Prophylactic enucleation in sympathetic ophthalmitis. The evolution of a heroic form of treatment.

To ENUCLEATE an eye as a prophylactic measure against sympathetic ophthalmitis always requires an act of courage. To have initiated such treatment originally must have been heroic, especially as it was known that the second eye might eventually be the more seriously affected. Yet the development of this form of treatment in the nineteenth century was a slow and highly responsible process, based on speculation, observation and careful thought. The germ of this idea may be found in the writings of James Wardrop (1782-1869) (fig. 1), a Scottish surgeon of character and insight, fond of field sports and with considerable knowledge of horses. Indeed he wrote an article entitled An Essay on Diseases of the Eye of the Horse and their Treatment. Between 1808 and 1818 Wardrop's Essays on the Morbid Anatomy of the Human Eye was published in Edinburgh. In the chapter 'Of the Sympathies of the Eye' dealing with bilateral diseases of the eye in general, the following passage is found: