The Ophthalmologist’s Time Machine 38

It is generally known that prominent ophthalmologist Lucien Howe of Buffalo, New York eventually came to promote eugenics in the early 20^th century (1, 2) as did many American physicians and scientists of the pre-World War II period (1, 3). What is perhaps less well-known is how his personal circumstances may have contributed to this stance.

In 1887, Howe published the case series of a family suffering from multiple cases of "hereditary glaucoma"across three generations (Figure 1) (3). In that era, “glaucoma” typically referred to what we would term today as “angle-closure glaucoma” (2, 4). We now understand that plateau iris is one type of angle-closure glaucoma which can have a strong heritable component (2).

Iridectomy as a treatment for “glaucoma” was reported by Albrecht von Graefe in 1857 (4). An iridectomy (or iridotomy) can be effective.  However, as we see even today, the procedure does not provide a permanent cure in all cases of angle-closure glaucoma (5). In fact, long-term follow-up of the cases which Graefe originally described shows that some continued to progress and develop blindness (4). Thus, “glaucoma” was became a much feared disease in the 19^th century (2).

In 1893, the 45-year-old Howe married his 33-year-old first cousin (2). What has not been generally known until recently is that, according to a colleague, in Howe’s family “glaucoma appeared in each generation of his own pedigree" (2). Given that Howe had established the heritable nature of this disorder, he had reason to fear it would develop in any children from his marriage.

In 1918, Howe wrote “It is unjust to the blind to allow them to be brought into existence simply to lead miserable lives… It is unjust to the taxpayers to be compelled to support them… this misery and expense could be gradually eradicated by sequestration or by sterilization" (2). Howe noted that one could trace “serious eye defects” when “first cousins of such crossings marry" (2). He also noted that “when two persons contemplate matrimony, it can usually be taken for granted that their judgment has, for the time, taken wing" (2). Howe mentioned that his wife worked in his office. An ophthalmologist who worked at the School for the Blind in Howe’s home city of Buffalo spoke up in the discussion to say he knew of more than one “family of cousins” in Buffalo costing the New York taxpayer.

By 1923, Howe even considered that for couples contemplating marriages deemed dangerous, the state shcould impose sterilization, imprisonment, or requirement of a bond to cover the cost of raising children afflicted by hereditary blindness (1, 2).

Howe and his wife never had children (1, 2).