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Ophthalmology
Ophthalmology
LEAD EDITORS FIFTH EDITION
Myron Yanoff, MD Jay S. Duker, MD
Chair Emeritus, Ophthalmology Director
Professor of Ophthalmology & Pathology New England Eye Center
Departments of Ophthalmology & Pathology Professor and Chairman
College of Medicine Department of Ophthalmology
Drexel University Tufts Medical Center
Philadelphia, PA, USA Tufts University School of Medicine
Boston, MA, USA

SECTION EDITORS
James J. Augsburger, MD Michael H. Goldstein, MD, MBA Alfredo A. Sadun, MD, PhD
Professor and Chairman Co-Director, Cornea and External Diseases Flora Thornton Chair, Doheny
Department of Ophthalmology Service Professor of Ophthalmology
University of Cincinnati College of Medicine New England Eye Center Vice-Chair of Ophthalmology, UCLA
Cincinnati, OH, USA Tufts Medical Center Los Angeles, CA, USA
Boston, MA, USA
Dimitri T. Azar, MD, MBA Joel S. Schuman, MD
Senior Director, Google Verily Life Sciences Narsing A. Rao, MD Professor and Chairman of Ophthalmology
Distinguished University Professor and B.A. Professor of Ophthalmology and Pathology Director, NYU Eye Center
Field Chair of Ophthalmic Research USC Roski Eye Institute Professor of Neuroscience and Physiology
Professor of Ophthalmology, Pharmacology, and Department of Ophthalmology Neuroscience Institute
Bioengineering University of Southern California NYU School of Medicine
University of Illinois at Chicago Los Angeles, CA, USA Professor of Electrical and Computer
Chicago, IL, USA Engineering
Shira L. Robbins, MD NYU Tandon School of Engineering
Sophie J. Bakri, MD Clinical Professor of Ophthalmology
Professor of Neural Science
Professor of Ophthalmology Ratner Children’s Eye Center at the Shiley Eye
Center for Neural Science, NYU
Vitreoretinal Diseases & Surgery Institute
New York, NY, USA
Mayo Clinic University of California San Diego
Rochester, MN, USA La Jolla, CA, USA Janey L. Wiggs, MD, PhD
Paul Austin Chandler Professor of
Scott E. Brodie, MD, PhD Emanuel S. Rosen, MD, FRCS, Ophthalmology
Professor of Ophthalmology FRCOphth Harvard Medical School
NYU School of Medicine Private Practice Boston, MA, USA
New York, NY, USA Case Reports Editor for Journal of Cataract &
Jonathan J. Dutton, MD, PhD Refractive Surgery
Professor Emeritus Manchester, UK
Department of Ophthalmology
University of North Carolina
Chapel Hill, NC, USA
For additional online content visit ExpertConsult.com

Edinburgh London New York Oxford Philadelphia St Louis Sydney 2019

© 2019, Elsevier Inc. All rights reserved.

First edition 1999

Second edition 2004
Third edition 2009
Fourth edition 2014

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Chapter 4.29: “Endothelial Keratoplasty: Targeted Treatment for Corneal Endothelial Dysfunction” by
Marianne O. Price, Francis W. Price, Jr.
Marianne O. Price and Francis W. Price, Jr. retain copyright of the video accompanying this chapter.

Chapter 6.5: “Contact B-Scan Ultrasonography” by Yale L. Fisher, Dov B. Sebrow

Yale L. Fisher retains copyright of the video accompanying this chapter. The remainder of this lecture as
well as additional lectures on ophthalmology can be found at www.OphthalmicEdge.org.

Chapter 7.2: “Mechanisms of Uveitis” by Igal Gery, Chi-Chao Chan

This chapter is in the Public Domain.

Chapter 7.23: “Masquerade Syndromes: Neoplasms” by Nirali Bhatt, Chi-Chao Chan, H. Nida Sen
This chapter is in the Public Domain.

Chapter 11.8: “Torsional Strabismus” by Scott K. McClatchey, Linda R. Dagi

This chapter is in the Public Domain.

Chapter 12.16: “Aesthetic Fillers and Botulinum Toxin for Wrinkle Reduction” by Jean Carruthers,
Alastair Carruthers
Jean Carruthers retains copyright of Figures 12.16.1 & 12.16.6.

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug
dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier,
authors, editors or contributors for any injury and/or damage to persons or property as a matter of
products liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

ISBN: 978-0-323-52819-1
E-ISBN: 978-0-323-52821-4
ISBN: 978-0-323-52820-7

Content Strategist: Russell Gabbedy

Content Development Specialist: Sharon Nash
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Design: Brian Salisbury
Illustration Manager: Karen Giacomucci
Illustrator: Richard Tibbitts
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Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 User Guide

User Guide
COLOR CODING
Ophthalmology is organized into 12 parts, which are color-coded as follows
for quick and easy reference:

Part 1: Genetics

Part 2: Optics and Refraction

Part 3: Refractive Surgery

Part 4: Cornea and Ocular Surface Diseases

Part 5: The Lens

Part 6: Retina and Vitreous

Part 7: Uveitis and Other Intraocular Inflammations

Part 8: Intraocular Tumors

Part 9: Neuro-Ophthalmology

Part 10: Glaucoma

Part 11: Pediatric and Adult Strabismus

Part 12: Orbit and Oculoplastics

EXPERTCONSULT WEBSITE
n Full searchable text and downloadable image gallery
n Full reference lists for each chapter
n Additional online content including text, figures, & video clips

v
 Video Contents Video available at
Video Contents
ExpertConsult.com

Part 3: Refractive Surgery Chapter 6.25 Coats’ Disease and Retinal Telangiectasia
Chapter 3.4 LASIK 6.25.1 Pars Plana Vitrectomy and Subretinal Fluid and Exudate Drainage Performed
for a Severe Exudative Retinal Detachment
3.4.1 iLASIK
Chapter 6.32 Macular Hole
Chapter 3.5 Small Incision Lenticule Extraction (SMILE)
6.32.1 Macular Hole Surgery
3.5.1 SMILE Instructional Video
Chapter 6.33 Epiretinal Membrane
Chapter 3.7 Phakic Intraocular Lenses
6.33.1 Epiretinal Membrane Removal
3.7.1 Cachet Lens
3.7.2 Artisan/Verisyse Lens Implantation for Hyperopia After Radial Keratotomy Chapter 6.34 Vitreomacular Traction
3.7.3 Toric Artiflex Phakic Intraocular Lens in a Patient With High Myopia and
6.34.1 Vitreomacular Traction Syndrome
Astigmatism After Deep Anterior Lamellar Keratoplasty
3.7.4 Toric Artiflex Lens Implantation in a Patient With a Previous Intracorneal Chapter 6.39 Rhegmatogenous Retinal Detachment
Ring for Keratoconus 6.39.1 Internal Limiting Membrane (ILM) Peeling for Primary Rhegmatogenous
3.7.5 ICL Implantation Repair to Reduce Postoperative Macular Pucker
3.7.6 ICL Exchange
Chapter 6.41 Choroidal Hemorrhage
Part 4: Cornea and Ocular Surface Diseases 6.41.1 Transconjunctival Trocar/Cannula Drainage of Suprachoroidal Fluid
Chapter 4.17 Noninfectious Keratitis
Chapter 6.43 Posterior Segment Ocular Trauma
4.17.1 Patient With Lax Eyelids Recommended for Sleep Study
6.43.1 Intraocular Foreign Body Removal
Chapter 4.29 Endothelial Keratoplasty: Targeted Treatment for Corneal 6.43.2 Intraocular Foreign Body Removal With Rare Earth Magnet
Endothelial Dysfunction
Part 9: Neuro-Ophthalmology
4.29.1 DSEK Pull-Through
4.29.2 DMEK Donor Preparation Chapter 9.19 Nystagmus, Saccadic Intrusions, and Oscillations
4.29.3 Descemet’s Membrane Endothelial Keratoplasty (DMEK) 9.19.1 Congenital Nystagmus
9.19.2 Oculocutaneous Albinism With Associated Nystagmus
Part 5: The Lens 9.19.3 Latent Nystagmus
Chapter 5.8 Anesthesia for Cataract Surgery 9.19.4 Spasmus Nutans
5.8.1 Standard Technique for Sub-Tenon’s Anesthesia 9.19.5 Right Internuclear Ophthalmoplegia
5.8.2 “Incisionless” Technique for Sub-Tenon’s Anesthesia 9.19.6 Convergence Retraction Nystagmus in Parinaud’s Syndrome

Chapter 5.9 Phacoemulsification Part 10: Glaucoma

5.9.1 Two Examples of “Sculpting” Using Low Flow and Vacuum but Higher Chapter 10.7 Optic Nerve Analysis
Power/Amplitude 10.7.1 Three-Dimensional Imaging of the Optic Nerve Head
5.9.2 Two Examples of Using Higher Flow and Vacuum for Nucleus Fragment
Removal Chapter 10.28 Minimally Invasive and Microincisional Glaucoma Surgeries
Chapter 5.11 Small Incision and Femtosecond Laser-Assisted 10.28.1 iStent G1 Implantation
Cataract Surgery 10.28.2 Key Steps in Trabectome Surgery
5.11.1 Unexpected Subluxation Chapter 10.29 Trabeculectomy
5.11.2 Microincision Phaco 10.29.1 Bleb Leak Detection Using Concentrated Fluorescein Dye
5.11.3 Microincision Refractive Lens Exchange 10.29.2 Trabeculectomy With Mitomycin C
5.11.4 700µ Phaco 10.29.3 5-Fluorouracil Subconjunctival Injection
Chapter 5.13 Combined Procedures Chapter 10.32 Complications of Glaucoma Surgery and Their Management
5.13.1 Combined Phacoemulsification Cataract Surgery and Descemet’s Stripping 10.32.1 Small Pupil Cataract Surgery With Use of Pupil Expansion Ring (I-Ring;
Automated Endothelial Keratoplasty (DSAEK) Beaver Visitec, Waltham, MA) and Trypan Blue Capsular Staining
5.13.2 Combined Phacovitrectomy 10.32.2 Repair of Bleb Leak
Chapter 5.16 Complications of Cataract Surgery
Part 11: Pediatric and Adult Strabismus
5.16.1 Artisan Implantation
Chapter 11.3 Examination of Ocular Alignment and Eye Movements
Part 6: Retina and Vitreous 11.3.1 Strabismus Exam Elements
Chapter 6.3 Retinal and Choroidal Circulation 11.3.2 Cover/Uncover Test
11.3.3 Exotropia
6.3.1 Fluorescein and Indocyanine Green (ICG) Video Angiogram 11.3.4 Esotropia
Chapter 6.5 Contact B-Scan Ultrasonography 11.3.5 Hypertropia
11.3.6 Prism Alternate Cover Test
6.5.1 Examination Techniques for Contact B-Scan Ultrasonography
11.3.7 Simultaneous Prism Cover Test
Chapter 6.11 Scleral Buckling Surgery 11.3.8 Exophoria
11.3.9 Alternate or Cross Cover Test
6.11.1 Scleral Buckle
6.11.2 Suture Total running time approximately 2 hours and 34 minutes
6.11.3 Drain
Chapter 6.12 Vitrectomy
6.12.1 Vitrectomy for Nonclearing Vitreous Hemorrhage

