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+*** START OF THE PROJECT GUTENBERG EBOOK 78625 ***
+
+Transcriber’s notes
+
+As the title indicates, this book recounts the history of Moorfields
+Eye Hospital over the first one hundred years following its founding
+in 1805, the significance of which is that it was the world’s first
+hospital created to service a single specialty, viz. ophthalmology. In
+recent times, two more volumes have been published to bring the history
+up to date but copyright constraints prevent them being available in
+digitised format.
+
+The text of this e-transcription has been preserved as in the original,
+including inconsistent spelling (storey/story) and hyphenation
+(inpatient/in-patient, and ‘retching’ being misspelt as ’reaching’
+on p.165. Italic text is denoted by _underscores_ and bold text by
+*asterisks*
+
+
+
+
+                   THE HISTORY AND TRADITIONS OF THE
+                        MOORFIELDS EYE HOSPITAL
+
+PLATE I.
+
+[Illustration: JOHN CUNNINGHAM SAUNDERS.
+
+From an engraving by Anthony Cardon, after a picture by A. W. Devis.]
+
+
+
+                        THE HISTORY & TRADITIONS
+                                 OF THE
+                        MOORFIELDS EYE HOSPITAL
+
+                          ONE HUNDRED YEARS OF
+                   OPHTHALMIC DISCOVERY & DEVELOPMENT
+
+                                   BY
+
+                          E. TREACHER COLLINS
+
+       CONSULTING SURGEON; MEMBER OF THE COMMITTEE OF MANAGEMENT;
+         FORMERLY, CLINICAL ASSISTANT; JUNIOR AND SENIOR HOUSE
+             SURGEON; CURATOR OF THE MUSEUM AND LIBRARIAN;
+                     ASSISTANT SURGEON AND SURGEON
+
+                        WITH TWENTY-SEVEN PLATES
+
+
+[Illustration: Publisher's logo]
+
+                                 LONDON
+
+                          H. K.  LEWIS CO. LTD.
+
+                                  1929
+
+
+
+                        DEDICATED TO THE MEMORY
+                                 OF THE
+                     MEMBERS OF THE SURGICAL STAFF
+                                 OF THE
+                        MOORFIELDS EYE HOSPITAL
+                       IN THE YEARS 1883 TO 1887
+
+                   TO WHOSE INFLUENCE AND INSTRUCTION
+                    THE AUTHOR IS SO DEEPLY INDEBTED
+
+
+
+
+PREFACE
+
+
+Great traditions are the most valuable assets which a hospital or a
+teaching establishment can possess. They give it a personality which
+makes it beloved and respected. Traditions are made up of the energies
+and enterprise of those who have gone before, and will live on from
+generation to generation long after the bones of those who have created
+them have crumbled into dust. The primary aim of this book is to put on
+record the traditions of the Moorfields Eye Hospital for the benefit of
+past, present, and future workers within its walls.
+
+So intimately associated has this Hospital been with all the
+discoveries and developments which have taken place in connection with
+ophthalmology during the nineteenth century, that it was not possible
+to write a history of the first hundred years of its existence without
+giving an account of them also. By having done this, it is hoped that
+the book may find a wider circle of readers than those for whom it was
+in the first instance intended.
+
+An endeavour has been made to give an account of events as they have
+happened in chronological order, and by so doing to produce the effect
+of a cinematograph film, rather than that of an album of photographs.
+
+For the facts recorded, numerous different sources have been tapped.
+Much information as to the commencement of the Institution has been
+derived from Barnsby Cooper’s biography of his uncle, Sir Astley
+Cooper. Great use has been made of the minute books of the Committee of
+Management of the Hospital, and of its annual reports.
+
+For biographical details, the _Dictionary of National Biography_ has
+been consulted, and also the articles on the “British Masters of
+Ophthalmology” which have been published in the _British Journal of
+Ophthalmology_.
+
+It has been said that “when a medical man begins to write on the
+history of his subject it is a sure sign of senility.” The writer of
+these traditions does not claim that his case is any exception to this
+rule. In early life a man has to learn history. In middle life he is
+engaged in making history; and it is in his later years that he becomes
+best qualified to write history. It is then that, on looking back, he
+obtains the most comprehensive view, and is able to regard objects in
+their truest perspective.
+
+In conclusion I have to thank the Committee of Management of the
+Hospital for its permission to reproduce the portraits of several
+former members of the surgical staff, which hang in its Board Room;
+also the _British Journal of Ophthalmology_ for permission to use the
+blocks of some of the illustrations which have been published in its
+pages; and lastly my friend Mr. Frank Juler for kindly reading through
+and correcting the proof-sheets.
+
+
+
+
+CONTENTS
+
+
+  CHAPTER                                                PAGE
+
+     I. THE FOUNDERS AND FOUNDATION                         1
+
+    II. THE WORK OF JOHN CUNNINGHAM SAUNDERS               17
+
+   III. BENJAMIN TRAVERS AND SIR WILLIAM LAWRENCE          33
+
+    IV. REMOVAL TO MOORFIELDS                              48
+
+     V. THE ROYAL LONDON OPHTHALMIC HOSPITAL               67
+
+    VI. THE INTRODUCTION OF INHALATION ANÆSTHESIA
+          AND OPHTHALMIC SURGERY                           82
+
+   VII. THE DISCOVERY OF THE OPHTHALMOSCOPE                99
+
+  VIII. THE COMMENCEMENT OF “THE OPHTHALMIC
+          HOSPITAL REPORTS”                               119
+
+    IX. GROWTH AND EXTENSION                              132
+
+     X. ANTISEPTICS, BACTERIOLOGY, AND LOCAL ANÆSTHESIA   152
+
+    XI. THE SELECTION OF A NEW SITE, AND THE ERECTION
+          OF THE NEW HOSPITAL                             168
+
+   XII. THE HOSPITAL IN THE CITY ROAD                     190
+
+
+
+
+LIST OF PLATES
+
+
+PLATE FACING PAGE
+
+      I. JOHN CUNNINGHAM SAUNDERS              _Frontispiece_
+
+     II. SHOWING THE SOUTH SIDE OF CHARTERHOUSE
+           SQUARE AND NO. 40 WHERE THE LONDON DISPENSARY
+           FOR CURING DISEASES OF THE EYE AND EAR
+           WAS FIRST OPENED IN 1805                        14
+
+    III. SIR ASTLEY PASTON COOPER, BART., F.R.S.           34
+
+     IV. BENJAMIN TRAVERS, F.R.S.                          38
+
+      V. SIR WILLIAM LAWRENCE, BART., F.R.S.               44
+
+     VI. THE LONDON OPHTHALMIC INFIRMARY AS FIRST
+           ERECTED AT MOORFIELDS IN 1822                   52
+
+    VII. FREDERICK TYRRELL                                 62
+
+   VIII. JOHN SCOTT                                        65
+
+     IX. DR. JOHN RICHARD FARRE                            73
+
+      X. JOHN DALRYMPLE, F.R.S.                            78
+
+     XI. GEORGE CRITCHETT                                  86
+
+    XII. SIR WILLIAM BOWMAN, BART., F.R.S.                 94
+
+   XIII. WILLIAM CUMMING                                  102
+
+    XIV. JAMES DIXON                                      105
+         JOHN CAWOOD WORDSWORTH                           105
+
+     XV. JOHN WHITAKER HULKE                              111
+         GEORGE LAWSON                                    111
+
+    XVI. SIR JONATHAN HUTCHINSON, F.R.S.                  123
+
+   XVII. EDWARD NETTLESHIP, F.R.S.                        140
+
+  XVIII. THE HOSPITAL AT MOORFIELDS AFTER THE ADDITION
+           OF A NEW WING IN 1868, AND A NEW STOREY
+           IN 1875                                        143
+
+    XIX. WAREN TAY                                        151
+
+     XX. JOHN COUPER                                      157
+
+    XXI. R. MARCUS GUNN                                   160
+
+   XXII. JAMES E. ADAMS                                   163
+
+  XXIII. A. QUARRY SILCOCK                                167
+
+   XXIV. THE PLEASURE BATH, PEERLESS POOL, CITY ROAD      175
+
+    XXV. THE ROYAL LONDON OPHTHALMIC HOSPITAL IN
+           THE CITY ROAD, OPENED IN 1899                  190
+
+   XXVI. SIR JOHN TWEEDY, LL.D.                           202
+
+  XXVII. WILLIAM LANG                                     204
+
+
+
+
+THE HISTORY AND TRADITIONS OF THE MOORFIELDS EYE HOSPITAL
+
+
+
+
+CHAPTER I
+
+THE FOUNDERS AND FOUNDATION
+
+
+In the board room of the Royal London Ophthalmic Hospital hangs a
+framed document in which the names of Saunders, Farre, and Battley are
+associated as being the first promoters of the institution.
+
+Who were these three men? What brought them together? And how came they
+to establish an institution unlike any which had previously existed?
+
+John Cunningham Saunders was born and bred in Devonshire; he first saw
+the light of day at Levistone on October 10th, 1773. He went to school
+at Tavistock and South Molton, and at the age of seventeen commenced a
+five years’ apprenticeship to Mr. John Hill, surgeon, of Barnstaple.
+It was during his apprenticeship that he had his first introduction to
+ophthalmic surgery, for Mr. Hill, though only a country practitioner,
+was bold enough in those pre-anæsthetic days to operate for cataract.
+It was from him also that Saunders first learnt the value of the use of
+belladonna for dilatation of the pupil. William Adams, who also became
+an ophthalmic surgeon, was likewise a pupil of Mr. John Hill, but of
+him more anon.
+
+Saunders, at the expiration of his apprenticeship, came to London to
+complete his medical education at the then combined borough schools
+of St. Thomas’s and Guy’s Hospitals. The skill and diligence which
+he displayed in the dissecting room, together with his deftness as a
+draftsman, soon attracted the attention of Astley Cooper, who was then
+rapidly rising into fame. On Cooper’s election to the chair of anatomy
+in 1797, he offered to take Saunders into his house and make him a
+demonstrator of anatomy on the terms shown in the following letter:
+
+  “Dear Sir,
+
+  “I ought long since to have informed you of my plan for the winter,
+  so far as it concerns you, and as I have been able to decide.
+
+  “It is my wish that you should lodge and board in my house. I have
+  informed you that I live in a plain and economical style, and that
+  you are only to expect a joint of meat and a pudding; if this will
+  satisfy you, a bed will be ready whenever you return to London.
+
+  “I can say nothing about the salary you are to receive, for I have
+  not been able to form any idea of what will be proper, or how much
+  you may expect; all I can say is that the sum shall be annually
+  increased, which at the same time as it may act as a stimulus to
+  you, and make it an object to proceed in your career, will be more
+  convenient to myself, because, if no stroke of adverse fortune
+  prevents it, my income must be yearly improving.
+
+  “It is my wish that you should dissect for lecture-work in
+  Comparative Anatomy, and assist in my preparations. With respect to
+  the first of these, the labour is certain, and all other occupations
+  and objects must yield to it; with regard to the latter, the quantum
+  of employment shall be guided by your feelings. It is a duty I have
+  performed, without injury to my health, with much amusement, and
+  great advantage.
+
+  “I am in hopes that you will have no objection to giving me three
+  months’ information if any other pursuit should lead you to quit the
+  situation, as otherwise, I may be unable to procure a substitute, and
+  suffer great inconvenience from the want of one.”
+
+Saunders accepted the offer, and was shortly afterwards appointed the
+demonstrator of anatomy at St. Thomas’s Hospital. His association with
+Astley Cooper proved an exceedingly happy one, he on several occasions
+being entrusted with the charge of Cooper’s patients during his absence
+in the country. Saunders was evidently a good teacher, and possessed
+of a most attractive personality, so that he became exceedingly popular
+with the students, who on several occasions presented him with pieces
+of plate as a token of their regard.
+
+John Richard Farre was two years younger than Saunders, being born in
+Barbados in 1775, where he was educated, and commenced the study of
+medicine under his father. He came to England in 1792 to complete his
+studies at St. Thomas’s and Guy’s Hospitals. The commencement of his
+acquaintance with Saunders and Battley may best be given in his own
+words:
+
+  “In 1792 I entered as a dresser at Guy’s Hospital. At that time Sir
+  Astley Cooper had, by his open manner, become well known among the
+  pupils, but I was not intimate with him, until after my return, in
+  1794, from the expedition in which I served under Lord Moria. I then
+  became more particularly acquainted with him in the following manner.
+
+  “About the year 1798, Sir Astley excited great zeal in the
+  prosecution of minute anatomy, and the order of the day became the
+  injection of the absorbents, and the dissection of parts concerned in
+  operations, especially those of hernia. It was at this time that my
+  acquaintance commenced with Mr. Saunders and Mr. Battley, who were
+  both engaged in the dissecting room. So earnest were we all in the
+  pursuit of the subjects above described, that Mr. Saunders and myself
+  became jaundiced, in consequence of the continually constrained
+  position to which we were subjected, while leaning over bodies under
+  dissection.
+
+  “Mr. Saunders also suffered from a punctured wound of the finger
+  received while dissecting, which was followed by extensive
+  inflammation of the arm; nor did this subside until nearly two
+  hundred leeches had been applied.”
+
+Richard Battley was older than his two friends, having been born at
+Wakefield in 1770; he was educated at the Grammar School there, and
+subsequently became the pupil of a physician in that town. For a while
+he studied at the Infirmary in Newcastle-on-Tyne, and came to London in
+1795. Entering as a pupil at St. Thomas’s Hospital at the same time as
+Saunders, a close and lasting intimacy sprang up between the two men.
+
+Having thus brought these three men together from Devonshire, Bermuda,
+and Wakefield to the dissecting room at St. Thomas’s Hospital, it next
+becomes necessary to trace the circumstances which led them to start
+the “London Dispensary for Curing Diseases of the Eye and Ear,” the
+name by which the present “Royal London Ophthalmic Hospital” was first
+known.
+
+In 1800, when twenty-seven years of age, Saunders became anxious
+about his future prospects. His ambition prompted him with the desire
+to practise as a surgeon in London; probably also about this time
+influences began to work which made him desire to settle down with an
+assured income, so that he might enter into the state of matrimony.
+There was little prospect of his obtaining any higher appointment
+than that of demonstrator of anatomy in the hospital at which he was
+working, the custom in the old-established hospitals at that time being
+to select for the staff appointments a pupil of one of their surgeons,
+and one who had been articled at the Royal College of Surgeons for
+at least six years. Saunders had not been so articled, having served
+his apprenticeship in the country. He was not, therefore, eligible to
+compete against those who had proceeded in the recognised manner, no
+matter how great his merits. This was pointed out to him by Astley
+Cooper, who advised him in his own interests to seek some other means
+of support. Saunders then resigned his post as demonstrator of anatomy
+and took over the practice of a surgeon in Gravesend.
+
+Astley Cooper, however, soon began to miss his able assistant, and
+found that the other arrangements he had made, which had to some extent
+caused Saunders to take offence, did not work smoothly. He therefore
+wrote him the following letter, and induced Saunders’ friend Battley to
+go to Gravesend to use his influence in persuading him to resume his
+old post:
+
+  “LONDON,
+
+  “_July_ 28_th_, 1801.
+
+  “Dear Sir,
+
+  “I have so often explained my reasons for the change which I made
+  last winter at the Hospital, that I consider it as almost unnecessary
+  to say anything further upon the subject. The trial has been made;
+  Mr. D——has been weighed against you in the balance, and been found
+  wanting.
+
+  “His excessive vanity has disgusted, his want of perseverance has
+  disappointed me, and I feel most thoroughly convinced that his
+  abilities are inadequate to the task which has been assigned to him.
+
+  “I felt it my duty to act as I have done, and my conduct, I fear, has
+  been the cause of uneasiness to you; but as our separation was not
+  the effect of misconduct upon your part, or of any disapprobation
+  on mine, I hope we shall be again united in the pursuit of medical
+  science, and that we shall entertain for each other that respect and
+  esteem which I must ever feel for you.
+
+  “As I told you in our last conversation, I have ever felt a degree
+  of veneration for your acquirements and abilities, which has made me
+  diffident in expressing my wishes. But as you have now courted it, I
+  will say, that I have wished to see you join in the debates of Guy’s
+  Medical Society. The capability of expressing our ideas in public is
+  a source of more power than anything with which I am acquainted. It
+  is the road to bring a public teacher to character and to fortune.
+
+  “_Secondly_, I should much wish for your assistance in making
+  experiments upon animals. I am certain that everything valuable
+  in physiology is only to be so obtained. What is every day under
+  observation of the senses is well known, but few men have sufficient
+  knowledge of anatomy to be capable of making the interior parts of
+  the body the subject of inquiry.
+
+  “_Thirdly_, you will do me a favour by making my collection in
+  comparative anatomy more complete. This, I am aware, is the greatest
+  favour I can ask, as you are neither captivated by its splendour nor
+  convinced of its utility; but as I have embarked on it, you will
+  confer an obligation upon me by assisting me in making it complete.
+
+  “I shall endeavour to make your situation comfortable in a pecuniary
+  point of view, but I had rather make that the subject of conversation
+  when I see you.
+
+  “I am, dear Sir,
+
+  “Yours, with the utmost esteem,
+
+  “A. C. ”
+
+Battley had a high appreciation of his friend’s talents, and felt
+strongly that they would not have sufficient scope in such a confined
+sphere as Gravesend. The combined effect of his persuasive influence,
+and of Cooper’s letter, ultimately induced Saunders to resume the
+duties of demonstrator of anatomy at St. Thomas’s.
+
+Shortly afterwards he took a house in Ely Place, with the intention
+of practising as a surgeon, and on April 7th, 1803, married Miss Jane
+Louisa Colkett.
+
+During the last years of the eighteenth and the first years of the
+nineteenth centuries England was at war with France. Farre, in 1793,
+went with Lord Moira’s expedition to France, returning, however, to
+London on its failure. Battley for a time served in the Navy as an
+assistant surgeon, and was present at several engagements under Sir
+Sidney Smith.
+
+In 1799 Napoleon invaded Egypt, and after the destruction of his fleet
+by Nelson at the Battle of the Nile, English troops under Sir Ralph
+Abercrombie were landed at Aboukir, in 1800. Almost all were attacked
+by what was called “Egyptian ophthalmia,” but which we now know must
+have been a mixed infection of purulent ophthalmia and trachoma.
+After the evacuation of Egypt by the English in 1803, the troops were
+disbanded, and spread this very infectious form of eye disease in all
+the stations at which they stopped and throughout Great Britain.
+
+Mr. Patrick Macgregor, surgeon to the Royal Military Asylum, writes of
+the effects of the disease in the Army as follows:
+
+  “The progress of the ophthalmia since its first introduction into
+  this country in the year 1800 has, in the Army, been very rapid and
+  extensive, and has at different periods materially interfered with
+  its discipline and efficiency. It has crippled many of our best
+  regular regiments to such a degree as for a time to render them unfit
+  for service; and though the regiments which were in Egypt have,
+  in general, suffered most from the disease, yet it has prevailed
+  extensively in others which have never served in that country.”
+
+The terribly destructive character of the disease may be shown by its
+effects on the second battalion of the 52nd Light Infantry, which are
+recorded by Dr. Vetch: out of 636 cases 50 were dismissed with the loss
+of both eyes, and 40 with that of one.
+
+The spread of the disease was not confined to the Army, but extended
+widely throughout the country in the towns and villages, when the
+disbanded troops returned to their homes carrying infection with them.
+
+That the medical men and the hospitals in this country were badly
+prepared to deal with such an immense increase in eye diseases may be
+shown by quoting a description of the condition of things which then
+existed, written by Sir William Lawrence some thirty years later:
+
+  “The diseases of the eye, in general hospitals, are inadequate, from
+  the smallness of their number, to the purposes of practical study,
+  particularly that of exemplifying the various operations. Thus these
+  institutions have been inefficient in reference to this important
+  department. As the general body of surgeons did not understand
+  diseases of the eye, the public naturally resorted to ‘oculists’” [in
+  speaking of “oculists” he refers to those that have bestowed that
+  title on themselves without having had any regular medical training]
+  “who, seeing such cases in greater numbers, became better acquainted
+  with the symptoms, diagnosis, and treatment; and especially
+  more skilful in the operative department. At the same time, the
+  subject, being imperfectly understood, was neglected in the general
+  surgical courses, in which many important affections were entirely
+  unnoticed, and the whole very inadequately explained. Thus students,
+  who resorted to London for the completion of their professional
+  studies, had no means of learning this important department of
+  the profession, which was tacitly abandoned, even by the hospital
+  surgeons, and turned over to the ‘oculists.’ The latter, not being
+  conversant with the principles derived from anatomy, physiology, and
+  general pathology, attended merely to the organ, and relied almost
+  exclusively on what is comparatively of little importance, local
+  treatment. Hence ophthalmic surgery, being in a manner dismembered
+  from the general science, was reduced to a very low ebb. Until within
+  a few years, it was, in this country at least, in a state of almost
+  total darkness.”
+
+It will thus be seen that at the time Saunders established himself as
+a surgeon in London there was an immense increase in the amount of
+eye disease, but that very few medical men were in any way trained or
+competent to deal with it, and scanty, if any, provision was made for
+its treatment in the hospitals.
+
+Saunders’ attention had early in his career been attracted to diseases
+of the eye during his apprenticeship under Mr. John Hill, and his
+studies in the dissecting room had afforded him a sound basis for their
+treatment, in an intimate knowledge of the anatomy of the organ and its
+surrounding structures. His association with Astley Cooper had also
+led him to devote special attention to the anatomy of the ear and to
+disorders of hearing. Astley Cooper in 1800 made a communication to the
+Royal Society, on the effects of destruction of the tympanic membrane
+of the ear. He had found that considerable openings might be made in it
+without impairment of the hearing power, and was thereby led to perform
+the operation of puncturing the membrane in cases of deafness resulting
+from obstruction in the Eustachian tube, with a remarkably good result
+in the restoration of hearing, in the first cases in which he employed
+it. Subsequent experience, however, showed it not to be so generally
+useful as he had originally anticipated. He made a second communication
+on the same subject in the following year, and in 1802 was elected a
+Fellow of the Royal Society, and awarded the Copley Medal.
+
+Whilst these papers were being written the subject of them must have
+been much discussed by Cooper and his assistant Saunders, the latter’s
+interest in ear disease being thereby awakened.
+
+On starting in practice at Ely Place, Saunders decided to devote
+himself to the treatment of diseases of the eye and ear, a decision
+which must have required considerable courage at that time by one who
+wished to remain of good repute with other members of his profession.
+Up to that time the treatment of eye diseases had been mainly in the
+hands of itinerant quacks, who dubbed themselves oculists.
+
+George Coats, who has written an account of the lives and practices
+of many of these worthies, has well described the condition of things
+which then existed. He says:
+
+  “In the eighteenth century ophthalmology had not yet vindicated,
+  in England, its position as a separate branch of practice. It was
+  the province of a set of ambulant practitioners who toured the
+  country accompanied by all the apparatus of shameless advertisement
+  (including ‘monkies,’ we are told), couching cataracts, and selling
+  infallible salves and eyewashes. This taint of quackery appears
+  to have deterred respectable surgeons from meddling much with the
+  subject; their operative experience was probably small, and the
+  procedure of couching, attended frequently with brilliant immediate,
+  but disastrous after, results, was likely to be performed with fewer
+  scruples by itinerant oculists, here to-day and gone to-morrow, than
+  by settled practitioners who had to abide the consequences of their
+  handiwork.”
+
+Such men were naturally looked upon as charlatans by the medical
+profession, but that did not prevent them becoming the recipients of
+royal favours.
+
+One William Read, who commenced life as a tailor, and became a
+mountebank and itinerant quack oculist, settled in London in 1694,
+advertising in the _Tatler_ “that he had been thirty-five years in the
+practice of couching cataracts, taking off all sorts of wens, curing
+wry necks and hair-lips [_sic_] without blemish.” In 1705 he was
+knighted, “as a mark of royal favour for his great services, done in
+curing great numbers of seamen and soldiers of blindness gratis”; and
+about the same time was appointed oculist-in-ordinary to Queen Anne. It
+is stated that the wealth he acquired enabled him to mix with the best
+literary society of the day. Swift, in writing to Stella, commented on
+the quality of his punch which he served in golden vessels. One sample
+of his methods of treatment need only be quoted—“the putting of a louse
+into the eye when it is dull and obscure, and wanteth humours and
+spirits. This,” he says, “tickleth and pricketh, so that it maketh the
+eye moist and rheumatick and quickeneth the spirits.”
+
+On Sir William Read’s death in 1715, his rival, Roger Grant, succeeded
+to the post of oculist to Queen Anne, and afterwards to George I.
+Grant, originally a cobbler and later a Baptist minister, lost one eye
+as a soldier in the service of the German Emperor, and then set up as
+an oculist in Mouse Alley, Wapping. He advertised profusely in the
+journals of the day, giving accounts of his cures, with certificates
+attached from the patients themselves and others.
+
+George II. appointed as his oculist-in-ordinary John Taylor, better
+known as “Chevalier Taylor,” of whom Coats says:
+
+  “Amongst travelling quacks the name of the ‘Chevalier’ Taylor stands
+  pre-eminent for unblushing effrontery, blatant self-laudation, and
+  all the methods of the charlatan, but also for mental endowments far
+  above the average of his tribe, and for real acquaintance with the
+  contemporary state of ophthalmic knowledge. His fame extended to
+  every country in Europe; his boast of having conversed with kings
+  and princes is no idle one; he had an acquaintance, not always
+  felicitous, with some of the best known men, medical and lay, of
+  his time; counting translations and minor works he was the author
+  of nearly fifty books; and in later life he wrote an autobiography,
+  which, if it gives few and unreliable particulars as to his actions,
+  does much to reveal the character of the man.”
+
+The Chevalier’s talents seem to have been hereditary, for his son and
+two grandsons followed the same line of practice, and were each in turn
+the recipients of royal favours.
+
+It was with such prating mountebanks that Saunders ran the risk
+of being confused in devoting himself specially to the treatment
+of eye diseases. He was not, however, the first reputable medical
+practitioner in London to specialise in this line of work, having
+been preceded by both Wathen and James Ware. Dr. Wathen published, in
+1785, _A Dissertation on the Theory and Cure of Cataract_, and held
+the appointment of oculist to George III. He took Ware when a young
+man into partnership with him, a partnership which lasted for fourteen
+years, during which time Ware acquired such a liking for eye work that
+he decided to devote himself exclusively to it.
+
+Ware, like Saunders, had studied at St. Thomas’s Hospital, and held
+there the post of demonstrator of anatomy, so it would seem highly
+probable that his example may have had some influence in determining
+Saunders to take up surgery of the eye as a special branch of practice.
+
+In 1801 Ware contributed to the Royal Society a paper dealing with
+the case of a boy of seven years of age upon whom he had operated for
+cataract, and as the result of this communication he was elected a
+Fellow of the Royal Society. It was one of Saunders’ most noteworthy
+achievements, as we shall see later, to introduce an operation for
+cataract in infants who are born blind.
+
+The suggestion that Saunders should start a special institution for the
+treatment of diseases of the eye and ear is stated by Battley to have
+originated with Astley Cooper, whose own experience, in the treatment
+of diseases of the ear, had shown him what insufficient accommodation
+the General Hospitals offered for the treatment of diseases of the
+special organs. As his letters show, he held a very high opinion of
+Saunders’ professional abilities, and he saw only too clearly that the
+nature of Saunders’ apprenticeship would prevent him being promoted
+to any surgical post at either of the Borough Hospitals. Consequently
+the idea suggested itself to him that a special hospital might be
+established for diseases of the eye and ear, at which Saunders might
+find a suitable field for the exercise of his skill and ingenuity.
+
+Before taking any action in the matter, Saunders first sought the
+advice of the physicians and surgeons of St. Thomas’s and Guy’s
+Hospitals, and having obtained from them a testimonial of their
+approbation, on October 1st, 1804, he published the following proposal
+for instituting “A Dispensary for the Poor afflicted with Diseases of
+the Eye and Ear,” with their testimonial attached:
+
+  “Among the many charitable institutions which mark the wisdom and
+  benevolence of the inhabitants of this Metropolis there is none
+  particularly appropriated to the relief of the poor afflicted with
+  diseases of the Eye and Ear. No diseases which do not affect the
+  life of the patient are more distressing than such as are incident
+  to these organs or demand greater dexterity and skill in their
+  treatment. The structure of the Eye and Ear is so delicate and
+  complex and their irritability under injury so extreme, that they
+  cannot easily be treated but by those who make them the objects of
+  peculiar study and attention. The acknowledged difficulty in the
+  treatment of the diseases to which they are liable has induced a few
+  to separate themselves from the general practice of professional
+  duties and to devote themselves to the exercise of this branch alone,
+  a fact which sufficiently establishes the necessity of making them
+  the objects of a specific institution. Every surgeon must allow
+  that most unremitting care and attention is necessary after some
+  of the capital operations on the eye, and that through the want of
+  it some of the most dexterous operations are frequently defeated.
+  In large hospitals and dispensaries which embrace a variety of
+  objects, where the medical attendants are deeply interested in the
+  most formidable and excruciating diseases, it can rarely happen that
+  sufficient leisure is afforded for the exercise of that strict care
+  and attention which operations on the eye demand, much less will
+  it happen, when patients are the subjects of fortuitous operations
+  and retire afterwards to their own homes where they experience a
+  miserable want of every comfort and convenience, that such operation
+  can be successful. Impressed with these considerations the author of
+  this address, who devotes himself to the treatments of diseases of
+  the Eye and the Ear, solicits the public to patronise an institution
+  which will enable him to extend relief to the poor afflicted with
+  these diseases. An institution of this kind will be the means of
+  restoring to society the exertions of many industrious individuals
+  and will be established and carried on at a very moderate expense.
