism, his first paper being published in Holland in 1866 
 and again in the United States in 1867."^ His paper 
 in the English language was entitled "On the Detection 
 and Measurement of Astigmatism," in which, after giv- 
 ing the definition of the term and a historical sketch of 
 the subject, he proceeded to explain the methods of de- 
 termining its presence, suggesting the use of new forms 
 of charts made up of radiating lines or radiating rows 
 of dots, designed in different forms and varying in num- 
 bers. He suggested also certain improvements in the 
 test types of Snellen which had both a mathematical 
 and practical interest. In a later article the same 
 
 64. From report of Dr. John Green, of St. Louis, Trans. Am. 
 Ophthalmological Society, 190S, vol. x, p. 190. 
 
 65. Am. Jour. Med. Sci., 1867, liii, 117. 
 
190 OPHTHALMOLOGY IN AMERICA. 
 
 year** he wrote another paper on "Astigmatism Consid- 
 ered in Its Eelation to Defective Vision, Asthenopia and 
 Progressive Myopia." After the contribution of Bon- 
 ders this, so far as it went, was one of the most im- 
 portant on the subject of astigmatism, and especially in. 
 its causal relations to myopia. The article can not be 
 easily summarized, but should be read in full. 
 
 Dr. Green's invaluable teachings in regard to the de- 
 tection and correction of ametropia, beginning in 1867, 
 have had great weight and they have permeated the 
 whole ophthalmologic profession, and its members, many 
 of them unconscious of their authorship, are determin- 
 ing and treating astigmatism in accordance with them, 
 to-day. 
 
 pkay's astigmatic letters. 
 Soon after the ingenious charts of Dr. Green were 
 presented to the public Dr. 0. M. Pray, of Brooklyn, 
 suggested a form of test-type for astigmatism, in which 
 the letters were made of lines running in difEerent direc- 
 tions."^ These astigmatic letters met with great favor 
 on the part of ophthalmologists for a long time. I fear 
 they are not used as much to-day as they should be. 
 
 PHOTOGRAPHY OE THE OCULAR EUNDUS. 
 
 Early in the '60s attempts were made by Dr. H. D. 
 Noyes, of New York, and Dr. Liebreich, of Berlin, to 
 photograph the fundus of the eye, but they were unsuc- 
 cessful. In 1864 Dr. A. M. Rosebrugh, of Toronto, Can- 
 ada, made another attempt with partial success. He 
 devised a special form of ophthalmoscope with a camera 
 
 66. Am. Jour. Med. Sci., 1867, liv, 82. 
 
 67. Knapp's Arcli. Oph. and Otol., 1869, i, 17. 
 
OPHTEALMOLOGY IN AMERICA. 191 
 
 attached, and after a long series of experiments, assisted 
 by our Toronto colleague, Dr. Eeeve, he succeeded in 
 obtaining a "photograph of the eye of a cat, showing 
 very clearly the nerve entrance and the larger branches 
 of the vessels of the retina.""^ At the time of describ- 
 ing his instrument and method he had not attempted 
 to photograph the fundus of the human eye. This pio- 
 neer effort, although not perfectly successful, demon- 
 strated the scientific enterprise of this distinguished oph- 
 thalmologist, and it was the forerunner of the successful 
 results which have been obtained in the last few years. 
 
 The above are a few of the more important American 
 contributions that have been made to ophthalmology 
 during its transition stage in this country from 1850 to 
 1870. They forcibly indicate the energy, intelligence, 
 resourcefulness and progressiveness of our ophthalmolo- 
 gists of that period. While there were no momentous 
 discoveries or startling revelations, there was a growing 
 literature of genuinely scientific and practical value. 
 There were many new experiences and new investiga- 
 tions which tended either to confirm or to disprove the 
 conclusions and views which other students and practi- 
 tioners had advanced. Such instrumental devices as 
 were made were of value, and both the surgical and 
 medical therapeutics were more or less improved. Clin- 
 ical facilities were increased by the readjustment of the 
 old institutions and the cieation of new ones, and the 
 provisions of lectureships and professorships in our 
 medical schools promoted the ophthalmologic movement. 
 The organizing zeal and enterprise of our medical men 
 in founding the American Ophthalmological Society 
 