vi
 Preface
Preface

It’s been 20 years since the first edition of Ophthalmology was published. Ophthalmology was never intended to be encyclopedic, but with each
We are delighted that our textbook now has gone to a fifth edition. The lon- edition we strived to make it quite comprehensive, readable, and easy to
gevity of this title reflects the uniqueness and utility of its format; the hard access. Like the fourth edition, this edition is thoroughly revised, with new
work of our authors, editors, and publishers; and the pressing need in our section editors and many new authors. Chapters have been rewritten and
field for updated, clinically relevant information. We continue to recognize restricted to reflect the new way diseases are diagnosed, categorized, and
the advantage of a complete textbook of ophthalmology in a single volume treated. We have discarded out-of-date material and have added numerous
rather than multiple volumes. The basic visual science is admixed with new items. Extra references and other material have been moved online to
clinical information throughout, and we have maintained an entire sepa- keep the book itself as one volume.
rate section dedicated to genetics and the eye.

xii
 Preface to First Edition

Preface to First Edition

Over the past 30 years, enormous technologic advances have occurred in To achieve the same continuity of presentation in the figures as well
many different areas of medicine—lasers, molecular genetics, and immu- as in the text, all of the artworks have been redesigned from the authors’
nology to name a few. This progress has fueled similar advances in almost originals, maximizing their accessibility for the reader. Each section is
every aspect of ophthalmic practice. The assimilation and integration of color coded for easy cross-referencing and navigation through the book.
so much new information makes narrower and more focused ophthalmic Despite the extensive use of color in artworks and photographs through-
practices a necessity. As a direct consequence, many subspecialty textbooks out, the cost of this comprehensive book has been kept to a fraction of the
with extremely narrow focus are now available, covering every aspect of multivolume sets. We hope to make this volume more accessible to more
ophthalmic practice. Concurrently, several excellent multivolume textbooks practitioners throughout the world.
detailing all aspects of ophthalmic practice have been developed. Yet there Although comprehensive, Ophthalmology is not intended to be encyclo-
remains a need for a complete single-volume textbook of ophthalmology pedic. In particular, in dealing with surgery, we do not stress specific tech-
for trainees, nonophthalmologists, and those general ophthalmologists niques or describe rarer ones in meticulous detail. The rapidly changing
(and perhaps specialists) who need an update in specific areas in which nature of surgical aspects of ophthalmic practice is such that the reader
they do not have expertise. Ophthalmology was created to fill this void will need to refer to one or more of the plethora of excellent books that
between the multivolume and narrow subspecialty book. cover specific current techniques in depth. We concentrate instead on
This book is an entirely new, comprehensive, clinically relevant, sin- the areas that are less volatile but, nevertheless, vital surgical indications,
gle-volume textbook of ophthalmology, with a new approach to content and general principles of surgical technique, and complications. The approach
presentation that allows the reader to access key information quickly. Our to referencing is parallel to this: For every topic, all the key references are
approach, from the outset, has been to use templates to maintain a uniform listed, but with the aim of avoiding pages of redundant references where a
chapter structure throughout the book so that the material is presented in smaller number of recent classic reviews will suffice. The overall emphasis
a logical, consistent manner, without repetition. The majority of chapters of Ophthalmology is current information that is relevant to clinical practice
in the book follow one of three templates: the disease-oriented template, superimposed on the broad framework that comprises ophthalmology as
the surgical procedure template, or the diagnostic testing template. Metic- a subspecialty.
ulous planning went into the content, sectioning, and chapter organization Essential to the realization of this ambitious project is the ream of
of the book, with the aim of presenting ophthalmology as it is practiced, Section Editors, each bringing unique insight and expertise to the book.
rather than as a collection of artificially divided aspects. Thus, pediatric They have coordinated their efforts in shaping the contents list, finding
ophthalmology is not in a separate section but is integrated into relevant contributors, and editing chapters to produce a book that we hope will
sections across the book. The basic visual science and clinical information, make a great contribution to ophthalmology.
including systemic manifestations, is integrated throughout, with only two We are grateful to the editors and authors who have contributed to
exceptions. We dedicated an entire section to genetics and the eye, in rec- Ophthalmology and to the superb, dedicated team at Mosby.
ognition of the increasing importance of genetics in ophthalmology. Optics Myron Yanoff
and refraction are included in a single section as well because an under- Jay S. Duker
standing of these subjects is fundamental to all of ophthalmology. July 1998

xiii
 List of Contributors
List of Contributors

The editor(s) would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition
would not have been possible.

Erika C. Acera, OC(C) Ferhina S. Ali, MD, MPH Steve A. Arshinoff, MD, FRCSC Nicole Balducci, MD
Clinical Orthoptist Vitreoretinal Surgery Fellow Associate Professor Consultant
Department of Ophthalmology Wills Eye Hospital University of Toronto Ophthalmology Division
Anne F. and Abraham Ratner Retina Service Department of Ophthalmology and Studio Oculistico d’Azeglio
Children’s Eye Center Mid Atlantic Retina Visual Sciences Bologna, Italy
Shiley Eye Institute Philadelphia, PA, USA Toronto, ON, Canada
University of California San Diego Piero Barboni, MD
La Jolla, CA, USA Jorge L. Alió, MD, PhD Penny A. Asbell, MD, FACS, FARVO Consultant
Professor of Ophthalmology Professor of Ophthalmology Neuro-Ophthalmology
Natalie A. Afshari, MD Miguel Hernandez University, Vissum Icahn School of Medicine at Mount Scientific Institute San Raffaele
Stuart I. Brown MD Chair in Alicante, Spain Sinai Milan, Italy
Ophthalmology in Memory of New York, NY, USA Studio Oculistico d’Azeglio
Donald P. Shiley Norma Allemann, MD Bologna, Italy
Professor of Ophthalmology Adjunct Professor Kerry K. Assil, MD
Chief of Cornea and Refractive Surgery Department of Ophthalmology and Corneal, Cataract and Refractive Cullen J. Barnett, COT, CRA, OCT-C,
Vice Chair of Education Visual Sciences Surgeon CDOS
Shiley Eye Institute University of Illinois at Chicago Medical Director Clinical Supervisor of Ophthalmology
University of California San Diego Chicago, IL, USA The Assil Eye Institute Roski Eye Institute
La Jolla, CA, USA Adjunct Professor Beverly Hills, CA, USA Keck Medicine USC
Department of Ophthalmology and Los Angeles, CA, USA
Anita Agarwal, MD Visual Sciences Neal H. Atebara, MD, FACS
Adjoint Professor of Ophthalmology Escola Paulista de Medicina (EPM) Associate Professor Soumyava Basu, MS
Vanderbilt Eye Institute Universidade Federal de São Paulo Department of Surgery Head of Uveitis Services
West Coast Retina (UNIFESP) University of Hawaii LVPEI Network
Vanderbilt University Medical Center São Paulo, SP, Brazil John A. Burns School of Medicine L V Prasad Eye Institute
San Francisco, CA, USA Honolulu, HI, USA Bhubaneswar, Odisha, India
David Allen, BSc, MB, BS, FRCS,
Joshua S. Agranat, MD FRCOphth James J. Augsburger, MD Priti Batta, MD
Resident Physician Consultant Ophthalmologist (Cataract) Professor of Ophthalmology Assistant Professor of Ophthalmology
Department of Ophthalmology Cataract Treatment Centre Dr. E. Vernon & Eloise C. Smith Chair Director of Medical Student Education
Massachusetts Eye and Ear Sunderland Eye Infirmary of Ophthalmology New York Eye and Ear Infirmary of
Harvard Medical School Sunderland, Tyne & Wear, UK College of Medicine, University of Mount Sinai
Boston, MA, USA Cincinnati New York, NY, USA
Keith G. Allman, MBChB, MD, FRCA Founding Director, Ocular Oncology &
Radwan S. Ajlan, MBBCh, FRCS(C), Consultant Anaesthetist Diagnostic Ultrasonography Service, Caroline R. Baumal, MD, FRCSC
FICO, DABO West of England Eye Unit University of Cincinnati Medical Associate Professor of Ophthalmology
Assistant Professor Royal Devon and Exeter NHS Trust Center Director ROP Service
Retina and Vitreous Exeter, Devon, UK Attending Surgeon, University of Vitreoretinal Surgery
Department of Ophthalmology Cincinnati Medical Center New England Eye Center
University of Kansas School of Nishat P. Alvi, MD Consulting Surgeon, Cincinnati Tufts University
Medicine Medical Director of Ophthalmology Children’s Hospital Medical Center School of Medicine
Kansas City, KS, USA The Vision Institute of Illinois Cincinnati, OH, USA Boston, MA, USA
Elgin, IL, USA
Anam Akhlaq, MBBS G. William Aylward, FRCS, FRCOphth, Srilaxmi Bearelly, MD, MHS
Postdoctoral Fellow Leonard P.K. Ang, MBBS, MD, FRCS, MD Assistant Professor of Ophthalmology
Center for Translational Ocular MRCOphth, MMed, FAMS Consultant Ophthalmologist Ophthalmology
Immunology Associate Professor of Ophthalmology London, UK Columbia University Medical Center
Department of Ophthalmology Medical Director, Lang Eye Centre New York, NY, USA
Tufts Medical Center Singapore Dimitri T. Azar, MD, MBA
Senior Director, Google Verily Life Jesse L. Berry, MD
Boston, MA, USA David J. Apple, MD †
Associate Director, Ocular Oncology
Sciences
Thomas A. Albini, MD Formerly Professor of Ophthalmology Distinguished University Professor Service
Associate Professor of Ophthalmology and Pathology and B.A. Field Chair of Ophthalmic Associate Residency Program Director
Department of Ophthalmology Director, Laboratories for Ophthalmic Research for Ophthalmology
Bascom Palmer Eye Institute Devices Research Professor of Ophthalmology, USC Roski Eye Institute
University of Miami John A. Moran Eye Center Pharmacology, and Bioengineering Keck School of Medicine, University of
Miami, FL, USA University of Utah University of Illinois at Chicago Illinois Southern California
Salt Lake City, UT, USA College of Medicine Attending Surgeon, Children’s Hospital
Ahmed Al-Ghoul, MD, MBA, FRCSC, Chicago, IL, USA of Los Angeles
DipABO Maria Cecilia D. Aquino, MD, MMED, Los Angeles, CA, USA
Clinical Lecturer (Ophthalmology) Sophie J. Bakri, MD
Division of Ophthalmology Resident Physician II Professor of Ophthalmology Angela P. Bessette, MD
Department of Surgery Ophthalmology/Glaucoma Vitreoretinal Diseases & Surgery Assistant Professor
University of Calgary National University Hospital Mayo Clinic Department of Ophthalmology
Calgary, AB, Canada National University Health System Rochester, MN, USA Flaum Eye Institute
Singapore University of Rochester
Laura J. Balcer, MD, MSCE Rochester, NY, USA
Anthony C. Arnold, MD Professor of Neurology
Professor and Chief Vice-Chair, Neurology
Neuro-Ophthalmology Division New York University
xiv UCLA Stein Eye Institute
Los Angeles, CA, USA
School of Medicine
†
Deceased New York, NY, USA
Nirali Bhatt, MD Igor I. Bussel, MS, MHA Chi-Chao Chan, MD Abbot (Abe) Clark, PhD, FARVO
Assistant Professor Doris Duke Clinical Research Fellow Scientist Emeritus Regents Professor of Pharmacology