+  The author of this address offers his services to the Charity without
+  any emolument to himself and he pledges himself to the promoters
+  of the institution, that the public shall reap the fruits of their
+  beneficence.
+
+  “J. C. SAUNDERS,
+
+  “_Surgeon and Demonstrator of Practical Anatomy at St. Thomas’s
+  Hospital_.
+
+  “24, Ely Place, Holborn,
+
+  “_October_ 1_st_, 1804.”
+
+  “We are of the opinion that the establishment of the dispensary will
+  prove beneficial, and is therefore worthy of public support, and that
+  the author of the proposal is qualified to procure the accomplishment
+  of its object.
+
+  Signed:
+
+  _Physicians of St. Thomas’s_.    _Physicians of Guy’s_.
+    Wm. Lister, M.D.                 Wm. Babington, M.D.
+    W. C. Wills, M.D.                James Curry, M.D.
+    Thos. Turner, M.D.               M. Alexander, M.D.
+    G. Gilbert Currey, M.D.
+
+  _Surgeons of St. Thomas’s._      _Surgeons of Guy’s_.
+    G. Chander.                      T. Foster.
+    I. Birch.                        Wm. Lucas.
+    H. Cline.                        Astley Cooper.”
+
+As the outcome of the issue of this circular a committee was formed
+which held its first meeting at the City Coffee House on January 4th,
+1805, Mr. Benjamin Travers, a wealthy City merchant and the father of
+the surgeon of the same name, being in the chair.
+
+This Mr. Benjamin Travers, Sen., in the keen pursuit of knowledge,
+had attended Astley Cooper’s lectures on anatomy, and had become so
+interested in them and the lecturer, that he apprenticed his son to him
+as a pupil, and later extended his patronage to the project of founding
+an eye dispensary put forward by Cooper’s demonstrator and protégé.
+
+At the meeting the following resolutions were moved and unanimously
+agreed to:
+
+  “That a dispensary be instituted under the name of the London
+  Dispensary for the Relief of the Poor afflicted with Diseases of the
+  Eye and the Ear, where they may apply and obtain advice and medicines
+  gratis.
+
+  “That the dispensary be situated in a central part of this city and
+  contain beds for the reception of patients who undergo the operation
+  for the cataract or any other operation of the eye requiring minute
+  care.
+
+  “That the Charity consist of a Treasurer, Governors, Secretary, and
+  Medical Officers.
+
+  “That Henry Kensington, Esq., be appointed Treasurer.
+
+  “That a person contributing an annual subscription of one guinea
+  be a governor and have the right of recommending and keeping under
+  the care of the charity one out-patient, and if two guineas, two
+  out-patients, and so in proportion to his subscription.
+
+  “That patients admitted into the house be admitted according to
+  priority of recommendation, except in cases of emergency, when the
+  medical officers must determine.
+
+  “That Mr. J. C. Saunders be appointed Surgeon of the Dispensary, and
+  that Dr. Farre be appointed Consulting Physician in cases requiring
+  medical aid.”
+
+Richard Battley, who was then practising as an apothecary in St. Paul’s
+Churchyard, undertook the duties of Secretary, which he continued to
+discharge in an honorary capacity, with the utmost assiduity, for
+fourteen years.
+
+Many City merchants, with whom Saunders had no previous acquaintance,
+became subscribers, and sufficient funds were soon forthcoming to
+provide for the purchase of the lease of No. 40, Charterhouse Square,
+for eighteen years, for the sum of £300 and an annual rental of £65.
+
+PLATE II.
+
+[Illustration: SHOWING THE SOUTH SIDE OF CHARTERHOUSE SQUARE AND NO. 40
+
+Where the London Dispensary for Curing Diseases of the Eye and Ear was
+first opened in 1805.]
+
+On March 25th, 1805, _The London Dispensary for Curing Diseases of the
+Eye and Ear_ was opened for the reception of patients.
+
+Sir Charles Price, Bart., a former Lord Mayor, and Member of
+Parliament for the City of London, accepted the post of President of
+the Institution, and several of the Aldermen of the City became its
+Vice-Presidents.
+
+One Sarah Clark was appointed nurse and housekeeper, she being required
+to act under the control of the Surgeon, who had power to dismiss her
+for misconduct. She was allowed coals and candles and a gratuity at the
+end of the year “such as the Committee may deem proportionate to her
+services.” Her husband was subsequently engaged to dispense drugs, and
+the two of them received £50 a year for their services, together with
+the aforesaid coals and candles.
+
+In 1804, after Saunders had brought forward his proposal for the
+establishment of an Eye Dispensary, Mr. Wathen (afterwards Sir Wathen
+Waller), an oculist of eminence, described to King George III. the sad
+state of the soldiers and sailors who had returned from the campaign
+in Egypt suffering from ophthalmia, and suggested the desirability
+of establishing an Infirmary exclusively for eye diseases: “Their
+Majesties and the Royal Family graciously and humanely approved of the
+plan, and honoured it with their patronage and benefactions.” Such was
+the origin of the Royal Infirmary for Diseases of the Eye, in Cork
+Street, which commenced under Mr. Wathen, and was subsequently carried
+on as a comparatively private institution, under the charge of Mr.
+Charles Alexander, up to the time of his death in 1872.
+
+This institution must not be confused with that started in the Western
+district of London, by the Army surgeon Guthrie, in 1816, which exists
+to-day as the Royal Westminster Ophthalmic Hospital.
+
+That Wathen’s Infirmary was opened for the reception of patients three
+months before the London Dispensary, though the proposal for its
+establishment was not made until after the publication of Saunders’
+circular, evidently caused the latter considerable annoyance, for in a
+letter addressed to the Committee of the Dispensary in 1808 Saunders
+writes:
+
+  “Subsequently to the date of my Proposal, a similar Institution,
+  honoured with the Royal Patronage, was formed and established in
+  Westminster. Although the Prospectus of the Royal Infirmary was not
+  heard of until many months after the Publication of my Proposal,
+  yet it must be admitted that that Institution first appeared before
+  the Public in a regular and organised form, and this, which is the
+  original, is consequently considered by all who are unacquainted with
+  the facts as the copy. Apprehensive of this impression, I immediately
+  claimed by public advertisements, which were never answered, the
+  priority of my Proposal.
+
+  “I should be excused for thus obtruding on your notice if I sought
+  merely the indulgence of honest pride, by maintaining this just
+  claim to respect, but I shall yet more readily be excused, when
+  you reflect, that if I had abandoned this claim, the Public would
+  continue to regard me as an humble copyist.”
+
+This Royal Infirmary, whose rivalry at its commencement caused Saunders
+so much annoyance, continued in existence until Alexander’s death in
+1872. It was then resolved at a meeting of its Life Governors and
+Subscribers to close the Institution and to hand over the balance of
+its funds, after the settlement of all its liabilities, to the Royal
+London Ophthalmic Hospital. Two hundred pounds was ultimately received
+by the Hospital, and three of the Committee of the old Infirmary were
+elected as Life Governors, one of them being a relative of the late Mr.
+Alexander.
+
+
+
+
+CHAPTER II
+
+THE WORK OF JOHN CUNNINGHAM SAUNDERS
+
+
+That the Institution which Saunders had founded provided a much felt
+want is evident from the following statement of the number of patients
+with eye diseases dealt with, and the numbers stated to be “cured,”
+during the first four years of its existence.
+
+  1st year, 1805, admitted 600, cured 500. 2nd year, 1806, admitted
+  1,526, cured 1,036. 3rd year, 1807, admitted 2,126, cured 1,796. 4th
+  year, 1808, admitted 2,357, cured 1,970.
+
+It must be admitted that it is somewhat doubtful what the term cured
+actually implied, for in a list of the diseases which those “cured”
+suffered from are included some, such as total opacity of the cornea,
+for which even to-day no absolute cure is known.
+
+Successful as the Institution proved to be in dealing with eye disease,
+it was far less so in connection with ear disease.
+
+Saunders’ first publication was a book entitled _The Anatomy of the
+Ear: A Treatise on the Diseases of that Organ. The Causes of Deafness
+and their Treatment_. It must evidently have met with much demand, for
+a third edition was published after his death, in 1829. Although he had
+devoted so much study to the treatment of diseases of this organ, he
+seems soon to have realised that the interests of his Institution would
+be best served by restricting its aims to the treatment of diseases of
+the eye only. His reasons for doing so are set out in the following
+letter which he sent to the Committee in December, 1807:
+
+  “Gentlemen,
+
+  “Antecedent to the establishment of this Dispensary the diseases
+  of the Eye and Ear had never been made the object of a specific
+  institution, although their great variety and complexity seem to
+  require the most minute and attentive investigation. Those who have
+  practised on the eye have always partially cultivated the ear, and
+  when I chose the former for professed pursuit, the latter also
+  became the subject of my serious enquiry. I had ascertained by
+  observation that certain cases of disease are alleviable. Still I
+  was aware how little would be the success, as the most complicated
+  structure of the organ, which occupies an inaccessible part of our
+  frame, is most frequently the seat of disease. Regardless of this
+  conviction and solely influenced by a knowledge of the positive
+  good which the deaf occasionally receive, I did combine in my
+  proposal for the institution of this charity, the ear with the eye,
+  solicitous of gaining public esteem by doing for the public all
+  the good in my power. But the experience which this institution
+  affords demonstrated the proportion of curable and incurable cases,
+  a proportion much smaller than was expected, at most exceeding
+  (obstruction from inspissated wax excepted) one in a hundred. It
+  grieves me now to state, this branch of our institution exhausts
+  the funds without an adequate advantage, and consumes a portion of
+  my time on an impracticable point, that must ultimately tend to
+  diminish my reputation. The performance of this part of my duty is,
+  therefore, irksome to me, not because it is laborious, but because
+  it neither leads to distinction nor obtains even the common reward
+  of benevolent institutions. To be thankful for intended benefits
+  demands a refinement of reason which none but liberal minds possess.
+  Of those who are dismissed incurable more are made vindictive by
+  disappointment than are grateful for the care bestowed upon them, and
+  the former almost universally represent him who has ineffectually
+  attempted their relief as the author of their misfortunes.
+
+  “My attention to the vast number of irremediably deaf which are
+  accumulated at the Charity is not merely disagreeable to my
+  feelings, but absolutely injurious to my interest by causing me
+  to be considered as an Aurist when I am in fact an Oculist. The
+  branch of the profession has always been in my private practice a
+  secondary object. In this light I should wish it to be placed in
+  the Dispensary. The Ear may consistently with the preservation of
+  those privileges which the Governors have acquired be withdrawn from
+  public notice. Then, whilst I render the same service to those for
+  whom they may individually be interested, it will cease to operate to
+  my prejudice. The mode to be adopted for the accomplishment of this
+  object is implicitly submitted to your judgment.
+
+  “I am, gentlemen,
+
+  “Your obedient servant,
+
+  “J. C. SAUNDERS.”
+
+After consideration of this letter by the Governors it was resolved, at
+a General Meeting in the following January:
+
+  “That diseases of the Eye shall in future be the sole object of the
+  Charity, and that its name be changed to that of The London Infirmary
+  for Curing Diseases of the Eye.”
+
+In June, 1806, Saunders published an Essay “On Inflammation of the
+Iris, and the Influence of the Extract of Belladonna to prevent the
+Consequent Obliteration of the Pupil.” In it he gives an accurate
+description of the clinical characteristics of the affection, and
+records several cases treated at the Dispensary in which he had
+prevented loss of sight from closure of the pupils by keeping them
+dilated with the extract of belladonna, applied to the conjunctiva
+whilst the inflammation lasted.
+
+In January, 1809, he advertised in the medical journals his intention
+of publishing a treatise on some practical points relating to the
+diseases of the eye, and particularly on the nature and cure of
+cataract in persons born blind.
+
+Up to the beginning of the nineteenth century only two forms of
+operation for cataract were in vogue: that of displacing the opaque
+lens downwards with a needle out of the axis of vision, the operation
+of “couching,” which may be regarded as one of the most ancient of
+surgical procedures; and that of removal of the opaque lens out of
+the eye, the operation of “extraction,” first performed by the French
+surgeon Daviel in 1745.
+
+It was observed by several operators who couched cataracts that if they
+failed in displacing the lens down it was sometimes possible to break
+it up with the needle, and that the fragments so formed tended in time
+to disappear. Percival Pott, a surgeon at St. Bartholomew’s Hospital,
+in 1775, first pointed out that this disappearance of the fragments of
+lens substance was due to them becoming dissolved in the fluids of the
+eye, and he advocated a procedure to facilitate their solution.
+
+To Conradi, a surgeon at Nordheim in Hanover, seems to be due the merit
+of first proposing a distinct method of operating for cataract by its
+division with a needle through the cornea, and he published an account
+of his method in 1797.
+
+Neither the operation of couching nor that of extraction were found
+suitable for small children afflicted with cataract, and it was
+customary in cases of congenital cataract to advise postponement of
+operation until the patient had arrived at the more manageable age of
+twelve to fourteen. As has been already mentioned, James Ware, in 1801,
+contributed a paper to the Royal Society, describing how he had removed
+a cataract from a boy, aged seven, by breaking it up with a couching
+needle.
+
+In the medical report of the Dispensary at the end of its second year
+it is recorded that three children born blind with cataract had been
+cured at the respective ages of seven, five, and four years. On its
+receipt by the Governors the following resolution was passed:
+
+  “That the thanks of this General Meeting be given to Mr. Saunders
+  for the ability and care by which he has cured so great a number
+  of patients, many of them labouring under the most complicated
+  diseases of the eye, and more especially for having been the first
+  to establish by repeated success the propriety of performing the
+  operation for the cataract at the earliest ages in children born
+  blind of that disease.”
+
+So pleased were the Governors with this proof of the value of their
+charitable institution that they directed that these three small
+children whose sight had been restored should be introduced at the
+anniversary dinner. These anniversary dinners were held each year for
+the purpose of increasing the number of subscribers to the Charity. The
+dinner at which these children were exhibited was held at the London
+Tavern, Bishopsgate Street, in May, 1807, at 5 p.m. It is recorded
+that the price of the dinner was 7s. per head, including beer, bread,
+cheese, and radishes. The dessert was 1s. 6d. extra, and the wines,
+port and sherry. The President, Sir Charles Price, Bart., M.P., was
+in the chair, and about one hundred gentlemen were present; sixty new
+subscribers were obtained.
+
+At a similar dinner held in the following year the number of Governors
+and their friends who attended was 277, and new subscriptions to the
+amount of £708 15s. were received.
+
+In a letter to the Committee, dated March, 1808, Saunders wrote as
+follows with reference to his work in connection with congenital
+cataract:
+
+  “By the adaptation of an operation on the cataract to the condition
+  of childhood I have successively cured without a failure fourteen
+  persons born blind, some of them even in infancy, and it has just
+  been performed on an infant only two months old who is in a state of
+  convalescence. As I reserve for another occasion the communication
+  of the method which I pursue for the cure of very young children, I
+  shall no further compare it with extraction, than by observing that
+  extraction is wholly inapplicable to children, or only fortuitously
+  successful. Those who on all occasions adhere to this operation, and
+  have never turned their thoughts towards the application of means
+  more suitable to this tender age, have been obliged to wait until the
+  patient has acquired sufficient reason to be tractable; otherwise
+  when they have deviated from this conduct, the event has afforded
+  little cause of self-congratulation.
+
+  “How great the advantage of an early cure is a question of no
+  difficult solution. Eyes originally affected with cataracts contract
+  an unsteady and rolling motion, which remains after their removal,
+  and retards, even when it does not ultimately prevent, the full
+  benefit of the operation. A person cured at a late period cannot
+  overcome this awkward habit by the utmost exertion of reason or
+  efforts of the will. But the actions of infants are instinctive.
+  Surrounding objects attract attention, and the eye naturally follows
+  them. The management of the eye is therefore readily acquired, his
+  vision rapidly improves, and he will most probably be susceptible of
+  education about the usual period.”
+
+During 1809 Saunders, in preparation for the publication of his
+advertised treatise, wrote essays “On the Inflammation of the
+Conjunctiva in Infants” and “On the Cure of the Inversion of the
+Eyelids by Excision of the Tarsus.” He also commenced to put together
+his notes on congenital cataracts and of his methods of operating
+on them. His work, however, in these matters became much impeded by
+recurrent, violent, acute attacks of headache due to brain disease,
+which in February of the following year proved fatal.
+
+Saunders had realised that congenital cataracts varied considerably
+in character and consistency, and also that they might be dealt with
+either by passing the needle, as in couching, through the sclerotic
+and behind the iris in its approach to the pupillary area, or through
+the cornea, the so-called anterior operation. He was wisely waiting
+to gain experience as to which form of procedure was better suited
+for the different forms of cataract before rushing into print on the
+matter. He had two pupils working with him at the Dispensary, both
+of whom subsequently became ophthalmic surgeons, and both of whom in
+later years wrote in glowing appreciation of all they learnt from him.
+The one was William (afterwards Sir William) Adams, and the other John
+Stevenson. Two letters addressed to the latter in April and August,
+1808, are the only authentic documents in Saunders’ writing descriptive
+of his operation for cataract; with the first he enclosed two of his
+improved needles for Stevenson’s own use. Needles of a similar pattern
+are still employed, and known by Saunders’ name, at the present time.
+
+  “My dear Friend,
+
+  “I confide the method of operating which I pursue for cataract to
+  your honour, and I am very certain that it is safely deposited. I
+  shall not have time to point out all the advantages which result from
+  this deviation from the old method of couching; but simple as they
+  appear, they are very important, as you will perceive when I detail
+  all the circumstances, which I shall sometime do, in a treatise on
+  the cataract.
+
+  “I always use the solution of Belladonna, and never begin the
+  operation until the pupil is as much dilated as it will admit of,
+  keeping the eye, by means of Pellier’s elevator, or else my own
+  fingers, as steady as possible. The object of my introducing the
+  instrument into the eye is, to cut the capsule in the anterior part
+  of the crystalline; and therefore, as the lens is generally more
+  dense towards the centre, I take care that it shall pass through the
+  crystalline as near to the capsule as possible. That the instrument
+  may traverse the lens freely, you will observe that it is made of the
+  greatest tenuity, and flat, and that it cuts towards the point on
+  each side. I find by experience that it can be conducted, with care,
+  through the hardest lens; whereas the needles, such as Scarpa’s and
+  Hey’s, only push the whole lens before them, and without being able
+  to carry the instrument to the capsule, the lens is made to press on
+  and protrude the iris; whence results the consequent inflammation. As
+  for the crystalline itself, you may or may not meddle with that; it
+  may be well to loosen its texture in some instances, but you ought
+  never to depress it....
+
+  “The instrument should enter the sclerotica about a line behind the
+  ciliary ligament, and should be conducted through the anterior part
+  of the crystalline which is softest. You may loosen the texture of
+  the cataract before you divide the capsule, or after, as in the
+  operation seems most convenient, but the _capsule must be divided
+  at all events_. I do not much care what becomes of the substance of
+  the crystalline. I sometimes let it go in considerable quantity into
+  the anterior chamber, if it seems tending that way, but I never push
+  it, because that must press the iris. N. B.—Follow Hey’s rule, to be
+  careful not to do too much. After the operation the plan with me is
+  purely antiphlogistic, and I believe you well know what that is. If
+  your operation should not succeed at the first attempt, describe to
+  me the appearances, and I will gladly give you my sentiments as to
+  repeating it.
+
+  “With respect to congenital cataracts, from the repeated
+  conversations we have had on the subject, it seems scarcely necessary
+  for me to remind you, that they are generally capsular, the whole or
+  greater part of the lens having probably been, at some antecedent
+  period during the foetal state, spontaneously absorbed. I shall only
+  add to what I have already stated, that the steps to be pursued in
+  the operation are nearly similar to those adopted for lenticular
+  cataract; the great object being either to make a sufficiently large
+  central aperture for the rays of light to pass freely through it to
+  the retina, or also to endeavour to tear the condensed capsule into
+  as small fragments as possible, and be gradually absorbed; for which
+  purpose, you may use the needle with much more freedom than in the
+  former case.
+
+  “With our united regards,
+
+  “I am yours faithfully,
+
+  “J. C. SAUNDERS.”
+
+It is interesting to note how in these pre-anæsthetic days the
+small children were kept sufficiently still to allow of operations
+for cataract to be performed on their eyes. The following is the
+description of the method employed given by Dr. Farre:
+
+  “Four assistants, and in stouter children five, are required to
+  confine the patient. The first fixes the head with reversed hands,
+  the second not only depresses the lower lid with his forefinger, but
+  also receives the chin of the child between his thumb and forefinger,
+  as in a crutch. By this means the play of the head on the breast is
+  prevented, a motion which the child incessantly attempts, and which
+  will very much embarrass the surgeon. The third assistant confines
+  the upper extremities and body; the fourth the lower extremities. The
+  surgeon, seated on a high chair behind the patient, takes Pellier’s
+  elevator in his left hand, and the needle in his right, if he is
+  about to operate on the right eye, or the speculum in his right hand
+  and the needle in his left, if the operation is to be performed on
+  the left eye.”
+
+The following is the commencement of an unfinished medical report
+which Saunders had in preparation to present to the Committee of the
+Infirmary at the time of his death.
+
+  “Gentlemen,
+
+  “Five years have now passed since my proposal for establishing
+  this Infirmary was submitted to your notice, during which I have
+  incessantly and anxiously laboured to redeem the pledge then given
+  to make it a beneficial Institution to Society. My anxiety has been
+  relieved, and my labour consoled in the progress of this Institution,
+  by repeated instances of your respect; and the recollection of them
+  at present only heightens the satisfaction I feel, on finding myself
+  confirmed as the conductor of an establishment supported by liberal
+  and zealous advocates, and possessed of the means of performing an
+  important part in Society, and esteemed by Society for it.
+
+  “In prosecuting the object of attracting public attention towards
+  this Institution, I trust I have kept free from the practice of any
+  disingenuous art. Popularity has not been snatched; but studiously
+  and unremittingly sought: it was expected only as a reward of
+  service; and the share of it which has been gained, is ascribable
+  to the estimation in which the Governors have been pleased to hold
+  this service. I have confided the character of the Institution to the
+  quantum of professional good—excepting you may be pleased to add,
+  that mindful of being an agent for liberal and philanthropic men, I
+  have always administered with humanity and attention to the feelings
+  of the poor that relief which their bounty has supplied.”
+
+Owing to the early death of Saunders, before the publication of his
+promised book on diseases of the eye, and of any description of his
+operation for cataract, there was much heated controversy for many
+years afterwards, in which the Committee of Management of the Infirmary
+became involved.
+
+The chief matters around which dispute arose were: the publication
+of Saunders’ unfinished manuscripts; his claim to having introduced
+a new form of treatment for cataract; the advertisement of his
+successful results prior to making known to the profession his method
+of procedure; and the priority of his invention of an operation for
+the restoration of sight in those in whom it had become impaired from
+Egyptian ophthalmia.
+
+Saunders died intestate, and there was nothing left for his widow but
+what might result from the publication of his unfinished manuscripts.
+The Governors of the Institution decided, in the first instance, that
+the book should be published at its expense, and that the proceeds
+of the work (without any deduction) should be appropriated to the
+sole use and benefit of Mrs. Saunders. It was afterwards found that
+Mr. Saunders’ brother and sister could claim legal rights to the
+proceeds. It was, therefore, decided in lieu to present £50 to Mrs.
+Saunders and an annuity of £40. Dr. Farre, at the request of the widow
+and of Mr. Saunders’ brother, consented to edit the book and make
+good its deficiencies, and it was published by Messrs. Longman and
+Company in 1811, delay being caused in connection with the question
+of copyright. Eighteen months after Saunders’ death his widow married
+again, under which circumstances the Committee considered they had
+reserved to themselves the right of reconsidering her annuity, and it
+was discontinued. It was agreed, however, that she should retain the
+copyright of her late husband’s book and receive any further proceeds
+that might arise from its sale; these rights she later parted with to
+Messrs. Longman and Company for the sum of £50. When a second edition
+of the book was called for, Longmans offered the copyright to Dr.
+Farre; he refused it for himself, but accepted it on behalf of the
+Infirmary. The discontinuance of the annuity to Saunders’ widow after
+her second marriage was the subject of an attack by those at enmity
+with Farre and Battley up to the time of her death in 1817.
+
+The book, entitled _A Treatise on some Practical Points relating to
+the Diseases of the Eye_, opens with a short account of Saunders’
+life, a rather detailed account of his last illness, and a statement
+of the morbid appearances found by Astley Cooper on the examination of
+his body. The account of his illness suggests that he suffered from
+a tumour of the brain, which had affected one of his optic nerves and
+caused impairment of the sight of his right eye. At the post-mortem
+examination, however, no tumour was found, the immediate cause of death
+being cerebral haemorrhage.
+
+The first two chapters of the book consist of the three previously
+published essays already referred to; the other three of unfinished
+notes which were arranged and added to by Dr. Farre, and which deal
+with “Cases illustrating Changes of Structure in the Eye,” and with
+“Congenital Cataract.”
+
+In the course of events it not infrequently happens that circumstances
+lead up to an epoch when some new development becomes ripe for
+discovery, and that then more than one mind independently “hits the
+moment” at about the same time. Later on, when history steps in to
+record the event, considerable discussion is liable to arise as to
+whom the palm of priority is to be awarded. This is what occurred in
+connection with the introduction of the operation of solution for the
+removal of congenital cataracts.
+
+The solubility of the substance of the crystalline lens in the aqueous
+humour of the eye had been recognised long before Saunders began to
+operate for cataract. But in introducing the method of solution for
+the dispersion of cataracts in infancy he undoubtedly believed he had
+discovered a new method of treatment. He appears to have been unaware
+of Conradi’s method of needling cataracts in adults, published in
+Germany. The real value of his contribution to ophthalmology in this
+matter is well estimated in the following extract from a lecture
+published in the Lancet by Mr. Green, a surgeon at St. Thomas’s
+Hospital, in 1823:
+
+  “I do not mean to say that this operation is entirely new; if you
+  read Mr. Pott’s works, you will find that, in some instances, he
+  performed a very similar operation. He tells you, that in cases where
+  the cataract was too soft for depression, he sometimes lacerated
+  the anterior layers of the capsule, so as to admit the aqueous
+  humour, and procure the solution of the cataract. Hey, Scarpa, and
+  Ware have performed similar operations. We are not, however, to
+  consider those as inventors of any practice who have merely employed
+  it here and there, without stating any certain rules for its general
+  applicability. It is to Dr. Saunders that we are indebted for having
+  shown the principle on which he performed this particular operation,
+  its applicability to cataract in children, and to some cases of
+  cataract in adults. Dr. Saunders, therefore, may be justly considered
+  as the inventor of this operation, and entitled to our respect and
+  admiration of so material an improvement in this branch of surgery.”
+
+It must, however, be admitted that it was an error of judgment on
+Saunders’ part to have allowed the Committee of Management to advertise
+in the public press, stating that operations were being performed at
+the Infirmary on children born blind of cataract, before the nature
+of the operation had been made known to the medical profession. Such
+a practice, together with the exhibition of the children who had been
+operated on at a public dinner, savoured rather of the methods of the
+quack oculists, though Saunders himself derived no pecuniary benefit
+and died a poor man.
+
+Benjamin Gibson in Manchester, independently of Saunders, recognised
+the possibility of operating successfully on congenital cataracts in
+infancy, and in the October number, for 1811, of the _Edinburgh Medical
+and Surgical Journal_, published a description of his methods in an
+article entitled “On the Use of the Couching-needle in Infants of a Few
+Months Old.” The description of his operation was, therefore, published
+almost at the same time as Dr. Farre’s description of Saunders’ methods
+of procedure.
+
+Saunders’ two pupils, William Adams (afterwards Sir William) and
+John Stevenson, followed the example of their teacher, both claiming
+to having introduced new methods of operating on the eye, and both
+founding institutions for the treatment of its diseases.
+
+William Adams, as already mentioned, had, like Saunders, served his
+apprenticeship with John Hill, of Barnstaple, and had completed his
+medical education at St. Thomas’s and Guy’s Hospitals. He worked
+under Saunders in the dissecting room and also at the Eye Infirmary,
+assisting him for a year and a half in both his public and private
+operations. After obtaining the diploma M.R.C.S. in 1807, he went to
+reside in Exeter, where he founded the West of England Eye Infirmary
+for curing diseases of the eye, on the same lines as the one in London;
+this Institution continues its work to-day under the same name. To it
+Saunders allowed his name to be attached as Consulting Surgeon, and
+wrote advice on several occasions to Adams concerning his work there.
+
+Saunders had pledged Adams not to reveal the nature of the operations
+he had learnt from him before he had had time to publish a description
+of them. Even before Saunders’ death Adams resented being bound to
+observe this pledge, and after his death considered himself exonerated
+from its further observance. Most operators in the course of their
+practice introduce modifications in their procedures. Adams considered
+that the modifications which he introduced in the operations he had
+learnt from Saunders justified him in claiming them as his own. It was
+on the strength of these claims, that on his return to London, after
+Saunders’ death in 1810, he was appointed to operate on pensioners
+dismissed from the Army as blind through Egyptian ophthalmia. The
+operation he performed was a modification of that introduced by
+Saunders of excision of the tarsus of the eyelid. He was also appointed
+to operate for cataract on seamen at Greenwich, and later an Ophthalmic
+Institution was founded for him in part of the York Hospital, Chelsea,
+which was afterwards transferred to Regent’s Park.
+
+He became oculist extraordinary to the Prince Regent and to the Dukes
+of Kent and Sussex, and in 1814 was knighted. A Select Committee of
+Parliament reported on his work at the Ophthalmic Institution and on
+his claim to public money, and with Lord Palmerston’s support he was
+voted the sum of £4,000.
