Civil War Eye Surgeon
Thomas P. Lowry, MD
Originally published in May 2011 in the Surgeon’s Call
Joseph Sullivan Hildreth was born in Massachusetts in 1832. He graduated from the Medical Department of the University of Pennsylvania in 1856 and later studied under Desmarres in Paris and Virchow in Berlin. (Louis-August Desmarres [1810-1882] was one of Europe’s leading ophthalmologists, whose clinic saw thousands of patients each year. His 1847 textbook of eye diseases was widely used, and instruments designed by him are still in use today. Rudolph Virchow [1821-1902] has been dubbed “the father of modern pathology,” and was a pioneer in microscopy and cell theory.)
In 1862 Hildreth was commissioned Surgeon, US Volunteers. In December 1862, in Washington, DC, the government seized the home of Charles Hill, corner of 14th and M Streets, for use as an “Eye and Ear Infirmary” with Hildreth as eye specialist. He worked there until March 1864, when he was ordered to establish an eye hospital in Chicago.(It is only fair to note that Hildreth was frequently in conflict with his medical and military superiors, on issues such as hospital location, leaves of absence, and Hildreth’s own post of duty.)
The usual public memory of Civil War surgery is an endless parade of amputated arms and legs. While amputation was, indeed, important, the small and delicate structures of the eye were even more susceptible to injury and equally in need of repair. Civil War eye surgeons faced limitations compared with specialists of today. There was no local anesthetic; cocaine, an excellent local anesthetic , still in wide use medically, was years in the future. Surgical anesthesia was largely with chloroform. There were no steroids to treat inflammation. There were no antibiotics to treat infection. There was no electricity to illuminate an opthalmoscope.
Yet even with these limitations, the surgical summaries in the Medical-Surgical History of the War of the Rebellion tell us of the advanced state of eye surgery 150 years ago. Anyone who has ever had eye surgery, or any serious eye disease, or even a bit of dirt in one eye, will feel cold chills in reading what follows. The devastating injuries, the ferocious infections, and the measures used to treat both, make a gripping story.
A partial list of operations by Dr. Hildreth follows:
- Staphyloma involving entire cornea of right eye, result of variolous pustules, rapidly increasing in size. November 1864 excision of staphyloma. Pensioned, discharged July 1865. Pvt. G. Anderson, 15th Veteran Reserve Corps (VRC).
- Attachment of fold of conjunctiva to cornea, right eye; nebulous and imperfect condition left cornea, result of ophthalmia. Flap dissected. Staphyloma involved whole cornea. Excision, staphyloma right eye, Dec. 1864. Iridectomy, Feb. 1865. Pensioned July 1865. Totally blind, right eye. Almost total loss of sight, left eye. Pvt. C. Barry, 58th Illinois.
- Gonorrheal ophthalmia with central leucoma, left eye; vision null. Artificial pupil at upper and int. margin of cornea. Recovery of vision of large objects. Pvt. H. Boas, 8th VRC.
- Pterygium, right eye. Treated by Desmarres’ process. Adherent in a few days. Corp. F. Brandy, 42nd Indiana.
- Large pterygium, both eyes. Desmarres’ method. Flap milled; pterygium disappeared. Pvt. B. Brown, 84th Illinois.
- Leucoma of both eyes, from purulent ophthalmia. Iridectomy, both eyes, by process of déchirement. Can see large objects. Discharged and pensioned, totally blind. Pvt. T. Chandler, 7th Illinois Cavalry.
- Entropion, left eye, result of granular ophthalmia. Lashes in perpetual contact with the globe. Elliptical section of external integument of upper lid; new position maintained by three sutures. Complete remedy, all eyelashes preserved and in their proper position. Eyes weakened. Discharged and pensioned. R. Cornell, 103rd Illinois.
- Cornea right eye, ulcerated, slightly panniform and somewhat anesthetic. Neuralgic pains. Division of ciliary muscle. Pain relieved; ulceration speedily modifying. Pvt. J. Crippen, 161st New York.
- Cornea both eyes, ulcerated. Panniform and anesthetic. Repeated paracentesis, both eyes, without relieving pain. Division of ciliary muscles of both eyes between external and inferior recti-muscles. Pain relieved. Condition of eyes improved. Right eye permanently destroyed. Pensioned. Pvt. DeArcey, 1st Michigan Engineers and Mechanics.
- Age 17. Purulent ophthalmia both eyes, with moderate chemosis. Division of ciliary muscle, right eye. Cornea improved for a few days, then sloughed away. Cornea of other eye also destroyed. Discharged blind. Pvt. J. Doran, 3rd Illinois Artillery.
