Isaac Hays, MD: Nineteenth-Century Pioneer in Ophthalmology

Isaac Hays (Figure 1) wasa distinguished pioneer in the early days of American ophthalmology.^1-6 Hiscontributions may have been mightier by the pen than by the scalpel, but hisniche in the history of ophthalmology is secure. In addition to actively practicingophthalmology and fostering its growth into a recognized medical specialty,Hays also had the time and talent to edit one of the premier medical journalsof his day, to become one of the founders of the American Medical Association(AMA), to author the first code of ethics of the AMA, and to edit or writeworks as diverse as Treatise on Diseases of the Eye, AmericanOrnithology, and Descriptions of the Inferior MaxillaryBones of Mastodons.

Isaac Hays, the eldest of 4 children, was born into a wealthy Philadelphia,Pa, merchant family in 1796. When he graduated from the University of Pennsylvaniawith a bachelor of arts degree in 1816, his father, intending for him a careerin the East India trade (the family enterprise), started him out in the "countinghouse." The young Isaac decided after a year that the trade was not for him,and he opted instead for a career in medicine. At this critical juncture inhis life, Hays was fortunate to become the pupil and preceptee of a physicianof great stature and culture in Philadelphia, Nathaniel Chapman, MD, who laterbecame the first president of the AMA. Beginning as Chapman's office apprentice,Hays enjoyed a friendship and relationship with Chapman that was to influencenot only his early career but also his eclectic pursuits for almost 4 decadesthereafter.

Hays entered the Medical School of the University of Pennsylvania in1818 while still serving as apprentice to Chapman, and he graduated in 1820with a doctor of medicine degree. Medical faculties at that time were smalland were rarely full-time. Among his teachers, and arguably the most famous,was Philip Syng Physick, MD, a general surgeon whom some regard as the "fatherof ophthalmology" in America. Not that Physick was primarily an ophthalmologist;he was a general surgeon whose teaching and practice included fractures, amputations,bladder stones, and infectious diseases in addition to cataract surgery. Hewas a dynamic and charismatic lecturer. Among his pupils, along with Hays,were George Frick, MD, who wrote the first American textbook on ophthalmologyand later became the first American surgeon to devote himself exclusivelyto ophthalmology; William Gibson, MD, who devised the first successful operationfor strabismus; and George McClellan, MD, who founded the first eye hospitalin Philadelphia.

Shortly after entering practice, Hays was appointed to the staff ofMcClellan's Institution for Diseases of the Eye and Ear, the third ophthalmologyhospital in the United States. This hospital was soon eclipsed by a rivalinstitution, the Pennsylvania Infirmary for Diseases of the Eye and Ear (thefourth ophthalmic hospital in the United States), dedicated to caring forthe afflicted poor. It was here that Hays began to make his mark in ophthalmology,publishing articles such as "Observations of the Inflammation of the Conjunctiva,""Inflammations of the Sclera," "The Pathology and Treatment of Iritis," and"Diseases of the Cornea." In 1830, his chapter, "Diseases of the Eye," appearedin the authoritative textbook Practice of Medicine, editedby William Potts Dewees, MD (1833). Hays was the most active and productivemember of the staff.

It was not until the 1830s that Hays became associated with the hospitalthat was to be the most important in his ophthalmologic career. In 1825, JamesWills, a wealthy Quaker merchant in Philadelphia, bequeathed his estate forthe establishment of "The Wills Hospital for the Relief of the Indigent Blindand Lame" (later for the blind alone). The hospital was opened in 1834, withHays as the eldest of the 4 surgeons on the staff. It was at the Wills Hospitalthat Hays made his most notable contributions to ophthalmology. He was thefirst to publish a study on noncongenital color blindness. He also reportedthe first case of astigmatism in America,⁷ thatof a Rev Mr Goodrich, whose cylindrical lenses were made by the noted opticalfirm of the Messrs McAllister of Philadelphia. Hays prescribed similar lensesfor astigmatism in 2 subsequent cases.

It was also at the Wills Hospital that Hays devised a needle-knife forcataract extraction. Although it later became obsolete, in its day the needle-knifewas regarded as a useful adjunct in cataract surgery.

The major contribution of Hays, however, during his years in practiceand during his attendance at the Pennsylvania Infirmary and at Wills Hospitalwas his prodigious output as an author and editor. (Wills Hospital, now knownas Wills Eye Hospital, is affiliated with Jefferson Medical College of ThomasJefferson University in Philadelphia. It still ranks as one of the best inthe United States.) The year he graduated from medical school he joined thestaff of the Philadelphia Journal of Medical and PhysicalSciences, edited by his esteemed mentor, Nathaniel Chapman. By 1827he was appointed coeditor of the journal, which was renamed The American Journal of the Medical Sciences. To these journals Haysbrought an active and intense ophthalmologic perspective, both writing andediting articles of ophthalmologic importance. By 1841 he had become soleeditor of the journal, which during his tenure was also known as "Hays' Journal."For 52 years he was associated with the journal as coeditor or editor. WilliamOsler, MD, doyen of American medicine, called it "one of the few great journalsof the world." When Hays relinquished the editorship, the helm passed to hisson, I. Minis Hays, MD.