+
+Sir William Adams’ claims to the invention of new operative procedures
+was much resented by Farre and Battley, who regarded them as piracy
+of their deceased friend’s work at the Eye Infirmary. In 1814 the
+Committee of Management of that Institution requested its medical
+directors to furnish them with a report on the matter, showing how Sir
+William Adams’ claims had been anticipated. This report was sent to His
+Royal Highness the Duke of York, the Commander-in-Chief of the Army,
+and to His Majesty’s Ministers, with the request that deputations from
+those connected with the Infirmary might be received. As an outcome
+of the deputation to the Duke of York, His Royal Highness graciously
+condescended to become a Patron of the Infirmary.
+
+In 1817, when the question of a monetary grant to Sir William Adams was
+raised in Parliament, further deputations waited on Lord Palmerston
+and on the Chancellor of the Exchequer with the object of refuting his
+claims, and of obtaining some pecuniary assistance for the Infirmary’s
+building fund, but no success in the latter direction was met with.
+
+In later life Adams became interested in Anglo-Mexican mines, but his
+speculations do not appear to have been attended with success. Two
+years before his death he changed his name to Rawson in compliance with
+the will of his wife’s mother, the widow of Colonel Rawson.[A]
+
+  [A] It is due to this change of name that a writer of a life of Sir
+  William Adams, in Vol. II. of the _British Journal of Ophthalmology_,
+  failed to find a notice of him in the _Dictionary of National
+  Biography_. It is from the description there given of Sir William
+  Rawson that most of the above facts respecting him have been taken.
+
+John Stevenson, like Adams, worked under Saunders in the dissecting
+room at St. Thomas’s Hospital and at the Eye Infirmary. Having
+obtained the diploma of M.R.C.S., he settled in or near Nottingham, but
+on Saunders’ death returned to London to practise there as an oculist
+and aurist. In 1813 he was appointed as such to the Prince of Wales and
+to Leopold, the Duke of Saxe-Coburg.
+
+He wrote several treatises on the structure and functions of the eye
+and ear, and much on the subject of cataract and its treatment. Whilst
+always acknowledging his obligations to Saunders and his admiration
+for his genius and industry, he claimed credit for having introduced
+a method of successfully removing cataracts in adults at an earlier
+stage in their development than was then usual, and thereby obviating a
+prolonged period of semi-blindness.
+
+In 1830 he founded at 13, Little Portland Street, Cavendish Square, the
+Royal Infirmary for Cataract and other Diseases of the Eye, under the
+Patronage of His Majesty King William IV., to whom he was soon after
+appointed oculist and aurist. This Infirmary, besides the patronage of
+the King, had a long list of Royal Patronesses and of noble supporters.
+The indigent poor suffering from all forms of diseases of the eye were
+treated gratis as out-patients, but only cataract cases were admitted
+as in-patients. In the _Dictionary of National Biography_ it is stated
+that after 1844 all trace of Stevenson is lost.
+
+It is noteworthy that both this Infirmary and Wathen’s Institution,
+which were established under Royal Patronage in the West End of London,
+existed for only a comparatively brief time, whilst that founded by
+Saunders, with the approval and support of the medical and surgical
+staffs of the Borough Hospitals, and under the patronage of the City
+fathers, has continued to flourish and grow in the manner which the
+following pages will relate.
+
+Farre described Saunders as a man of middle size, well made and of an
+engaging mien, with an active mind, generous in his private practice,
+and perfectly unreserved in stating his opinion in cases submitted to
+his judgment. That he had the capacity of forming firm friendships is
+shown by the marked respect which Farre describes as having been paid
+to him at his funeral, and the steps which were taken to perpetuate his
+memory. At a General Meeting of the Governors of the Eye Infirmary it
+was unanimously agreed that a portrait and bust of Mr. Saunders should
+be obtained and placed in the Committee Room. In accordance with this
+resolution a portrait was painted by Devis, and a bust was executed by
+Henry Weekes. The former hangs to-day in the Board Room of the present
+Hospital, and an engraving of it by Anthony Cardon was inserted as a
+frontispiece to Saunders’ treatise, and is still used to adorn the
+certificates which are presented to students who have completed a
+course of instruction at the Hospital.
+
+This portrait shows Saunders with a mass of brown curly hair coming low
+down over his forehead, with mutton-chop whiskers, pronounced features
+and a mouth shaped like a Cupid’s bow. He wears a high white stock
+round his neck, has a frill to his shirt, and a blue coat.
+
+
+
+
+CHAPTER III
+
+BENJAMIN TRAVERS AND SIR WILLIAM LAWRENCE
+
+
+The death of the founder of the Charity only five years after it was
+first opened placed its Committee of Management in a most difficult and
+unexpected position. Astley Cooper came to its immediate assistance,
+conducting the operating department and frequently attending in
+the receiving room until a new surgeon was appointed. Being keenly
+interested in all branches of surgery, he was probably pleased to have
+this opportunity of gaining experience in the surgery of the eye.
+
+The vacancy was advertised in three leading London newspapers, several
+applications being received in response. Amongst the candidates were
+Saunders’ former pupil at the Infirmary, John Stevenson, and William
+Lawrence (afterwards Sir William), who was then demonstrator of anatomy
+at St. Bartholomew’s Hospital; both of these, however, withdrew their
+applications in favour of Benjamin Travers’ who was unanimously elected
+at a ballot of the General Committee.
+
+Benjamin Travers was then twenty-seven years of age, and had been
+a house pupil of Astley Cooper’s, of whom evidently he was a great
+admirer, for in later years he wrote this description of him:
+
+  “Astley Cooper, when I first knew him, had the decidedly handsomest,
+  that is the most intelligent and finely formed countenance and person
+  of any man I remember to have seen. He wore his hair powdered,
+  with a queue, then the custom, and having dark hair and always a
+  fine, healthy glow in his cheeks, this fashion became him well. His
+  frequent costume during the summer when taking horse exercise (for
+  at this season he rode daily on horseback) was a blue coat, yellow
+  buckskin breeches and top-boots, then much in vogue.”
+
+Travers had been articled at the Royal College of Surgeons for six
+years; he was, therefore, unlike Saunders, eligible for appointment
+as surgeon to a general hospital when a vacancy arose, and was so
+appointed to St. Thomas’s Hospital in 1815. At the time of Saunders’
+death he was demonstrator of anatomy at Guy’s Hospital and surgeon to
+the East India Company.
+
+In accepting the post of surgeon to the Eye Infirmary he did not, like
+Saunders, devote himself exclusively to treating diseases of the eye
+and ear, but combined the practice of ophthalmic surgery with that
+of general surgery. In the preface of a book he subsequently wrote,
+entitled _A Synopsis of Disease of the Eye_, he claims to have been the
+first general hospital surgeon in this country to have given more than
+a cursory attention to diseases of the eye. In doing so he incurred
+no small risk to his reputation as a general surgeon, for, as already
+stated, those who practised as oculists at that time were of but low
+repute. His courageous and disinterested action in this matter served,
+however, to raise the surgery of the eye out of the condition of
+quackery into which it had fallen.
+
+Shortly after Travers was appointed surgeon to the Infirmary it was
+decided to increase its accommodation by providing eight additional
+beds, so that other than cataract cases might be admitted.
+
+In 1811, in accordance with the recommendation of Dr. Farre and Mr.
+Travers, the practice of the Infirmary was opened to medical students,
+and permission was granted to the medical officers to deliver lectures
+on the subject of their profession. Thus was started the school of
+ophthalmology which has since developed into a teaching centre of
+worldwide renown.
+
+PLATE III.
+
+[Illustration: SIR ASTLEY PASTON COOPER, BART., F.R.S.
+
+From an engraving by W. H. Mote, after a picture by Sir T. Lawrence,
+P.R.A.]
+
+Amongst the earliest students to avail themselves of the instruction
+given were two young Americans, who had recently graduated in medicine
+at the College of Physicians and Surgeons in New York, and who had come
+to London to complete their training: Dr. Edward Delafield and Dr. J.
+Kearney Rodgers. So impressed were they with the Institution and its
+teaching that, on their return to New York in 1818, they determined
+to establish one on similar lines in that city. In August, 1820, “The
+New York Eye and Ear Infirmary” was opened, and continues as one of
+the leading special hospitals of the sort in America at the present
+time. It is interesting to note that whilst the parent Institution has
+changed its title from that of “Infirmary” to that of “Hospital,” the
+daughter Institutions both in Exeter and New York retain the older name.
+
+Dr. Delafield later showed his appreciation of Travers’ teaching by
+editing an edition of his _Synopsis of Diseases of the Eye_, which
+was published in New York. As one of the first surgeons in the United
+States to devote himself to the study of diseases of the eye, he was,
+when the American Ophthalmological Society was founded in 1864, most
+appropriately elected its first President.
+
+A few years later Dr. Edward Reynolds came from Boston, Mass., to
+London to pursue his medical studies. He attended the practice and
+lectures at the Eye Infirmary under Benjamin Travers and William
+Lawrence, and, in a letter written home to Dr. J. C. Warren, gave the
+following description of the former:
+
+  “He is not a very pleasant lecturer—his voice is low and his manner
+  is very inanimate and uninteresting, but his matter, however, is very
+  valuable.”
+
+On Dr. Reynolds’ return from Europe he found his father blind from
+cataract in both eyes. There were no specialists in that part of the
+country at that time, so, fortified by his recent experiences in
+London, he decided to operate, happily with complete success. The
+following is an interesting description of this event, written by Dr.
+Edward Reynolds’ grandson in 1910:
+
+  “I well remember my grandfather’s telling me of his operation on
+  his father’s eye. He told me that his father, finding his eyesight
+  failing, made great efforts to accustom himself to its gradual
+  disappearance and to the performance of his ordinary duties without
+  the aid of sight, and that upon one occasion, after finishing the
+  process of shaving between two windows in his room, he put away his
+  razor and, turning to his wife, said to her: ‘My dear, I am at last
+  totally blind, I can see nothing.’ My grandfather said that his
+  father had written him nothing of this infirmity, which came on while
+  he was a student in London; that it was, in consequence, a great
+  shock to him to find his father blind. He said that on looking at the
+  eyes, and satisfying himself that the blindness was due to cataracts,
+  he thought the situation over; that his father was too old to take
+  the sailing voyage to London and, so far as he knew, no operation
+  for cataracts had been performed in America, and certainly none in
+  this locality; that he was therefore probably better qualified than
+  any one available for the performance of the operation; and that he
+  decided to attempt it. He said: ‘I went into my closet and offered a
+  prayer to Deity for success, took a glass of sherry and went ahead to
+  do my best.’ The three phrases of this sentence have always seemed to
+  me exceedingly characteristic of the man as I knew him.”
+
+The success of the operation becoming widely known led to the
+foundation of Dr. Reynolds’ reputation as the leading surgeon in
+Boston in diseases of the eye, and to the foundation in 1824 of “The
+Massachusetts Charitable Eye and Ear Infirmary.”
+
+As already mentioned, Travers held the appointment of surgeon in
+London to the East India Company. In 1819 its Honourable Directors
+became impressed by the great prevalence of eye disease in the large
+and populous districts over which they ruled, and applied to Travers
+in the matter. He pointed out to them the excellent results which
+had followed the establishment of the Eye Infirmary in London, and
+that similar Institutions might be started in India. This advice was
+accepted, and Mr. R. Richardson, one of the Company’s surgeons, who
+had studied ophthalmology under Travers, was sent to Madras, where he
+founded “The Madras Eye Infirmary,” which was each year resorted to by
+increasing numbers of patients. The Infirmary has been several times
+enlarged, and in 1888 its name was altered to that by which it is now
+known, “The Government Ophthalmic Hospital.”
+
+Stimulated by the success which attended the establishment of the
+Eye Infirmary in Madras, the East India Company determined to start
+similar Institutions in other provinces. In 1824 two other surgeons
+who had studied at the London Eye Infirmary were sent out to India for
+this purpose: Mr. Jeafferson went to Bombay and Mr. C. J. Egerton to
+Calcutta, where each of them founded an Eye Hospital.
+
+During the first seven years that the London Eye Infirmary was open for
+medical students 412 pupils received instruction there, of whom fifty
+were physicians and the rest surgeons. They came not only from the
+three divisions of the United Kingdom, but also from India, America,
+Germany, Portugal, and other countries; many of them held important
+posts in the Army and Navy. Ten years later still it is recorded that
+the number who had received instruction at the Institution considerably
+exceeded one thousand, and that they were spread over every part of the
+world.
+
+In 1814 Travers found the increasing number of patients coming to
+the Infirmary made the work so arduous that it was impossible for
+one individual to cope with it satisfactorily, and he wrote to the
+Committee requesting them to appoint a second surgeon to co-operate
+with him. This they readily agreed to, and, at a meeting of the General
+Committee, with whom the election of members of the medical staff
+then rested, William Lawrence, demonstrator of anatomy and assistant
+surgeon to St. Bartholomew’s Hospital, was appointed.
+
+One of Travers’ earliest surgical achievements was the cure of a
+pulsating tumour of the orbit, described as an aneurism by anastomosis,
+by ligature of the common carotid artery. It was the first case
+in which such treatment had been employed, and the second case on
+record of successful ligature of that artery. He communicated the
+case to the newly formed Medico-Chirurgical Society in 1809. He was
+possessed of considerable literary ability, and rendered Sir Astley
+Cooper considerable assistance in collaborating with him in the
+production of a volume of surgical essays. In 1815 Travers was elected
+a Fellow of the Royal Society, and in 1820, after he had resigned
+his appointment at the London Eye Infirmary, published the treatise
+already referred to, entitled _A Synopsis of Diseases of the Eye_,
+which he dedicated to Dr. J. R. Farre, in esteem for his character,
+admiration of his talents, and gratitude for his friendship. This book
+had the merit of being entirely the outcome of his own observations at
+the Eye Infirmary, and was not a compilation of the work of others.
+It is stated to have been the application of Hunterian principles
+of inflammation to the diseases of the eye. That it met with a wide
+appreciation is shown by its having passed through three editions, by
+its having been translated into Italian, and by its being reedited and
+reproduced in New York by Travers’ former pupil, Dr. Delafield.
+
+From a writer of an obituary notice we get the following description of
+Travers as a man:
+
+  “He was tall, large formed, and well proportioned, with a highly
+  intelligent and pleasing countenance. His manners were prepossessing,
+  and in consultation with his professional brethren he showed a
+  high-bred courtesy which marked the refinement of his mind.”
+
+Pressure of work, and some fears as to his health, necessitated his
+retirement from the staff of the Eye Infirmary in 1817. He lived,
+however, until 1858, and was twice elected President of the Royal
+College of Surgeons. The year before his death he was appointed
+serjeant surgeon to Queen Victoria.
+
+PLATE IV.
+
+[Illustration: BENJAMIN TRAVERS, F.R.S.]
+
+The chief financial support of the Infirmary for many years after its
+foundation was derived from subscriptions and donations received at its
+anniversary dinners. The exhibition of patients at these dinners was
+apparently continued until 1812, for a minute of that year states that
+their attendance was in future to be dispensed with.
+
+Another method of raising funds in support of the Charity was to obtain
+the services of some eminent divine to preach a sermon on its behalf
+on the Sunday before the dinner, with permission for him to do so at
+one of the City churches. Alderman Ansley, who had been one of the
+Infirmary’s most jealous supporters since its conception, in the year
+of his Mayoralty, not only presided at its annual meeting of Governors
+and at the anniversary dinner, but also attended in state at Bow Church
+when the Rev. Henry White preached a sermon in support of the Charity.
+
+It is interesting further to note that, in spite of the Peninsular War,
+which is said to have cost England £100,000,000, and of the European
+campaign which followed Napoleon’s escape from Elba and ended with the
+Battle of Waterloo, the funds of the Charity showed a steady increase,
+both that for general purposes and one started in 1813 for purchase
+of a freehold and the erection of a suitable building. In 1815, the
+Waterloo year, the anniversary dinner was held in May, presided over by
+the President, Sir Charles Price, Bart., and the anniversary sermon was
+preached at St. Botolph’s, Aldersgate Street, before the Lord Mayor.
+The invested fund for general purposes in April that year amounted to
+£2,415, and the building fund to £852; in October the general purposes
+fund had increased to £2,800 and the building fund to £1,160.
+
+The rapid increase in the work of the Infirmary, both in the in-
+and out-patients’ departments, necessitated in 1816 a reorganization
+of its resident staff, and it was arranged that this should consist
+of a housekeeper and sister with a salary of 25 guineas per annum, a
+housemaid at 10 guineas, a cook at 12 guineas and a resident apothecary
+and sub-secretary at £50 per annum. A year previously a dispenser had
+been appointed to make up and distribute drugs for the patients in
+place of Mr. Clarke, the porter; it was now decided that these duties
+should be performed by a resident officer. From the rules drawn up
+detailing the apothecary’s duties, they would seem to have included
+all those now performed by the house surgeons, dispensers, and the
+assistant secretary.
+
+His first and most important occupation is defined as follows:
+
+  “To compound and dispense the medicines, to cup, bleed, apply
+  leeches, dress setons, etc., and to obey orders of the Medical
+  Directors relative to the business of the Infirmary.”
+
+The withdrawal of blood was regarded at that time as of the utmost
+importance for the reduction of inflammatory conditions of the eye,
+and the apothecary must have had his time fully occupied in this way.
+Respecting the general principles for its employment, Lawrence wrote:
+
+  “Of the means of reducing inflammation, abstraction of blood is the
+  most powerful. Blood is the material by which the increasing action
+  of the part is maintained. In the figurative language, which the
+  obviously increased heat has suggested, we may say that it is the
+  fuel by which the fire is kept up. If we could completely command the
+  supply of blood, the increased action might be effectively controlled
+  or arrested. In comparison with the loss of blood, all other means
+  are of minor importance in lessening the local disorder and quieting
+  the general disturbance.”
+
+Regarding the quantity of blood to be drawn from the arm, he says:
+
+  “We cannot determine the amount beforehand; we cannot decide that
+  ten, twelve, or sixteen ounces will be sufficient; it may be
+  necessary to take twenty, thirty, or forty ounces, or to produce
+  syncope, if you cannot otherwise make the requisite impression on the
+  vascular system.”
+
+After venesection the next best method of taking blood is:
+
+  “By cupping from the back of the neck or the temple, especially
+  the latter, from which blood can be obtained quickly and in large
+  quantity. Branches of the temporal artery are commonly wounded in
+  this operation, facilitating the abstraction of the blood, and
+  causing neither danger nor inconvenience.”
+
+With regard to the use of leeches he writes:
+
+  “It is a common error here, as in other inflammations, to apply them
+  in too small a number; if the disease be active and the patient
+  adult, it will seldom be proper to put on fewer than twelve, while
+  eighteen or twenty-four will more frequently be necessary, in order
+  to produce decided benefit.”
+
+In a book published “on the traffic with leeches” in 1826, it is stated
+that not less than seven million two hundred thousand of these animals
+were annually sent to England.
+
+This so-called “antiphlogistic treatment,” which was so implicitly
+relied upon in those times for the relief of inflammation in the eye,
+consisted, not only in the withdrawal of blood, but also in purging,
+dieting and the administration of tartar emetic to excite perspiration,
+nausea, or vomiting Lawrence writes:
+
+  “It is not sufficient in the treatment of inflammation to diminish
+  the quantity of the circulating fluid by the abstraction of blood, we
+  must prevent the introduction of further supplies into the vascular
+  system by the use of purgatives and the regulation of diet.”
+
+The diet of the patients in the Infirmary, from the table then in use,
+seems, according to our present standards, to have been both meagre
+and monotonous. It was arranged under three headings, “Low diet”;
+“Reduced diet”; and “Full diet.” Low diet consisted of milk pottage
+or gruel, with 12 oz. of bread for women, and 1 lb. for men. Reduced
+diet consisted of the same allowance of bread, but included broth
+in addition to milk pottage. Full diet had, in addition to the milk
+pottage and bread, 8 oz. of meat, broth and vegetables for dinner, and
+one pint of small beer.
+
+In 1817 new regulations were drawn up for the election of medical
+officers. The qualifications required of candidates for the offices
+of physician, surgeon, and apothecary were as follows: _Physician_:
+that he be a Fellow or Licentiate of the London College of Physicians,
+or a Bachelor of Medicine of one of the English Universities.
+_Surgeon_: that he be a Member of the College of Surgeons, and have
+served an apprenticeship at one of the hospitals of this Metropolis.
+_Apothecary_: that he be a Member of the College of Surgeons, and a
+Licentiate of the Society of Apothecaries. It was further arranged that
+the election of medical officers should be vested in the Governors, and
+not left to the General Committee, as was previously the case.
+
+After these regulations had been passed Travers resigned the post
+of surgeon, which he had held for seven years, and was elected a
+Vice-President. It had been a source of great satisfaction to him to
+have had a man of William Lawrence’s professional attainments appointed
+as his colleague on the staff. In the year previous to his joining the
+Infirmary Lawrence had been elected a Fellow of the Royal Society, and
+appointed assistant-surgeon to St. Bartholomew’s Hospital. Travers
+felt that, with Lawrence’s co-operation, his unprecedented step of
+associating the practice of an oculist with that of a general surgeon
+was being justified. The Infirmary also gained a better reputation in
+the profession, by showing that it was not merely the offshoot of one
+hospital, but was prepared to appoint as members of its staff those
+educated at, and connected with, other institutions.
+
+William Lawrence not only became the leading ophthalmic surgeon of
+his time, but also a leading general surgeon, a philosophic writer,
+an eloquent teacher and lecturer, and a strongly combative medical
+politician. It is unnecessary here to go into the inconsistencies in
+his career, such as the withdrawal from publication of his book on the
+_Comparative Anatomy, Physiology, Zoology, and Natural History of Man_,
+when it aroused an angry outcry from the orthodox religious folk of the
+day; and his change from being a leading reformer of the constitution
+of the College of Surgeons to one of its most vigorous supporters. In
+his recognition of the importance of a knowledge of diseases of the eye
+by medical men he always remained firm, being the first to advocate
+that a course of instruction in it should be included in the medical
+curriculum. In an introductory chapter to his _Treatise on Diseases
+of the Eye_, he urged that the course of procedure in the study of
+ophthalmology should be the same as that for diseases in general,
+and be founded on the science of anatomy, physiology, pathology, and
+therapeutics. He pointed out that the instruction given at the Eye
+Infirmary was intended to impart to physicians and surgeons a knowledge
+of ophthalmic disease, and not merely to make oculists.
+
+In this same introductory chapter he gives a short history of
+ophthalmology, from which some points may here be quoted. Amongst the
+ancient Egyptians there were specialists for affections of the eye, as
+there were for every other class of disease. Herodotus tells us that
+Cyrus, King of Persia, sent to Amasis, King of Egypt, for an oculist.
+The extent of the Greeks’ knowledge of eye disease is evidenced by the
+imperishable records of language, for many of them still bear the names
+given to them by the ancient Greek writers. That the Roman Emperors
+Augustus and Tiberius had oculists is evident from inscriptions on
+seals. In the fifteenth, sixteenth, seventeenth, and first half of
+the eighteenth centuries, the management of diseases of the eye was
+left to quacks, mountebanks, and itinerant practitioners, the French
+writers on the subject, Maitre-Jan, St. Yves, and Janin, being more
+respectable than their contemporary brethren in other countries.
+The anatomy of the organ began to be more carefully cultivated by
+the Germans about the middle of the eighteenth century, when Zinn,
+Professor of Anatomy at Gottingen, published his excellent _Descriptio
+Anatomic Oculi Humani_, and later Soemerring his _Icones Oculi Humani_,
+with its beautiful and accurate engravings. Boerhaave of Leyden made
+some study of the pathology of the eye in his _De Morbus Oculorum_.
+But the most important era in the history of ophthalmic surgery was
+the establishment of the Vienna school of ophthalmology in 1773, by
+Joseph Barth, who was appointed lecturer on ophthalmic surgery in
+the University of Vienna in that year. He was succeeded by Schmidt,
+and afterwards by Beer, who held the post of Professor of Ophthalmic
+Medicine in the University for many years, wrote several theses on the
+subject, and attracted students to his clinic from all parts of Europe.
+
+If a man’s worth is to be judged by the estimates of those who were
+his pupils and assistants, then indeed Sir William Lawrence must be
+described as great. Sir James Paget, who in his day was the most fluent
+and mellifluous orator in the medical profession, said in describing
+Lawrence’s teaching:
+
+  “It was the best method of scientific speaking that I ever heard,
+  and there was no one, at that time in England, if I may not say in
+  Europe, who had more completely studied the whole principle and
+  practice of surgery.”
+
+Sir William Savory, Lawrence’s most devoted disciple, who described him
+as “a model of intellectual beauty,” speaks of
+
+  “his natural grace and dignity of bearing,” of “his vast and
+  capacious intellect,” of “his unfailing fluency of pure and
+  perspicuous language,” and says “he touched nothing that he did not
+  adorn.”
+
+PLATE V.
+
+[Illustration: SIR WILLIAM LAWRENCE BART., F.R.S.
+
+From an engraving by E. R. Whitfield, after a picture by Pickersgill,
+R.A.]
+
+On the vacancy on the staff being advertised after Travers’
+retirement, applications were received from Edward Stanley, a former
+pupil at the Infirmary, who was then demonstrator of anatomy at
+St. Bartholomew’s Hospital; Frederick Tyrrell, who had served his
+apprenticeship under Sir Astley Cooper at Guy’s and St. Thomas’s
+Hospitals, who had also studied at Edinburgh University, and worked in
+the Military Hospital at Brussels after Waterloo; Samuel Cooper, whose
+name is famous in connection with his _Dictionary of Surgery_, Henry
+Earle, surgeon of the Foundling Hospital and assistant-surgeon to St.
+Bartholomew’s Hospital.
+
+It soon became evident that the Governors were in favour of a
+candidate coming from St. Thomas’s Hospital, with which Travers, who
+was retiring, was connected, and the other candidates withdrew their
+applications, expressing their wish to come forward again on some
+future occasion, so that Tyrrell was elected.
+
+Lawrence continued as senior surgeon to the Infirmary until 1826,
+retiring at the age of forty-three. Both he and Dr. Farre were regular
+attendants at the meetings of the Committee of Management, and lent
+valuable aid and advice in the arrangements connected with the building
+of the new Infirmary at Moorfields.
+
+After his retirement he published a book on _The Venereal Diseases
+of the Eye_. Previous to its appearance, affections of the eye had
+received but scant attention from writers on venereal diseases in this
+country, though they had been dealt with more extensively by Schmidt
+and Beer in Vienna. The former seems to have been the first to describe
+inflammation of the iris, and to have used the term “iritis.”
+
+In the first chapter of the book Lawrence says:
+
+  “The venereal diseases of the eye have been mentioned by many
+  writers, but, for the most part, in such general terms as to convey
+  no clear information respecting the circumstances under which they
+  arise, their characteristic appearances, their progress, effects, or
+  treatment. Hence, although one of these affections, namely acute
+  gonorrhœal inflammation of the conjunctiva, is of the most violent
+  and rapidly destructive kind, and another, syphilitic iritis,
+  produces, more or less speedily, changes of structure which injure or
+  destroy sight, they have entirely escaped the notice of some modern
+  writers in this country, who have been regarded as the principal
+  authorities on the venereal diseases.”
+
+The book gives a full account of the nature, symptoms, and treatment of
+these diseases, based entirely on Lawrence’s own experience. The notes
+of the cases from which his descriptions were drawn are appended, most
+of them having been under his care at the Eye Infirmary, thus bearing
+evidence to the advantage of a special hospital in supplying material
+for the study of the natural history of disease.
+
+In 1833 he published his _Treatise on Diseases of the Eye_, a most
+scholarly work, based, as he says in the advertisement, on the lectures
+on Anatomy, Physiology, and Diseases of the Eye, which he delivered
+at the London Ophthalmic Infirmary, and which were reported at the
+time in the _Lancet_. It contained not only the outcome of his matured
+experience, but also references to the views and practice of all the
+best known European writers. It is probably one of the best, if not the
+best, book dealing with eye disease in pre-ophthalmoscopic times; two
+further editions were published in England and one in America. It was
+also translated into several foreign languages, part even into Arabic.
+
+Lawrence continued to hold his post of surgeon to St. Bartholomew’s
+Hospital until 1865, when he retired at the age of eighty-two, no age
+limit having been fixed previous to his appointment. In 1867 he was
+appointed serjeant surgeon to Queen Victoria, and in 1867 was made a
+Baronet, but died the following year.
+
+In 1818 Richard Battley, who had gratuitously performed the duties
+of secretary to the Institution since its establishment, found it
+necessary to resign. He did not, however, cease to interest himself in
+the work of the Charity he had helped to found; he continued to attend
+its Committees, and, as we shall see later, he taught and lectured to
+students on matters connected with pharmaceutical subjects.
+
+In the same year the Infirmary lost, through death, two of its earliest
+and most enthusiastic supporters, its first President, Sir Charles
+Price, Bart., and the Chairman of its Committee, Mr. Harry Sedgwick. To
+the post of President thus left vacant Mr. William Mellish, M.P., was
+elected. The name of Sedgwick is still held in grateful remembrance at
+the Hospital, and will be as long as it continues, for in his will he
+provided for its endowment, as is shown by the following extract:
+
+  “I leave the interest of the remainder of my Property to my wife and
+  children or the survivors of them for their lives, and to my sister
+  if she survives them for her life. After her decease, I leave in
+  trust the principal, to be invested in the 3 Per Cent. Consols, in
+  the names of the President, Treasurer, Physician, and Surgeon of
+  the London Infirmary for Curing Diseases of the Eyes, now situated
+  in Charterhouse Square, the principal on no account whatever to be
+  touched, but the interest as it arises to be applied to the benefit
+  of that truly benevolent and valuable Institution for ever.”