List of Contributors
Department of Ophthalmology Department of Ophthalmology Laboratory of Immunology and Neuroscience
University of Pennsylvania University of Pittsburgh School of National Eye Institute Executive Director, North Texas Eye
Perelman School of Medicine Medicine National Institutes of Health Research Institute
Philadelphia, PA, USA Pittsburgh, PA, USA Bethesda, MD, USA University of North Texas Health
Visiting Professor Science Center
Orry C. Birdsong, MD Louis B. Cantor, MD Zhongshan Ophthalmic Center Fort Worth, TX, USA
Clinical Fellow Jay C. and Lucile L. Kahn Professor Sun Yat-Sen University
Ophthalmology and Chair China Jonathan C.K. Clarke, MD, FRCOphth
Hoopes Vision Department of Ophthalmology Consultant Ophthalmologist
Draper, UT, USA Indiana University Melinda Y. Chang, MD NIHR Moorfields Biomedical Research
School of Medicine Assistant Professor of Ophthalmology Centre
Jyotirmay Biswas, MS, FMRF, FNAMS, Indianapolis, IN, USA USC Roski Eye Institute and Children’s Moorfields Eye Hospital
FIC, Path, FAICO Hospital Los Angeles UCL Institute of Ophthalmology
Director Hilda Capó, MD Keck School of Medicine of the London, UK
Uveitis and Ocular Pathology Professor of Clinical Ophthalmology University of Southern California
Department Bascom Palmer Eye Institute Los Angeles, CA, USA François Codère, MD
Sankara Nethralaya Division Chief Pediatric Associate Professor
Chennai, Tamil Nadu, India Ophthalmology and Adult Stanley Chang, MD Ophthalmology/Oculoplastic and
Strabismus KK Tse and KT Ying Professor of Orbital Surgery Section
Bahram Bodaghi, MD, PhD, FEBOphth Miller School of Medicine Ophthalmology Université de Montréal
Professor of Ophthalmology John T. Flynn Professor of Department of Ophthalmology Montréal, QC, Canada
DHU ViewRestore Ophthalmology Chair Columbia University
APHP, UPMC, Sorbonne University University of Miami New York, NY, USA Ian P. Conner, MD, PhD
Paris, France Miami, FL, USA Assistant Professor
Victoria S. Chang, MD Ophthalmology
Swaraj Bose, MD Antonio Capone, Jr., MD Assistant Professor of Clinical UPMC Eye Center
Associate Professor of Ophthalmology Professor Ophthalmology Pittsburgh, PA, USA
UCI and Attending Physician Department of Ophthalmology Ophthalmology, Cornea and External
Cedars Sinai Medical Center Oakland University Disease Peter Coombs, MD
Los Angeles, CA, USA William Beaumont Hospital Bascom Palmer Eye Institute Vitreoretinal Physician and Surgeon
School of Medicine University of Miami Utah Eye Centers
Charles S. Bouchard, MD, MA Salt Lake City, UT, USA
Professor and Chairman of Auburn HIlls, MI, USA Naples, FL, USA
Ophthalmology Alastair Carruthers, MA, BM, BCh, David G. Charteris, MD, FRCS(Ed), Zélia M. Corrêa, MD, PhD
Loyola University Health System FRCP(Lon), FRCPC FRCOphth Tom Clancy Endowed Professor of
Maywood, IL, USA Clinical Professor Professor Ophthalmology
Department of Dermatology and Skin Vitreoretinal Unit Head of Ocular Oncology and
Michael E. Boulton, PhD Echography
Susan and Dowd Ritter/RPB Endowed Science Moorfields Eye Hospital
University of British Columbia London, UK Retina Service, Wilmer Eye Institute
Chair of Ophthalmology Johns Hopkins University School of
University of Alabama Birmingham Vancouver, BC, Canada
Soon-Phaik Chee, MD Medicine
Birmingham, AL, USA Jean Carruthers, MD, FRCSC, Professor Baltimore, MD, USA
James D. Brandt, MD FRC(OPHTH) Cataract Service, Ocular Inflammation
Clinical Professor & Immunology Service Steven M. Couch, MD, FACS
Professor Assistant Professor
Department of Ophthalmology & Department of Ophthalmology Singapore National Eye Centre
University of British Columbia Singapore Department of Ophthalmology &
Vision Science Visual Sciences
Vice-Chair for International Programs Fellow
American Society for Ophthalmic John J. Chen, MD, PhD Washington University in St Louis
and New Techology Assistant Professor St Louis, MO, USA
Director - Glaucoma Service Plastic and Reconstructive Surgery
Vancouver, BC, Canada Department of Ophthalmology and
University of California Davis Neurology Stuart G. Coupland, PhD
Sacramento, CA, USA Keith D. Carter, MD, FACS Mayo Clinic Associate Professor
Lillian C. O’Brien and Dr. C.S. O’Brien Rochester, MN, USA Department of Ophthalmology
Scott E. Brodie, MD, PhD University of Ottawa
Professor of Ophthalmology Chair in Ophthalmology
Professor and Chair Xuejing Chen, MD, MS Ottawa, ON, Canada
NYU School of Medicine Clinical Fellow
New York, NY, USA Department of Ophthalmology & Claude L. Cowan, Jr., MD, MPH
Visual Sciences Retina
Ophthalmic Consultants of Boston Clinical Professor of Ophthalmology
Michael C. Brodsky, MD Carver College of Medicine Georgetown University Medical Center
Professor of Ophthalmology and University of Iowa New England Eye Center at Tufts
Medical Center Washington, DC, USA
Neurology Iowa City, IA, USA Staff Physician
Knights Templar Research Professor of Boston, MA, USA
Rafael C. Caruso, MD Surgical Service
Ophthalmology Paul T.K. Chew, MMed, FRCOphth Veterans Affairs Medical Center
Mayo Clinic Staff Clinician
National Eye Institute Director Glaucoma Division Washington, DC, USA
Rochester, MN, USA Ophthalmology/Glaucoma
National Institutes of Health E. Randy Craven, MD
Cassandra C. Brooks, MD Bethesda, MD, USA National University Hospital Singapore
Singapore Associate Professor, Glaucoma
Resident in Ophthalmology Johns Hopkins University
Duke Eye Center Harinderpal S. Chahal, MD
Oculofacial Plastic and Reconstructive Bing Chiu, MD Baltimore, MD, USA
Duke University School of Medicine Ophthalmology Resident
Durham, NC, USA Surgery Catherine A. Cukras, MD, PhD
Eye Medical Center New York University
New York, NY, USA Director, Medical Retina Fellowship
Matthew V. Brumm, MD Fresno, CA, USA Program
Ophthalmologist Clement C. Chow, MD National Eye Institute
Cataract and Refractive Surgery Wallace Chamon, MD
Adjunct Professor Partner Physician National Institutes of Health
Brumm Eye Center Retinal Diagnostic Center Bethesda, MD, USA
Omaha, NE, USA Department of Ophthalmology and
Visual Sciences Campbell, CA, USA
Linda R. Dagi, MD
Donald L. Budenz, MD, MPH University of Illinois at Chicago Mortimer M. Civan, MD Director of Adult Strabismus
Kittner Family Distinguished Professor Chicago, IL, USA Professor of Physiology and Professor Boston Children’s Hospital
and Chairman Adjunct Professor of Medicine Associate Professor of Ophthalmology
Department of Ophthalmology Department of Ophthalmology and Department of Physiology Director of Quality Assurance
University of North Carolina at Chapel Visual Sciences University of Pennsylvania Department of Ophthalmology
Hill Escola Paulista de Medicina (EPM) Perelman School of Medicine Children’s Hospital Ophthalmology
Chapel Hill, NC, USA Universidade Federal de São Paulo Philadelphia, PA, USA Foundation Chair
(UNIFESP) Harvard Medical School
São Paulo, SP, Brazil Boston, MA, USA
xv
 Elie Dahan, MD, MMed, (Ophth)† Gary R. Diamond, MD† Bryan Edgington, MD Ayad A. Farjo, MD
Formerly Senior Consultant Pediatric Formerly Professor of Ophthalmology Associate Professor, Cornea Division President & Director
List of Contributors
Ophthalmology and Glaucoma and Pediatrics Casey Eye Institute Brighton Vision Center
Department of Ophthalmology Drexel University School of Medicine Oregon Health Sciences University Brighton, MI, USA
Ein Tal Eye Hospital Philadelphia, PA, USA Staff Ophthalmologist
Tel Aviv, Israel Veterans Health Administration Eric Feinstein, MD
Daniel Diniz, MD Portland Health Care System Surgical Retina Fellow
Iben Bach Damgaard, MD Surgical Optics Fellow Portland, OR, USA Department of Ophthalmology
PhD Fellow Department of Ophthalmology & Rocky Mountain Lions Eye Institute
Department of Ophthalmology Visual Sciences Howard M. Eggers, MD University of Colorado
Aarhus University Hospital Federal University of São Paulo Professor of Clinical Ophthalmology School of Medicine
Aarhus, Denmark (UNIFESP) Harkness Eye Institute Denver, CO, USA
São Paulo, SP, Brazil New York, NY, USA
Karim F. Damji, MD, FRCSC, MBA Karen B. Fernandez, MD
Professor Diana V. Do, MD Dean Eliott, MD Consultant
Department of Ophthalmology & Professor of Ophthalmology Stelios Evangelos Gragoudas Associate Department of Ophthalmology
Visual Sciences Byers Eye Institute Professor of Ophthalmology The Medical City
University of Alberta Stanford University Harvard Medical School Pasig City, Metro Manila, Philippines
Edmonton, AL, Canada School of Medicine Associate Director, Retina Service
Palo Alto, CA, USA Massachusetts Eye & Ear Yale L. Fisher, MD
Dipankar Das, MD Boston, MA, USA Voluntary Clinical Professor
Senior Consultant & Ocular Pathologist Peter J. Dolman, MD, FRCSC Department of Ophthalmology
Uveitis, Ocular Pathology and Neuro- Clinical Professor George S. Ellis, Jr., MD, FAAP, FAAO, Bascom Palmer Eye Institute
ophthalmology Services Division Head of Oculoplastics and FACS Miami, FL, USA
Sri Sankaradeva Nethralaya Orbital Surgery Director Ophthalmology Voluntary Clinical Professor
Guwahati, Assam, India Fellowship Director Children’s Hospital New Orleans Department of Ophthalmology
Department of Ophthalmology & Associate Clinical Professor of Weill Cornell Medical Center
Adam DeBusk, DO, MS Visual Sciences Ophthalmology and Pediatrics New York, NY, USA
Instructor Division of Oculoplastics and Orbit Tulane University
Department of Ophthalmology University of British Columbia Associate Clinical Professor of Gerald A. Fishman, MD
Wills Eye Hospital Vancouver General Hospital Ophthalmology and Pediatrics Director
Sidney Kimmel Medical College Vancouver, BC, Canada Louisiana State Universities Schools of The Pangere Center for Inherited
Thomas Jefferson University Medicine Retinal Diseases
Philadelphia, PA, USA Sean P. Donahue, MD, PhD New Orleans, LA, USA The Chicago Lighthouse
Professor Professor Emeritus of Ophthalmology
Jose de la Cruz, MD, MSc Department of Ophthalmology & Michael Engelbert, MD, PhD Department of Ophthalmology &
Assistant Professor Visual Sciences Research Assistant Professor Visual Sciences
Ophthalmology, Cornea Refractive Vanderbilt University Department of Ophthalmology University of Illinois at Chicago
Surgery Service Nashville, TN, USA NYU/VRMNY College of Medicine
University of Illinois Eye and Ear New York, NY, USA Chicago, IL, USA
Infirmary Richard K. Dortzbach, MD
Chicago, IL, USA Professor Emeritus Miriam Englander, MD Jorge A. Fortun, MD
Department of Ophthalmology and Attending Surgeon Associate Professor of Ophthalmology
Joseph L. Demer, MD, PhD Visual Sciences Vitreo-Retinal Surgery Vitreoretinal Diseases and Surgery
Arthur L. Rosenbaum Chair in University of Wisconsin Ophthalmic Consultants of Boston Medical Director of Bascom Palmer
Pediatric Ophthalmology School of Medicine and Public Health Boston, MA, USA Eye Institute
Professor of Neurology Madison, WI, USA Palm Beach Gardens Bascom Palmer
Chief, Pediatric Ophthalmology and Bita Esmaeli, MD, FACS Eye Institute
Strabismus Division Kimberly A. Drenser, MD, PhD Professor of Ophthalmology University of Miami Miller School of
Director, Ocular Motility Laboratories Associated Retinal Consultants, PC Director, Ophthalmic Plastic & Medicine
Chair, EyeSTAR Residency/PhD and Department of Ophthalmology Reconstructive Surgery Fellowship Miami, FL, USA
Post-doctoral Fellowship Program in Oakland University Program, Department of Plastic
Ophthalmology and Visual Science William Beaumont Hospital School of Surgery Veronica Vargas Fragoso, MD
Member, Neuroscience Medicine Chair, Graduate Medical Education Refractive Surgery Fellow
Interdepartmental Program Royal Oak, MI, USA Committee Vissum Corporation
Member, Bioengineering University of Texas MD Anderson Alicante, Spain
Interdepartmental Program Jacob S. Duker, MD Cancer Center
University of California Los Angeles Resident Physician Houston, TX, USA Nicola Freeman, MBChB, FCOphth,
Los Angeles, CA, USA Department of Ophthalmology MMed
Bascom Palmer Eye Institute Joshua W. Evans, MD Senior Specialist
Shilpa J. Desai, MD University of Miami Assistant Professor of Ophthalmology Department of Pediatric
Assistant Professor Miami, FL, USA Division of Glaucoma Ophthalmology
Department of Ophthalmology University of Kentucky Red Cross Children’s Hospital
Tufts University Jay S. Duker, MD Lexington, KY, USA Cape Town, Western Province, South
School of Medicine Director Africa
Boston, MA, USA New England Eye Center Monica Evans, MD
Professor and Chairman Ophthalmology David S. Friedman, MD, MPH, PhD
Deepinder K. Dhaliwal, MD, L.Ac Department of Ophthalmology San Jose, Costa Rica Director, Dana Center for Preventive
Professor of Ophthalmology, University Tufts Medical Center Ophthalmology
of Pittsburgh School of Medicine Tufts University School of Medicine Daoud S. Fahd, MD Professor of Ophthalmology, Wilmer/
Director, Cornea and Refractive Boston, MA, USA Clinical Assistant Professor Glaucoma
Surgery Services Department of Ophthalmology Johns Hopkins University
Director and Founder, Center for Vikram D. Durairaj, MD, FACS Ophthalmic Consultants of Beirut Baltimore, MD, USA
Integrative Eye Care ASOPRS Fellowship Director and Jal el Dib, Metn, Lebanon
Co-Director, Cornea and Refractive Managing Partner Deborah I. Friedman, MD, MPH
Oculoplastic and Orbital Surgery Lisa J. Faia, MD Professor
Surgery Fellowship Partner, Associated Retinal Consultants
Associate Medical Director, Charles TOC Eye and Face Department of Neurology
Austin, TX, USA Associate Professor & Neurotherapeutics and
T. Campbell Ocular Microbiology Oakland University
Laboratory Ophthalmology
Jonathan J. Dutton, MD, PhD William Beaumont School of Medicine University of Texas
Medical Director, UPMC Laser Vision Professor Emeritus Ophthalmology - Retina
Center Southwestern Medical Center
Department of Ophthalmology Royal Oak, MI, USA Dallas, TX, USA
University of Pittsburgh Medical University of North Carolina
Center Chapel Hill, NC, USA Katherine A. Fallano, MD Neil J. Friedman, MD
Pittsburgh, PA, USA Department of Ophthalmology Adjunct Clinical Associate Professor
University of Pittsburgh School of Department of Ophthalmology
Medicine Stanford University School of Medicine
Pittsburgh, PA, USA
xvi †
Stanford, CA, USA
Deceased
Nicoletta Fynn-Thompson, MD Jeffrey L. Goldberg, MD, PhD Jason R. Guercio, MD, MBA Joshua H. Hou, MD
Partner Professor and Chairman Senior Resident in Anesthesiology Assistant Professor

