Herpes Simplex Keratouveitis and the Fall of Vicksburg

481049

Jefferson Davis, originally from Kentucky, lived from 1808-1889, and was United States Senator from Mississippi, United States Secretary of War, and President of the Confederate States of America during the American Civil War.

From http://civilwarmed.blogspot.com/2009/07/medical-department-26-turning-blind-eye.html and http://www.ncbi.nlm.nih.gov/pubmed/17134650:

[Hertle and Spellman] begin the article with a brief biography of Davis as soldier, politician, and statesman, and then turns to a discussion of the eye disease that can be traced back to his first bout with malaria. About a dozen years later, during a relapse, Davis suffered a “severe eye attack” such that, in the words of his wife Varina, he could not “bear a ray of light on either eye.” Documents show that the disease recurred almost annually from that time and through the Civil War.

In a severe relapse in1858, Davis was seen by two famous eye physicians of the time – Drs. Robert Stone and Isaac Hayes. Stone described the condition of Davis’s left eye in detail, including “ulceration of the cornea,” “abscess of the eye,” and “hypopyon” (a collection of pus cells in the aqueous humor). It was Hayes who commented that he couldn’t see why Davis’s eye had not already burst. Davis was given treatments of the day, including “quiet” and bandages soaked in herbal remedies; he also underwent eye surgeries in 1859 and 1860.

Next, Dr. Hertle puts on his clinician’s hat, and discusses a possible diagnosis of Davis’s disease. He feels that it can be divided into at least two parts – a primary disease and the secondary consequences of the inflammation and, not surprisingly, the treatments. In Dr. Hertle’s opinion, the list of possible primary diseases is long, and includes no less than a dozen infectious agents. Using a combination of anecdotal and scientific evidence – including modern studies – Dr. Hertle and his nephew conclude that Davis suffered from “herpes simplex keratouveitis,” a condition that remains a major cause of injury to the eye.

An especially interesting part of the article concerns the authors’ opinion that Davis’s eye condition had consequences during the Civil War, especially during the spring and early summer of 1863. At that time, Davis was confined to his home for weeks at a time, and the disease thus interfered with his duties as President of the Confederate States. Coincidentally, it was also a pivotal period in military planning for the Confederacy. The authors argue that the eye disease, or perhaps medicines used in the treatment, impaired Davis’s decision-making ability resulting in poor advice to and poor communication with senior military commanders such as Lee and Pemberton.