+
+
+
+
+CHAPTER IV
+
+REMOVAL TO MOORFIELDS
+
+
+The lease of the house in Charterhouse Square was purchased for a
+period of eighteen years; at the end of nine years it became obvious
+that, to cope with the continuously increasing work of the Charity, it
+would be necessary when the lease expired to provide larger and more
+commodious premises. It was, therefore, decided in 1813 to open a fund
+for the provision of a suitable freehold and building. To this fund the
+Lord Mayor, Aldermen, and Common Council of the City of London, as a
+mark of their approval, contributed £100.
+
+In March, 1819, a Building Committee was appointed to find a suitable
+site and to draw up plans. The possibility of acquiring from the City a
+piece of ground in Moorfields soon came under consideration. Frederick
+Tyrrell was the son of Timothy Tyrrell, who was the City Remembrancer
+and resided at the Guildhall, and it was with his aid that negotiations
+for this site were entered into. Timothy Tyrrell became a member of the
+General Committee of the Infirmary, and his eldest son, John Tyrrell, a
+barrister, became an active member of the Building Committee.
+
+Though the option for refusal of a plot of land to the north of the
+Roman Catholic Chapel in Moorfields was then obtained from the City,
+it was not until more than a year later that an agreement to acquire
+the freehold was decided upon. In the meantime, several other possible
+sites had been inspected and rejected.
+
+It was in October, 1820, that, at a meeting at the Guildhall with the
+Committee of the City Lands, the following terms were finally entered
+into:
+
+  “That the Infirmary should acquire the freehold of a plot of land
+  on the North-East side of Moorfields, to the extent of 88 ft. in
+  width and 85 ft. in depth, for the sum of £800, to be paid at the
+  time of the roof of the intended building being complete, and that
+  a pepper-corn rent only be paid from Christmas next until Lady Day
+  1822. The Institution to be at the expense of preparing the Title.”
+
+Robert Smirke, F.R.S., F.A.S., R.A. (afterwards Sir Robert), was
+commissioned to prepare plans for the building, the expenses of which
+were to be limited to £5,000. Subsequently Smirke found that, in
+consequence of the unexpected loose nature of the land of the site
+chosen, extra expense would be incurred in forming the foundations of
+the proposed building, and the limit of the amount was increased to
+£5,500.
+
+On May 2nd, 1821, the General Committee of the Infirmary, after
+having assembled at the City of London Tavern, proceeded with the
+President to the ground in Moorfields to lay the foundation stone of
+the new building, in which stone was deposited the following coins: 1
+sovereign, 1 half-sovereign, 1 crown, 1 half-crown, of the reign of
+George IV.; 1 shilling, 1 sixpence, and in silver, one piece value each
+4d., 3d., 2d., 1d., of the reign of George III.; upon these was placed
+a brass plate having the following inscription engraved thereon:
+
+  “London Infirmary for Curing Diseases of the Eye, founded by the late
+  John Cunningham Saunders Esq., A.D. MDCCCIV. The foundation-stone of
+  the new building for the same Institution, henceforth to be entitled
+  The London Ophthalmic Infirmary, was laid in Moorfields, on the
+  second day of May, 1821, by the President.
+
+               _Patron_: Field-Marshal His Royal Highness
+                      the Duke of York, K.G., etc.
+
+                   _President_: William Mellish, Esq.
+
+                           _Vice-Presidents_:
+
+  St. Asaph, The Right Rev.        Sir Charles Flower, Bart., Ald.
+    Lord Bishop of.                Thos. F.  Foster, Esq.
+  John Ansley, Esq., Ald.          Sir William Leighton, Ald.
+  John Julius Angerstein, Esq.     Sir Charles Price, Bart.
+  William Babington, M.D., F.R.S.  Jeremiah Olive, Esq.
+  George Bainbridge, Esq.          Thomas Rowcroft, Esq.
+  Thomas Boddington, Esq.          Sir James Shaw, Bart., Ald.
+  George Byng, Esq., M.P.          John Thompson, Esq.
+  Henry Cline, Esq, F.R.S.         Benjamin Travers, Esq., F.R.S.
+  Astley Cooper, Esq., F.R.S.      Sir Robert Wingram, Bart.
+
+
+                _Treasurer_: Michael Bland, Esq., F.R.S.
+
+                          _Medical Directors_.
+
+                 _Physician_: John Richard Farre, M.D.
+               _Surgeons_: William Lawrence, Esq., F.R.S.
+                        Frederick Tyrrell, Esq.
+
+                              _Committee_:
+
+  Aaron, Lewis, Esq.               Kerr, Niven, Esq.
+  Bainbridge, John, Esq.           Mackie, John, Esq.
+  Bonsor, Joseph, Esq.             Mellish, Thos., Esq.
+  Blades, John, Esq.               Ommanney, Sir F. M., M.P.
+  Brandain, Samuel, Esq.           Pearce, J. M. , Esq.
+  Brown, Thomas, Esq.              Price, Ralph, Esq.
+  Browning, William, Esq.          Price, Richard, Esq.
+  Brydon, William, Esq.            Price, Charles, Esq.
+  Battley, Richard, Esq.           Russell, Rev. John, D.D.
+  Cazenove, John, Esq.             Read, Samuel, Esq.
+  Clarke, John, Esq.               Row, William, Esq.
+  Cohen, Joseph, Esq.              Rudge, Rev. Jas., D.D., F.R.S.
+  Crawley, William, Esq.           Smirke, Robert, Esq.
+  Croskey, J. D., Esq.             Solly, Thomas, Esq.
+  Curtis, Timothy, Esq.            Sparks, R. W. , Esq.
+  Dean, John, Esq.                 Towle, Thomas, Esq.
+  Elgie, William, Esq.             Thomas, John, Esq.
+  Gamble, Robert, Esq.             Tyrrell, John, Esq.
+  Hartshorne, John, Esq.           Tyrrell, Timothy, Esq.
+  Heathfield, Richard, Esq.        Warburton, Thos., Esq.
+  Hodgkinson, John, Esq.           Ward, Samuel, Esq.
+  Horner, John, Esq.               Yates, William, Jun., Esq.
+
+
+  _Hon. Chaplain_: The Rev. Thos. Gill, M.A.
+  _Solicitor_: Robert Pitches, Esq.
+  _Secretary_: Matthew Heathfield, Esq.
+  _Apothecary_: Mr. Charles Craddock.
+  _Architect_: Robert Smirke, Esq., F.R.S., F.A.S., R.A.”
+
+A prayer suitable to the occasion was offered up to Almighty God by the
+Chaplain.
+
+At six o’clock the Governors and friends of the Charity dined at the
+City of London Tavern, when contributions since January 1st of that
+year were announced to the amount of about £1,200 for the building fund.
+
+Moorfields was originally a piece of moorland lying to the north of
+the old City wall, access to which was obtained through the Moorgate.
+Early in the seventeenth century it was drained, laid out in walks, and
+planted with trees. For a long time it remained a place of recreation
+and jollification for the City folk—a place of swings and roundabouts,
+as is described in the following verses in the vade mecum for malt
+worms:
+
+  “In Moor’s most pleasant Field, where Northern Lads
+  With Western Youths contend for broken Heads,
+  And where our Weal thy Citizens repair
+  To lengthen out their Lives with wholesome Air;
+  Jointing to Trotter’s famous Castle, stands
+  A noted Mansion built by artful Hands;
+  Where Young and Old, at small Expense can find
+  Delightful Pastimes to refresh the Mind.
+  Hither the sprightly Genius has recourse
+  To practise Riding on the Flying-Horse;
+  Where danger-free, he through the Air may scow’r,
+  And, void the Wings, fly fifty miles an Hour;
+  Nor that has this Courser, tho’ he runs so fast,
+  One living Leg to expediate him hast,
+  Yet carries double, treble, if requir’d,
+  But never stumbles or is ever tir’d.
+  As for the pregnant Wife, or tim’rous Maid,
+  Here’s a true South-Sea Coach, that sporting flies
+  Between the humble Earth and lofty skyes,
+  Manag’d to rise and fall with little Pains,
+  Like the uncertain Stock that turns our Brains.
+  Liquors, the best, are also vended here,
+  From Heav’nly Punch to Halsey’s Noble Beer,
+  By gen’rous Whitehead, who deserves the Bays
+  From all the Sons of Malt that Merit praise;
+  Therefore, if any will prove the Poet just,
+  Thither repair and you will surely find
+  Your entertainment good and Landlord kind.”
+
+In a map of London of the middle of the eighteenth century Moorfields
+is shown divided up into three sectors, Upper, Middle, and Lower. The
+site of the Upper Moorfields is now marked by Finsbury Square, and that
+of Lower Moorfields by Finsbury Circus; Middle Moorfields lay between
+the two.
+
+It was at the north-east corner of Lower Moorfields that the Infirmary
+was erected. No paved roads led up to it, only tracks: one of these to
+the north, then called Broker Row, became Eldon Street, another leading
+out of London Wall to Broker Row became Blomfield Street. It was in
+the angle between these two streets that the Infirmary was situated.
+The site now occupied by Broad Street Station, directly opposite the
+Infirmary, was then an open space.
+
+On the laying of the foundation-stone of the new building its name
+was changed, for the third time, to that of “The London Ophthalmic
+Infirmary and this was yet again altered in 1837, under circumstances
+that will be mentioned later, to that which it now bears, “The Royal
+London Ophthalmic Hospital.” The name, however, by which it is most
+generally known is “The Moorfields Eye Hospital,” though it has never
+been officially so designated.
+
+PLATE VI.
+
+[Illustration: THE LONDON OPHTHALMIC INFIRMARY AS FIRST ERECTED AT
+MOORFIELDS IN 1822.
+
+From an engraving by R. Acon, after a drawing by Tho. H. Shepherd.]
+
+It was not the first “Moorfields Hospital”; if a patient had said that
+he had been an inmate of “The Moorfields Hospital” in the eighteenth
+century he would have been regarded as an escaped lunatic. “The
+Bethlehem Royal Hospital” for lunatics was built on the south side of
+Lower Moorfields in 1675; it was a substantial building accommodating
+150 patients, and remained in existence until 1815, when it was
+removed to Lambeth. To go and see the lunatics at Moorfields was for
+over 200 years one of the sights of London, the public being admitted
+to view the poor wretches on the payment of a small charge. It is
+stated that as much as £400 a year was received towards the upkeep of
+the Institution in this way; the chains with which the patients were
+secured and the other sufferings to which they were subjected is,
+however, not part of this history.
+
+The architect of the Ophthalmic Infirmary, Robert Smirke, R.A., who
+was knighted in 1832, has left his mark deeply impressed on London;
+to him we owe, amongst other important London buildings, the British
+Museum, Covent Garden Theatre, the East Wing of Somerset House, the
+College of Physicians, and the Carlton and other Clubs. The Infirmary
+in its original state was a plain, unpretentious, but not unpleasing
+structure; in later years, whatever merits its external appearances
+originally possessed were destroyed by the addition of a new wing
+on one side and an upper storey. It originally consisted of three
+floors, a flight of stone steps leading up to the entrance hall in
+the centre of the ground floor. The out-patient consulting room was
+on the right of the entrance hall, and a room was specially set apart
+for Dr. Farre’s use on the left. In the basement, besides the kitchen,
+etc., there were the porters’and maids’ rooms, and the one bathroom
+and wash-house. On the first floor, in the centre, was the operating
+theatre, on the right a committee room, and on the left a room
+designated as the library, but not used as such for some years. The
+apothecary and the nurse-housekeeper also had their apartments on this
+floor, the second floor being devoted to wards for the patients.
+
+The in-patients in the house in Charterhouse Square were restricted
+to operation cases, and cases of purulent ophthalmia; with increased
+accommodation in the new building no such restrictions were made, and
+a nurse was engaged to assist the nurse-housekeeper. To relieve the
+apothecary of some of his duties, a professional cupper was appointed
+to attend three days a week, and a room was set apart for him in the
+basement in which to carry on his sanguinary proceedings.
+
+Smirke, the architect, advised the Committee of the Infirmary, and
+as afterwards turned out most wisely, to secure the vacant land in
+its immediate vicinity with a view to possible future extensions. The
+ground immediately behind the Infirmary, having a frontage of 36 feet
+to the north and a depth of 69 feet, had already been disposed of by
+the City to a Mr. Turner, who consented to part with his purchase for
+£15 per annum, or at twenty years’ purchase, £300, for which latter it
+was ultimately secured.
+
+When the building of the new Infirmary was completed, work commenced
+there without any ceremonial opening procedure. The first committee
+meeting held in it was on October 2nd, 1822, and it must have been
+opened for the reception of patients the same month.
+
+On November 12th, 1822, Dr. Farre delivered to the pupils an
+introductory lecture in which he announced the arrangement of the
+following courses of instruction:
+
+  Lectures on Morbid Anatomy illustrative of the Practice of Physic in
+  general, as well as Ophthalmic Medicine in particular. To be given
+  occasionally and separately announced.
+
+  By Dr. J. R. Farre, Physician to the Infirmary.
+
+  Lectures of the Anatomy, Physiology, and Diseases of the Eye. First
+  Course on Tuesdays, Thursdays, and Saturdays at half-past 5 o’clock.
+  Second and subsequent courses on Tuesdays and Saturdays at the same
+  hour.
+
+  By Mr. William Lawrence, F.R.S., Senior Surgeon to the Infirmary.
+
+  Clinical Lectures, on select cases of Ophthalmic Diseases occurring
+  in the In- or Out-Patients of the Infirmary. To be given on days and
+  at hours adapted to the convenience of the pupils.
+
+  By Mr. F. Tyrrell, Junior Surgeon of the Infirmary.
+
+  Lectures in Optics. To be given on Thursdays at 7 o’clock in the
+  evening.
+
+  By the Rev. T. Gill, M.A., Hon. Chaplain to the Infirmary.
+
+Dr. Farre concluded his announcement of these lectures with the
+following remarks:
+
+  “There remains one subject of great interest—The Chemistry of
+  Light—to which I have invited the attention of Mr. Battley, not
+  because he was the oldest and most faithful friend of Mr. Saunders,
+  but because he has actually worked for a long time at that part of
+  the subject which respects the vegetable kingdom, and his labour has
+  deservedly attracted the attention of the College of Physicians. I
+  think that the profession is much obliged to him, and I shall do
+  everything in my power to promote his very interesting enquiries
+  respecting the composition and decomposition of those more important
+  vegetable substances which form a part of the Materia Medica. His
+  success in the decomposition of opium, and in the discovering the
+  _Liquor Opii Sedativus_, one of the most valuable preparations of
+  opium, whether externally applied for the mitigation of extreme
+  suffering, as in the cancerous fungi of the eye and other parts
+  of the body, or internally administered for the cure of various
+  irritative diseases, and his beautiful preservation of the natural
+  green pigment and medical virtues of other preparations of the
+  narcotic tribe, as _Digitalis Conium_, and the like, induced me,
+  in July last, to invite him to communicate his thoughts on those
+  subjects to the class of the Infirmary, and, in a letter received
+  only this day, he has led me to hope that he will indulge my wishes
+  in the spring of the ensuing year.”
+
+To what extent this ambitious programme of instructions was carried
+out is uncertain. Of Dr. Farre’s teaching but few records remain; with
+regard to it, Lawrence said in the introductory chapter of his treatise:
+
+  “Dr. Farre set the example at the Infirmary, of applying the general
+  principles of pathology and therapeutics to the elucidation and
+  treatment of ophthalmic diseases. In the clinical illustration of
+  cases, the exposition of curative indications and simplicity of
+  treatment, he could not be surpassed. All who have had the advantage
+  of his instructions will remember them with gratitude and respect,
+  and will regret that he has not communicated to the public, through
+  the Press, the interesting results of his long practice, his close
+  observation and mature reflection.”
+
+The report of one of his lectures at the Infirmary in the _Lancet_
+gives anything but a good impression of him as a teacher; it is a long
+rambling discourse, professedly on the cardiac system, with but scant
+reference to eye disease, and set out with scriptural quotations and
+protests against materialism. We learn, however, from it that he had
+previously delivered a course of lectures on the gastric system as
+applicable to ophthalmic medicine.
+
+Lawrence’s lectures were reported as they were delivered in the
+_Lancet_ in 1825–26, and subsequently formed the basis of his treatise.
+The Rev. T. Gill resigned his appointment as Chaplain to the Infirmary
+in February, 1823, owing to some disrespectful behaviour to him on the
+part of the housekeeper, for which she was duly reprimanded. So he
+could only have given one course of instruction on optics; there is no
+record of any of his successors taking on a similar duty.
+
+A room in the basement, which it had been suggested to Battley might be
+used by him as a laboratory and museum, was not found suitable for that
+purpose, and the courses of instruction which it was suggested that he
+might give in Materia Medica seem to have been left in abeyance until
+the establishment of what was termed “The Saunderian Institution.”
+
+Besides the unoccupied land behind the Infirmary, already referred
+to, there was another piece to the south of it, lying between it and
+the Roman Catholic Chapel. The leasehold of this was offered to,
+and secured by, Dr. Farre, who subsequently transferred it to the
+Infirmary. Part of the agreement permitted the previous owner of the
+lease to erect a stable for his own use on about two-thirds of the
+site, for which he was to pay only a peppercorn rent. On the remaining
+one-third, Dr. Farre obtained permission to erect, at the expense of
+the Saunderian Fund, which had been established by him, a building to
+be called “The Saunderian Institution.” The purpose of this Institution
+was the cultivation of minute anatomy, especially of the eye, and a
+general analysis of the Materia Medica to increase the remedial agents
+of the Hospital, as well as benefit the profession. The management of
+the Institution was to remain entirely in the hands of Dr. Farre during
+his life.
+
+“The Saunderian Fund” was one specially established for the erection
+of a monument to John Cunningham Saunders; to it Dr. Farre himself
+contributed £120, and to it also were added the proceeds of the sale
+of the second edition of Saunders’ book edited by Dr. Farre. Out of
+the fund a bust of the late J. C. Saunders was constructed, which now
+stands in the entrance hall of the present Hospital; the remainder of
+it seems to have been devoted to this Institution.
+
+In the year 1827, the Laboratory of the Institution was opened by Mr.
+Battley for the analysis of the vegetable substances of the Materia
+Medica, with a view to the improvement of Pharmacy, by showing wherein
+the efficient powers of these substances reside and by what means the
+most useful preparations of them may be obtained. It appears that he
+held large classes of students there, more than 2,000 from various
+Medical Schools, British and foreign, having attended for instruction.
+
+Dr. Farre, in an Introductory Lecture entitled “Apology for British
+Anatomy,” at the opening of the pathological department of the
+Institute, or Academy, as he sometimes described it, pointed out that
+the objects which it had in view were: the study of the anatomy of
+structure; the performance of post-mortem examinations; the study of
+minute morbid anatomy; the publication of a journal; the publication
+of separate essays; the cultivation of the Fine Arts of drawing and
+modelling as connected with minute practical and morbid anatomy.
+
+John Dalrymple, who afterwards became a surgeon to the Ophthalmic
+Infirmary, was appointed demonstrator and secretary to the Academy.
+
+In connection with the announcement of Lawrence’s resignation of his
+post of surgeon to the Ophthalmic Infirmary in 1826, there commenced
+a series of editorial articles in the _Lancet_, attacking members of
+the Committee of Management and imputing to them the most base and
+degrading motives.
+
+The _Lancet_ had been founded in 1823 by Thomas Wakley, and at first,
+as his biographer says, “Some men read it, some men laughed at it, and
+some men wondered at it, but nobody much marked it, for its views were
+not sufficiently condensed and its objects not definitely defined.”
+
+In 1825 Tyrrell summoned Wakley for libel, claiming £2,000 damages, in
+that the _Lancet_ had accused Tyrrell of plagiarism in connection with
+his publication of Astley Cooper’s Surgical Lectures. Though the jury
+gave their verdict in Tyrrell’s favour, they only assessed his damages
+at £50.
+
+Gradually after this trial the policy of the _Lancet_ became directed
+to three main objects:
+
+  (1) The maintenance of a right to publish, for the benefit of the
+  profession at large, the sayings and doings of members of the
+  Hospital Staff’s, with or without their permission.
+
+  (2) A fight against nepotism in the matter of staff appointments at
+  the Hospitals.
+
+  (3) An exposure of, what Wakley delighted in calling, a “Hole in the
+  Corner Policy” by members of Hospital Staffs—_i.e_., the employment
+  of secretive methods in their practice.
+
+In the affairs of the Ophthalmic Infirmary Wakley found a suitable
+field for attack in these three directions, and, though his objects
+may have been excellent, his mode of conducting his campaign was
+inconsiderately bitter and personal.
+
+For the unauthorised publication in his Journal of the notes of
+cases at St. Thomas’s Hospital, Wakley had been expelled from that
+Institution, where he had studied as a student, the letter of expulsion
+being signed by the three surgeons, Travers, Tyrrell, and Green.
+
+Lawrence, who was at that time a prominent medical reformer, and for
+whom Wakley evidently had a great admiration, welcomed the publication
+of his lectures, delivered at the Ophthalmic Infirmary, in the _Lancet_.
+
+Tyrrell, who had been prominent in the fight against Wakley at St.
+Thomas’s and who had also taken legal proceedings against him, resented
+having his demonstrations at the Ophthalmic Infirmary reported in
+the Journal. On this matter there may very likely have been some
+disagreement between the two surgeons of the Infirmary. There is no
+note in the minute book of the Committee of any discussion on the
+matter having taken place, or of any bye-law being passed to the
+effect that “no pupil should be allowed in future to take notes of
+cases.” Wakley, therefore, seems to have been wrong in attributing
+Lawrence’s resignation of his post on the staff of the Infirmary to
+his disgust with the Committee for having passed such a bye-law. When
+the _Lancet_’s first attacks on Dr. Farre and Mr. Battley were brought
+to the notice of the Committee, Lawrence protested emphatically that
+neither directly nor indirectly had he been in any way concerned in
+them. The real reason of his resignation probably was that he had
+become connected with the newly constituted Aldersgate Street School of
+Medicine, where he delivered a course of lectures on Surgery.
+
+As has been mentioned, the idea of establishing a special institution
+for treating diseases of the eye was originally suggested to Saunders
+by Sir Astley Cooper, who always took a fatherly interest in it.
+It was, therefore, inevitable that, to commence with, it should be
+mainly staffed by his disciples and followers. Saunders had been
+his house pupil and demonstrator; Travers and Tyrrell were both his
+articled pupils, the latter having also married his niece. Farre and
+Battley had both studied under him. In making his charge of nepotism,
+Wakley complained chiefly of the rule which made it obligatory that a
+candidate for the post of surgeon should have served an apprenticeship
+at one of the Hospitals of the Metropolis. He pointed out that for
+these apprenticeships to the London Hospital surgeons a premium of as
+much as £1,000 was sometimes demanded and received, and that those for
+whom these large sums were paid thereby obtained an unfair advantage
+when competing for staff appointments likely to lead to renown and
+emoluments.
+
+He also commented on a rumour that a post of assistant-physician to
+the Infirmary was about to be created, to which Dr. Frederick Farre,
+Dr. J. R. Farre’s son, was to be appointed. This, as we shall see, did
+ultimately take place, but not until ten years later and after the post
+had been duly advertised, Dr. Frederick Farre being the only applicant.
+
+The Infirmary’s announcement of Saunders’ operation for cataract in
+infancy, before he had made known to the profession his method of
+procedure, afforded Wakley an excellent illustration of secret surgery,
+or “Hole in the Corner methods” as he termed them. He eagerly made the
+most of it, raking up what he considered the misdeeds of Saunders, who
+had been dead seventeen years, and whom he had never known personally.
+He reprinted much of Gibson’s article on operations for congenital
+cataract from the _Edinburgh Medical and Surgical Journal_, to show
+that the publication of his procedure actually preceded Farre’s
+publication of Saunders’ posthumous work by two months. He even accused
+Dr. Farre of wilful delay in the matter, a delay which was entirely due
+to the difficulties which arose in connection with the copyright.
+
+The Committee of the Infirmary took legal advice in connection with
+these defamatory articles, but contented itself with the insertion of
+the following letter in The Times and other leading papers:
+
+  “LONDON OPHTHALMIC INFIRMARY, MOORFIELDS.
+
+  “At a meeting of the Committee, 6th November, 1826, Ralph Price,
+  Esq., in the Chair, five numbers of a weekly publication, called
+  the _Lancet_, dated the 7th, 14th, 21st and 28th October last, and
+  4th instant, and _The Times_ newspaper of the 28th October, were
+  laid before the Meeting; the former containing false statements and
+  offensive reflections upon the Members of this Committee in their
+  official capacities, but in a particular manner calculated to insult
+  the memory of the late Mr. Saunders, and wound the feelings of Dr.
+  Farre and Mr. Battley; and the latter echoing similar calumnies in
+  the form of a letter, directed ‘to the Editor of _The Times_’ and
+  signed ‘A Governor’; when it was resolved: That the freedom of the
+  Press has been violated, by becoming, in the instances referred
+  to, an instrument of gross malignity and abuse, and of the foulest
+  injustice towards two of the earliest and most tried supporters of
+  the Charity; that this Meeting experiences the greatest satisfaction
+  in again bearing testimony to the high value of Dr. Farre’s and Mr.
+  Battley’s undeviating and disinterested exertions during a period of
+  twenty-two years, which, in conjunction with their liberal pecuniary
+  subscriptions, have largely contributed to the rise and establishment
+  of this Institution.
+
+  That, this Resolution, signed by the Chairman, be inserted in four of
+  the Morning and two of the Evening Papers.
+
+  “RALPH PRICE, _Chairman_.”
+
+On the retirement of Lawrence from the post of surgeon to the
+Infirmary, John Scott, who had served his apprenticeship at the London
+Hospital with Sir William Blizard, was appointed as Tyrrell’s colleague.
+
+Lawrence, as has been shown in the previous chapter, was what may
+be described as “a whole hogger,” so far as withdrawal of blood was
+concerned for the relief of inflammation in the eye. Tyrrell, though
+he employed it in many cases, was evidently doubtful as to its general
+utility; thus he writes in his textbook:
+
+  “It is a great mistake to suppose that it is necessary to take away
+  large quantities of blood; or to bleed to such an extent as to
+  occasion faintness, in order to check severe local disease: I am
+  confident that more harm than good results from such practice.”
+
+He advocated the importance of promoting and maintaining power in
+the circulation, the principal means on which he relied being “diet,
+stimuli, and tonics, which are materially aided by quietude, proper
+clothing, and pure air.”
+
+In the preparation for extraction of cataract, to prevent subsequent
+inflammation, especially in the robust and plethoric, Lawrence
+practised depletion, taking blood freely and repeatedly by venesection
+before operation. Gradually this preliminary measure seems to have been
+less and less resorted to, and, in a small monograph on _Cataract and
+its Treatment_, published by Scott in 1843, he writes:
+
+  “Of the last fifty cases of extraction, taken in succession, which I
+  have performed at the Ophthalmic Hospital, where an accurate record
+  of the treatment is kept, I have not had occasion to draw blood from
+  the arm in a single instance, either before or after the operation.”
+
+An anonymous writer has recorded his personal recollections of Tyrrell
+thus:
+
+  “His appearance was prepossessing, his manner to his patients kind
+  and reassuring, and his calmness was conspicuous in circumstances
+  of difficulty. It is a singular fact that, when first attached to
+  Moorfields, his ill success as an operator was so great that he was
+  suspended from performing the major operations for a year; yet by
+  steady perseverance he acquired a dexterity with either hand that
+  could not be surpassed. In extraction of cataract his neatness was
+  remarkable, and we well remember an instance of his coolness. The
+  point of the section knife broke off, and dropped into the anterior
+  chamber. Mr. Tyrrell withdrew the knife, and without the least
+  expression of impatience, asked for the blunt-pointed knife, with
+  which he enlarged the section. He then removed the bit of steel and
+  proceeded to extract the lens with such perfect _sang froid_ that no
+  one who had not seen the breaking of the knife would have known
+  that anything untoward had occurred.
+
+  “Mr. Tyrrell’s great success depended fully as much on his judicious
+  after-treatment as on his manual dexterity; and his secret lay in not
+  exhausting the systems of his patients unnecessarily, but keeping the
+  balance of power precisely at healing point.
+
+  “On a hot day in May, 1843, whilst an active competition for a
+  house was going on at the Auction Mart, an alarm was raised that a
+  gentleman had fainted. He was carried out. Alas! it was Frederick
+  Tyrrell, who had attended the sale for the purpose of purchasing the
+  very lot then under competition, which, indeed, was the house he
+  occupied. His heart was diseased and thus he died!”
+
+PLATE VII.
+
+[Illustration: FREDERICK TYRRELL.]
+
+In 1840 he published a book in two volumes entitled _A Practical Work
+on the Diseases of the Eye and their Treatment, Medically, Topically,
+and by Operation_. It was dedicated to his ophthalmic pupils, and
+contained the outcome of the extensive experience which he had gained
+at the Infirmary. His memory has, however, become enshrined in the
+annals of ophthalmology, not so much by his writings, as by a blunt
+hook which he introduced for the operation of making an artificial
+pupil, which is still known as “Tyrrell’s hook,” and without which no
+ophthalmic armamentarium is complete.
+
+It is interesting here to note how far more frequent operations to
+produce an artificial pupil were one hundred years ago than they
+are now. In all the early treatises on eye disease much space was
+devoted to the discussion of the various methods of producing such
+artificial openings for the restoration of sight. The only inference
+is that occlusion of the natural pupil by inflammatory membranes was
+then of more frequent occurrence, and that the improved methods of
+treating inflammatory eye affections, and the more successful operative
+procedures for cataract, have reduced the number of such occlusions.
+
+In 1828 a body of ladies interested in the Charity carried out a
+most successful sale of useful and ornamental work on its behalf. The
+President of the Infirmary, Mr. William Mellish, obtained for the sale
+the patronage of the Lord and Lady Mayoress, and permission to hold it
+in the Egyptian Hall at the Mansion House. The sale commenced on April
+30th, and lasted three days; stalls were presided over by thirteen
+ladies, and the sum of £2,309 9s. 6d. was realised.