List of Contributors
Cornea, Cataract and Refractive Surgery Department of Ophthalmology Department of Anesthesiology Department of Ophthalmology &
Ophthalmic Consultants of Boston Byers Eye Institute at Stanford Duke University Medical Center Visual Neurosciences
Boston, MA, USA University Durham, NC, USA University of Minnesota
Palo Alto, CA, USA Minneapolis, MN, USA
Neha Gadaria-Rathod, MD Julie Gueudry, MD
Assistant Clinical Instructor Debra A. Goldstein, MD, FRCSC Senior Consultant Odette M. Houghton, MD
Department of Ophthalmology Magerstadt Professor of Ophthalmology Senior Associate Consultant
SUNY Downstate Medical Center Ophthalmology Charles Nicolle University Hospital Ophthalmology
New York, NY, USA Director Uveitis Service Rouen, France Mayo Clinic
Northwestern University Scottsdale, AZ, USA
Debora E. Garcia-Zalisnak, MD Feinberg School of Medicine Ahmet Kaan Gündüz, MD
Cornea Fellow Chicago, IL, USA Professor of Ophthalmology Kourtney Houser, MD
Department of Ophthalmology Ankara University Assistant Professor
University of Illinois at Chicago Michael H. Goldstein, MD, MBA Faculty of Medicine Ophthalmology
Chicago, IL, USA Co-Director, Cornea and External Ankara, Turkey University of Tennessee
Diseases Service Health Science Center
Gregg S. Gayre, MD New England Eye Center Joelle A. Hallak, PhD Memphis, TN, USA
Chief of Eye Care Services Tufts Medical Center Assistant Professor, Executive Director
Department of Ophthalmology Boston, MA, USA Ophthalmic Clinical Trials & Frank W. Howes, MBChB, MMed, FCS,
Kaiser Permanente Translational Center FRCS, FRCOphth, FRANZCO
San Rafael, CA, USA John A. Gonzales, MD Department of Ophthalmology & Associate Professor
Assistant Professor Visual Sciences Bond University
Steven J. Gedde, MD Francis I. Proctor Foundation and University of Illinois at Chicago Company and Clinical Director
Professor of Ophthalmology, John Department of Ophthalmology Chicago, IL, USA Cataract Refractive & Glaucoma
G. Clarkson Chair, Vice Chair of University of California San Francisco Surgery
Education San Francisco, CA, USA Julia A. Haller, MD Eye & Laser Centre
Bascom Palmer Eye Institute Ophthalmologist-in-Chief, Wills Eye Gold Coast, QLD, Australia
University of Miami Miller David B. Granet, MD, FACS, FAAp Hospital
School of Medicine Anne F. Ratner Chair of Pediatric William Tasman, MD Endowed Chair Jason Hsu, MD
Miami, FL, USA Ophthalmology Professor and Chair of Ophthalmology Co-Director of Retina Research
Professor of Ophthalmology & Sidney Kimmel Medical College at Retina Service of Wills Eye Hospital
Igal Gery, PhD Pediatrics Thomas Jefferson University Associate Professor of Ophthalmology
Scientist Emerita Director of the Ratner Children’s Eye Philadelphia, PA, USA Thomas Jefferson University
Laboratory of Immunology Center at the Shiley Eye Institute Mid Atlantic Retina
National Eye Institute University of California San Diego Pedram Hamrah, MD, FACS Philadelphia, PA, USA
National Institutes of Health La Jolla, CA, USA Director of Clinical Research
Bethesda, MD, USA Director, Center for Translational Jeffrey J. Hurwitz, MD, FRCS(C)
Matthew J. Gray, MD Ocular Immunology Professsor, Ophthalmology
Ramon C. Ghanem, MD, PhD Assistant Professor Cornea and Associate Professor, Ophthalmology University of Toronto
Director External Disease Tufts Medical Center Oculoplastic Specialist
Cornea and Refractive Surgery Department of Ophthalmology Tufts University Mount Sinai Hospital
Department University of Florida School of Medicine Toronto, ON, Canada
Sadalla Amin Ghanem Eye Hospital Gainesville, FL, USA Boston, MA, USA
Joinville, SC, Brazil Francisco Irochima, PhD
Kyle M. Green, BA David R. Hardten, MD Professor, Biotechnology
Vinícius C. Ghanem, MD, PhD Medical Student Researcher Director of Refractive Surgery Universidade Potiguar
Ophthalmologist, Medical Director Ophthalmology Department of Ophthalmology Natal, Rio Grande do Norte, Brazil
Department of Ophthalmology University of Southern California Minnesota Eye Consultants
Sadalla Amin Ghanem Eye Hospital Roski Eye Institute Minnetonka, MN, USA Jihad Isteitiya, MD
Joinville, SC, Brazil Los Angeles, CA, USA Cornea Fellow, Ophthalmology
Alon Harris, MS, PhD, FARVO Icahn School of Medicine at Mount
Saurabh Ghosh, MBBS, DipOphth, Craig M. Greven, MD Professor of Ophthalmology Sinai
MRCOphth, FRCOphth Richard G. Weaver Professor and Letzter Endowed Chair in New York, NY, USA
Consultant Ophthalmologist Chairman Ophthalmology
Cornea, Cataract, External Eye Disease Department of Ophthalmology Director of Clinical Research Andrea M. Izak, MD
Sunderland Eye Infirmary Wake Forest University Eugene and Marilyn Glick Eye Institute Post-Doctoral Fellow
Sunderland, Tyne & Wear, UK School of Medicine Indiana University Storm Eye Institute
Winston-Salem, NC, USA School of Medicine Medical University of South Carolina
Allister Gibbons, MD Charleston, SC, USA
Assistant Professor Indianapolis, IN, USA
Margaret A. Greven, MD
Bascom Palmer Eye Institute Assistant Professor Jeffrey S. Heier, MD Deborah S. Jacobs, MD
University of Miami Ophthalmology Co-President and Medical Director Associate Professor of Ophthalmology
Miami, FL, USA Wake Forest University Director, Vitreoretinal Service Harvard Medical School
School of Medicine Ophthalmic Consultants of Boston Medical Director
James W. Gigantelli, MD, FACS BostonSight
Professor Winston-Salem, NC, USA Boston, MA, USA
Needham, MA, USA
Department Ophthalmology & Visual Josh C. Gross, MD Leon W. Herndon, Jr., MD
Sciences Clinical Research Fellow Professor, Ophthalmology Sandeep Jain, MD
University of Nebraska Medical Center Ophthalmology Duke University Eye Center Associate Professor, Ophthalmology
Omaha, NE, USA Eugene and Marilyn Glick Eye Institute Durham, NC, USA University of Illinois at Chicago
Indiana School of Medicine Chicago, IL, USA
Pushpanjali Giri, BA Allen C. Ho, MD
Research Specialist Indianapolis, IN, USA Henry D. Jampel, MD, MHS
Wills Eye Hospital Director of Retina
Department of Ophthalmology Ronald L. Gross, MD Research Odd Fellows Professor of
University of Illinois at Chicago Professor and Jane McDermott Schott Retina Service Ophthalmology
College of Medicine Chair Wills Eye Hospital Wilmer Eye Institute
Chicago, IL, USA Chairman, Department of Philadelphia, PA, USA Johns Hopkins University
Ophthalmology School of Medicine
Ivan Goldberg, AM, MB, BS, FRANZCO, Christopher T. Hood, MD Baltimore, MD, USA
FRACS West Virginia University
Morgantown, WV, USA Clinical Assistant Professor
Clinical Professor Michigan Medicine Ophthalmology Lee M. Jampol, MD
University of Sydney Sandeep Grover, MD Cornea and Refractive Surgery Clinic Louis Feinberg Professor of
Head of Discipline of Ophthalmology Associate Professor & Associate Chair W.K. Kellogg Eye Center Ophthalmology
and Glaucoma Unit of Ophthalmology Ann Arbor, MI, USA Feinberg School of Medicine
Sydney Eye Hospital University of Florida Northwestern University
Director Jacksonville, FL, USA Chicago, IL, USA
Eye Associates xvii
Sydney, NSW, Australia
 Aliza Jap, FRCS(G), FRCOphth, FRCS Kevin Kaplowitz, MD Jeremy D. Keenan, MD, MPH Victor T.C. Koh, MBBS, MMed(Oph),
(Ed) Assistant Professor Associate Professor of Ophthalmology FAMS
List of Contributors
