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Texas History
Texas | Columns | "Texas Tales"

A Clear Look at
Eye Surgery History

by Mike Cox
Mike Cox

Cataract surgery these days doesn't sound like a big deal.

Still, when you're the one answering a nurse's questions about what prescription drugs you take, whether you have any allergies and when you last ate or drank anything, you become somewhat more attuned to the situation at hand. Even so, when it comes to medical procedures, cataract surgery is the grown-up Baby Boomer's equivalent of wisdom teeth extraction. Only having your wisdom teeth pulled is much more bothersome than getting a clouded lens replaced.

What all this has to do with Texas history we'll get to shortly, but for anyone who's been putting off getting cataracts fixed, go get it done. My appointment at the day surgery center was 8:15 a.m.; surgery began 10-ish that morning and by mid-day I was home eating barbecue for lunch. Oh, as soon as the dilation lessened, it was readily apparent that I no longer needed prescription glasses for distance vision and only over-the-counter readers for close-up work. Not only that, I'm able to drive at night again just like a big boy.

However, regaining good vision by undergoing a medical procedure has not always been so easy. My grandmother had cataracts removed in 1961 and was in Austin's old Seton Hospital for at least a week, her head held immobile by sandbags so the incisions could heal properly. (Apparently doctors did both eyes at once back then. Too, her surgery came only nine years after the first successful implant of artificial lenses in the U.S.) Grandmother did not enjoy the experience and despite going through all that, she was never able to drive again.

Her treatment was cutting edge for the day, if witch-doctory by today's standards. And obviously, the farther back you look, the more complicated and risky eye surgery was.

The earliest procedure, believed to have been developed by the ancient Egyptians, was called couching. Basically, a surgeon just scooped out the opaque lens. It worked sometimes, but the success rate was low and the likelihood of complications or even death was high. Then, in the mid-1700s, French opthalmologist Jacques Daviel pioneered extracapsular cataract surgery in which he removed clouded lenses by suction.

One of the first documented cataract procedures in Texas took place in the late 1840s in the Hill Country.

The surgeon was Dr. Ferdinand Ludwig von Herff, who had immigrated from Germany a few years before and settled in what is now Llano County. Trained in Berlin and Giessen, the doctor had plenty of work in the new Republic of Texas. A look at Herff's long career-he went on to practice in San Antonio for decades and lived until 1912-demonstrates that no matter the relatively primitive state of the medical art in the 19th century, a cautious, intelligent physician capable of deductive thinking could do patients some good.

Herff was what today would be called a general surgeon. He did develop one specialty-removing Indian arrows and treating gunshot wounds. In contrast to dealing with the medical aftermath of conflict along the frontier, the doctor had an affinity for language and learned to communicate with both Apaches and Comanches.

Word of his linguistic and medical prowess spread among the Indians, and one day an older Comanche chief came to the doctor complaining of poor vision. Herff examined him and diagnosed advanced bilateral cataracts. He said he could possibly restore his sight and the Indian agreed to surgical intervention.

Ahead of his time in understanding on some level the importance of clean water to a medical procedure, Herff decided to use cistern water rather than the more readily available but highly mineralized ground water. Examining a specimen of the cistern water under his microscope, the doctor saw that it was alive with small creatures he called "animalcules." So before proceeding with his operation, he boiled the water.

On the cutting edge of 19th century medical technology, the doctor used ether for anesthesia. Knowing the high flammability of the knock-out chemical, he planned to do the operation outdoors to take advantage of natural light, thus avoiding the fire danger posed by a lantern. Finally, to lower the chance of dust getting in his patient's exposed eyes, he waited for a sunny, windless day.

With bystanders warding off flies with palm fronds, Herff used some of the instruments he had brought over from Germany to remove the opacified lenses from the unconscious Indian's eyes.

The operation proved successful. Amazed and deeply grateful for his restored eyesight, the chief promised to bring Herff a gift. Six months later, the chief returned to the German settlement with a token of appreciation-a captured Mexican girl the Indian offered as a slave. The doctor politely accepted the "gift," but as soon as the Comanche headman left he freed the young woman.

My eye surgeon, Dr. Todd Smith of Austin, was content to accept my insurance and Medicare for services rendered.

Mike Cox
"Texas Tales" July 25, 2018

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