+
+On the announcement of this result at a General Meeting of Governors a
+long and flowery resolution of thanks was passed to all concerned, of
+which the opening sentence will suffice as an example of the rest:
+
+  “That this unprecedented success of the plan conceived with so much
+  benevolence and executed with so much zeal and ability by the ladies
+  who have honoured the Institution with their patronage on this
+  occasion, whilst it reflects the highest honour on the ingenuity,
+  industry and charity, which combined to produce so beneficial a
+  result, is eminently conducive to the best interests of the Infirmary
+  and highly gratifying to its Governors and friends.”
+
+In 1830 Tyrrell, who had been carrying on the duties of surgeon
+to the Institution for twelve years, became desirous of receiving
+some aid, and applied to the Committee for the appointment of an
+assistant-surgeon; this was agreed to, and after the post had been
+advertised two applicants came forward, Gilbert Mackmurdo and John
+Dalrymple. In the ballot which ensued 591 Governors voted, Mackmurdo,
+who had served his apprenticeship under Travers at St. Thomas’s
+Hospital, obtaining a majority of 143.
+
+Two years later it was found desirable to open the Infirmary for
+out-patients on four days a week instead of three, as had up to
+then been the custom, and also to make the hours of attendance from
+8 a.m. until 10 a.m. instead of from 12 noon to 2 p.m. A second
+assistant-surgeon was then appointed to act with John Scott, and John
+Dalrymple, who was the only applicant, was elected.
+
+PLATE VIII.
+
+[Illustration: JOHN SCOTT.
+
+From an engraving, after a picture by H. Howard, R.A.]
+
+John Scott, shortly after his appointment as surgeon to the
+Infirmary, was appointed assistant-surgeon to the London Hospital,
+becoming full surgeon there in 1831. He continued his work at the
+Ophthalmic Infirmary until shortly before his death, which occurred
+after a prolonged illness in 1846.
+
+His name is best remembered in General Surgery in connection with his
+treatment of joints and chronic ulcers of the leg. “Scott’s dressing”
+and “Scott’s ointment” are still well known, the latter being a
+camphorated mercurial ointment. He was the first surgeon in England to
+remove the upper jaw, and was renowned for his skill in bandaging. His
+only published contribution to ophthalmology was a small monograph on
+_Cataract and its Treatment_, in which he described a new method of
+making the section of the cornea in the operation of extraction. It
+had previously been the custom to use a wedge-shaped knife for this
+purpose, which was made to cut by thrusting it through the anterior
+chamber of the eye; the force necessary to do so tended to rotate the
+eyeball in an objectionable manner. Scott devised a knife, shaped like
+a sickle, with which he was able to transfix the cornea and then cut
+upwards. Though his knife has fallen completely out of use, the general
+principle of first transfixing and then cutting out is now almost
+universally employed. The writer of his obituary notice, his junior
+colleague at the London Hospital, Walter Rivington, describes him as
+“an honest but very irritable man,” and one who had no sympathy with
+humanity.
+
+Another writer who knew him says:
+
+  “A colleague of Frederick Tyrrell’s at Moorfields was John Scott,
+  who presented as great a contrast to the former as could well be
+  imagined. Impatient and irritable in manner, he could not bear
+  anything to go wrong; no man lost vitreous humour more frequently
+  during extraction, at which he was invariably annoyed, ascribing it,
+  however, to fluidity of that body.”
+
+A great loss to the Infirmary in 1835 was occasioned by the death of
+its secretary, Matthew Heathfield, who had served it in that capacity
+with marked assiduity and enthusiasm for fifteen years. His successor
+only held the office for a few months before he was obliged to give
+it up on account of ill-health. In April, 1835, Francis William
+Bircham was appointed secretary at a salary of £52 10s. annually.
+It is noteworthy that the firm of solicitors to which he belonged,
+Messrs. Bircham, Dalrymple and Drake, now Messrs. Bircham and Co., of
+46, Parliament Street, S.W.1, still act as honorary solicitors to the
+Hospital.
+
+
+
+
+CHAPTER V
+
+THE ROYAL LONDON OPHTHALMIC HOSPITAL
+
+
+His Royal Highness the Duke of York, the Infirmary’s first Patron, died
+in 1827.
+
+At the three days’ sale at the Mansion House in 1828 the Duchess of
+Kent was one of the Lady Patronesses. In 1836 the Rev. Dr. Blomberg,
+a member of the General Committee of the Infirmary, stated that he
+had reasons to hope that an application to their Royal Highnesses the
+Duchess of Kent and the Princess Victoria to become Patronesses of
+the Institution would be likely to meet with success. A letter was
+then drawn up, addressed to the Rev. Dr. Blomberg, and signed by the
+President, with a statement of the following claims by the Institution
+to so high a distinction: That the grand total of patients admitted
+since its establishment to the end of 1835 (a period of about thirty
+years) was 116,890, during which time 1,070 cases of cataract or closed
+pupil (including 136 born blind) had had their sight restored. That
+the annual number of patients admitted of late years had varied from
+5,000 to 5,500. That 74 capital operations were performed in 1834, 69
+of which were successful, and of 78 performed in 1835 four only failed
+to produce the desired effect. That no less than 1,320 physicians and
+surgeons had been pupils at the Infirmary, and were now dispensing
+its benefits in various parts of the globe. That it was the parent
+institution of the numerous hospitals since established throughout the
+kingdom for the same benevolent purpose.
+
+It was requested that the Rev. Dr. Blomberg would bring these facts
+before the notice of the Duchess of Kent and her illustrious daughter,
+the Heiress-Presumptive to the Throne, requesting their gracious
+permission to place the Institution under their august patronage.
+
+In response to this petition the following letters were received:
+
+  “KENSINGTON PALACE,
+
+  “12_th March_, 1836.
+
+  “My dear Sir,
+
+  “By the accompanying letter which you will be so good as to forward
+  you will see that the Duchess of Kent has lent her aid and that of
+  the Princess Victoria to the excellent charity whose cause was so
+  ably advocated in Mr. Mellish’s letter.
+
+  “Her Royal Highness is very happy to find an occasion to meet a wish
+  of yours.
+
+  “Believe me always, my dear Sir,
+
+  “Yours very faithfully,
+
+  “JOHN CONROY.
+
+  “THE REV. DR. BLOMBERG.”
+
+  “KENSINGTON PALACE,
+
+  “12_th March_, 1836.
+
+  “Sir,
+
+  “I have the honour to lay before the Duchess of Kent your letter of
+  yesterday’s date, and Her Royal Highness begs you will assure the
+  Committee of the London Ophthalmic Infirmary, Moorfields, that it
+  will be very gratifying to her to allow her name and that of Her
+  Royal Highness the Princess Victoria to be placed as Patronesses of
+  so benevolent an Institution.
+
+  “I have the honour to be, Sir,
+
+  “Your most obedient servant,
+
+  “JOHN CONROY.
+
+  “WM. MELLISH, ESQ.,
+
+  “112, Bishopsgate Street Without.”
+
+As the outcome of the Royal Patronage, it was agreed at a General
+Meeting of Governors, on April 20th, 1836, that the name of the
+Institution should be changed to “The Royal London Ophthalmic Hospital,
+Moorfields.”
+
+In 1837, on Queen Victoria’s accession to the Throne, the Chairman
+of the Committee of the Hospital applied to Lord John Russell, the
+Secretary of State for the Home Department, to ascertain Her Majesty’s
+pleasure as to continuing Patroness of the Hospital, and received from
+him the following reply:
+
+  “WHITEHALL,
+
+  “_August_ 29_th_, 1837.
+
+  Sir,
+
+  “I have the honour to lay before the Queen the petition of the
+  Committee of Management of the Royal Ophthalmic Hospital.
+
+  “And I have the satisfaction to inform you that Her Majesty has been
+  graciously pleased to be the Patroness of that Hospital.
+
+  “I have the honour to be, Sir,
+
+  “Your obedient servant,
+
+  “J. RUSSELL.
+
+  THE REV. J. RUSSELL, D.D., etc.,
+
+  “Rectory House,
+
+  “Devonshire Square.”
+
+The Patronage of the Queen, thus commenced, continued throughout the
+whole of her long reign.
+
+In 1838 William Mellish, who had been President of the Hospital for
+twenty years, died, and the Committee placed on record their gratitude
+and respect for the uninterrupted paternal care and attention he had
+shown to the interests of the Institution during his time of office. He
+was what may be described as a real live President, having been always
+ready to take the Chair at the annual meetings of Governors and at the
+anniversary dinners. He was succeeded in the office of President by
+Earl Fitzwilliam, who resided mainly in the country, and but seldom
+visited the Hospital, so that the control of its affairs fell largely
+into the hands of the Chairman of the General Committee, who was at
+that time the Rev. J. Russell, D.D.
+
+It was obvious at the foundation of a special institution devoted to
+eye diseases that the treatment would be mainly surgical, but the
+importance of the medical side of ophthalmology was recognised by the
+appointment of a physician. With the expansion of the work of the
+Institution during the first thirty years of its existence the number
+of surgeons on the staff had to be increased from one to four. During
+all that time Dr. J. R. Farre acted alone as consulting physician,
+having referred to him for his advice and aid cases requiring medical
+treatment. In 1836, when he had reached the age of sixty-one, a special
+Committee, of which he was not a member, decided that it was desirable
+to appoint an assistant-physician; the post was advertised in the
+daily journals, and Dr. Frederick John Farre, assistant-physician at
+St. Bartholomew’s Hospital, son of Dr. J. R. Farre, was appointed, he
+being the only candidate. It was then arranged that the Hospital should
+be opened for out-patients, to be seen by the assistant-physician, on
+Wednesday mornings at eight o’clock, and that notices to that effect
+should be advertised.
+
+In turning over the leaves of the minute books recording the doings
+of the various Committees, it is remarkable to find how much time and
+attention Dr. J. R. Farre devoted to the management and administration
+of the Infirmary during its first thirty years. Travers aptly described
+him as “the foster-father of the London Ophthalmic Infirmary.” He has
+also aptly been described as “the father of Ophthalmic Medicine.” He
+was most regular in his attendance, and when a petition, a report, or
+any letter of importance had to be composed, his assistance was always
+sought for. Though his style now seems florid and verbose, it met the
+requirements of the time, and generally effected the purpose for which
+it was intended.
+
+With remarkable foresight he endeavoured to establish, with varying
+degrees of success, many of the developments which have in later
+years become some of the most prominent features of the Hospital’s
+work. Thus the Saunderian Institute, one of the purposes of which was
+the investigation of the minute anatomy of the eye, foreshadowed the
+Pathological Laboratory and Museum which were established later.
+
+In 1828 Dr. Farre started the publication of a Journal, of which,
+however, only one number appeared, but in a way it may be considered
+the precursor of the Royal London Ophthalmic Hospital Reports, which
+commenced in 1857. Farre’s Journal contained a most remarkable mixture
+of subjects, and serves to show him as a man of wide and varied
+interests.
+
+It was entitled, _Journal of Morbid Anatomy, Ophthalmic Medicine
+and Pharmaceutical Analysis, with Medico-Botanical Transactions
+communicated by the Medico-Botanical Society_.
+
+It contained reports from the Calcutta and Madras Eye Infirmaries;
+notes on cases and pathological examinations of rupture of the heart,
+angina pectoris, aneurysm, etc., by various observers; a paper by
+Richard Battley on experiments on Chinchona; the Transactions of the
+Medico-Botanical Society; observations on the climate of the Azores, of
+Hastings, and Penzance; a paper by John Dalrymple, ‘On the Muscularity
+of the Iris,” which, Dr. Farre said, in some introductory remarks, met
+the principal object for which his Academy was instituted—
+
+  “the inquiry having been physiologically conducted and pathologically
+  directed, assumed the very spirit which he most desired to encourage
+  amongst the many British candidates for anatomical character.”
+
+It was announced that:
+
+  “Parts of the Journal will be published at fixed periods of Midsummer
+  and Christmas, and also intervening parts, as opportunity may admit,
+  for the completion of each volume, if the Editor’s health should, by
+  God’s permission, enable him to separate from the hours of his repose
+  a portion of time adequate to the service announced in this notice to
+  contributors.”
+
+These good intentions were, however, not realised, no further number of
+the Journal being issued.
+
+The Library, for which a special room had been set apart in the new
+building, was started by Dr. J. R. Farre’s presentation of eighteen
+volumes of the Philosophical Transactions and various works on optics.
+These formed a nucleus around which has been built up one of the most
+extensive and valuable collections of books dealing with ophthalmology,
+a collection which has proved of inestimable service for purposes of
+reference and research to several successive generations of workers at
+the Hospital.
+
+In 1837 Dr. J. R. Farre advised the Committee that it was desirable
+that a Pharmacopœia should be constructed for the use of the Hospital;
+in its compilation Dr. Frederick Farre, who was lecturer on Botany at
+St. Bartholomew’s Hospital, and later lecturer there on Materia Medica,
+rendered valuable assistance.
+
+Dr. Farre, senior, seems to have been a man who inspired the warmest
+regard and affection in all who became associated with him; in 1838 a
+full-length portrait of him was presented to the Hospital by some of
+his friends with the accompanying letter:
+
+  “LONDON, 18_th August_, 1838.
+
+  “34, Montagu Square.
+
+  “Gentlemen,
+
+  “I have the honour on behalf of my brothers and myself to present to
+  the Royal London Ophthalmic Hospital, of which he has so long been
+  a liberal patron and zealous benefactor, a portrait of our esteemed
+  friend Dr. John Richard Farre, painted by T. Phillips, R.A.
+
+  “To those who appreciate the character and services of the worthy
+  original we feel assured that we need only offer in order to obtain
+  for it a welcome reception.
+
+  “I am, Gentlemen,
+
+  “Your most obedient servant,
+
+  “J. ROACH BOVELL.
+
+  “THE PRESIDENT, VICE-PRESIDENTS, TREASURER AND COMMITTEE OF THE
+  R.L.O.H.”
+
+On receiving it the Committee passed the following resolution:
+
+  “That recognising in Dr. Farre not only one of the Founders of the
+  Institution but a munificent contributor to its funds, and the able
+  physician by whom the science communicated and dispensed within
+  its walls has been effectively upheld and enlarged, the Committee
+  accepts the testimonial of private esteem and affection with peculiar
+  pleasure as the means of publicly manifesting, and of transmitting to
+  posterity, the high claims of public respect and gratitude for that
+  highly distinguished public benefactor.”
+
+PLATE IX.
+
+[Illustration: DR. JOHN RICHARD FARRE.
+
+From an engraving by Frank Bromley, after a picture by Thomas Phillips,
+R.A.]
+
+Thomas Phillips, R.A., painted the portraits of most of the celebrated
+literary and scientific men of his time; that of Dr. Farre must
+certainly have been one of his largest works of this description. It
+now occupies a dominating position in the Board Room of the Hospital,
+and shows Dr. Farre clothed in stockings and knee-breeches, with a
+buff-coloured waistcoat, stock, and blue coat with brass buttons. He is
+represented seated at a table with the drawing of a malformed heart in
+one hand, and a portfolio beside him, evidently containing his valuable
+collection of drawings of pathological specimens, which was afterwards
+presented to St. Bartholomew’s Hospital Museum.
+
+Dr. Farre was a religiously devout man, and most appropriately there is
+conspicuously shown amongst the books on his table a copy of the Holy
+Bible. He continued to serve the Hospital in the capacity of consulting
+physician until 1843, but lived on until 1862, when he died in his
+eighty-eighth year, having outlived all those who had been associated
+with him in the Hospital’s foundation.
+
+His son, Dr. Frederick J. Farre, was educated at Charterhouse School,
+and was the captain of it during Thackeray’s first year there.
+Thackeray afterwards introduced him in _The Adventures of Philip_ as
+Sampson Major, the cock of the whole school.
+
+Mackmurdo and Dalrymple’s duties as assistant-surgeons consisted mainly
+in the treatment of the out-patients. After having been so employed
+for several years, they not unnaturally aspired to gaining skill and
+experience in the performance of the major operations of ophthalmic
+surgery on the in-patients. With such aspirations several members of
+the Committee of Management were in sympathy, and much discussion took
+place as to some alteration in the rules which would permit of them
+acting as full surgeons. Tyrrell and Scott, however, were opposed
+to any proposal which was likely to lead to a curtailment of their
+privileges as senior officers.
+
+The following return was drawn up and laid before the Committee to show
+how the work of the Institution was distributed amongst the different
+members of the medical staff in the year 1842.
+
+  Out-patients:
+    Dr. F. Farre          607 (one day a week)
+    Mr. Tyrrell           1,090
+    Mr. Scott             1,037 (two days a week)
+    Mr. Mackmurdo         1,274
+    Mr. Dalrymple         1,714
+
+
+  Operations performed:
+                    _Extraction of_  _Needling of_  _Artificial_
+                      _Cataract._     _Cataract._     _Pupil._
+    Mr. Tyrrell           42              20             7
+    Mr. Scott             29               9             7
+    Mr. Mackmurdo          0               4             0
+    Mr. Dalrymple          0               5             0
+
+The matter was brought to a head by the death of Tyrrell in June, 1843.
+By that time Mackmurdo had served the Hospital as assistant-surgeon for
+a period of thirteen years, and Dalrymple for eleven years.
+
+After due notice had been given it was then agreed, at a special
+General Meeting of the Governors, that the laws regarding the
+appointment of the medical officers should be suspended, and that Mr.
+Mackmurdo and Mr. Dalrymple should forthwith be appointed surgeons to
+the Hospital; also that two new assistant-surgeons should be elected.
+Mr. John Scott strongly protested against such an increase in the
+surgical staff, pointing out, quite correctly, that such an increase
+was out of proportion to the increase in the number of patients.
+
+Shortly afterwards Dr. Frederick J. Farre was likewise promoted from
+assistant-physician to physician to the Hospital, his father, Dr. J. R.
+Farre, being described as consulting physician, the capacity in which
+he claimed to have always served as a member of the staff.
+
+The candidates for the two posts of assistant-surgeon were:
+
+Mr. James Dixon, who had been articled as apprentice to Tyrrell, and
+who was demonstrator of anatomy at St. Thomas’s Hospital.
+
+Mr. George Critchett, who had been articled to Scott, and who was
+demonstrator of anatomy at the London Hospital.
+
+Mr. William Bowman, who had served his apprenticeship at the Birmingham
+Hospital, and who was demonstrator of anatomy at King’s College
+Hospital.
+
+The latter withdrew his candidature in favour of the two former when
+he found that they had been already working at the Hospital, but at
+the same time intimated his intention of applying again when a further
+vacancy arose. This occurred in 1846, due to Scott’s retirement from
+ill-health, and Bowman was then elected assistant-surgeon unopposed.
+
+Dr. J. R. Farre was, as already shown, a man of ideas as well as
+of affairs; the time, however, occupied by the latter precluded
+his putting many of the former into practice. He was, therefore,
+exceedingly fortunate in finding in John Dalrymple a most energetic and
+capable disciple.
+
+John Dalrymple, who was related to the Stair family, was born in 1803.
+His father, William Dalrymple, who had studied under Astley Cooper, was
+surgeon to the Norfolk and Norwich Hospital. He was a liberal-minded
+man as well as a skilful surgeon, and attracted considerable attention
+in 1813 by repeating successfully Travers’ operation of tying the
+common carotid artery in a case of “aneurism by anastomosis” of the
+orbit. He had also devoted some attention to ocular pathology, and had
+made a valuable collection of anatomical and pathological preparations,
+which he presented to the Norfolk and Norwich Hospital.
+
+John seems to have served his apprenticeship under his father, and to
+have acquired from him a liking for both pathology and ophthalmology.
+He studied for a time at Edinburgh University, and came to London,
+where he qualified as M.R.C.S. in 1827.
+
+His association with Dr. Farre and with the Moorfields Hospital then
+commenced, with his appointment already mentioned, as demonstrator
+and secretary to the newly opened Saunderian Institution, where he
+carried out anatomical and pathological investigations. In 1834, as
+the outcome of his work at the Institute, he published a treatise on
+the _Anatomy of the Human Eye_, which he dedicated to Dr. J. R. Farre,
+Frederick Tyrrell, and John Scott, his colleagues at the Infirmary,
+to which he had been appointed assistant-surgeon the previous year.
+This book, besides containing a description of his own dissections,
+gives an excellent review of the work of previous investigators, and is
+illustrated by five engraved plates from his own anatomical drawings.
+Dalrymple’s investigations were not restricted to ophthalmology;
+between the years 1840 and 1849 he contributed several papers to
+the Medico-Chirurgical Society’s Transactions relating to general
+pathology, and also wrote articles dealing with Natural History.
+
+Tyrrell’s unexpected decease, and later Scott’s retirement, left
+Dalrymple in a leading position in ophthalmology, and his reputation
+and practice rapidly increased. In 1847 he found the state of his
+health to be such as to render it impossible for him to keep up his
+attendance at the Hospital during the winter months. As he was the only
+surgeon in attendance on Wednesdays and Saturdays, whereas on the
+other days of the week both a surgeon and an assistant-surgeon were
+on duty, the Governors agreed to appoint a third assistant-surgeon,
+and thereby relieve Dalrymple of his duties during the winter. Alfred
+Poland, who had served his apprenticeship under Aston Key at Guy’s
+Hospital, and who was a demonstrator of anatomy there, was elected to
+the post.
+
+Dalrymple’s health did not tend to improve, and in 1849 he felt
+compelled to resign his appointment on the active staff, and was
+appointed consulting surgeon. On his retirement no fresh appointment
+was made to the staff, Critchett being promoted to the post of surgeon
+in his place. In 1850 Dalrymple was elected a Fellow of the Royal
+Society.
+
+For a number of years John Scott and Dalrymple had been collecting
+water-coloured drawings of diseases of the eye, made from patients
+under their care at the Hospital by the best artists. Scott, at his
+death, bequeathed to Dalrymple the drawings he had collected, and
+these, added to Dalrymple’s own, amounted to several hundred. It was
+from a selection of them that in 1852 Dalrymple was able to produce his
+great Atlas of _Pathology of the Eye_. The publication of the volume
+was entrusted to Mr. Churchill, and every advantage that fine paper
+and artistic skill could afford was supplied. The Atlas consisted of
+thirty-six plates, some containing six figures, and others full-page
+illustrations, with explanatory letterpress. The original drawings
+were made by W. H. Kearney and Leonard, and the drawings on stone
+by W. Bragg. It can safely be asserted that no illustrations of eye
+diseases ever surpassed or even equalled those in this Atlas, both
+as regards artistic merits and faithfulness in the depiction of the
+characteristics of the conditions they represent. The cost of the
+production of the Atlas was nearly fifteen hundred pounds, and copies
+of it now are exceedingly scarce. Dalrymple only lived a few weeks
+after its completion, dying in the zenith of his fame and the full
+tide of prosperity. The whole collection of drawings, from which those
+reproduced in the Atlas were selected, was bequeathed by him in his
+will to the library of the Royal London Ophthalmic Hospital, where they
+are still preserved.
+
+It is perhaps remarkable that, though Dalrymple did so much for
+ophthalmology by his anatomical investigations and the production
+of this Atlas, his name is best known by ophthalmic surgeons at the
+present day in connection with the symptom of retraction of the upper
+lids in “Graves’ disease” or “exophthalmic goitre,” which produces
+the peculiar staring look that forms one of its most characteristic
+features. This symptom is spoken of in textbooks as “Dalrymple’s sign,”
+but to his description of it Dalrymple himself apparently attached but
+little importance.
+
+John Dalrymple was one of a family of nine; two of his brothers became
+medical men and practised in Norwich; another, named Robert Francis,
+was a solicitor in the firm of Bircham, Dalrymple, and Draise, and
+on the retirement of Francis Bircham, his partner, from the post of
+secretary to the Hospital in 1844, R. F. Dalrymple was appointed in his
+place. He discharged the duties of the office most efficiently for two
+years, and was then succeeded by Mr. F. A. Curling.
+
+PLATE X.
+
+[Illustration: JOHN DALRYMPLE, F.R.S.]
+
+Richard Battley married one of Dalrymple’s sisters. John Dalrymple died
+in May, 1852, and Battley in 1856. The latter’s widow, after the death
+of her husband, presented to the Hospital a bust of her brother, which
+now stands in the hall of the present building. In the same year, 1856,
+Robert Dalrymple was elected a member of the Committee of Management of
+the Hospital, and presented to it an engraving of his brother, which
+still hangs in the Board Room of the Hospital, mounted in what was
+described at the time as “an elegant gilt frame.” Another presentation
+to the Hospital that year was a copy of Dalrymple’s Atlas from John
+Churchill, the publisher, with the following inscription on the flyleaf:
+
+  “Presented to the Royal London Ophthalmic Hospital, in honour of that
+  sight-saving Institution, and as a memorial of the highest respect
+  and esteem for the memory of the author, whose lamented death took
+  place soon after the completion of his immortal work, the subscriber
+  having enjoyed the friendship of the author, as well as being his
+  publisher.
+
+  “(Signed) JOHN CHURCHILL.
+
+  “6_th October_, 1856.”
+
+At the Annual General Meeting of the Governors of the Hospital, after
+the death of Richard Battley, the following resolution was passed:
+
+  “That this Meeting most gratefully acknowledge the eminent services
+  to this Hospital of the late Mr. Richard Battley; that to his energy
+  and perseverance are attributed more especially the establishment
+  of the Hospital; that in its origin, when checked by impediments
+  and surrounded by difficulties, it was fostered by his influence
+  and exertions and, in the arduous circumstances which ensued and
+  continued during many years, was succoured and sustained by his
+  active zeal; and that it is especially to be recorded that he
+  upheld the Institution by an undeviating regard to the professional
+  appointments by which the Hospital has been distinguished from its
+  foundation.
+
+  “That this memorial be engraved and placed in the committee room of
+  the Hospital with the portraits of his early friends, Saunders and
+  Farre.”
+
+Gilbert M. Mackmurdo was Dalrymple’s senior; he remained a member of
+the active staff of the Hospital until 1856, and died at an advanced
+age in 1869. In his obituary notice he is said to have had a fine
+appearance, a fair patrimony, and to have enjoyed great City and
+mercantile influence; it was largely due to the latter that he obtained
+his early appointment to the staff at Moorfields, and that of surgeon
+to St. Thomas’s Hospital and to Newgate Prison. The last appointment
+gave him for many years a handsome salary, with a commensurate retiring
+allowance.
+
+Being well provided for with this world’s goods, he seems to have
+contented himself with the practice of the art of his profession
+without making contributions to its science. Early in life he was
+elected a Fellow of the Royal Society, but for what particular reason
+no record can be found. His only contribution to ophthalmic literature
+seems to be a short description of a case of recurrent haemorrhage
+from the inferior palpebral artery. He is said to have been thoroughly
+popular with his pupils and with his patients of all degrees, and
+never, never to have made an enemy in his life, either willingly or
+wilfully.
+
+In 1849 Mrs. Dodson, who had held the post of matron at the Hospital
+for a number of years, died, and a Committee was appointed to report
+on the general arrangements and accommodation of the Institution. The
+following extract from it serves to show what these were, after the
+Hospital had been in existence for half a century:
+
+  “The establishment consists of a Resident Apothecary, a Matron, one
+  Nurse, one Housemaid, and one Cook, all of whom reside upon the
+  premises, and a Porter or Messenger who neither sleeps nor takes his
+  meals in the building.
+
+  “There are 23 beds for patients in five separate wards, and during
+  the winter only from one to five are occupied, whilst during the
+  summer, or from May to October, when the season is propitious for the
+  various operations, the whole of the beds are occupied.
+
+  “The Committee recommends that the new Matron to be appointed should
+  be discreet and mild in her manner, whose standing and carriage
+  is superior to a servant, of about 40 years of age and without
+  encumbrances, and whose duties shall be to render assistance to and
+  alleviate the sufferings of the patients by a regular oversight of
+  them.
+
+  “Her salary to be 30 guineas a year, with an allowance of £5 for tea
+  and sugar.”
+
+As the fame of the Hospital extended there was a rapid increase in
+the patients who came to it seeking relief. The annual number of new
+out-patients became doubled in the course of ten years; in 1841 there
+were 5,643, and in 1851, 11,384.
+
+This large increase made it necessary to provide for increased
+accommodation in the out-patient department. In a letter to the
+Committee, Dr. J. R. Farre drew attention to the early age at which the
+death of several of the members of the surgical staff had taken place.
+Saunders died at the age of thirty-six; Tyrrell at forty-nine; Scott
+at forty-eight; and Dalrymple at forty-nine. Farre suggested that this
+might to some extent be due to the tainted atmosphere of the receiving
+rooms for patients, and to the strain involved in having to attend to
+such large numbers.
+
+A rearrangement of the rooms of the ground floor of the Hospital was
+then made to provide more space for those waiting to be attended to;
+an assistant was engaged to aid in the dispensing; and the staff was
+increased by the appointment of another assistant-surgeon.
+
+The candidates for this post were Mr. H. H. Mackmurdo and Mr. T. N.
+Nunn; the former received 330 votes and the latter 160. The former
+probably, like his brother Gilbert, was able to bring considerable City
+and mercantile influence to assist him; he, however, only held the
+post for a year, and then resigned. Mr. J. C. Wordsworth, who was a
+descendant of a collateral branch of the poet’s family, and who was an
+assistant-surgeon at the London Hospital, was appointed in his place.
+
+
+
+
+CHAPTER VI
+
+THE INTRODUCTION OF INHALATION ANÆSTHESIA AND OPHTHALMIC SURGERY
+
+
+Ether was first employed as an anæsthetic for surgical operations
+in England on December 19th, 1846, when Robert Liston performed an
+amputation of the thigh, and the removal of a great toe-nail, on
+patients under its influence, at University College Hospital, Gower
+Street. In Edinburgh, Sir James Simpson first gave a description of his
+use of chloroform, at the Medico-Chirurgical Society in that city, in
+November, 1847.
