The Practice of Ophthalmology in Rural Wisconsin in the Mid-19Th Century from the Casebooks of Francis Paddock, MD
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SPECIAL ARTICLE The Practice of Ophthalmology in Rural Wisconsin in the Mid-19th Century From the Casebooks of Francis Paddock, MD Daniel M. Albert, MD, MS; Sarah L. Atzen, BA; Payam Morgan, MD rancis Paddock (1814-1889), a graduate of Fairfield Medical College in western New York State, opened a general medicinal and surgical practice in the small town of Salem in Kenosha County, Wisconsin, between 1838 and 1839, where he lived and worked until his death a half century later. Two early volumes of his casebooks, spanning the Fyears 1841 to 1852, came to light and are now analyzed from the standpoint of ophthalmic-related problems and their treatment. His life as a frontier physician and leading citizen of his community are documented in the context of 19th-century medicine in America and Wisconsin. Arch Ophthalmol. 2010;128(6):783-788 The history of American ophthalmology, as before his casebooks’ ophthalmic con- usually reported, is the history of cel- tents are discussed, the man himself ebrated physicians in the major East Coast should be given a proper introduction. cities: men and, occasionally, women who first attempted the medical and surgical FRANCIS PADDOCK’S EARLY LIFE treatment of eye disease. Subsequently, the historical record continues as their stu- Francis Paddock was born in Camillus, On- dents and successors begin to specialize in ondaga County, New York, on September eye disease treatment and form the soci- 15, 1814.1 He was the oldest of 6 children eties and journals we recognize today. But and took his education seriously from a what of rural America, where most Ameri- young age. Because of his industrious na- cans in the 19th century lived? What of ture and intellectual curiosity, he acquired those people west of the Allegheny Moun- a good education and became a school- tains? Is there a record of who treated their teacher at the age of 17 years. He taught in eye diseases and how they did it? It is often the winter and attended Fairfield Medical difficult to gain insights into this aspect of College in Herkimer County, New York, American ophthalmic history. during the summer, receiving his medical To help explore this lesser studied degree sometime between 1835 and 1839.2 facet of American ophthalmic history, one of us (D.M.A.) recently obtained the PADDOCK’S MEDICAL EDUCATION casebooks of Francis Paddock, MD AND TRAINING (1814-1889), a frontier physician and leading citizen in Salem, Kenosha Paddock’s alma mater, Fairfield Medical County, Wisconsin (Figure 1). The College, was the first medical school casebooks cover the details of Paddock’s west of the Hudson River and was an off- medical practice from 1841 to 1852, and shoot of the Fairfield Academy, a private its pages are a window into the extent high school that opened in 1803.3 The and method of ophthalmic practice dur- academy, in its early years, had several ing those years (Figure 2). However, instructors who were physicians. Over Author Affiliations: Department of Ophthalmology and Visual Sciences, University time they offered medical courses that of Wisconsin School of Medicine and Public Health, Madison (Dr Albert and included anatomy, surgery, medicine, Ms Atzen); and The Gavin Herbert Eye Institute, Department of Ophthalmology, pharmacy, and obstetrics. By 1812, a University of California, Irvine (Dr Morgan). total of 43 students were studying medi- (REPRINTED) ARCH OPHTHALMOL / VOL 128 (NO. 6), JUNE 2010 WWW.ARCHOPHTHALMOL.COM 783 ©2010 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 Figure 2. An excerpt from Francis Paddock’s casebook. Reprinted from the private collection of Dr Daniel M. Albert. Figure 1. Francis Paddock, MD. Lyman FH. The City of Kenosha and Kenosha County, PADDOCK’S MENTOR dition, closing old ulcers by new skin Wisconsin: A Record of Settlement, transplantation was continually at- Organization, Progress and Achievement. Chicago, IL: SJ Clarke Publishing Company; Francis Paddock studied with Frank tributed to him by French and Ger- 1916:319. Hastings Hamilton, MD, of Auburn, man physicians.7 New York (Figure 4), before leav- Dr Hamilton was also a consult- cal subjects, and in that year the ing for Wisconsin.2 Already distin- ing surgeon to many hospitals and be- academy was granted a charter guished at the time Paddock studied came a well-known authority on sur- under the formal name The Col- with him, Dr Hamilton became an im- gery. His important works include lege of Physicians and Surgeons of portant figure in American surgery. Treatise on Strabismus (1844), Trea- the Western District of New York Hamilton was well trained. In 1833, tise on Fractures and Dislocations (Figure 3). It continues to be at the age of 20 years, he received a (1860; fifth edition was published in commonly referred to, however, as medical degree from the Medical 1880), Practical Treatise on