Considering his literary talent and ophthalmologic expertise, it issurprising that Hays wrote no books; in the authorship of books he was "alwaysthe bridesmaid, never the bride." In 1830, as previously noted, he wrote thechapter "Diseases of the Eye" in Dewees' Practice of Medicine. In 1843, he edited the American edition of Sir William Lawrence's A Treatise on Diseases of the Eye, a well-known Englishbook. In subsequent editions, his notes and commentary added much to the originaltreatise. In 1849, he edited the American edition of T. Wharton Jones' Principles and Practice of Ophthalmic Medicine and Surgery, againsupplementing the text with his own notes. Working afield from ophthalmology,he edited Arnott's Elements of Physics, Wilson's American Ornithology, and Hoblyn's Dictionaryof Medical Terms. He was truly an indefatigable editor. When Hays died,Samuel David Gross, MD, said of him that he was "the most gifted medical journalistof the 19th century."

In medical organizations, Hays was a joiner, a founder, an officer,and an honoree. One of his earliest appointments, presaging his career asa world-famous editor, was as chairman of the Publishing Committee of theAcademy of Natural Sciences, to which he was elected while still a medicalstudent in 1818. He was a founder of the Franklin Institute in Philadelphia,which exists to this day as a premier scientific institute and library. Whenthe Pennsylvania Infirmary for Diseases of the Eye and Ear was organized in1822, Hays was elected secretary as well as 1 of 9 managers. When its successor,the Wills Hospital, was opened in 1834, Hays was 1 of the 4 original surgeonsto be appointed by the president of its Board of Managers. In 1835 he becamea fellow of the College of Physicians in Philadelphia, in which he was chairmanof the building committee and a long-time editor of their transactions.

The role of Hays in the history of the AMA⁸ beganin 1847 when he was chairman of the Committee on Arrangements for the annualmeeting of The National Medical Convention, held at the Academy of NaturalSciences in Philadelphia. From that meeting of The National Medical Conventioncame the formation of the AMA, with Hays as one of its principal founders.At the same meeting he was elected the first treasurer of the AMA and thechairman of the Committee on Publications. He also is credited with authorshipof the first Code of Ethics of the AMA, a predecessor of the current and morevoluminous Code in use today.⁹ (Although thecommittee reporting the Code was headed by John Bell, MD, Hays is cited ashaving done "most of the work in the preparation of the principles."⁹)

When the American Ophthalmological Society was founded in 1864, Hayswas made an honorary member at its first meeting. Six years later, he waselected the first president of the Philadelphia Ophthalmological Society.It is obvious that he was recognized by his peers and colleagues as one ofthe leaders in the phenomenal growth of the specialty of ophthalmology, inno small measure due to his efforts. The years 1850 to 1870 have been called"The Golden Age of Ophthalmology."¹⁰

A few years before his death, in his own indefatigable fashion, he beganan American Cyclopedia of Practical Medicine and Surgery. Unfortunately, this work never got beyond "Axilla," and it is probablythe only work he left unfinished in his lifetime. Death came to Hays in 1879at age 83 years when he fell victim to an influenza epidemic that swept Philadelphiathat year.

When Hays began his career in medicine and ophthalmology, in the earlydecades of the 19th century, ophthalmology was firmly ensconced in the provinceof general surgery. Philip Syng Physick, Hays' teacher at the University ofPennsylvania, was one of the foremost general surgeons of the day, yet hepracticed, wrote about, and taught ophthalmology to an extent that he wasconsidered one of the foremost eye surgeons of his day. Many decades later,David Hays Agnew, MD, professor of the Principles and Practice of Surgeryat the University of Pennsylvania in 1871, was preeminent in ophthalmologyin his practice, writing, and teaching. Similarly, Samuel David Gross, anothersurgical great, professor of surgery at Jefferson Medical College, was alsoproficient in the surgical treatment of the eye. The latter 2 surgeons wereimmortalized in paintings by Thomas Eakins (The Agnew Clinic and The Gross Clinic), but it was not eyesurgery that was pictured. It was the breast and an extremity, more commonlywithin the province of the general surgeon.

To Hays must go the credit for helping propel ophthalmology into therealm of a specialty worthy to stand on its own. Early in his career he devotedhimself exclusively to ophthalmology, and he played a major part in the successof early American eye hospitals (The Pennsylvania Infirmary and Wills Hospital).When, in 1839, he wrote that he had been told "by a professor of surgery ina school of high standing that . . . three lectures [were] ample for teachingeverything of consequence relative to the diseases of the eye," it was hisidea that this notion required radical change. This he did by editing 2 authoritativeBritish texts of ophthalmology for American physicians and by editing thepremier medical journal in the United States, The AmericanJournal of the Medical Sciences. In the journal, from 1827 to 1879,he featured and encouraged articles, discussions, and advances in ophthalmologyto an extent seen in no other journal. It was not until 1862 that a journaldevoted exclusively to the eye was published (The AmericanJournal of Ophthalmology [not related to the current journal of thesame name]).

The many honors from ophthalmologic societies that Hays received duringhis lifetime attest to his important role in the growth and development ofthis specialty in America. (Sometimes, in an error of historiography, hisname is confused with that of a younger contemporary, Isaac Hayes, also aphysician, whose chief claim to fame was his accompaniment of the physician-adventurerElisha Kent Kane to the Arctic.¹¹) He was apioneer and a man worthy to be remembered.

Corresponding author and reprints: Leon Morgenstern, MD, Center forHealth Care Ethics, Cedars-Sinai Medical Center, 444 S San Vicente Blvd, MarkGoodson Building, Suite 602, Los Angeles, CA 90048 (e-mail: morgenstern@cshs.org).

Submitted for publication May 15, 2003; final revision received August12, 2003; accepted September 10, 2003.