+
+The adoption of anæsthetics for general surgical procedures rapidly
+followed, but, due to the sickness by which they were often followed,
+their employment in ophthalmic surgery was for some time delayed. Thus,
+Mackenzie of Glasgow, writing in 1854, says:
+
+  “Needle operations may be performed on timid adults under the
+  influence of chloroform. In extraction I have not ventured to use it,
+  being afraid lest the vomiting which is apt to follow might cause
+  rupture of the internal structures of the eye.”
+
+In a review of Haynes Walton’s textbook on eye diseases in 1853, an
+anonymous writer says:
+
+  “We agree with Mr. Walton that it is not advisable to use chloroform
+  in the extraction of cataract, and we would remark that a surgeon
+  with a sharp eye, a cool head, and a steady hand will usually prefer
+  to have the command of his patient’s voluntary motions, and to avoid
+  the danger which may arise from his restlessness on awaking from his
+  drunken sleep.”
+
+Hulke, writing of his reminiscences of Sir William Bowman’s work, said:
+
+  “In London, so far as my knowledge extends, Sir William Bowman was
+  the first surgeon who employed chloroform in ‘extraction.’ In his
+  first case the administration of chloroform was followed by vomiting
+  after the completion of the operation—which could not have been more
+  perfectly performed—and the violent straining induced choroidal
+  hæmorrhage with extrusion of the vitreous humour and the retina
+  through the corneal incision—the eye was lost. So serious a disaster
+  would have deterred many men from the further trial of chloroform,
+  but its advantages in respect of the performance of the operation
+  were so manifest that Sir William Bowman persevered in its use, and
+  in order to inspire confidence in his patients he experimentally
+  inhaled it to complete anæsthesia himself. His conviction of its
+  extreme usefulness in extraction was soon shared by others, and its
+  employment quickly became general.”
+
+The practice as regards the use of chloroform at Moorfields Hospital
+during the first decade after its introduction is summed up in the
+following extract on the subject from the second edition of James
+Dixon’s _Guide to the Practical Study of the Diseases of the Eye_:
+
+  “We may regard it under two aspects: as saving the patient from
+  pain, and as facilitating the manipulations of the surgeon. Now, it
+  is notorious that operations performed on the globe itself cause
+  very little pain, and last but a very short time. Those on the
+  lids, involving as they do the wounding of the skin, are of course
+  more painful; but, in respect of the suffering they cause, none of
+  these are comparable to the larger operations in General Surgery,
+  and there are few adults who, if thoroughly informed as to the real
+  nature of such operations as those for cataract, artificial pupil and
+  strabismus or even entropion and ectropion in their slighter forms,
+  will not readily undergo them without the aid of anæsthetics.
+
+  “A perfect passive condition of the eye is so desirable in the
+  delicate operations of cataract and artificial pupil, that one
+  would naturally expect to find chloroform universally applicable
+  in such cases; and specially indicated in the most delicate of
+  all—extraction. But this forms a peculiar and exceptional case, and
+  for the following reasons: We have seen that—provided the operation
+  has been properly performed—the successful result of an extraction
+  chiefly depends upon the rapidity with which the union of the corneal
+  wound can be effected. Now, with every precaution it will sometimes
+  happen that chloroform induces vomiting, and the violent efforts
+  which attend this might disturb the lips of the wound, and cause the
+  vitreous body to escape between them, thus inducing a prolapse of
+  the iris, with all its accompanying irritation and retarded union.
+  But, without taking such an extreme case as this, we shall find a
+  very serious objection to the use of chloroform in the fact, that the
+  squeamishness and disrelish for food which it induces may interfere
+  with the reparative process, by impairing the nutrition of the cornea
+  during the critical twenty-four hours immediately following the
+  operation.
+
+  “In adults who are extremely fearful and unsteady, chloroform may be
+  required in the operations for artificial pupil and strabismus; it
+  will always be indicated in cases of extirpation of the globe, and it
+  may greatly facilitate the examination of eyes rendered irritable by
+  disease or by the presence of foreign bodies.
+
+  “In children all these manipulations will be greatly facilitated
+  by the use of chloroform, and some can hardly be performed at all
+  without its aid.”
+
+White Cooper, who was a great friend and follower of Dalrymple, wrote
+in 1853 as follows:
+
+  “In common with many others, I for some time hesitated before using
+  chloroform in extraction of cataract, from a fear that the object of
+  the operation might be defeated by the eye receiving injury during
+  the return of consciousness, or by vomiting afterwards. It appeared
+  to me, however, so deserving of a trial that nearly two years ago I
+  first employed it, and since that time have availed myself of it very
+  frequently in operations on the eye, including 16 cases of extraction
+  of cataract, 9 of artificial pupil, 4 of foreign body in the eyeball,
+  and 2 of tumours of the globe, besides numerous needle cases.
+
+  “The advantage obtained by the use of chloroform in operations on
+  the eye are a perfectly quiescent condition of the globe or the
+  lids, absence of congestion of the eye, and mental tranquillity for
+  the patient. To the operator the perfect repose of the eye affords
+  a manifest advantage, the various steps of the operation being
+  performed with as much facility as in a demonstration on the dead
+  subject; the risk of prolapse of the iris (which is usually caused by
+  muscular action) is greatly diminished, and the corneal flap can be
+  accurately adjusted.”
+
+By improved methods of preparation of patients before the
+administration of chloroform the risks of vomiting became reduced. By
+a modification of the operation of extraction so that a piece of the
+iris was removed, either at the time of the extraction of the cataract
+or as a preliminary procedure, the risk of its protrusion into the
+wound was avoided; and by the modification of the opening made in the
+eye, so that it formed a straight linear incision instead of a flap,
+the risk of its gaping open subsequently was diminished. Ultimately, up
+to the time of the introduction of cocaine in 1884, the employment of
+chloroform for extraction of cataract became the general custom, and
+the performance of the operation without its aid the exception.
+
+The following return of the number of cases to which chloroform was
+administered during the first six months in 1868 shows how general
+its use in operative procedures on the eye had then become: Cataract,
+74; removal of eye, 67; iridectomy, 99; iriddesis, 11; syringe, 15;
+entropion and ectropion, 36; abscission, 5; strabismus, 166; tumours of
+lid and orbit, 8. Total, 481.
+
+After the introduction of anæsthetics many new operative procedures
+on the eye were invented, and those formerly in use, like that of
+extraction of cataract, became modified and improved. In all these
+changes and advances Critchett and Bowman, at Moorfields Hospital,
+played a conspicuous part.
+
+Excision of the eyeball was at one time a most formidable procedure,
+and was only resorted to in cases of malignant growths. Hulke has
+recorded the following graphic description of his recollections of it
+at the time of his pupillage:
+
+  “The first excision of the eyeball that I saw was to me, a novice,
+  so horrible and distressing a scene that the impression it made
+  still lingers in my recollection. No anæsthesia. The surgeon first
+  passed through the eyeball a stout needle armed with stout silk,
+  and knotting the ends, formed a loop. Next, with this he dragged
+  forwards the eyeball, and then scooped it out of its socket with
+  a double-edged scalpel curved on the flat of the blade. This done
+  an assistant, who stood ready with a large brass clyster-syringe,
+  checked the profuse bleeding by squirting into the orbit iced water.
+  How different this from enucleation as now done—methodical circular
+  division of the conjunctiva, severance of the muscles at their
+  insertions into the globe, careful section of the optic nerve with
+  scissors!”
+
+The suggestion that the eyeball might thus neatly and safely be
+dissected out of its encircling capsule originated with an anatomist,
+O’Ferrall, in Dublin in 1841, and was first put into practice by
+Bonnet in France in the following year. George Critchett independently
+adopted it, and gave a description of the proceeding in 1851. After
+that, excision of the eye became an increasingly frequent operation
+for the relief of pain, when the sight was irretrievably destroyed, or
+for the improvement of appearances where the eye had become unsightly
+and disfiguring. The consequent increased demand for artificial eyes
+resulted in their improvement in construction and appearance. Their
+manufacture became a highly specialised art, and a Mr. Gray was
+appointed purveyor of artificial eyes to the Hospital.
+
+PLATE XI.
+
+[Illustration: GEORGE CRITCHETT]
+
+In 1844 Lawrence wrote:
+
+  “The influence of one eye upon the other is not confined to cases
+  of disease. When an eye has been lost by accident, the other
+  often becomes diseased sooner or later, without any imprudence
+  or any external influence that would be injurious under ordinary
+  circumstances. This kind of occurrence is so common, that it is
+  necessary to warn those who have lost an eye of this danger, and the
+  necessary precautions for avoiding it.”
+
+The prophylactic treatment of removal of eyes injured in such a way
+as to provoke this sympathetic disease does not, however, seem to
+have been put into practice until 1854, when it was first adopted by
+Prichard of Bristol. So effectual did this prophylactic measure prove
+that it soon became generally adopted, and excision of the eyeball at
+Moorfields Hospital, from being a rarely performed operation, as it was
+in the pre-anæsthetic days, became one of the commonest operations.
+
+The operation for squint, before the introduction of anæsthetics, was
+a very crude procedure, and was performed often in what seems to-day a
+very indiscriminate manner.
+
+The patient was seated in an armchair with a high back, against which
+the head was fixed by an assistant who stood behind it. The same, or
+another assistant, held the eyelids apart. The operator, standing in
+front, exposed the muscle to be dealt with by making a long incision
+in the membrane overlying it. He then passed a curved grooved director
+beneath it, and divided the muscle by running a sharp-pointed bistoury,
+or knife, along the groove in the director, no special attention being
+paid as to whether the tendon or the muscle itself was cut across. Loss
+of mobility with an unsightly prominence of the eye not infrequently
+resulted; whilst the large, open wound which was left often developed a
+mass of granulation tissue which considerably delayed healing.
+
+Through the ingenuity of George Critchett, a much neater and simpler
+procedure was devised, by which many of the disadvantages of the older
+method were obviated. Only a small opening was made in the conjunctiva,
+the whole proceeding for division of the tendon being carried on
+beneath it, a hook was inserted under the muscle in place of the
+director, and scissors were used to cut through the tendon close to its
+insertion into the eyeball.
+
+Disorders arising in connection with the drainage apparatus for the
+passage of the tears from the eye to the nose have attracted the
+attention of those engaged in the healing art since very ancient times.
+In 1833 Sir William Lawrence wrote that to give a description of all
+the proceedings which have been proposed for removing obstruction to
+the tear duct would fill a moderate volume, but that the greater part
+were obsolete. The collection of all those which have been proposed
+since that date would fill a second volume. Amongst all these different
+methods of treatment, that devised by Bowman in 1851 of slitting up
+the openings into the tear sac at the inner angle of the eyelids, the
+lacrymal puncta and canaliculi, represented a considerable advance on
+those which had been previously employed. He first practised it in
+cases of overflow of tears caused by closure or displacement of the
+lacrymal puncta; afterwards, in the treatment of obstruction of the
+nasal duct, he passed probes through the slit canaliculus to dilate the
+stricture in the duct, and introduced through it styles to be worn for
+a time in order to maintain the dilatation. The introduction of styles
+worn in this way avoided the disfigurement entailed when, as formerly,
+they were introduced through the skin of the nose overlying the tear
+sac.
+
+Gibson of Manchester (as mentioned in Chapter II.), independently of
+Saunders, introduced in 1811 a method of operating on cataracts in
+infants. He first broke up the lens, and reduced it to a pulp, with a
+couching needle; then, two or three weeks later, evacuated it through a
+small incision in the cornea by the introduction of a curette.
+
+This operation, though practised for some time in Manchester, fell into
+disuse. At Moorfields, the Saunderian tradition was still adhered to,
+allowing the lens matter slowly to become dissolved in the fluids of
+the eye. In 1851 Bowman revived and improved upon Gibson’s operation,
+and in 1864, in the Ophthalmic Hospital Reports, T. Pridgin Teale,
+junr., described how, in order to aid the removal of softened lens
+matter, he had employed a suction curette. The curette was converted
+into a tube by having its groove roofed over to within a line of
+its extremity; it was connected with an indiarubber tube, and the
+suction was made by the mouth of the operator. The idea of extraction
+by suction can, he said, “boast of considerable antiquity, as the
+following quotation, kindly sent me by Mr. Bowman, will show
+
+  “According to Avicenna a similar proceeding (viz., excision of
+  cataract, by opening in the cornea and drawing out the cataract by
+  a needle) was practised by the Persians in the fourth century, and
+  Albucasis reports that the procedure was gradually displaced by the
+  ‘suctions-method,’ in which the cataract was sucked out through a
+  hollow needle.”
+
+Bowman himself, later on, had constructed a suction apparatus for soft
+cataracts, which could be manipulated with one hand, the suction being
+made by the movement upwards of a piston with the thumb.
+
+After the introduction of anæsthetics, which allowed of patients being
+kept perfectly quiet during the performance of operations on the eye,
+procedures requiring great precision and skill were introduced by both
+Bowman and Critchett for the formation of artificial pupils.
+
+Bowman, in order to produce an enlargement of the pupil of a limited
+extent, in a suitable direction, whilst still keeping it as central
+as possible, made use of canula-scissors. These were scissors with
+delicate blades expanding from a stem which moved up and down in a
+canula, the size of a cataract needle, by means of a spring in the
+handle. When the spring was pressed the scissors were closed by being
+drawn partly into the canula, and when it was relaxed they opened,
+being protruded by the spiral wire. One blade of the scissors, which
+protruded beyond the other, was pointed with a sharp cutting edge
+capable of penetrating the cornea and allowing the whole of the closed
+scissors being introduced into the anterior chamber of the eye. The
+other shorter blade of the scissors was blunt-pointed. When within
+the eye, the blades of the scissors were opened and made to cut the
+pupillary border of the iris, the blunt-pointed blade being passed
+behind and the sharp-pointed one in front. The calibre of the canula
+was so graduated as to plug the wound through which it was introduced,
+and prevent the escape of the aqueous humour.
+
+For use in other cases he had constructed a modified form of Tyrrell’s
+hook. It was of the same size, but sharp and flattened at the point.
+Its stem was cylindrical so as exactly to occupy the corneal wound and
+prevent the escape of the aqueous humour. With this “needle hook,” as
+he termed it, the necessity of making a preliminary incision with the
+loss of the aqueous humour, before the introduction of the hook, was
+avoided; the needle hook introduced itself into the eye, the retention
+of the aqueous humour facilitating the precision with which the hook
+could be passed round the pupillary border.
+
+Critchett invented an operation which he called “iriddesis,” or the
+formation of artificial pupil by tying the iris. The purpose of the
+procedure he described as follows:
+
+  “The formation of what is commonly called an artificial pupil is
+  required under various morbid or abnormal conditions of the eye,
+  and demands a corresponding variety in the modes by which it is
+  accomplished. In some cases, a restoration of the original pupil as
+  regards size and situation is all that is wanted; in others, a change
+  in the size, shape, and situation of the natural pupil is required;
+  or, again, it may be necessary to form a new pupil in an abnormal
+  situation and in the very substance or tissue of the iris. In each
+  of these different cases the object is the same—viz., to establish a
+  clear pupil or aperture in the iris opposite to a transparent part of
+  the cornea.
+
+  “It is very desirable that, in the formation of an artificial pupil,
+  the conditions upon which the perfection of the natural pupil
+  depends should be as nearly as possible preserved and imitated, both
+  as regards its position and defined border, its size, mobility,
+  and sensitiveness to light. In the methods usually employed these
+  conditions are frequently unattainable, and the circular fibres of
+  the natural pupil are either cut or torn through, and an opening is
+  formed which is very probably large and irregular in shape, fixed and
+  insensible to light, ill-defined and extending to the margin of the
+  cornea—thus admitting rays of light that are too much refracted by
+  the margin of the lens, and having the effect altogether of confusion
+  of vision.”
+
+His operation, designed to overcome the disadvantages above mentioned,
+consisted in drawing into a wound at the margin of the cornea, with
+canula-forceps, a small piece of the periphery of the iris and fixing
+it there by tying a loop of silk around it. In this way an alteration
+of the position of the pupil was effected without its margin being cut
+or the sphincter muscle interfered with.
+
+The operation was for some time extensively practised at Moorfields,
+not only by Critchett, but also by Bowman and Poland. In cases of
+conical cornea, Bowman, by performing this operation at the outer and
+inner margin of the cornea, produced a laterally elongated slit-like
+opening; in order to create the same beneficial visual effect, in such
+cases, as is sometimes derived by holding a slit-shaped opening in a
+metal disc in close proximity to the eye.
+
+Later on, it was found that this ingenious operation of iriddesis was
+liable to be followed by inflammation in the eye of a type which might
+spread to the fellow eye: it became, therefore, entirely abandoned.
+
+Another discovery which largely extended the range of operative
+ophthalmic surgery was that glaucoma could be relieved by the removal
+of a piece of the iris.
+
+A. von Graefe first performed an operation of this description for
+glaucoma in Berlin in June, 1856. His study of the natural history
+of the disease, and of its ophthalmoscopical appearances, had led
+him to the conclusion that increased hardness, or tension, of the
+eyeball was the leading factor in its causation, and that, if some
+means could be devised of permanently lowering the tension, its cure
+might be effected. Experience had shown him that after the removal
+of a piece of the iris to form an artificial pupil, in eyes where the
+tension was increased, normal tension became restored. After having
+performed experimental iridectomies on animals’ eyes, he felt justified
+in trying the effect of the operation on patients suffering from
+glaucoma, and with the most gratifying results. Up to that time the
+disease inevitably resulted in blindness, and in some of its forms was
+accompanied by the most agonising pain and distress. The discovery of
+a means whereby not only could the pain be relieved, but the loss of
+sight also prevented, must always be regarded as one of the greatest
+triumphs of ophthalmic surgery.
+
+The successful performance of iridectomy for glaucoma requires a
+steadier hand and more skill than any other operation on the eye. It is
+also necessary to have the patient absolutely quiet. The acute pain to
+which the affection gives rise renders the eye exceedingly sensitive,
+and even to-day most surgeons prefer to perform it on patients under
+the influence of a general anæsthetic. Indeed, the introduction of
+inhalation anæsthesia may be said to have paved the way for the
+operative treatment of glaucoma.
+
+1851 was the year of the first Great Exhibition in London, held in
+the Crystal Palace in Hyde Park. Visitors from all parts of the world
+flocked to see it, and amongst them came Albrecht von Graefe, then
+twenty-three years of age, full of enthusiastic ardour and fresh
+from his studies in the clinics of Germany, Vienna, and Paris; also
+Frans Cornelius Donders, thirty-three years of age, whom his friend
+Moleschott described with fervid admiration as “a swelling rose-bud,
+whose calix leaves signified nothing but pure science; the flower
+leaves hidden glory. In one word, he was a man complete—perfect for
+his time of life.” He was at that time Professor Extraordinary at the
+University of Utrecht, and lectured on no less than four subjects—viz.,
+Forensic Medicine, Anthropology, General Biology, and Ophthalmology.
+
+These two men and Sir William Bowman, destined to revolutionise the
+practice of ophthalmology, met for the first time in London in that
+eventful year, and remained on terms of the most intimate friendship
+for the rest of their lives. Donders and Bowman have left on record the
+following interesting descriptions of their first meeting; the first
+wrote:
+
+  “In August, 1851, at the International Exhibition, chance threw von
+  Graefe and myself together in London. I had already enjoyed the
+  companionship of Friedrich von Jaeger, when one morning a young man
+  in Alpine costume rushed into Guthrie’s eye hospital—he had reached
+  London but two hours before—and threw himself into Jaeger’s arms.
+  With the words, ‘You are made for each other,’ the latter literally
+  threw him into mine. And he was not mistaken. From early morning,
+  when, on our way to Moorfields Hospital, we took our modest breakfast
+  in Oxford Street amongst the workmen going to their work, till late
+  evening, when we gratefully quitted the hospitable home of our friend
+  William Bowman, we remained inseparably united in common objects of
+  pursuit. Von Graefe was my guide in practical work, of which I had as
+  yet but little experience, and I again could impart to him much from
+  the physiological side. This mutual instruction constituted for us a
+  great attraction. These days in which von Graefe unfolded the whole
+  charm of his nature belong to the happiest recollections of my life.”
+
+Bowman, in describing Donders’ visit to London that year, says:
+
+  “It was his first travel, and it brought him, at least, one thing for
+  which he had great reason to be thankful—the personal friendship of
+  Albrecht von Graefe, an association soon to be fraught with splendid
+  results for the expanding science of ophthalmology; for these two
+  men, both of the first capacity, laboured ever afterwards to advance
+  it as brothers in council, and alike fruitfully; freely communicating
+  their ideas to each other, always in perfect harmony of aim. While
+  von Graefe, a stranger in London, was able to tell Donders of the
+  European hospitals he had been visiting, and of the new clinical
+  ideas he was maturing, as well as of the construction in that year,
+  by Helmholtz at Konigsberg, of a dioptric apparatus for rendering
+  visible the fundus of the eye, Donders, a stranger there too, could
+  on his side explain many discoveries of his own in the physiological
+  field, and, amongst other things, declare the true nature of the act
+  of accommodation, quite recently disclosed with certainty by his
+  countryman Cramer, under, it may be added, his own inspiration and in
+  his own laboratory.”
+
+Sir William Bowman at the time of this memorable meeting was older than
+his two friends, being thirty-five years of age. His biographer wrote
+of him:
+
+  “At a period of life when most men are only beginning to apply
+  their powers of observation and reflection, he, exercising both
+  in a high degree, had already done work quite unexampled for its
+  novelty, interest, variety, and above all for its accuracy. Before
+  attaining the age of twenty-six, he had won for himself a leading
+  position amongst the most eminent anatomists of his time as a
+  microscopist of first-rate ability, and the discoveries he had made,
+  with the conclusions he drew from them, have ever since exercised
+  an important influence in practical medicine, and have served as
+  models for all subsequent and similar investigations. Later in life
+  he became distinguished as an original investigator in physiology,
+  and as a teacher in that subject, and, at a still later period,
+  devoting himself to a special branch of his profession, he stepped
+  naturally and easily into the position of leader and representative
+  of ophthalmic medicine and surgery, holding the same position in this
+  country, though for a far longer period, that was occupied in Germany
+  by his friend von Graefe, and in Holland by his still more intimate
+  associate Donders.”
+
+PLATE XII.
+
+[Illustration: SIR WILLIAM BOWMAN, BART., F.R.S.]
+
+As the immediate result of his histological work on muscle, Bowman was
+in 1841, at the unusually early age of twenty-five, elected a Fellow
+of the Royal Society. At the Oxford meeting of the British Medical
+Association, in 1847, he read a paper entitled, “On some Points in the
+Anatomy of the Eye, chiefly in Reference to the Power of Adjustment,”
+in which he demonstrated, simultaneously with and independently of
+Bruecke, the structure and function of the ciliary muscle.
+
+In the same year, he delivered to the students at Moorfields Hospital a
+series of six lectures dealing with the parts concerned in operations
+on the eye and on the structure of the retina. They contained an
+account of his investigations into the microscopical anatomy of the
+eye, and were published in book form two years later, a book which ever
+since has been regarded as one of the classics of ophthalmology; a
+French translation of it by M. Testelin was published in the _Annales
+d’Oculistiques_ in 1855.
+
+Bowman’s discovery of the ciliary muscle, bearing as it did on Donders’
+investigations on the accommodation of the eye, formed from the first a
+bond of intellectual union between the two men, which, with the growth
+of years, ripened into the warmest esteem and friendship. Donders wrote
+on the front leaf of his great work, _On the Anomalies of Accommodation
+and Refraction of the Eye_:
+
+  “To William Bowman, F.R.S., whose merits in the advancement of
+  Physiology and Ophthalmology are equally recognised and honoured
+  in every country, this work on the anomalies of refraction and
+  accommodation is, in testimony of the warmest friendship and of the
+  highest esteem, inscribed by the Author.”
+
+Though Graefe first performed the operation of iridectomy for glaucoma
+in June, 1856, it was not until the following year that he published an
+account of his great discovery. He wisely waited until he had tested it
+in the different varieties and stages of the disease until he gave an
+account of it to the world at large.
+
+Dr. Bader, the curator and registrar at Moorfields, wrote in 1859:
+
+  “The first instance of glaucoma treated by excision of a portion
+  of iris by von Graefe’s method was in a case of chronic glaucoma,
+  operated upon May 1st, 1857; a second case was treated in the same
+  manner in October in the same year. Both were cases of chronic
+  glaucoma in an advanced stage, and the immediate result for vision
+  was not such as would recommend the operation. Then came several
+  cases of acute and subacute glaucoma, in which a striking improvement
+  followed shortly after the operation. Since then iridectomy has been
+  tried extensively at Moorfields, and with good and lasting results in
+  many cases.”
+
+In the second number of the _Ophthalmic Hospital Reports_, published in
+January, 1858, Critchett recorded some cases of acute glaucoma which he
+had treated successfully by iridectomy, though not quite in accordance
+with Graefe’s method.
+
+Some years later Bowman wrote the following description of the
+introduction of the operation into this country:
+
+  “Since the winter of 1856–7, the splendid researches of von Graefe
+  on the nature and treatment of glaucoma have prominently attracted
+  attention. On the Continent, his proposal to arrest the disease by
+  the excision of a portion of the circle of the iris has been adopted
+  and practised by the ablest men, including especially Professors
+  Donders of Utrecht, Arlt of Vienna, and Desmarres of Paris. In May,
+  1857, I first performed it in England. At the Ophthalmological
+  Congress at Brussels, in September following, von Graefe gave an
+  account of his researches, and distributed amongst his friends an
+  essay on the subject, then just presented to the French Institute.
+  In the ensuing autumn, iridectomy as a remedy for glaucoma was, in
+  my opinion, and in that of my friend and colleague, Mr. Critchett,
+  established by the facts we had ourselves observed, as a proceeding
+  competent to cope with the disease, by reducing that tension of the
+  eyeball, and compression of the retina and its vessels, which is the
+  cause of the loss of sight.
+
+  “It was our earnest wish that the value of von Graefe’s discovery
+  should be early and extensively acknowledged by medical men, so
+  that those suffering from so serious a malady might no longer be
+  drifting, as before, into hopeless blindness. Since then we have
+  with no faltering voice continued to advocate the practice, and have
+  performed the operation on all suitable occasions, both in private
+  and in public. At Moorfields, iridectomy has been exhibited and
+  tested on a very large scale, scarcely a week having passed since
+  1858 without one or more instances of it; and a host of competent
+  observers, both students and practitioners, have witnessed the method
+  of performing it, and its results, in the hands of several of my
+  colleagues and myself.”
+
+Both Critchett and Bowman began as general surgeons as well as
+ophthalmic surgeons. Critchett was appointed assistant-surgeon at the
+London Hospital in 1846, and became full surgeon in 1861. Bowman was
+appointed assistant-surgeon at King’s College Hospital in 1840, and
+became full surgeon in 1856.
+
+So extensive and absorbing became their work in ophthalmology that both
+of them ultimately found it necessary to resign their general surgical
+appointments and devote themselves exclusively to the treatment of eye
+diseases.
+
+Their reputation as masters in their speciality was not confined to
+their own country, but became world-wide. George Critchett, who was
+an admirable French scholar frequently attended the meetings of the
+International Ophthalmological Congress, and his son, Sir Anderson, was
+fond of relating how, at one of its meetings held in Paris in 1867, he
+performed the operation of extraction of cataract before the assembled
+Congress, on the two eyes of a patient, using his right hand for the
+one eye and his left hand for the other. So great was his dexterity
+that at the conclusion of the operation, Graefe, who was presiding
+at the Congress threw his arms round his neck and kissed him on both
+cheeks.
+
+Both Critchett and Bowman were men with strong and attractive
+personalities, and collected around them at Moorfields not only a large
+body of students, but also practitioners who were devoting themselves
+to ophthalmology from all parts of the world. In 1859 they commenced to
+supplement their clinical teaching by giving a systematic three months
+course of lectures on Ophthalmic Surgery, attendance at which course
+enabled students to comply with the rules of the Royal College of
+Surgeons for obtaining a certificate.
+
+Most foreign missionaries from this country have endeavoured to
+promote the spread of Christianity by practising gratuitously the
+healing art. David Livingstone was a qualified medical man, and
+administered medical relief to large numbers of the African natives
+amongst whom he lived. From some remarks of Sir J. Risdon Bennett,
+with reference to Livingstone’s medical studies in London in 1839, it
+seems probable that he was then in attendance at Moorfields Hospital.
+Many missionaries have not sufficient medical training to entitle them
+to practise in this country, but, when abroad, feel themselves called
+upon to administer such European drugs as they possess, having greater
+knowledge of their uses than the inhabitants of the district in which
+they are situated. It was to aid such persons to alleviate affections
+of the eye that the Committee of Management of the Hospital obtained
+the consent of the medical staff, in 1854—
+
+  “To admit gratuitously to the practice of the Hospital gentlemen
+  qualified to derive advantage from it, by the possession of some
+  amount of preliminary medical knowledge; provided they be duly
+  authenticated to them by a Missionary Society or otherwise, as being
+  about to proceed on missionary labours abroad.”
+
+A letter was then drawn up and printed, embodying this resolution, for
+circulation amongst those whom it might interest. Large numbers of
+missionaries, both men and women, have since availed themselves of the
+opportunities thus afforded them before taking up their duties abroad,
+and in this way the teaching and benefits of Moorfields have been
+spread to remote regions and to many uncivilised people.
+
+
+
+
+CHAPTER VII
+
+THE DISCOVERY OF THE OPHTHALMOSCOPE
+
+
+The two decades from 1850 to 1870 may well be described as the golden
+age of ophthalmology, on account of the many new discoveries and
+developments made in connection with it during that epoch.