Senior Consultant Ophthalmologist Ophthalmology, VA Loma Linda Francis I. Proctor Foundation and Associate Consultant, Ophthalmology
Division of Ophthalmology Loma Linda University Department of Ophthalmology National University Hospital
Changi General Hospital, Singapore Loma Linda, CA, USA University of California San Francisco Singapore
Singapore National Eye Centre San Francisco, CA, USA
Singapore Michael A. Kapusta, MD, FRCSC Thomas Kohnen, MD, PhD, FEBO
Associate Professor Kenneth R. Kenyon, MD Professor and Director
Chris A. Johnson, PhD, DSc Director of Retina and Vitreous Surgery Clinical Professor, Ophthalmology Department of Ophthalmology
Professor Department of Ophthalmology Tufts University University Clinic Frankfurt
Department of Ophthalmology & Jewish General Hospital School of Medicine Goethe University
Visual Sciences McGill University Harvard Medical School Frankfurt am Main
University of Iowa Hospitals and Montreal, QC, Canada Schepens Eye Research Institute Germany
Clinics Boston, MA, USA
Iowa City, IA, USA Rustum Karanjia, MD, PhD, FRCSC Andrew Koustenis, BS
Assistant Professor, Ophthalmology Sir Peng Tee Khaw, PhD, FRCS, FRCP, Medical Student
Mark W. Johnson, MD University of Ottawa FRCOphth, FRCPath, FRSB, FCOptom Clinical Ophthalmology Research
Professor, Chief of Retina Section Ottawa Hospital Research Institute (Hon), DSc, FARVO, FMedSci Internship
Department of Ophthalmology & The Ottawa Hospital Professor of Glaucoma and Ocular Department of Ophthalmology
Visual Sciences Ottawa, ON, Canada Healing Eugene and Marilyn Glick Eye Institute
University of Michigan Doheny Eye Institute Consultant Ophthalmic Surgeon Indiana University
Ann Arbor, MI, USA Doheny Eye Centers Director, National Institute for Health School of Medicine
UCLA, David Geffen School of Research, Biomedical Research Indianapolis, IN, USA
T. Mark Johnson, MD, FRCS(C) Medicine Centre for Ophthalmology
Attending Surgeon, Vitreo-Retinal Los Angeles, CA, USA Moorfields Eye Hospital Stephen S. Lane, MD
Surgery UCL Institute of Ophthalmology Medical Director
Retina Group of Washington Randy H. Kardon, MD, PhD London, UK Adjunct Clinical Professor
Rockville, MD, USA Professor and Director of Neuro- Chief Medical Officer and Head Global
ophthalmology and Pomerantz Gene Kim, MD Franchise Clinical Strategy
Mark M. Kaehr, MD Family Chair in Ophthalmology Assistant Professor and Residency Associated Eye Care
Partner Ophthalmology/Neuro-ophthalmology Program Director University of Minnesota, Alcon
Associated Vitreoretinal and Uveitis Director of the Iowa City VA Center Department of Ophthalmology & Minneapolis, MN, USA
Consultants for the Prevention and Treatment of Visual Science at McGovern Medical
Assistant Clinical Professor of Visual Loss School at UTHealth Patrick J.M. Lavin, MB, MRCPI
Ophthalmology University of Iowa and Iowa City VA Houston, TX, USA Prof. Neurology and Ophthalmology
Indiana University Medical Center Neurology, Ophthalmology and Visual
Associated Vitreoretinal and Uveitis Iowa City, IA, USA Ivana K. Kim, MD Science
Consultants Associate Professor of Ophthalmology Vanderbilt University Medical Center
Indiana University Carol L. Karp, MD Retina Service, Massachusetts Eye and Nashville, TN, USA
School Of Medicine Professor of Ophthalmology Ear
Indianapolis, IN, USA Richard K. Forster Chair in Harvard Medical School Fabio Lavinsky, MD, PhD, MBA
Ophthalmology Boston, MA, USA Research Fellow
Malik Y. Kahook, MD Bascom Palmer Eye Institute NYU Langone Eye Center
The Slater Family Endowed Chair in University of Miami Alan E. Kimura, MD, MPH NYU School of Medicine
Ophthalmology Miller School of Medicine Clinical Associate Professor New York, NY, USA
Vice Chair of Clinical & Translational Miami, FL, USA Department of Ophthalmology Director, Ophthalmic Imaging
Research University of Colorado Department
Professor of Ophthalmology & Chief of Amir H. Kashani, MD, PhD Health Sciences Center Lavinsky Eye Institute
Glaucoma Service Assistant Professor of Clinical Aurora, CO, USA Porto Alegre, Brazil
Director of Glaucoma Fellowship Ophthalmology
University of Colorado University of Southern California Michael Kinori, MD Andrew W. Lawton, MD
School of Medicine Roski Eye Institute Senior Physician Director, Neuro-Ophthalmology
Aurora, CO, USA Los Angeles, CA, USA The Goldschleger Eye Institute Division
Sheba Medical Center, Tel Hashomer Ochsner Health Services
Peter K. Kaiser, MD Michael A. Kass, MD Ramat Gan, Israel New Orleans, LA, USA
Chaney Family Endowed Chair in Bernard Becker Professor,
Ophthalmology Research Ophthalmology and Visual Science Caitriona Kirwan, FRCSI(Ophth) Bryan S. Lee, MD, JD
Professor of Ophthalmology Washington University Consultant Ophthalmic Surgeon Private Practitioner
Cleveland Clinic School of Medicine Mater Private Hospital Altos Eye Physicians
Cole Eye Institute St Louis, MO, USA Dublin, Ireland Los Altos, CA, USA
Cleveland, OH, USA Adjunct Clinical Assistant Professor of
Paula Kataguiri, MD Szilárd Kiss, MD Ophthalmology
Sachin P. Kalarn, MD Research Fellow Chief, Retina Service Director Stanford University
Resident Physician Department of Ophthalmology and Clinical Research Director Stanford, CA, USA
Department of Ophthalmology & Center for Translational Ocular Tele-Ophthalmology Director
Visual Sciences Immunology Compliance Associate Professor of Daniel Lee, MD
University of Maryland Tufts Medical Center Ophthalmology Clinical Instructor, Glaucoma Service
Baltimore, MD, USA New England Eye Center Weill Cornell Medical College Wills Eye Hospital
Boston, MA, USA New York, NY, USA Philadelphia, PA, USA
Ananda Kalevar, MD, FRCSC, DABO PhD Candidate
Associate Professor, Department of John W. Kitchens, MD Gregory D. Lee, MD
Department of Ophthalmology Retina Surgeon, Partner Assistant Professor, Ophthalmology/
Ophthalmology Universidade Federal de São Paulo
University of Sherbrooke Co-Fellowship Director Retina
(UNIFESP) Retina Associates of Kentucky New York University
Sherbrooke, QC, Canada São Paulo, SP, Brazil Lexington, KY, USA New York, NY, USA
Steven Kane, MD L. Jay Katz, MD
Cornea, Cataract, and Refractive Kendra Klein, MD Olivia L. Lee, MD
Director, Glaucoma Service Faculty Physician Assistant Professor of Ophthalmology
Surgery Specialist Wills Eye Hospital
Eye Institute of West Florida Department of Ophthalmology David Geffen School of Medicine
Philadelphia, PA, USA University of Arizona University of California Los Angeles
Largo, FL, USA
Paul L. Kaufman, MD Associated Retina Consultants Los Angeles, CA, USA
Elliott M. Kanner, MD, PhD Ernst H. Bárány Professor of Ocular Phoenix, AZ, USA Associate Medical Director
Chief, Glaucoma Service Pharmacology Doheny Image Reading Center
Hamilton Eye Institute Douglas D. Koch, MD Doheny Eye Institute
Department Chair Emeritus Professor and Allen, Mosbacher, and
University of Tennessee Department of Ophthalmology & Los Angeles, CA, USA
Health Science Center Law Chair in Ophthalmology
Visual Sciences Cullen Eye Institute
Memphis, TN, USA University of Wisconsin-Madison Baylor College of Medicine
xviii School of Medicine & Public Health Houston, TX, USA
Madison, WI, USA
Paul P. Lee, MD, JD Pedro F. Lopez, MD Jodhbir S. Mehta, BSc, MD, MBBS, Majid Moshirfar, MD, FACS
F. Bruce Fralick Professor and Chair Professor and Founding Chair FRCS(Ed), FRCOphth, FAMS Professor of Ophthalmology