 68. Oph. Rev., London, 1864-5, i, 119. 
 
192 OPHTEALMOLOGT IN AMERICA. 
 
 and the ophthalmologieal societies of New York City 
 and Philadelphia, together with the American Medical 
 Association, established a "forum" for the freer inter- 
 change of personal experiences, observations and con- 
 clusions and for the fostering of those fraternal and 
 ethical sentiments so conducive to united effort and 
 scientific uplift. And, finally. Dr. Knapp came to this 
 country, adopted it as his own, enriched it by his learn- 
 ing, gave encouragement by his enthusiasm, and in the 
 face of adverse prospects, supplied it with a journal 
 of ophthalmology, which became for years the principal 
 channel for transmitting to the profession the fruits 
 of the best labors and the most intricate studies of those 
 cultivating this branch of medical science. 
 
X. 
 
 THE NEW AMERICAN OPHTHALMOLOGY. 
 
 Developed to such definite proportions, erected on the 
 firm foundations of three-fourths of a century's labor, 
 built up of such forces as were at first nascent, and later 
 active, in the men whom I have mentioned, and sus- 
 tained by such activities as were going on in schools, in 
 clinics, in organizations and in journalism, ophthalmol- 
 ogy in America in 1870 had become an established spe- 
 cialty. It had reached a development which no influ- 
 ence could then retard, and an assurance of permanency 
 and progress which could not be doubted. It had not 
 only kept pace with the progress of general surgery and 
 the development of other specialties, and, for the most 
 part, had also shared in their improvemenis, but through 
 the discovery of general and local anesthesia, the inven- 
 tion of the ophthalmoscope, and the increased knowl- 
 edge of refraction and physiologic optics, it had excelled 
 them all in precision of diagnosis and in definiteness 
 and certainty of therapeutics. Moreover, it had opened 
 up a field of study and practice of greatly expanded 
 boundaries, as compared to former times, and with an 
 intensely fascinating attraction. 
 
 The ophthalmologic ranks have since been gradually 
 enlarged until now there are twenty-five hundred to 
 three thousand members in America, basing the esti- 
 mate on the membership of the Section on Ophthalmol- 
 ogy of the American Medical Association. No Ameri- 
 
194 OPHTHALMOLOGY IN AMERICA. 
 
 can medical school is without its didactic and clinical 
 teachers in ophthalmology. Besides the general hos- 
 pitals with ophthalmologic departments, there are at 
 least thirty-fiye special hospitals in this country. The 
 older eye institutions have grown to immense propor- 
 tions and, aside from their clinical advantages, are pro- 
 viding special facilities and opportunities for pathologic 
 study and investigation. They are also engaging in 
 experimental therapeutics which promise results of great 
 value. Their equipment, in short, of ophthalmologic 
 experts, of instrumental and laboratory appliances put 
 them on a high plane of modern excellence. 
 
 American ophthalmology, with its small army of prac- 
 titioners, workers and contributors, has already devel- 
 oped a literature too voluminous to be analyzed or even 
 specified on this occasion. The transactions of the Amer- 
 ican Ophthalmoligacl Society (1864) ; the ophthalmo- 
 logical section of the American Medical Association 
 (made a distinct organization in 1878, in my own city, 
 Buffalo, through the efforts of Eugene Smith, of Detroit, 
 and X. C. Scott, of Cleveland) ; the American Academy 
 of Ophthalmology and Oto-Laryngology (1895) and the 
 local ophthalmological organizations or sections of or- 
 ganizations in New York City, Philadelphia, Boston, 
 Chicago, Buffalo, Detroit, Denver and other cities; 
 Knapp's Archives (1869) ; Alt's American Journal of 
 Ophthalmology (1884) ; the Ophthalmic Record, 
 founded by Savage (1891), now under the management 
 of Wood and Woodruff; the Annuls of Ophthalmology 
 (1893), issued under the editorial supervision, at first 
 of James P. Parker, then of Wood and Wiirdemann, 
 and now of W. T. Shoemaker and C. W. Parker; and 
 
OPHTHALMOLOQY IN AMMBWA. 195 
 
 Wiirdemann's Ophihalmology (1904), are great store- 
 houses of American as well as foreign contributions of 
 varying but, in the aggregate, of immense scientific and 
 practical value. The history of ophthalmologic progress 
 since 1870 is, in fact, written in these volumes. 
 