+
+In the last chapter the surgical improvements which were effected have
+been spoken of, together with the crowning achievement of them all—the
+introduction of the operation of iridectomy for the relief of glaucoma.
+
+In this chapter will be described an event, destined not only to
+change the whole outlook of ophthalmology, but also to add a valuable
+means for the detection of disease in many of the organs and tissues
+of the body—the discovery of the ophthalmoscope. Following on its
+discovery, and to some extent incidental to it, came the recognition
+of the different forms of errors of refraction, and the building up of
+the methods for their correction with glasses, with which the name of
+Donders will for all time be associated.
+
+The merit of discovering the ophthalmoscope, and of having given it
+to the world in 1851, belongs to Professor von Helmholtz, who, having
+commenced his career as an army surgeon, was, by his mathematical
+talents, led on from the study of physiology to that of physics, and
+to the production of his greatest work, his _Manual of Physiological
+Optics_.
+
+The ophthalmoscope was, he said,
+
+  “a discovery rather than an invention; that is to say, when a
+  well-trained physicist came and grasped the importance of such an
+  instrument, nothing more was wanted, since all the knowledge had been
+  developed which was required for its construction.”
+
+In speaking of his discovery in later years he said:
+
+  “The ophthalmoscope has unfolded itself to me simply out of the
+  necessity of discussing, in my lectures on physiology, the theory
+  of emission of light by the eye. Why does the human eye not glisten
+  under ordinary circumstances, since in its background there is
+  situated a spot— small, indeed, but clear white; that is to say, the
+  end of the optic nerve, which must reflect light in the same way as
+  the most sparkling tapetum of animals’ eyes? Why do animals’ eyes
+  sometimes shine with such remarkable lustre, though they may only
+  be illuminated by a small distant flame? These questions, when once
+  proposed, were not difficult to answer, and now the answer is known
+  to everybody. Once answered, they furnished the means of lighting up
+  the eye of another human being, and of seeing it plainly.”
+
+It not infrequently happens, that when time is pregnant with some
+new discovery, more than one person is found to have been hopefully
+striving to become its accoucheur. So it was with the discovery of the
+ophthalmoscope. Here in England, in 1846, William Cumming, a young
+surgeon who was working at the Royal London Ophthalmic Hospital, had
+noticed that a reflex could be obtained from the fundus of the human
+eye under certain conditions of illumination. At the Medico-Chirurgical
+Society that year he read a paper entitled “On a Luminous Appearance
+of the Human Eye,” the conditions for obtaining which he described as
+follows:
+
+  “(a) That the eye must be at some distance from the source of light,
+  the distance being greater in proportion to the intensity; (b) that
+  the rays of light diffused around the patient (and sometimes around
+  the eye itself) should be excluded; (c) that the observer should
+  occupy a position as near as possible to the direct line between the
+  source of light and the eye examined.”
+
+With remarkable prospection he foreshadowed some of the results which
+were ultimately obtained from the use of the ophthalmoscope; thus he
+wrote:
+
+  “The establishment of the fact of a similar reflection from the human
+  eye to that from the eyes of animals appears to be chiefly important
+  in its adoption as a mode of examining the posterior part of the
+  eye. The retina and choroid hitherto concealed in the living eye,
+  and little opportunity being afforded of examining their condition
+  after life, in consequence of their diseases not terminating fatally,
+  considerable uncertainty had hitherto attended the diseases ascribed
+  to these structures; but the existence of this luminosity, its
+  non-existence, or abnormal appearance may enable us to detect changes
+  in these structures hitherto unknown, or satisfactorily to see those
+  which we only suspected.
+
+  “If we dilate the pupil with atropine, we have the means afforded
+  of seeing the condition of the retina and choroid in every case.
+  The cases I have examined in this way have confirmed the general
+  impression that the retina is not frequently the seat of changes
+  in amaurosis; for, out of several cases of amaurosis, in which the
+  non-opacity of the cornea, lens, and humours allowed this mode of
+  examination, I found but two in which the retina was so changed that
+  the reflection was not seen.”
+
+Cumming discussed these matters with Dixon and Bowman, the latter
+suggesting to him that the choroid and its pigment was probably the
+reflecting surface. Another quotation from his article will show how
+near he actually came to the discovery of the ophthalmoscope; thus he
+wrote:
+
+  “On approaching within a few inches of the eye the reflection is
+  not visible, for, before our eye can be brought within range of the
+  reflected rays, the incident rays are excluded.”
+
+Cumming died in 1855, at the early age of thirty-three, but just lived
+sufficiently long to see that what he had fore-told was being realised.
+In 1862 a portrait in oil-colours of him was presented to the Hospital
+by one of his relatives with the following letter:
+
+  “2, Vittoria Place, Limehouse,
+
+  “_November_ 11_th_, 1862.
+
+  “Sir,
+
+  “I have the pleasure of presenting to the Hospital a portrait of
+  the late William Cumming of Limehouse. It is from a painting in
+  possession of the family.
+
+  “William Cumming was honourably connected with the Institution, was
+  discoverer that the fundus of the living eye could be explored, and a
+  pioneer in the recent advances in Eye Surgery.
+
+  “He died in 1855 at the early age of 33 years.
+
+  “I am, etc.,
+
+  “JOHN STEWART CUMMING.”
+
+This portrait still hangs in the Board Room of the Hospital.
+
+In 1847 Charles Babbage, a distinguished mathematician and scientific
+mechanician, who held the Lucasian Chair of Mathematics at Cambridge,
+and who spent a large part of his life in the construction of
+a calculating machine, actually invented an ophthalmoscope. He
+himself published no description of it, and we know nothing of the
+circumstances which led up to this invention; the only record we have
+concerning it is that published by Wharton Jones in 1854, in a “Report
+on the Ophthalmoscope” in the _Medico-Chirurgical Review_. He wrote:
+
+  “It is but justice that I should here state, however, that seven
+  years ago Mr. Babbage showed me the model of an instrument that he
+  had contrived for the purpose of looking into the interior of the
+  eye. It consisted of a bit of plain mirror, with the silver scraped
+  off at two or three spots in the middle, fixed within a tube at such
+  an angle that the rays of light, falling on it through the side of
+  the tube, were reflected to the eye to be observed, and to which one
+  end of the tube was directed. The observer looked through the clear
+  spot of the mirror from the other end.”
+
+PLATE XIII.
+
+[Illustration: WILLIAM CUMMING.
+
+From a painting in the Board Room of the Hospital.]
+
+Probably Wharton Jones, who was himself short-sighted, in using
+Babbage’s reflecting mirror, without any lens, only obtained a red glow
+from the fundus of the eye, and saw nothing of the optic nerve or of
+the retinal bloodvessels, for, had he done so, it seems unlikely that a
+man of his powers of observation and scientific attainments would not
+have realised the possibilities of such an instrument.
+
+Anyhow, he gave Babbage no encouragement, and the instrument was laid
+aside as a mere toy.
+
+Indeed, it seems doubtful if Helmholtz himself at first fully realised
+the possibilities of his great discovery. On the occasion of the
+presentation to him of the first Graefe medal in Heidelberg in 1886,
+Donders spoke as follows:
+
+  “How the ophthalmoscope could be serviceable to ophthalmologists,
+  how the eye under examination, whilst its fundus becomes visible,
+  constitutes for the emmetropic examiner a lens, too weak in myopia,
+  in hypermetropia too strong; and how simultaneously with the
+  examination of the fundus, the refraction can be determined; all this
+  was clearly indicated by von Helmholtz. But he never thought, or at
+  least he never said, that the new instrument implied the dawning of
+  a new era for ophthalmology. Von Graefe felt it immediately. When
+  he, for the first time, saw the background of the eye, with its
+  nerve-entrance and its bloodvessels, his cheeks reddened, and he
+  called out excitedly. ‘Helmholtz has unfolded to us a new world,’ and
+  then, ‘What remains there to be discovered?’ added he thoughtfully.
+
+  “It was, indeed, humiliating to hear it said, banteringly, that black
+  cataract was that disease in which the patient saw nothing, nor the
+  surgeon either. Treatment was then but a groping in the dark. Under
+  the same name were thrown together the most diverse affections of
+  the fundus oculi and of the nerve apparatus; and even disturbances
+  of refraction and accommodation, such as astigmatism and muscular
+  asthenopia, were reckoned with amblyopia. And, against these most
+  diverse disturbances, the same empirical remedies were employed many
+  of them a real torment to the patient not only with little beneficial
+  result, but sometimes at the cost of health.”
+
+The increasing number of operative procedures performed at the
+Hospital, and the coming of the ophthalmoscope, created a demand for
+more accommodation in both the in- and out-patient departments. The
+alterations necessary to supply these wants extended over several
+years, but ultimately resulted in the transference of the out-patient
+department, together with the dispensary and a dark room for
+ophthalmoscopic work, to newly erected buildings on the site of the
+Saunderian Institute, and the yard at the back of the main building.
+The ground floor of the latter was then utilised for rooms for the
+resident staff and for a committee room, and the first floor was turned
+into wards for in-patients.
+
+Battley having ceased his pharmaceutical investigations and teaching,
+and Dr. Farre his pathological researches, they consented to hand over
+all their rights in the Saunderian Institute so that it might be made
+use of by the Hospital.
+
+Shortly before Tyrrell’s death, the Committee of Management had under
+consideration the hardship of an assistant-surgeon remaining on
+the staff for a number of years without the opportunity of gaining
+experience in performing the major operations on the eye. When Tyrrell
+died, both Mackmurdo and Dalrymple became full surgeons, and the matter
+was left for a time in abeyance. In 1854, however, at a meeting of the
+Governors, the rules were altered so that—
+
+  “any assistant-surgeon who shall have served the Hospital five years
+  shall, provided he be a Fellow of the College of Surgeons, become, if
+  the Committee think fit, a surgeon.”
+
+At the same time the title of the resident medical officer was changed
+from apothecary to house surgeon.
+
+In 1854 the Crimean War commenced; its immediate effect on the Hospital
+was a reduction in its receipts from donations and subscriptions, which
+together amounted to £614 in 1853, and only to £236 in 1854. A Jubilee
+dinner to commemorate the fiftieth anniversary of the foundation of
+the Hospital was abandoned, and the building operations of the new
+out-patient department postponed.
+
+PLATE XIV.
+
+[Illustration: JAMES DIXON. JOHN CAWOOD WORDSWORTH.]
+
+In 1855 Wordsworth, the junior assistant-surgeon, answered Mr. Sydney
+Herbert’s call for volunteers in aid of the overtaxed military medical
+officers in the East, and, having obtained leave of absence from the
+Committee of Management, went as surgeon to the Civil Hospital at
+Smyrna. Later he was transferred to the Crimea, which he reached just
+in time to render good service “in the front” to those wounded in the
+attack upon the Redan. For three months of the following winter he was
+attached to the Castle Hospital on the heights above Balaclava.
+
+On the conclusion of the war, at the annual general meeting of the
+Governors, the following resolutions were passed:
+
+  “That this meeting, holding in the highest respect and esteem the
+  humane and benevolent consideration and sympathy manifested for the
+  Army in the East, during the late War with Russia, by the Right
+  Honourable Sydney Herbert, M.P., respectfully requests Mr. Herbert to
+  accept the nomination of Honorary Life Governor and Vice-President of
+  this Hospital.
+
+  “That this meeting appreciates most highly the humane and benevolent
+  ministrations of Miss Florence Nightingale to the sick and wounded
+  in the service of the country in the East during the late War with
+  Russia, and it is hereby resolved that Miss Nightingale be a Life
+  Governor of this Hospital.”
+
+Miss Nightingale and Mr. Sydney Herbert both replied accepting with
+pleasure these nominations.
+
+Though Miss Nightingale was made a Life Governor of the Hospital, it
+was not until many years later that the reforms in the system of sick
+nursing, which she was instrumental in bringing about, were introduced
+at Moorfields.
+
+In 1859, in consequence of the increased accommodation for in-patients,
+it was arranged that there should be a nurse with an assistant on each
+of the two floors. It was also ordered “that in future every patient
+on admission to the wards be bathed, unless otherwise ordered by the
+admitting officer.” But that much was left to be desired in the matter
+of nursing will be gathered from a note directed to the Committee by
+the Medical Council in 1861, in which it requested the Committee to
+consider the advisability of providing proper receptacles for keeping
+the in-patients’ clothes, “which are now generally put under the
+bedding, the consequence of which is that the beds occasionally get
+infested with vermin, to the serious discomfort of the patients who
+subsequently occupy them.”
+
+In 1856 Dr. Frederick Farre, who had become full physician at St.
+Bartholomew’s Hospital, found that pressure of work necessitated his
+resigning his post on the active staff at Moorfields. His father, Dr.
+J. R. Farre, at the same time withdrew from his position of consulting
+physician, and Dr. Frederick Farre was appointed in his place. The
+family’s connection with the Hospital was still further maintained by
+the appointment of Dr. J. R. Farre’s younger son, Dr. Arthur Farre, a
+distinguished physician accoucheur, as a member of the Committee of
+Management.
+
+Dr. Robert Martin, an assistant-physician at St. Bartholomew’s
+Hospital, being the only candidate, was elected physician.
+
+In the same year Gilbert Mackmurdo, who had served on the staff of the
+Hospital for a period of thirty-six years, resigned and was appointed
+consulting surgeon. The appointment of a new assistant-surgeon to fill
+the vacancy thus created gave rise to a most keenly contested election,
+in which 458 Governors recorded their votes. One of the daily papers,
+describing the event, stated “that the usually quiet neighbourhood of
+Finsbury was the scene of great excitement.”
+
+There were four candidates, and, at the close of the poll, the
+scrutineers announced that the votes had been distributed as follows:
+
+  Mr. J. S. Gamgee               3
+  Mr. J. W. Hulke              148
+  Mr. J. F. Streatfield        214
+  Mr. Walter Tyrrell            93
+
+This method of election by Governors of the members of the medical
+staff was the general practice at most hospitals at that time; but
+though it helped to increase the funds of those institutions, it
+was not well calculated to secure the services of the most suitable
+candidate, and, as we shall see later, was subsequently abandoned.
+
+The Governors consisted of “Life Governors”—_i.e_. those who had
+contributed ten guineas in the course of one year, and annual
+subscribers of one guinea. A body of electors so formed was not well
+qualified to judge of the relative merits of rival candidates; and a
+candidate, with a number of friends willing to promote his interests
+by becoming subscribers, might thereby bring about a preponderating
+influence in his favour. Moreover, where more than two candidates
+presented themselves, the successful candidate might, as in this 1856
+election, be elected without having received a majority of the votes
+recorded.
+
+With an electorate of between 400 and 500 Governors, a candidate who
+set out to canvass them had a formidable task before him, and one which
+often proved an expensive proceeding. The last surgeon elected to the
+staff in this way estimated his costs at nearly £100, which seems an
+inordinate amount to expend for obtaining the privilege of giving
+one’s time and service to the relief of the poor and needy. It can,
+therefore, be easily understood why a candidate who found his chances
+of election doubtful, frequently withdrew in favour of one of the
+others, and contented himself with announcing his intention of applying
+again on a future occasion.
+
+John Fremlyn Streatfield was the son of a well-known antiquarian, the
+Rev. Thomas Streatfield, of Charts Edge, Westerham, Kent. He inherited
+his father’s antiquarian instincts and was also a staunch Churchman.
+He studied medicine at the London Hospital, and, like several of the
+other oncoming surgeons at Moorfields, served in the East at one of the
+British hospitals during the Crimean War. In 1862 he was appointed
+assistant ophthalmic surgeon at the University College Hospital, and
+shortly afterwards, on the retirement from the staff there of Wharton
+Jones, succeeded him as full surgeon.
+
+Streatfield was gifted with remarkable manipulative dexterity, and
+delighted in using his fingers in a way which most people would
+have regarded as impracticable. There was, indeed, something almost
+acrobatic in his method of operating, and George Critchett used
+jokingly to remark that he expected one day, on going into the
+operating theatre, to find Streatfield removing a cataract whilst at
+the same time he balanced a feather on his nose.
+
+On the death of Earl Fitzwilliam, in 1857, the post of President of
+the Hospital became vacant, and Mr. William Cotton, D.C.L., F.R.S.,
+an eminent merchant and philanthropist, having consented to be
+nominated for the post, was elected by the Governors. He was at one
+time Governor of the Bank of England, and invented a most ingenious
+machine, which has ever since been in use, for weighing sovereigns at
+the rate of twenty-three per minute; it is capable of discriminating
+to a ten-thousandth part of a grain, discharging the full-weight and
+the under-weight into different compartments. He was, perhaps, even
+more noted for his philanthropy than his ingenuity: he founded several
+churches and gave assistance to many charitable institutions.
+
+At the same time H.R.H. the Duke of Cambridge was invited to become a
+Patron of the Hospital, which invitation he most graciously accepted.
+
+As the medical staff became enlarged, its members formed themselves
+into a “Medical Council,” to give collective consideration to matters
+referred to it by the Committee of Management, or to initiate measures
+for promoting the prosperity of the Hospital and the progress of
+ophthalmology. In 1857, when several regulations and practices which
+had been introduced were being codified, the following rule became
+included amongst those governing the Institution:
+
+  “The physicians, if any, surgical officers, with the consulting
+  physicians and consulting surgeons, if any, shall constitute a
+  Medical Board empowered to consult on all matters connected with the
+  medical department, with the admission and conduct of pupils, and
+  shall report to the Committee from time to time.”
+
+In 1856 this Medical Council made the following proposal to the
+Committee which led to the establishment of the posts of clinical
+assistants:
+
+  “That with a view to aid in treating the less important cases, to
+  assist the clinical work of the out-patient room and in case-taking,
+  it might be worthy of the consideration of the Committee, whether
+  advantage might not be taken of the zeal and knowledge of some of
+  the younger surgeons attending the Hospital, by electing them for a
+  period of six or twelve months, as assistants to the surgeons. The
+  Committee might appoint such assistants to any of the surgeons who
+  might require aid. They should be qualified to practise, and of such
+  established character that perfect confidence could be placed in them
+  for the steady performance of their duties. Many of these men, after
+  completing their term of office, would carry skill to various parts
+  of the country in which they settle, while from them the Governors
+  would be gradually furnished with highly competent candidates for the
+  vacancies which from time to time occur in the staff. Their title
+  might be that of ‘clinical assistants,’ and they would be entitled on
+  retirement to a superior certificate.”
+
+These recommendations of the Medical Council were put into practice,
+and have continued ever since to work out in the ways which it had
+forecast. The first clinical assistants to be appointed were Mr. J. W.
+Hulke, Mr. Jonathan Hutchinson, and Mr. Walter Tyrrell; and a year or
+so later, Mr. G. Lawson, Mr. Harkness, Mr. Hughlings Jackson, Mr. J. S.
+Wells, and Mr. J. Couper.
+
+The following rule with regard to these appointments became embodied in
+the laws of the Hospital in 1861:
+
+  “That the appointment of clinical assistants be held for one year,
+  and that these officers be annually re-eligible when approved by the
+  Medical Council and sanctioned by the Committee of Management.”
+
+The increasing number of eyes which were removed for the relief of
+pain, on account of disfigurement, to prevent inflammation spreading to
+the fellow eye, or on account of the presence of a new growth, supplied
+a large amount of material for pathological investigation, and for the
+formation of a museum of pathological specimens.
+
+When the Saunderian Institute was converted into a waiting room for
+out-patients, a room was set apart elsewhere for a museum and library;
+and with some of the money left over from the Saunderian Fund a
+microscope was purchased. In 1857 Dr. Charles Bader, a young German
+skilled in the use of the ophthalmoscope, was appointed curator and
+registrar, with an annual honorarium of 25 guineas.
+
+The increasing interest excited in the various changes in the
+fundus of the eye revealed by the ophthalmoscope made it desirable
+to have a collection of water-coloured drawings depicting them for
+preservation in the museum. An artist, Mr. Schweizer, was employed to
+make such drawings under the superintendence of Bader. A long list
+of those which he produced is recorded in the early numbers of the
+_Ophthalmic Hospital Reports_, where also some of them are published in
+lithographic plates. The changes represented are all drawn on a very
+small scale, the pictures themselves only measuring inches in diameter.
+They are, however, very faithful representations of the changes shown,
+and contain a remarkable amount of fine detail. There can be little
+doubt that Mr. Schweizer must himself have been short-sighted.
+
+PLATE XV.
+
+[Illustration: JOHN WHITAKER HULKE, F.R.S. GEORGE LAWSON]
+
+The interpretation of the nature of the changes revealed by the
+ophthalmoscope called for much careful dissection and microscopical
+investigation. The two chief pioneers in this work at Moorfields were
+Hulke and Bader. The former, in an article on the morbid anatomy and
+pathology of the choroid and retina in 1857, wrote:
+
+  “Since the discovery of the ophthalmoscope great advances have
+  been made in our knowledge of the diseases of the deeper parts of
+  the eyeball. We are daily becoming more familiar with the morbid
+  appearances which characterise the various affections of the
+  choroid, the retina the vitreous humour, and the lens. We read these
+  appearances during life, as if portrayed upon the pages of a book;
+  but our knowledge of them, of their exact situation and precise
+  natures must remain very imperfect without the explanation afforded
+  by dissections and the microscope. The extensive practice of the
+  Moorfields Ophthalmic Hospital has, by the liberality of the medical
+  staff, for a long time afforded me great opportunities for working
+  with the ophthalmoscope, and for making microscopical examinations of
+  diseased eyeballs immediately after their removal.”
+
+In 1859 the Royal College of Surgeons chose as the subject for the
+Jacksonian Prize Essay of that year:
+
+  “The morbid changes in the retina as seen in the eye of the living
+  person, and after removal from the body, together with the symptoms
+  associated with several morbid conditions.”
+
+John Whitaker Hulke’s essay was awarded the prize, and he subsequently
+published it in a somewhat altered form as a handbook to the use of the
+ophthalmoscope.
+
+Hulke, who was born in 1830, was educated at the Moravian College at
+Neuwied, and became a fluent German linguist; he studied medicine
+at King’s College Hospital where he early became associated with
+Bowman. During the Crimean War he was attached to the hospitals at
+Smyrna and Sebastopol. In 1857 he was appointed assistant-surgeon
+to King’s College Hospital, and in 1858, when an additional post of
+assistant-surgeon was created at Moorfields, he was elected unopposed,
+the only other candidate, Jonathan Hutchinson, retiring in his favour.
+In 1862 he transferred his services as a general surgeon to the
+Middlesex Hospital, where he became full surgeon in 1870. In 1867 he
+was elected a Fellow of the Royal Society for his researches relating
+to the anatomy and physiology of the retina in man and the lower
+animals, particularly the reptiles.
+
+Hulke not only distinguished himself as a general surgeon, an
+ophthalmologist, a pathologist, but also as a geologist; he contributed
+several papers to the Royal Society on Palæontology, more especially
+in connection with the great extinct land reptiles (Dinosauria) of the
+secondary period. In 1887 he was presented the Walleston Medal, the
+greatest honour in the power of the Royal Society to bestow.
+
+To those familiar with an Ophthalmic Hospital at the present time,
+it is difficult to conceive of its work being carried on without the
+devotion of much time and attention to the correction of errors of
+refraction with glasses. Yet it was only during the latter part of the
+nineteenth century that the scientific principles for the correction of
+such errors became recognised.
+
+Hulke, in some reminiscences of his youth, remarked:
+
+  “In my earliest student days the ophthalmoscope was unknown,
+  and errors of refraction were so little understood that a small
+  tortoise-shell case, which could be easily carried in the trousers
+  pocket, containing half a dozen convex and concave spherical lenses,
+  was held to comprise a sufficient stock for every trial.”
+
+The simultaneous but independent discovery by Bowman and Bruecke of the
+muscular nature of what was formerly known as the ciliary ligament,
+the change in the form of the lens in accommodation demonstrated by
+Cramer, and the discovery of the ophthalmoscope by Helmholtz, prepared
+the way for Donders’ great work, _On the Anomalies of Accommodation
+and Refraction of the Eye_, which was published in English by the New
+Sydenham Society in 1864.
+
+James Ware, to whom reference has already been made, was one of
+the first surgeons in England to devote himself specially to the
+treatment of eye diseases (_vide_ Chapter I., p. 11). He is entitled,
+Donders says, to be described as the discoverer of hypermetropia or
+long-sightedness. In a paper on “Observations Relative to the Near and
+Distant Sight of Different Persons,” which Ware read before the Royal
+Society in 1812, he said:
+
+  “There are also instances of young persons, who have so
+  disproportionate a convexity of the cornea or crystalline, or of
+  both, to the distance of these parts from the retina, that a glass of
+  considerable convexity is required to enable them to see distinctly,
+  not only near objects, but also those that are distant; and it is
+  remarkable that the same glass will enable many such persons to see
+  both near and distant objects, thus proving that the defect in their
+  sight is occasioned solely by too small a convexity in one of the
+  parts above-mentioned, and that it does not influence the power by
+  which their eyes are adapted to see at distances variously remote. In
+  this respect such persons differ from those who had the crystalline
+  humour removed by an operation, since the latter always require a
+  glass to enable them to discern distant objects, different from that
+  which they use to see those that are near.”
+
+These early and accurate observations of Ware’s were forgotten, and
+it was not until 1859, at a meeting at Heidelberg, that Donders first
+clearly differentiated long-sightedness or over-sightedness as some
+then termed it, from presbyopia, and suggested the term “hypermetropia”
+as an appropriate name for it. The importance of understanding
+correctly the nature of this affection of the eye was summed up thus by
+Donders:
+
+  “He who knows by experience how commonly hypermetropia occurs, how
+  necessary a knowledge of it is to the correct diagnosis of the
+  various defects of the eye, and how deeply it affects the whole
+  treatment of the oculist, will come to the sad conviction that an
+  incredible number of patients have been tormented with all sorts of
+  remedies and have been given over to painful anxiety, who have found
+  immediate relief and deliverance in suitable spectacles.”
+
+What is termed “asthenopia,” or tiredness of the eyes with confusion
+of vision after close work, without any alteration in their external
+appearance, had been attributed to a variety of causes by different
+observers. Lawrence spoke of it as an affection of the retina from
+excessive employment. Tyrrell endeavoured to prove that it was due to
+congestion of the choroid. It became recognised that it was not caused
+by contrasts of light and shade:
+
+  “All day the vacant eye without fatigue
+  Strays o’er the heaven and earth; but long intent
+  On microscopic arts, its vigour fails.”
+
+That it was produced by application of the eyes to near objects
+suggested that the muscles that move the eyeballs might be concerned,
+and some even practised tenotomy of them for its relief. It was not
+until Donders demonstrated its association with hypermetropia that the
+circumstances under which it may arise were made clear, and the way
+shown in which it could be relieved by the use of spectacles. Though
+we are indebted to Kepler for the earliest knowledge of short-sight,
+or myopia, it was not until after the discovery of the ophthalmoscope
+that the peculiar changes in the fundus of the eye associated with it,
+and due to enlargement of the posterior part of the eyeball, became
+recognised. At Moorfields they were described and pictured by Bader in
+the _Ophthalmic Hospital Reports_ in 1858.
+
+The elongation of the visual axis in myopic eyes, formed at the expense
+of the posterior wall, was first demonstrated by dissection by Arlt in
+Vienna in 1856.
+
+The asymmetry of the dioptric system of the eye which we call
+astigmatism was first observed by that versatile genius, Thomas Young,
+in his own eyes in 1793; and later by Airy, the Astronomer Royal, in
+1827, who introduced the use of cylindrical lenses for its correction.
+Airy’s colleague, Whewell, suggested the term “astigmatism.” That it
+was due to a difference in the curvature of the cornea in its two
+meridians was asserted by Wharton Jones in 1855 and by Wilde of Dublin.
+It was, however, Donders who by measurement first certainly proved that
+such asymmetry of the cornea actually existed.
+
+The introduction of systematic sight-testing for errors of refraction
+at Moorfields was of gradual growth. In 1860 J. Soelberg Wells, who was
+then working there as a clinical assistant, wrote as follows:
+
+  “There are perhaps few subjects connected with ophthalmic practice
+  which demand greater care and exactitude than the choice of a pair
+  of spectacles. The very frequency with which we are called upon to
+  improve vision by means of glasses is but too apt to make us somewhat
+  careless and empirical in our mode of selection, and to prescribe
+  those which the patient himself most fancies, even although they may
+  not quite accord with the range of his accommodation, or with the
+  scientific principles which should influence our choice. But how
+  much more does not this inefficiency in selecting spectacles obtain
+  among quasi-opticians, jewellers, etc. This is doubtlessly often
+  attended with the most disastrous results, and eyes, which might with
+  proper glasses have lasted a number of years, are soon recklessly
+  and unwittingly destroyed through ignorance and carelessness of
+  unscientific opticians. In order to obviate this, I would urgently
+  advise the adoption of a method practised in many parts of the
+  Continent. In Berlin, for instance, von Graefe has spectacle boxes,
+  containing convex and concave glasses (whose number corresponds
+  exactly with those kept by the opticians); from these he selects the
+  proper glasses, and puts the number of their focal distance on a slip
+  of paper, which the patient takes to an optician, who supplies him
+  with the spectacles thereon prescribed.
+
+  “I am fully aware that this proceeding would, at present, be carried
+  out with some difficulty in England, owing to the fact that different
+  opticians often number their glasses differently; but I have doubt,
+  that if the leading opticians would adopt a certain standard, the
+  others would soon follow their example.”
+
+In order to overcome the difficulties caused by the inaccurate
+dispensing of glasses, it was agreed in 1861, on the recommendation of
+the Medical Council, to appoint Thomas Doublet, optician, of 7, City
+Road, Finsbury Square, the official optician to the Hospital. This
+appointment led to a letter of protest from William Hawes, optician, of
+79, Leadenhall Street, in which he said that for the past twenty years
+he had been supplying spectacles ordered by the surgeons to patients of
+the Hospital at an agreed price. It is interesting to note this, as his
+son, Alfred Hawes, was later on appointed optician to the Hospital, an
+appointment which William’s grandson still holds.