List of Contributors
Director W.K. Kellogg Eye Center Department of Ophthalmology Associate Professor, Cornea and Hoopes Vision and John A. Moran Eye
Department of Ophthalmology & Herbert Wertheim College of Medicine External Disease Center
Visual Sciences Florida International University Singapore National Eye Centre Draper, UT, USA
University of Michigan Director of Vitreoretina and Macular Singapore
Heather E. Moss, MD, PhD
Ann Arbor, MI, USA Division
Luis J. Mejico, MD Assistant Professor
Center for Excellence in Eye Care
Richard M.H. Lee, MSc, FRCOphth Professor and Chair of Neurology Departments of Ophthalmology and
Miami, FL, USA
Clinical Fellow Professor of Ophthalmology Neurology & Neurological Sciences
Department of Glaucoma Mats Lundström, MD, PhD SUNY Upstate Medical University Stanford University
Moorfields Eye Hospital Adjunct Professor Emeritus Syracuse, NY, USA Palo Alto, CA, USA
London, UK Department of Clinical Sciences,
Carolina L. Mercado, MD Mark L. Moster, MD
Ophthalmology
Dawn K.A. Lim, MBBS, MRCP, Clinical Research Fellow, Director, Neuro-Ophthalmology
Faculty of Medicine
MMed(Int, Med), MMed(Ophth), FAMS Ophthalmology Fellowship
Lund University
Consultant, Ophthalmology/Glaucoma Bascom Palmer Eye Institute Professor, Neurology and
Lund, Region Skåne, Sweden
National University Hospital Miami, FL, USA Ophthalmology
Singapore Robi N. Maamari, MD Wills Eye Hospital
Ophthalmology Resident Shahzad I. Mian, MD Sidney Kimmel Medical College of
Jennifer I. Lim, MD, FARVO Department of Ophthalmology & Associate Chair, Terry J. Bergstrom Thomas Jefferson University
Marion H. Schenk Esq. Chair in Visual Sciences Professor Philadelphia, PA, USA
Ophthalmology for Research of the Washington University School of Associate Professor, Ophthalmology &
Aging Eye Visual Sciences Kelly W. Muir, MD, MHSc
Medicine in St Louis
Professor of Ophthalmology University of Michigan Associate Professor of Ophthalmology,
St Louis, MO, USA
Director of the Retina Service Ann Arbor, MI, USA Glaucoma Division
University of Illinois at Chicago Assumpta Madu, MD, MBA, PharmD Duke University
Illinois Eye and Ear Infirmary Vice Chair, Operations William F. Mieler, MD, FACS School of Medicine
Chicago, IL, USA Associate Clinical Professor of Cless Family Professor of Durham, NC, USA
Ophthalmology Ophthalmology
Ridia Lim, MBBS, MPH, FRANZCO Vice-Chairman of Education Ann G. Neff, MD
NYU School of Medicine
Ophthalmic Surgeon Illinois Eye and Ear Infirmary Dermatology Associates
NYU Langone Medical Center
Glaucoma Service University of Illinois at Chicago Sarasota, FL, USA
New York, NY, USA
Sydney Eye Hospital College of Medicine Jeffrey A. Nerad, MD
Sydney, NSW, Australia Maya H. Maloney, MD Chicago, IL, USA Oculoplastic & Reconstructive Surgery
Consultant, Medical Retina
Tony K.Y. Lin, MD, FRCSC David Miller, MD Cincinnati Eye Institute
Mayo Clinic
Assistant Professor Associate Clinical Professor of Volunteer Professor, Ophthalmology
Rochester, MN, USA
Department of Ophthalmology Ophthalmology University of Cincinnati
Schulich School of Medicine and Naresh Mandava, MD Harvard Medical School Cincinnati, OH, USA
Dentistry Professor and Chair Boston, MA, USA Neda Nikpoor, MD
Western University Department of Ophthalmology
Clinical Instructor, Ophthalmology
London, ON, Canada University of Colorado Kyle E. Miller, MD
Byers Eye Institute
School of Medicine Assistant Professor, Ophthalmology
Stanford University
John T. Lind, MD, MS Denver, CO, USA Naval Medical Center Portsmouth
Palo Alto, CA, USA
Associate Professor Portsmouth, VA, USA
Michael F. Marmor, MD
Department of Ophthalmology & Robert J. Noecker, MD, MBA
Professor Tatsuya Mimura, MD, PhD
Visual Sciences Director of Glaucoma
Department of Ophthamology Tokyo Womens Medical University
Washington University in St Louis Ophthalmic Consultants of
Byers Eye Institute Medical Center East
St Louis, MO, USA Connecticut
Stanford University Tokyo, Japan
Fairfield, CT, USA
Yao Liu, MD School of Medicine
Assistant Professor Palo Alto, CA, USA Rukhsana G. Mirza, MD Ricardo Nosé, MD
Department of Ophthalmology & Associate Professor Clinical Research Fellow
Jeevan R. Mathura, Jr., MD Department of Ophthalmology
Visual Sciences New England Eye Center
Private Practitioner and Owner Northwestern University
University of Wisconsin-Madison Tufts Medical Center
Diabetic Eye and Macular Disease Feinberg School of Medicine
Madison, WI, USA Boston, MA, USA
Specialists, LLC Chicago, IL, USA
Sidath E. Liyanage, MBBS, FRCOphth, Washington, DC, USA Annabelle A. Okada, MD, DMSc
PhD Mihai Mititelu, MD, MPH Professor of Ophthalmology
Cynthia Mattox, MD Assistant Professor
Consultant Ophthalmologist Kyorin University
Associate Professor, Ophthalmology Department of Ophthalmology &
Bristol Eye Hospital School of Medicine
Tufts University Visual Sciences
Bristol, UK Tokyo, Japan
School of Medicine University of Wisconsin-Madison
Alastair J. Lockwood, BM, BCh, Boston, MA, USA School of Medicine and Public Health Michael O’Keefe, FRCS
FRCOphth, PhD Madison, WI, USA Professor, Ophthalmology
Scott K. McClatchey, MD
Consultant, Ophthalmology Mater Private Hospital
Associate Professor, Ophthalmology Ramana S. Moorthy, MD
Queen Alexandra Hospital Dublin, Ireland
Naval Medical Center Clinical Associate Professor,
Portsmouth, Hampshire, UK San Diego, CA, USA Jeffrey L. Olson, MD
Ophthalmology
Nils A. Loewen, MD, PhD Indiana University Associate Professor
Stephen D. McLeod, MD
Associate Professor of Ophthalmology School of Medicine Department of Ophthalmology
Theresa M. and Wayne M. Caygill
Vice Chair of Electronic Health Founding Partner and CEO University of Colorado
Distinguished Professor and Chair,
Records in Ophthalmology Associated Vitreoretinal and Uveitis School of Medicine
Ophthalmology
University of Pittsburgh Consultants Denver, CO, USA
University of California San Francisco
Pittsburgh, PA, USA San Francisco, CA, USA Indianapolis, IN, USA Jane M. Olver, MB, BS, BSc, FRCS,
Reid A. Longmuir, MD Andrew A. Moshfeghi, MD, MBA FRCOphth
Brian D. McMillan, MD
Assistant Professor Director, Vitreoretinal Fellowship Consultant Ophthalmologist
Assistant Professor of Ophthalmology
Department of Ophthalmology & Associate Professor of Clinical Eye Department
WVU Eye Institute
Visual Sciences Ophthalmology Clinica London
West Virginia University
Vanderbilt University University of Southern California London, UK
School of Medicine
Nashville, TN, USA Morgantown, WV, USA Roski Eye Institute Yvonne A.V. Opalinski, BSc, MD, BFA,
Keck School of Medicine MFA
Alan A. McNab, DMedSc, FRANZCO, Los Angeles, CA, USA Clinical Associate Cardiovascular
FRCOphth
Surgery
Associate Professor and Director
Department of Cardiovascular Surgery
Orbital Plastic and Lacrimal Clinic
Royal Victorian Eye and Ear Hospital Trillium Health Partners xix
Toronto, ON, Canada
Melbourne, VIC, Australia
 Faruk H. Örge, MD Alfio P. Piva, MD P. Kumar Rao, MD Damien C. Rodger, MD, PhD
William R. and Margaret E. Althans Professor of Neurosurgery and Professor of Ophthalmology and Visual Assistant Professor of Clinical
List of Contributors
Chair and Professor Ophthalmology Science Ophthalmology
Director, Center for Pediatric University of Costa Rica Washington University Research Assistant Professor of
Ophthalmology and Adult San Jose, Costa Rica St Louis, MO, USA Biomedical Engineering
Strabismus USC Roski Eye Institute and Viterbi
Rainbow Babies, Children’s Hospital, Dominik W. Podbielski, HonBSc, MSc, Rajesh C. Rao, MD School of Engineering
UH Eye Institute MD, FRCSC Leslie H. and Abigail S. Wexner University of Southern California
Cleveland Medical Center Staff Physician, Ophthalmology Emerging Scholar Los Angeles, CA, USA
Cleveland, OH, USA Prism Eye Institute Assistant Professor, Retina Service
North Toronto Eye Care Department of Ophthalmology & Miin Roh, MD, PhD
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Another random document with
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The Project Gutenberg eBook of Behind the
scenes in Peking
 This ebook is for the use of anyone anywhere in the United
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Title: Behind the scenes in Peking