Military Fairfield Medical College and was School of the University of Pennsyl- Surgery (1861), and The Principles the second medical college to be vania. He settled in Auburn, where he and Practice of Surgery (1872).10 He chartered in New York State, the gave lectures on anatomy and physi- had many surgical terms named af- 11th in the United States. The ology.7 It was during this period that ter him, including the Hamilton ban- school attracted numerous well- Paddock studied with him.2 Five years dage, a compound bandage for the qualified physicians to its faculty after receiving his medical degree, lower jaw made of leather and linen; and built an excellent reputation. Hamilton was appointed professor of the Hamilton test, which involves Nonetheless, the medical college surgery at Fairfield Medical College. luxation of the shoulder joint so that was forced to close its doors in Later, Dr Hamilton would serve as a rule or straight rod is applied to the 1840 because of competition from a military surgeon for 2 years during humerus and touches the outer numerous new medical colleges the Civil War and was appointed condyle and the acromion simulta- established in New York and sur- medical inspector of the US Army in neously11; and the Hamilton pseu- rounding states. During its 28-year 1863. He was one of the consulting dophlegmon, a circumscribed swell- lifetime, the medical college surgeons after President James ing that may become red and granted more than 600 candidates Garfield was shot and performed indurated but never suppurates.12 medical degrees, 18 of whom many well-known operations in became professors at other medical which he improved upon surgical PADDOCK FAMILY’S colleges. Besides Paddock, notable techniques of the time. His inven- MIGRATION TO SALEM graduates of the medical college tions include a bone drill and a bro- include William Mather, scientist ken jaw apparatus, and he invented After Paddock completed his asso- and professor of chemistry, miner- or modified apparatuses for nearly ev- ciation with Hamilton, Paddock, at alogy, and geology4; Asa Gray, ery long-bone fracture. He was the the age of 25, together with 3 genera- botanist; and Marcus Whitman, first to introduce the use of gutta- tions of his family, traveled west from missionary to the Native Ameri- percha, the rubbery sap from certain New York in a covered wagon to what cans of the Oregon Territory. tropical trees,8 in the manufacture of was then the Wisconsin Territory. Graduates of Fairfield also created splints to support irregular joint sur- This trip occurred in 1838 or 1839, a medical college in Ohio, named faces and was the first to use gutta- depending on the information source. for Westel Willoughby, MD.5 percha in interdental splints.9 In ad- On the way, he passed Chicago and, (REPRINTED) ARCH OPHTHALMOL / VOL 128 (NO. 6), JUNE 2010 WWW.ARCHOPHTHALMOL.COM 784 ©2010 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 according to local legend, described it as “a marsh with a few Indian huts scattered here and there.”13 He and his family settled between 2 lakes, now known as Paddock Lake and Hooker Lake, in the town of Salem, Wiscon- sin, located at the southeast corner of the state. The property would even- tually be inherited by Paddock’s son, Alva.14 The eldest member of the Pad- dock clan was David Paddock, Fran- cis’s grandfather, a Revolutionary War veteran who lived in Salem un- til his death in 1847 at the age of 94 years. He was called Blind David be- cause he was blinded by powder burn injuries that had occurred in 1777 while fighting with George Wash- ington during the Revolutionary War Figure 3. Lecture ticket from the College of Physicians and Surgeons of the Western District of New at the second Battle of Saratoga.15 York. Reprinted with permission from Echols M. American Civil War Medical & Surgical Antiques. http: Starting life in Wisconsin, the //www.braceface.com/medical. Accessed July 2, 2009. Paddock family purchased approxi- mately 400 acres of land from the tic pencil. His eye water of choice was government at $1.50 an acre and a solution of lead acetate. This solu- built a log cabin on the land.13 It was tionwasderivedfromWilliamAlden’s Francis Paddock’s original inten- famous recipe and had been adapted, tion to come to Wisconsin to help published, and further popularized his parents relocate and then go on in the United States by Benjamin to Michigan and begin a medical Rush, MD, at the University of Penn- practice there. However, his father sylvania. According to Rush’s instruc- became ill when they arrived. This tions, 1⁄16 oz of sugar of lead (also compelled him to give up his origi- known as lead acetate; it was referred nal plans and remain in Wisconsin to as a sugar because it was used as a to manage affairs, where he stayed sugar substitute, although with fatal for the rest of his life, practicing results because of its poisonous medicine as a frontier physician.2 nature)16 and1ozofwhitevitriolwere mixed with 2 qt of spring water.