- Central leucoma of both eyes, caused by ophthalmia. Right eye quite useless. Operation for artificial pupil. Iridectomy of both eyes. Discharged with good vision. Pvt. G. Dunlap. 1st Missouri Cavalry.
- Pannus covering cornea of right eye; total obscurity of vision. Syndectomy. Pannus connecting necessitated re-operation. Disease reproducing itself. Hancock’s operation. Pensioned totally blind, complete opacity and staphyloma of both corneas. Pvt. J. Elliott, 30th Kentucky.
- Age 24. Gonorrheal ophthalmia with large chemosis of both eyes. Division of ciliary muscles, both eyes. Vision of right eye good. Left eye suffers from central leucoma. Pvt. J. Ellsworth. 1st Michigan Artillery.
- Trichiasis, right upper lid, caused by blepharitis and granular ophthalmia. Transposition “by a new process adopted for the first time, as far as is known.” Left upper lid same problem, same treatment. Deformity and induration of both upper lids. Structural changes, left eye, causing almost total loss of vision. Discharged and pensioned. Pvt. P. Frank, 58th Illinois.
- Staphyloma, right eye, result of gonorrheal ophthalmia. Leucoma of right eye, result of purulent ophthalmia. Excision of staphyloma, left eye. Iridectomy of right eye. Desmarres method of déchirement. Discharged and pensioned. Total loss of left eye, imperfect vision of right eye. Pvt. B. Getz, 4th US Cavalry.
- Central hernia, iris, left eye, from sloughing of cornea, result of purulent ophthalmia. Iridectomy by déchirement, followed by Hancock’s operation. Extent of opacity of cornea disappearing.
- Pensioned. Total loss of left eye. Pvt. W. Hamilton, 95th Illinois.
- Defective vision, right eye, from central albugo, result of ulceration, following fever. Excision of portion of iris. Vision improving. Sgt. P. Hayne, 60th New York.
- Strabismus, internus, (double). Blepharitis, granular lids. Graefe’s operation on rectus internus dexter. Later, same operation, on sinister. Strabismus not completely corrected. Corp. H. Hixon, 18th Massachusetts.
- Irido-choroiditis, right eye, permanent contraction of pupil. Division of ciliary muscle. Claim for pension rejected. [No reason given in the summary.] Pvt. J. Hughes, 14th Illinois Cavalry.
- Splinter perforated cornea and wounded lens. Left eye. Splinter extracted. Fragments of crystalline extracted. Protruding parts of iris excised. Form of eye well preserved but vision lost. Pvt. O. Morris, 5th Maine.
- Pterygium, double at interred [sic] angle of either eye. Displacement right eye by Desmarres’ process. Later, same operation on left eye, using Line [sic] stitch only to maintain position. About disappeared from right eye, left eye much more satisfactory owing to absence of second stitch. Pvt. A. Plowman, 6th Maryland.
- Purulent ophthalmia with chemosis, both eyes. Division of ciliary muscle, left eye. Abscess, cornea sloughed away. Staphyloma excised. Iridectomy, right eye. Discharged and pensioned. No vision, left eye. With right eye, enough vision to go about alone. Pvt. A. Scheming, 8th VRC.
- Nebulous condition of cornea of both eyes. Iridectomy, both corneas. Sight improving. Bids fair to become good enough to enable him to read fine print. Pvt. A. Smith, 8th VRC.
- Excessive myopia, both eyes. Hancock’s operation, right eye. Myopia disappeared. Amblyopia right eye; right eye useless. Sight feeble. Pvt. G. Street, 1st Connecticut Artillery.
- Double pterygium. Displacement of pterygium, right eye, Desmarres’ method. Doing well. Killed in a street brawl two weeks after surgery. Musician J. Wolf, 12th Pennsylvania Reserves.
- The records show two tonsillectomies performed by Dr. Hildreth. Pvt. J. Orlop, 1st Illinois Light Artillery had a right tonsil enlarged enough to impair breathing. The tonsil was removed and his general health improved. Pvt. M. Scott, 24th Ohio Battery, suffered from double otorrhea (draining from the ears). Large tonsils closed at least three-quarters of his throat. [And probably his Eustachian tubes.] Bilateral tonsillectomy resulted in “hearing and general health considerably improved.”
Looking at the twenty-five eye cases reported here, it is hard not to note the large numbers of disastrous outcomes. Hildreth was a graduate of one of America’s best medical schools, had studied with a leading French eye specialist, had merited appointment to head a specialized eye hospital, and in November 1865 had been brevetted lieutenant-colonel for “faithful service.” Were the poor outcomes a reflection of the limitations of mid-Victorian medicine or limitations in Hildreth’s own skills? This would be difficult to answer, but it is clear that Civil War soldiers suffered from some truly devastating eye diseases. Pension records could chart the post-war lives of these patients.