Being experiences during the siege of the Legations

Author: Mary Hooker

Release date: December 29, 2023 [eBook #72542]

Language: English

Original publication: London: John Murray, 1911

Credits: The Online Distributed Proofreading Team at

https://www.pgdp.net (This file was produced from
images generously made available by The Internet
Archive/American Libraries.)

*** START OF THE PROJECT GUTENBERG EBOOK BEHIND THE

SCENES IN PEKING ***
BEHIND THE SCENES IN PEKING
 First Edition . . . . . . . . November, 1910
Reprinted . . . . . . . . . . . . . . March, 1911
Photo, Elliott & Fry

SIR ROBERT HART

Frontispiece
BEHIND THE SCENES IN PEKING
BEING EXPERIENCES DURING THE
SIEGE OF THE LEGATIONS
BY MARY HOOKER

WITH ILLUSTRATIONS

LONDON
JOHN MURRAY, ALBEMARLE STREET, W.
1911
 PREFACE

It does not fall to the lot of every woman—or man, either—to go

through a siege, especially one so remarkable, and, indeed, unique
in many of its features, as that of the Legations in Peking.
The feeling that my experiences were out of the common, and
present new aspects of famous events, during which I was, to a
certain extent, at the same time on the stage and behind the
scenes, has induced me to publish the following pages. They are
taken from letters, owing to circumstances never sent, and my diary,
written spasmodically throughout the siege. While trying to introduce
something of the lighter side of life, and speaking of various
incidents, humorous and otherwise, I have endeavoured to avoid all
that can give offence or displeasure to those mentioned. If in any
case I have unwittingly failed in this endeavour, I crave pardon.
My thanks are due to Mrs. Woodward for giving permission to
reproduce her unique siege photographs.
MARY HOOKER.
September, 1910.
 LIST OF ILLUSTRATIONS

TO FACE PAGE

SIR ROBERT HART frontispiece

WHITE PAGODA IN THE TEMPLE OF LINGUA SU 2

HERBERT SQUIERS 14

RUSSIAN MARINE GUARD 16

CAPTAIN McCALLA COMMANDING THE AMERICAN 16

MARINES

CH’IEN MEN GATE 24

BARON VON KETTELER 26

BARRICADE BETWEEN THE AMERICAN AND RUSSIAN 30

LEGATIONS

READING THE SENTENCE OF DEATH TO THE BOXERS 30

CAUGHT IN THE RUSSIAN LEGATION
THE TSUNG-LI YAMEN 44

BARRICADE ACROSS THE CANAL TO THE FU 50

SANDBAG BARRICADE IN AMERICAN LEGATION 50

MRS. R. S. HOOKER 68

CAPTAIN JOHN T. MYERS 100

MRS. SQUIERS 110

LOADING THE “INTERNATIONAL” 116

AMERICAN AND RUSSIAN MARINES AT WORK ON 116

THE BARRICADE. BARON VON RAHDEN ON THE
RIGHT

SIR CLAUDE MACDONALD 120

EDWIN H. CONGER 136

A GATE INTO THE IMPERIAL CITY 154

GENERAL A. R. CHAFFEE 160

GENERAL SIR ALFRED GASELEE 176

THE RESULT OF THE SIEGE: IN THE AMERICAN 192

MINISTER’S HOUSE
THE RESULT OF THE SIEGE: FRENCH LEGATION 192
RUINS

MRS. HOOKER, MISS ARMSTRONG, LADY 196

MACDONALD’S LITTLE GIRLS, FARGO SQUIERS,
AND COLONEL ARTHUR CHURCHILL

COAL HILL 202

THE FORBIDDEN (PURPLE) CITY IMPERIAL CITY
 BEHIND THE SCENES IN PEKING

May 26, 1900.

When you were in Peking last year I don’t know whether you got
out to the hills or not. They are about fifteen miles from the imperial
city, and are the nearest point where foreigners can find relief from
the insufferable heat of the capital, which begins with an intensely
hot spring, continuing through a long, damp, sizzling summer.
Many of the diplomats have cottages and bungalows at Pei-ta-ho,
on the seashore, but its distance from Peking is a great drawback to
it as a summer residence, and they have been forced to accept the
hills, as a nearer and more practical place for their summer colony.
A large, commodious house has been built here for the British
Minister, as well as one for the officials of the Customs, both within
their respective compounds. The greater part of this colony,
however, have simply leased temples from Buddhist priests, and
converted them into the most attractive and livable summer homes,
the American and Russian Legations being the principal of these.
A huge, white pagoda, belonging to the temple of Linqua Su, in
the centre of this district, with its temples of Buddha and houses of
its priests surrounding it, is perched on the top of a hill at the base
of Mount Bruce, and for miles around is the most picturesque
feature of the landscape. In the highest point of this pagoda is hung
a wonderful bell, the only motive-power of which is the wind, and
which was placed there by the Chinese to frighten the evil spirits of
the air. When the breeze is strong, which is often the case, the bell
seems to thresh itself into a veritable fury, and again at midday,
when the breeze is light, one can just distinguish the faintest tinkle.

WHITE PAGODA IN THE TEMPLE OF LINGUA SU

High up in these hills, and built on the sides of Mount Bruce, stand
these temples with their subordinate and associated buildings, each
making up a separate community. Ours is somewhat above the
temple of Linqua Su, with its white pagoda, and is built on a most
wonderful natural shelf of the mountain-side. A terrace, edged by a
low, ivy-covered parapet, runs the length of our temple home, from
which we look right out on the world beneath us, down the valley
towards Peking; or, if we look above us, it is to see Mount Bruce rise
perpendicularly against the sky. Ancient and big are the stones that
pave the outer and inner courts of this temple, and as picturesque
as they are difficult to use are the stone steps, formed of heavy and
irregular slabs, which lead down to the valley or ascend up unto the
mountain, from which steps finally emerge innumerable tracks,
leading in their turn to shrines, homes of hermits, and temples built
on this continuous ridge. Nor is this barbaric and ancient setting for
a modern life made less extraordinary by the fact that one is served
by quiet, intelligent, besatined servants, who glide about and look as
if they had stepped into life straight from the half-fabulous days of
Kubla Khan; and you feel they have always been thus, and always
will be, and you wonder how it is that although the spirit of the
twentieth century is certainly felt in China, it is little seen.