 Auxiliary to these records have been those excellent 
 summaries of current ophthalmologic progress, first so 
 ably made by Hays and continued by Jackson in the 
 American Journal of Medical Sciences, and afterward 
 similarly presented by Noyes and Bull in the New York 
 Medical Journal, by Thomson, Gould, Oliver, Posey and 
 others in Sajous' Annual by Hansell, Clark, Eeber, Pyle 
 and others in Saunders' Year-Booh, by Wood in the 
 Practical Medicine Series volumes, and by Jackson and 
 de Sehweinitz in their Year-Booh. 
 
 Besides this form of literature there have been the 
 treatises, systems, text-books and manuals on diseases 
 of the eye, together with monographs and essays on spe- 
 cial subjects, beginning with the great work of Noyes, 
 in 1890, which was an outgrowth of a former treatise 
 published by him in 1881, and ending with those of the 
 last year or two, the authors of which are so well known 
 as to need no mention. Some of these works, according 
 to the purpose for which they have been written, are 
 not excelled in correctness of style, evidence of learning, 
 or comprehensiveness of matter, by similar works in any 
 language. 
 
 Supplementary to all of this there has been the inval- 
 uable indexes of all ophthalmologic, as well as other 
 medical literature, found in the Index Catalog of the 
 Surgeon-General's library and in the Index Medicus. 
 
XI. 
 
 CONCLUSION. 
 
 In my endeavor to describe the origin of our early eye 
 institutions; to call specific attention to those who have 
 been foremost in keeping alive and advancing ophthal- 
 mology in this country and in developing it into an or- 
 ganized entity of enduring vitality, of scientific value 
 and of honored recognition; and to trace its literature 
 and most important contributions, from 1800 to 1870, 
 I find that the material has been sufiiciently abundant, 
 important and interesting to warrant me in changing 
 the scope of this paper as originally planned, and to 
 bring it to a close at this point. I also justify myself 
 in this change by the fact that it has already attained 
 such proportions that the limitations of time and space 
 forbid me to proceed further, although the records 
 deepen in interest, at least to me, the nearer they ap- 
 proach the professional lives and environments of to-day. 
 
 Taking into consideration the educational and profes- 
 sional conditions incident to a new and democratic 
 country, it seems to me that American ophthalmology 
 has had a development fully commensurate with its op- 
 portunities and resources. It has been fostered by men 
 of character, intelligence and skill, and has suffered 
 comparatively little from the blighting influences of 
 charlatanism. If viewed properly, it has a past of which 
 all of us may feel proud. This is especially true of its 
 institutional, scientific and literary contributions dur- 
 ing the period beginning with 1870. 
 
OPHTHALMOLOGY IN AMERICA. 197 
 
 As to its future, there is every reason to believe that, 
 with the new intellectual and scientific life that has been 
 infused into it; with the inexhaustible clinical and 
 pathologic resources at command ; with the stimulation 
 to research work which such an organization as the Sec- 
 tion of Ophthalmology of the American Medical Asso- 
 ciation gives; and with a literature of such high excel- 
 lence dominating professional thought and action, the 
 outlook is resplendent with bright prospects and allur- 
 ing promises. There can be no turning backward. The 
 movement must be onward and upward. And when 
 su£Scient endowment of schools, teachers and labora- 
 tories is provided to meet the needs of research teachers 
 and students, and of experimental pathology, etiology 
 and therapeutics, American ophthalmology will lead and 
 not follow. May not such provision soon come as the 
 crowning recognition by this rich and prosperous coun- 
 try, of a pressing physical, iatellectual and scientific 
 need that can not otherwise be satisfied. 
 
"W>f.j *■■ ^g* wfj^rsii