May 27.
To-day we started off on a long tramp, making first the ascent of
Mount Bruce, which was so difficult at times that we could scarcely
accomplish it, and had we not had the help of a young house-
servant, known to us as “Number Three Boy,” I doubt if we could
have reached the summit. The wind whistled round the high peaks
of Mount Bruce to such an extent that Mrs. Squiers and I had to hold
on to each other to keep from being blown off our feet.
From here we could see the Empress-Dowager’s summer palace
and grounds, spread out below us like a toy garden, with its
wonderful landscape effects and its series of artificial waterways.
Then, perched high up on a mountain, we could see a white temple
belonging to the eunuchs of the palace, and reserved solely for their
use during the summer months; and to the west the Feng-tai station
of the Peking-Paoting-fu Railway, winding through the valleys below
us like a piece of grey thread. We then walked through the enclosure
of the temple occupied by the Russian Legation, and in passing
through a half shrine, half summer-house, most unexpectedly came
to a wall upon which was drawn a rough but cleverly executed head
of a lovely young girl. It was done in coloured pastels, and had been
drawn by some artist diplomat. The subject was the Countess
Marguerite Cassini, niece of the Russian Minister, who had been
stationed in Peking some years previous. It was a beautiful bit of
work, and was especially startling when seen surrounded by the
hideous, grinning faces of Buddhist gods.
 Heading for our own temple of Linqua Su, we walked miles,
keeping to the top of a ridge, where the views were gorgeous and
the air wonderful, and quite suddenly came upon a shepherd and his
flock. Fancy it, a Chinese shepherd tending his Chinese sheep! His
expression was gentler and happier by far than that of men leading
a like monotonous existence in the mountains of Switzerland or
elsewhere in the West. Could it be that there the shepherd longs to
return to the life in the villages, while here the life of the poorest
classes in the village communities is so hopeless a struggle that
individual members are glad to leave the hopelessness of it and tend
their flocks alone upon the mountains? This fascinating China! you
have been here, and you know it. I must not bore you with my
impressions, for if I attempted such a thing these letters to you
would assume the proportions of an encyclopædia.

May 27 (continued).
Mr. Squiers returned to the American Legation this morning. He
only gets out to the hills twice a week in time to dine and returns to
Peking the following morning. He tells us that the Boxers daily
become more daring, but the diplomats and people in general put
these things down to the usual spring riots which yearly seize
Peking, and are due to hunger and disease, prevalent among the
poorer classes after a long, hard winter. Nevertheless, it was deemed
wise to inform the Tsung-li Yamen (the Foreign Office) that we were
in the hills at the temple of Linqua Su, and would expect official
protection from all rioters or malcontents who might be in this
region, and a guard of twelve Chinese soldiers was promptly detailed
to protect “nos personnes et nos biens.” But such soldiers!—opera-
bouffe mannikins in a Broadway theatre would frighten one with
their martial air compared to these ridiculous apologies for soldiers,
which were sent to us for our protection, their only weapons being
dull-pointed rusty spears!
Clara, the German governess, returned from Peking to-day, where
she had gone to do some shopping, and tells us that all the natives
she passed seemed to be armed, and that in all the temple
enclosures companies of Chinese were being drilled.
Our servants, mostly native Christians, assure us that these people
are all Boxers, most of them flaunting the red sash, the insignia of
that Society, and that they are preparing for a general uprising when
the time shall be ripe—an uprising that has for its watchword,
“Death and destruction to the foreigner and all his works, and loyal
support to the great Ching dynasty.”

May 28.
The peace that settles on one after a long tramp in the mountains
was rudely broken up for us a short while after our return from our
walk yesterday, when we found ourselves thrown into the midst of a
most exciting situation, from which we knew the chances were
about even whether we should escape with our lives.
We could see from our mountain balcony that the railroad station
at Feng-tai, with its foreign settlement, was burning. The immense
steel bridge was gone, too, showing that dynamite and high
explosives had been used to destroy it. The locality was thick with
smoke and the flames sky-high. Our servants told us our highly
picturesque guard of twelve had run away as soon as they were sure
the Boxers were burning Feng-tai, for, they argued, the mob will
surely sack this foreign-devil temple when they finish with Feng-tai.
Since they had begun, they certainly would not desist until
everything foreign this side of Peking was sacked and burned, and
this guard had no desire to pose as the guardians of foreigners, but
thought it much safer to join the so far victorious rabble at Feng-tai.
We also learned that over a hundred men engaged in agricultural
and other peaceful occupations in and around the temples, of which
ours was one, had left during the day to join the Boxers.
Our position now, to say the least, was critical. Not a foreign man
on the place to protect us; a quantity of badly frightened Chinese
servants to reassure; three children, their governesses and
ourselves, to make plans for. We did what women always have to do
—we waited; and our reward came when we saw down in the valley
a dusty figure ambling along on a dusty Chinese pony, coming from
the direction of Feng-tai and making direct for our temple. It was Dr.
Morrison, correspondent of the London Times, and an intimate friend
of the Squierses.
On hearing early in the day of the mob at Feng-tai, and the
burning of the place, he promptly started off in that direction to get
as near as possible to the scene of action, and ascertain for himself
if the wild rumours circulating in Peking were truths before cabling
them to London. Finding the worst corroborated by what he saw
from a point near the mob, yet unseen by it, he started on his return
trip to Peking, hot haste for the cable office, when he became
oppressed with the startling remembrance that we were at the
temple, and probably alone and unprotected. So, instead of
returning to Peking, he promptly came to us. He feared lest Mr.
Squiers had not heard of the burning of Feng-tai, or, if he had heard
of it, that possibly the city gates might be closed against the
approaching mob, and he might be unable to leave the capital that
night. The fact that our temple was directly on the line of march to
Peking for the rioters made it look to Dr. Morrison as a most
probable possibility that they would stop chez nous before
proceeding to the capital. In case of such horrible eventuality he
hoped to defend us for a while, and to send to glory as many
Chinese as possible before turning up his own toes!
He was studying a possible defence of our balcony-home when Mr.
Squiers arrived post-haste, bringing with him a Russian Cossack,
whom he had borrowed from the Russian Minister. Plans were now
made to defend the place from attack or incendiaries during the
night. The Chinese servants worked with a will—our successful
defence meant safety for us and life for them. Sentry work of the
most careful sort continued all night, as well as the packing up of
our clothes and valuables.
 At 6 a.m. we were en route for Peking—an enormous caravan—
most of us in Chinese carts, some riding ponies, mules, or donkeys,
the forty servants placing themselves wherever they could—
anywhere, in fact—so that they should not be left behind. The three
protectors, heavily armed, rode by us, and three or four of the
Chinese were armed also, and the carts held such a position in the
caravan that in a moment they could be swung round as a defence
in case of an attack.
The fifteen miles through which we travelled were utterly deserted
except for the long, lonely lines of coal-carrying dromedaries. It
seemed as if the country people en masse had deserted their
villages and gone to some rallying-point for a demonstration; and
how anxiously and slowly each half-hour of the trip passed, for, while
it brought us nearer to our Legation, it also brought us nearer to the
possibility that our caravan would run into yesterday’s rioters with
added numbers of to-day’s malcontents.
At 10.30 we reached the American Legation compound, and most
painfully but thankfully we untwisted ourselves from the awful
position we were forced to take in the cart, and joyously grasped the
hands of friends. William Pethick, Li Hung Chang’s private secretary
for twenty years, a person of tremendous influence with the
Chinese, was in the compound, and was on the point of going to the
War Office to demand a regiment to go with him to our rescue out in
the hills. He had feared for us desperately during the night following
the burning of Feng-tai.

May 30.
The times have become so dangerous that no women are allowed
to leave the compound, but, of course, the diplomats and the
military—such as are here—must move about and try to find out
what the situation really is. The people who know the most about it
are the most pessimistic as to what may happen before the marines
arrive from Tien-tsin.
 We were glad to hear that the Belgian officials at the Feng-tai
station had heard of the intentions of the Chinese to burn them and
the place, and had escaped to Peking without loss of life.
All the Legations that have battleships at Taku wired some days
ago to them, and we are looking for a total of about three hundred
marines of all nationalities to reach Peking at any moment.
Legations, such as the Belgian and Austrian, which are some
distance from the Legation centre, are forced to do constant sentry
work to guard against thieves and incendiaries; the Ministers’
secretaries, and their foreign servants take turn night and day. They
are so surrounded by small streets and alleys that a few rioters could
rush their Legations easily, and they are forced to keep the most
alert watch. Melotte, the big blonde Belgian secretary, came to tea
to-day, and gave us a most vivid description of the difficulties of
their tiny garrison.
Sir Robert Hart, the beloved Inspector-General of the Customs,
dropped in also, and, while he seems fairly sanguine about the
present situation, I must say the tales of China and the Chinese that
he unfolded to us were quite terrible. Especially the massacre of the
Portuguese at Ning-po in 1870 by the Chinese in retaliation for their
having taken so much of the Yangtse River trade made a stirring
story when coming from his lips.
He was with that fascinating Englishman commonly known as
“Chinese Gordon” when he was the central figure in the history of
China during the early part of this century, and when Sir Robert was
quite a young man. I was so obviously spellbound by these real
reminiscences that, to my surprise and joy, he offered to send me,
on his return to his compound, a photograph of himself taken with
Gordon, marked with the latter’s autograph. I can’t say, however,
that his visit reassured us in our present dangerous situation.
Before leaving he looked at Mr. Squiers’s wonderful collection of
antique Chinese porcelains, which Mr. Pethick, a connoisseur in these
things, has collected for him. The Dana Collection was also procured
by him. Sir Robert is certainly a delightful person, and the cobalt-
blue tie twisted into a most unusual knot around his low collar gives
his personal appearance a tinge of rakishness and eccentricity.
This afternoon Dr. Morrison and some Customs students rode
down toward the station of Magi-poo to take a look at the congested
market-places and collections of angry rioters. Directly they were
seen they were furiously stoned, but as their Chinese ponies were
fleet of foot, they escaped with a few bruises.

May 31.
All day to-day everyone is wondering, “Will the marines get here
to-night?” A wire came through Admiral Kempff, saying they were
entrained. Last night we dined at Sir R. Hart’s, and danced until
twelve. He has two bands, brass and string, of Chinese musicians
whom he has taught. The secretary of the German Legation took me
out to dinner—Von Below, a most soldierly-looking person.