+
+The system then in vogue for numbering lenses was the “inch system,”
+the unit on which it was based being a lens having a principal focal
+distance of 1 inch. It was inconvenient, as it necessitated the
+refractive power of any lens of a weaker strength being expressed
+by a fraction, whose denominator represented its principal focal
+distance. Complications also arose owing to the variations of the inch
+in different countries. Thus in ordering glasses it was necessary to
+state if the trial lenses employed were graduated in English, Paris,
+or Prussian inches. It was Nagel in 1866 who proposed a metre system
+of numbering lenses—_i.e_., taking a lens with the principal focal
+distance of 1 metre as the unit, and speaking of it as having the
+refractive power of 1 diopter. The advantages of this new system soon
+became evident, and, after it had been considered and reported on
+favourably at the International Congress of Ophthalmology in 1872, its
+adoption became general.
+
+Letters or figures have always been employed by ophthalmologists as
+the most convenient method for testing the power of vision. Alfred
+Smee, F.R.S., surgeon to the Bank of England and to the Central London
+Ophthalmic Hospital, in a book entitled _Vision in Health and Disease;
+the Value of Glasses for its Restoration and the Mischief caused by
+their Abuse_, the first edition of which was published in 1847, gave
+a series of graduated sized prints for the testing of vision, and
+described an optometer he had constructed for “the adaption of glasses.”
+
+Ed. von Jaeger of Vienna, in 1854, published a series of typographical
+specimens, distinguishing the various sizes of the letters by numbers
+instead of technical names, which allowed of their use by all nations.
+These have ever since remained the most generally used test for near
+vision. It was Snellen of Utrecht, however, who first constructed
+test types on a definite scientific principle, so that the strokes
+composing the letters are all drawn on a regularly proportional scale
+of thickness, the letters exhibiting themselves under an angle of five
+minutes at the distance at which they should normally be seen.
+
+In 1860 the Committee of Management of Moorfields, at the request of
+the Medical Council, had drawn up and printed test types for use in the
+out-patient room.
+
+By the death of Mr. Richard Heathfield in 1859 the Hospital lost one of
+its oldest supporters, who had been a friend of Saunders and associated
+with him in its foundation. When the Rev. J. Russell retired from the
+Chairmanship of the Committee of Management, Heathfield had succeeded
+him, and was a vigorous promoter of the extensions of the institution
+rendered necessary by the advance of knowledge.
+
+Mr. F. G. Sambrooke was appointed Chairman in his place.
+
+On the death of Miss Marian Sedgwick, the last surviving daughter of
+the late Harry Sedgwick, in January, 1860, the Hospital came into
+possession of the reversion bequeathed by him (as mentioned in Chapter
+III.) of the sum of £19,841 Three per Cent. Stock, subject to 10 per
+cent. legacy duty. A portrait of this early supporter and munificent
+benefactor of the Charity had been previously presented by his family,
+and now hangs in the Board Room. In 1853 the Committee had commissioned
+Mr. Henry Weekes to construct a marble bust of Mr. Harry Sedgwick at
+the cost of £120, to be designed as a companion to that by the same
+artist of J. Cunningham Saunders. These two busts, together with that
+of Dalrymple, now adorn the entrance hall of the present building.
+
+
+
+
+CHAPTER VIII
+
+THE COMMENCEMENT OF “THE OPHTHALMIC HOSPITAL REPORTS”
+
+
+The first English journal devoted specially to the subject of
+ophthalmology originated with the medical staff of the Moorfields
+Hospital. The first number of the _Ophthalmic Hospital Reports_, as the
+journal was called, was published in October, 1857. Its origin and aims
+were set forth as follows:
+
+  “At a meeting of the Medical Council of the Hospital on the 25th
+  of August last, it was determined to issue a periodical record of
+  ophthalmic observation and experience; it was thought that, not only
+  at Moorfields, much valuable information was gained and lost that
+  should be preserved, and that such a journal might obtain favour
+  throughout the country. Mr. Streatfield was appointed to collect and
+  arrange, from time to time, the material and order its publication.
+
+  “The Ophthalmic Journal will be, for the present, issued quarterly.
+  It will give short monographs by members of the staff, and of the
+  profession generally (if we are so fortunate as to engage their
+  attention), on any physiological or pathological subjects connected
+  with our especial study; with, it is hoped, occasional engravings,
+  or photographs as illustrations. It will also contain a summary
+  reprint of the monthly reports of the Registrar of the Hospital, and
+  titles of books and preparations presented to the Ophthalmic Library
+  and Museum of the Hospital. It will not contain reviews of books as
+  such, or any correspondence, or anonymous publications. The opinions
+  expressed in it must be understood to be those of individual authors.
+  The editor will collect minor noteworthy observations, and record
+  novelties and illustrative cases, with regard to consecutive detail.”
+
+A list of the subscribers given in the fifth part, published a year
+later, shows them to have then numbered 195. By its establishment the
+Library at the Hospital became enriched, for exchanges were effected
+between it and several other journals dealing directly or indirectly
+with ophthalmology.
+
+Though the highly specialised subject of the journal prevented it
+from gaining a very extensive circulation, it became the medium for
+publication of original articles which are now regarded as among the
+classics of ophthalmic science.
+
+The first volume is composed of six parts, published at intervals
+between October, 1857, and January, 1859. The first part opened with
+an article by Bowman, giving an extended account of his investigations
+into the treatment of lacrymal obstruction by slitting up the lacrymal
+punctum and the use of probes, which has already been referred to in
+Chapter VI. Poland also commenced a series of articles, which were
+continued in subsequent parts, on “Protrusion of the Eyeball.” They
+contain a number of well recorded cases with interesting remarks,
+giving a vivid description of the treatment of inflammatory affection
+in pre-antiseptic days, by what was termed “antiphlogistic measures.”
+In the third volume of the _Reports_ Poland contributed an article on
+“Medico-legal Observations in Connection with Lesions of the Eye.” Much
+has been written on this subject since, but little has been added, as
+regards matters in this country, which is not dealt with by Poland. He
+quotes Mr. Harry Bodkin Poland, barrister-at-law, no doubt a relative
+of his, as stating the legal position in the assessment of damages for
+accidents to be as follows:
+
+  “There is no fixed mode of assessing damages from accident. When
+  it can be shown that a particular person is liable for causing an
+  accident, etc., the jury decide as to the amount of damages to which
+  the injured person is entitled, and neither the medical man nor the
+  lawyer interferes, except to put before the jury the real nature of
+  the injuries inflicted.”
+
+The following precautionary remarks, which he wrote some seventy years
+ago, evidently as the outcome of his experiences at Moorfields, are so
+applicable to-day that they may well be quoted:
+
+  “The causes which may lead to the loss of an eye through carelessness
+  and negligence ought well to be borne in mind by the thoughtless,
+  so that should any person be employed in any of the following acts,
+  he should pay due regard to the passers-by, or those standing near,
+  and thus obviate any necessity for rendering himself liable for the
+  damages committed.
+
+  “The carrying or whirling about of sticks, umbrellas, guns, etc., in
+  the public thoroughfares, the slashing about of whips, the careless
+  use of the line and rod in fishing, the letting off of fireworks, the
+  shooting of arrows, the throwing of missiles such as stones, lime,
+  etc.; the chipping of wood, stone, and metals in the public highways,
+  without adequate protection; the playing at tip-cat; the uncorking of
+  effervescing draughts; the explosion of chemicals and gunpowder; and
+  numerous other acts each and all of which have caused the loss of an
+  eye or of both, and have been the means of litigation.”
+
+In 1861 Alfred Poland was elected surgeon to Guy’s Hospital with charge
+of the large ophthalmic department, and, in accepting the appointment,
+was required by the Governors of Guy’s to resign his post of surgeon
+at Moorfields, which he did most reluctantly. Many competent observers
+described him as the best operator on the eye they had ever seen. He
+was a spare, thin man, and made remarkable recoveries from several
+severe illnesses, but died ultimately of consumption at the age of
+fifty-two. The following account of some of his other characteristics
+have been recorded by one of his colleagues at Guy’s:
+
+  “Poland had a remarkable power of gathering together detailed
+  knowledge, including dry facts and figures, so that his essays are
+  complete treaties on the subjects in hand, and are of permanent value.
+
+  “It was said with great truth that if Poland had been shut in a
+  room containing not a single book, but with only pens and paper, he
+  could have written a complete work on surgery, not in a vague way,
+  giving merely general descriptions and treatment, but in a systematic
+  manner, detailing the distinct forms and varieties of the disease
+  then in his mind.
+
+  “He was utterly careless as to his personal appearance. He would
+  leave the dissecting room without changing his coat, and it was often
+  the subject of surmise whether he washed his hands.
+
+  “On his appointment to the surgeoncy at Guy’s, the Treasurer had
+  no hesitation in telling him he would have to dress himself more
+  decently and cleanly. It is not, therefore, surprising that Poland
+  never had any practice to speak of. There was nothing in his manner
+  to give confidence, but he was a great favourite with students.
+
+  “His marriage a few years before his death was a misalliance, and
+  added much to his misfortunes.”
+
+One of the most conspicuous features of the _Reports_ since their
+commencement has been the contributions made to them by the several
+occupants in succession of the post of curator of the Museum,
+beginning with Charles Bader. This post has afforded the holders of
+it a most valuable field for pathological research, as all the eyes
+removed by the members of the staff are entrusted to the curator for
+his investigation, and often also a large number of specimens from
+elsewhere. The articles written by the several curators contain most of
+the valuable original work which has been done in this country on the
+subject.
+
+In the fourth part of the journal, published in July, 1858, Jonathan
+Hutchinson, who was then working as a clinical assistant at the
+Hospital, commenced his ever memorable series of articles “On the
+Different Forms of Inflammation of the Eye consequent on Inherited
+Syphilis.” In these articles he first definitely established the
+connection of interstitial keratitis with inherited syphilis, and
+showed its frequent connection with certain characteristics of the
+complexion and physiognomy, and with peculiarities in the formation
+of the permanent teeth. Which latter are now universally known as
+“Hutchinson’s teeth.”
+
+PLATE XVI.
+
+[Illustration: SIR JONATHAN HUTCHINSON, F.R.S.]
+
+Jonathan Hutchinson was born in Yorkshire in 1828, of Quaker ancestors.
+For four years he studied at the York School of Medicine, and then came
+to London, when he attended at St. Bartholomew’s Hospital. He there
+came under the influence of Sir William Lawrence, to whom he dedicated
+his book entitled _Diseases of the Eye and Ear consequent on Inherited
+Syphilis_, published in 1863, consisting mainly of his reprinted
+articles in the _Ophthalmic Hospital Reports_.
+
+It has already been mentioned in Chapter III. how much Lawrence did to
+increase the knowledge of venereal diseases of the eye by the careful
+collection and collation of notes of cases at the Ophthalmic Hospital.
+It was by the same careful collection and collation that Hutchinson was
+able to establish the connection of certain inflammatory eye affections
+with inherited syphilis, and he likewise found the most fruitful field
+for his investigations in the out-patient department at Moorfields. He
+was a most patient and elaborate note-taker and, in apologising for the
+lengthy notes of some or his published cases, remarked:
+
+  “I must plead that they are the stones out of which the edifice is
+  to be built, and that unless care be devoted to their preparation in
+  the first instance, it will be useless to expend it on the subsequent
+  elaboration.”
+
+Jonathan Hutchinson was a man intensely interested in the study of
+the natural history of disease in all its manifestations, and it
+may be added not only in the natural history of the disease, but of
+natural history generally. He was a great collector of facts, and had
+a remarkable flair for grouping them so as to draw new and unsuspected
+inferences.
+
+He was not inaptly described as “the greatest general practitioner
+in Europe,” and also as “the universal specialist.” He was appointed
+assistant-surgeon to the London Hospital in 1859 and full surgeon in
+1862; he was also surgeon at the Blackfriars Skin Hospital.
+
+He attracted around him a large number of able assistants of whose
+devoted services he was able to make very material use. His biographer
+writes:
+
+  “His teaching was made impressive by ingenious arguments, apt
+  illustrations, vivid metaphors, and quaint expressions, and was
+  driven home by the simplicity and solemnity with which they were
+  delivered.”
+
+On the retirement of Alfred Poland from the staff in 1861, it was
+decided that the surgical staff should be increased to eight in number
+by the appointment of two new assistant-surgeons. George Lawson and
+Jonathan Hutchinson were the only two candidates who came forward, and
+were both elected. Lawson, receiving a few more votes than Hutchinson,
+was appointed the senior of the two.
+
+George Lawson, like Hulke, received his medical education at King’s
+College Hospital. There was a remarkable parallelism between the
+careers of these two men. Both served as house surgeons under Sir
+William Ferguson. Both served as surgeons at the Crimea. Both became
+assistants to Bowman, and inspired by him combined ophthalmic surgery
+with general surgery. Both became general surgeons at the Middlesex
+Hospital, and ophthalmic surgeons at Moorfields.
+
+Though their careers were so similar, temperamentally they were very
+different. Hulke was an austere, conscientious disciplinarian, who
+seemed to have had no youth. Lawson, on the other hand, was full of
+kindly sympathy for the weaknesses of mankind, and never seemed to
+grow old. This difference was no doubt to some extent attributable,
+as Lawson himself suggested, to Hulke having had no children, whilst
+Lawson had a large family of boys.
+
+Hulke earned for himself the greater scientific reputation, but Lawson
+had by far the larger private practice. Hulke’s articles in the
+early numbers of the _Reports_ were numerous, some of them clinical
+records, but many of them dealing with histological and pathological
+investigations. Lawson’s contributions were also numerous, and dealt
+mostly with injuries of the eye and sympathetic ophthalmitis. In 1867
+he published his collected experience on these matters in a book
+entitled _Injuries of the Eye, Orbit, and Eyelids_. His attention had
+doubtless been specially attracted to such injuries during his service
+with the Army in connection with the Crimean War. Early in 1854, when
+war was threatening, Lawson joined the Army as an assistant-surgeon,
+and went in March of that year with the first batch of troops to Malta.
+He landed with the first troops in the Crimea, and was present at the
+battles of Alma and Inkerman. He was invalided home in July, 1855, with
+typhus fever, which he contracted from some mule drivers whom he was
+attending, and which left his circulation permanently impaired.
+
+In Part III. of the _Reports_, Streatfield gave a description of his
+operation of grooving the fibro-cartilage of the eyelid in cases where
+its margin or the eyelashes turned inwards: an operation which is still
+frequently performed as originally described, or in a modified form.
+
+In the last part of the first volume, which appeared in January, 1859,
+Dixon recorded a case in which he successfully removed a chip of steel
+from the vitreous chamber by grasping it with a pair of forceps. The
+case is of particular interest because it seems to have been the first
+in which an attempt to remove a foreign body from the interior of the
+eyeball with a powerful magnet was made, a line of practice which has
+since reached a high degree of usefulness. In Dixon’s case, the effect
+of the magnet was only to drag the chip of steel into a less desirable
+position, so that a pair of forceps had to be used in order to effect
+its removal.
+
+Amongst the numerous interesting articles in the second volume of the
+_Reports_ are some short contributions from the celebrated Glasgow
+ophthalmic surgeon, William Mackenzie, then in his fifty-ninth year,
+whose masterly _Practical Treatise on the Diseases of the Eye_ had
+obtained world-wide reputation. After serving his apprenticeship
+and passing his qualifying examination in Glasgow, he visited the
+medical schools of Paris, Pavia, and Vienna; at the latter he studied
+ophthalmology under Professor Beer. In 1818 he settled for a time in
+practice in London, in Newman Street, Oxford Street, and delivered a
+systematic course of lectures on “Diseases and Operative Surgery of the
+Eye.” Though we have no definite record of his attendance at the Eye
+Infirmary, then in Charterhouse Square, there can be little doubt that
+his keen interest in ophthalmology must have taken him there. In 1820
+he returned to Glasgow to fill the Anatomical Chair in the Andersonian
+University, and in 1824 he established the Glasgow Eye Infirmary.
+One of his articles in the _Reports_ deals with glaucoma, and he was
+the first to point out its connection with the increased tension of
+the eye—an increase of tension which he endeavoured to relieve by
+paracentesis of the eye through the sclerotic or cornea.
+
+To those familiar with the operation for removal of cataract, the
+fixing of the eyeball whilst making the incision, by grasping the
+conjunctiva with a pair of toothed forceps, seems such an obvious
+procedure that it is surprising that it should not have always been
+employed. We find, however, in the second volume of the _Reports_,
+an article by France advocating such fixation as a new departure.
+France was surgeon in charge of the ophthalmic department at Guy’s
+Hospital. When Saunders first established a special institution for the
+treatment of eye diseases, and for many years afterwards, there were
+no such special departments at any of the London general hospitals.
+Guy’s Hospital was the first of the general hospitals to establish
+an ophthalmic department, and by 1858 similar departments had been
+started at University College Hospital under Wharton Jones, and at
+St. Mary’s Hospital under White Cooper. These two latter surgeons also
+contributed articles to the _Ophthalmic Hospital Reports_, which in its
+early days was not restricted to work carried on at Moorfields.
+
+With the second volume of the journal the use of paper of a slightly
+yellow tint, instead of white, was commenced. Streatfield, the editor,
+explained that Charles Babbage, the mathematician, in printing his
+logarithmic tables, had experimented with specimens set up on paper of
+various shades and colours, and found that almost all those whom he
+consulted agreed with him in giving preference to the coloured papers.
+The particular tint, however, was not so unanimously fixed upon, though
+yellow appeared to have the preference. Several editions of Babbage’s
+_Tables of Logarithms_ were printed on the yellow and the white paper;
+the former were always in most demand. This slightly yellow tinted
+paper was apparently approved of by the contributors and readers of the
+journal, as it continued in use for several years.
+
+In this same volume there commenced a series of articles on “Paralytic
+Affections of the Muscles of the Eye,” by John Soelberg Wells, who in
+1860 became one of Bowman’s clinical assistants.
+
+Soelberg Wells was a tall, handsome man, of splendid physique, and
+possessed of ample private means. He graduated in medicine at Edinburgh
+University in 1856, but much of his education and training, general
+and professional, was conducted by German teachers, for he was partly
+German by extraction. For two years previous to his commencing work at
+Moorfields he studied under Graefe in Berlin, and was for a time one of
+his assistants. In his lectures and in his clinique Graefe devoted much
+time and patience to teaching the diagnosis of paralytic affections
+of the eye muscles, and Wells’ articles on the subject dealt with the
+rules he had learnt from Graefe, to the great accuracy and value of
+which he was able to testify.
+
+In the third volume of the _Reports_ commenced the publication of a
+“Periscope” of foreign ophthalmological literature; in this production
+Soelberg Wells’ knowledge of German and of the Continental cliniques
+was of great service, and he translated for the use of English readers
+articles by Müller, Donders, and Graefe. By such means international
+scientific intimacy, which is so eminently desirable, was stimulated
+and promoted.
+
+After the issue of the thirteenth number of the _Reports_, Streatfield
+resigned his editorship, and in April, 1861, what was termed a New
+Series was commenced, with the following prefatory remarks:
+
+  “The first number was issued October, 1857, and the publication,
+  though not strictly quarterly, has subsequently appeared with
+  regularity sufficient to complete two volumes.
+
+  “The later numbers, however, have assumed a very different appearance
+  to those which were at first submitted to the profession, and it has
+  therefore been deemed necessary to remodel the journal: at the same
+  time, as it is the only periodical in England specially devoted to
+  ophthalmic medicine and surgery, it is thought desirable to extend
+  its limits, by admitting reviews and periscopes, and thus to make it
+  more generally useful.
+
+  “It will be edited by members of the staff, and appear under the
+  title _Ophthalmic Hospital Reports, and Journal of Ophthalmic
+  Medicine and Surgery_.”
+
+Apparently very heavy expenses had been incurred in former numbers for
+engravings and coloured lithographs, which made a change of management
+desirable, for it was noted:
+
+  “In future the amount of illustration will much depend on the support
+  of the professional public, the medical officers of the Royal London
+  Ophthalmic Hospital having led the way by devoting their fees,
+  received from pupils, to the interests of the journal.”
+
+The art of perimetry or of taking the field of vision, which has now
+reached such a high degree of accuracy and importance, seems to have
+originated with von Graefe in 1856, and to have been first employed
+at Moorfields by Hulke in 1859. In the third volume of the _Reports_
+he described some cases, as he says, “to illustrate some forms of
+limitation of the field of vision.”
+
+Hulke’s method of procedure was similar to Graefe’s. He placed the
+patient before a large blackboard at a distance of 8 inches, covered
+one of his eyes, and made him fix a chalked dot in the centre of the
+board, on a level with his eyes, with the other. He then moved a white
+object over the board in various directions from its margins towards
+the centre and marked the places where it was first seen. A line
+connecting these marks gave the outline of the field of vision.
+
+The obvious defect of using a flat surface, like a blackboard, was
+that the various parts of the retina were not situated at an equal
+distance from it. To Forster belongs the credit of having introduced
+an instrument in which the field was projected on a hollow sphere. His
+perimeter consisted of a metallic semicircle capable of rotation in
+various meridians, and on this general principle all other models since
+produced have been constructed. Forster’s perimeter first came into use
+at Moorfields in 1870.
+
+The rapid development of surgical procedures in ophthalmology eclipsed
+for a time at Moorfields the medical side. Dr. Robert Martin, who held
+the post of physician from 1856 to 1884, made but little use of the
+opportunities it afforded him. He did not have patients allotted to
+him or any fixed time of attendance, like his predecessor. In 1867
+he suffered from a severe illness which seemed to threaten his mind,
+and necessitated his temporary retirement from work; he, however,
+completely recovered, and no one was appointed in his place at
+Moorfields during his absence.
+
+The discovery of the ophthalmoscope opened up a new field for medical
+investigation, which was fully taken advantage of by that distinguished
+neurologist, Dr. Hughlings Jackson, who at the commencement of his
+career worked at Moorfields, first with Poland and afterwards with
+Jonathan Hutchinson. In a Presidential Address which he delivered at
+the Ophthalmological Society in 1889, he remarked:
+
+  “It was the luckiest thing in my early life that I began the
+  scientific study of my profession at an Ophthalmic Hospital. Many
+  years ago I had the good fortune to be Mr. Hutchinson’s clinical
+  assistant at Moorfields. I suppose it is to his example and teaching
+  that I owe the beginning of the little scientific development I may
+  have. At an Ophthalmic Hospital one has the opportunity of being
+  well disciplined in exact observation. When a physician sees how
+  carefully and precisely ophthalmic surgeons investigate the simplest
+  case of ocular paralysis, he is getting a lesson in exactness, and
+  will be less likely in his own department of practice to deal in such
+  generalities as that a patient’s fit ‘had all the characters of an
+  ordinary epileptic fit,’ and more likely to take pains to describe
+  the convulsion, the place of onset, the march and the range of the
+  spasm.”
+
+Dr. Hughlings Jackson contributed many most valuable papers to the
+_Reports_ dealing with ophthalmoscopic findings in connection with
+brain disease. He wrote, as he said in one of them, “as a physician and
+not as an ophthalmologist,” having studied ophthalmic medicine merely
+as a help to the study of diseases of the nervous system. And, again,
+in another article he remarked:
+
+  “The physician is quite as much indebted to Helmholtz as the
+  ophthalmologist. Defects of sight of all kinds occur so often in
+  affections of the nervous system that it is not too much to say that
+  to the student of these diseases a knowledge of amaurosis, both in
+  the widest and loosest, and in the narrowest and most precise use of
+  the word, is of more importance than a knowledge of any other class
+  of symptoms.”
+
+He was never tired of impressing on physicians the value of the routine
+use of the ophthalmoscope. Thus he wrote in 1889:
+
+  “I urge young physicians to study eye diseases at an Ophthalmic
+  Hospital or at an ophthalmic department of a General Hospital; this
+  nowadays needs no urging on physicians especially interested in
+  neurology.”
+
+In 1863 Dr. Argyll Robertson contributed a paper from Edinburgh to the
+_Reports_, “On the Effects of Calabar Bean on the Eye,” in which he
+stated that the miotic action of this drug had been first discovered
+by Dr. Thomas R. Fraser. Besides describing its effects on the normal
+eye, he enumerates several affections in which he had found its use
+beneficial, but makes no mention of glaucoma. It was apparently not
+until 1876 that it became employed for the reduction of increased
+intraocular tension, Adolph Weber and Laquer describing its use for
+this purpose about the same time.
+
+
+
+
+CHAPTER IX
+
+GROWTH AND EXTENSION
+
+
+When the Eye Infirmary was first built in lower Moorfields in 1821 the
+district was an exceedingly quiet one; in front of it was a large open
+space, which had been the old Bethlehem Hospital burial-ground, but had
+not been used as such after the removal of that Hospital to the other
+side of the river in 1814.
+
+In 1899, when the Eye Hospital was transferred to the City Road, the
+district had become one of the busiest and noisiest in the City of
+London. The cause of this change was the erection of the Broad Street
+and Liverpool Street Stations on the site of the old burial-ground,
+and on that of a large number of courts and alleys in its vicinity,
+which were cleared away for the purpose. Out of these terminal stations
+there poured forth every morning the various City workers, and back to
+them they streamed in the afternoons and evenings. The railway termini
+became the starting-points of various omnibuses, the roll of the wheels
+of which on stony streets and the clatter of the horses’ hoofs kept
+up a continuous roar. The erection of the London and North-Western
+Railway’s Goods Station, to the north of the Hospital on the opposite
+side of Eldon Street, added noises at night, as well as day, in the
+rattle and banging of milk-cans. To patients coming from country
+districts this continuous noise proved very disturbing and detrimental.
+In 1870 some mitigation of the trouble was obtained by the substitution
+of asphalt paving in the streets around the Hospital in place of
+cobble-stones.
+
+The increased facilities which the railways and omnibuses afforded
+for approach to the Hospital tended largely to increase the number
+of patients coming to it for relief. In 1851 new out-patients
+numbered 11,384, and in 1878 they had increased to 19,177. To provide
+accommodation for this increase, and for the larger number of patients
+requiring operative treatment, it became obvious that a new wing would
+have to be added on the south side of the Hospital. A lease for the
+land on which it was to be erected had, through the foresight of Dr.
+Farre, been obtained in 1823 for a period of seventy-seven years from
+the Corporation of London. On it a stables had been built and let off
+until such time as the Hospital found it necessary to take possession.
+When the new building was contemplated, an attempt was made to obtain
+a freehold of the site from the Bridge House Estate, but owing to the
+Hospital not being an incorporated body the negotiations fell through.
+
+The original London terminus of the Great Eastern Railway, opened in
+1839, was at Shoreditch. In 1863 a Bill was introduced into the House
+of Lords to give the Great Eastern Railway power to extend their line
+to Finsbury Circus, and to make a station there which would absorb all
+the surrounding houses and the recently erected London Institution. It
+was obvious that such an undertaking would seriously interfere with
+the amenities of the Hospital, and the Committee of Management drew up
+a petition against the Bill pointing out how the work of the Hospital
+would be interfered with if it was passed. This petition they confided
+to Mr. Alfred Smee, who at that time resided in Finsbury Circus, to be
+forwarded to the Earl of Shaftesbury for presentation to the House of
+Lords.
+
+The Bill was rejected and the Committee of the Hospital passed a vote
+of thanks to the Right Hon. the Earl of Shaftesbury for his important
+services in the matter.
+
+Pending the final selection of sites by the different railways for
+their terminal stations, the Committee of the Hospital had to postpone
+their plans for enlargement, but ultimately, early in 1868, the long
+contemplated building was commenced; it did not, however, become ready
+for occupation until July, 1870; the total cost was £7,226, towards
+which Her Majesty the Queen graciously contributed £100.
+
+The reform in hospital architecture which commenced after the Crimean
+War with the publication of Miss Nightingale’s celebrated _Notes on
+Hospitals_ was then still in its infancy. St. Thomas’s Hospital, which
+was being erected on the Thames Embankment at the same time as the
+new wing at Moorfields, was the embodiment of her ideas; adequate
+cubic space, not only in the wards but also in the passages, being
+considered the most essential factor. It has been jokingly said that,
+at St. Thomas’s, so large and lofty is the children’s ward that it is
+difficult to find the children. Listerism, with its passion for aseptic
+cleanliness, rounded corners, and polished surfaces, had not then
+dawned.
+
+The new wing at Moorfields was designed by Mr. Robert Brass,
+and consisted of three floors. The ground floor was devoted to
+out-patients. The first and second floor each contained three small
+six-bedded wards leading out of a long passage. Their arrangement
+was neither good for administration or for ventilation. The curious
+device was adopted of placing the fireplaces immediately beneath the
+windows, which necessitated an elbow-shaped bend in the chimneys. The
+consequence was that soot which collected in the bends caught fire,
+causing from time to time considerable consternation and excitement
+amongst the patients and resident staff.
+
+In 1866 the staff of the Hospital consisted of four surgeons and
+four assistant-surgeons, but Critchett was desirous of having an
+assistant-surgeon to work with him on his days of attendance, and
+it was mainly at his instigation that it was decided to appoint a
+fifth assistant-surgeon. To this post John Couper, who for several
+years had acted as Critchett’s clinical assistant, and who was an
+assistant-surgeon at the London Hospital, was unanimously elected.
+
+In 1867 the President of the Hospital, Mr. William Cotton, D.C.L.,
+F.R.S., died, and the Governors obtained the consent of the
+distinguished banker, scientist, and statesman, Sir John Lubbock,
+F.R.S., M.P. (afterwards Lord Avebury), to take his place.
+
+In that year yet another addition was made to the surgical staff by the
+election as assistant-surgeon of John Soelberg Wells, to whose early
+career and scientific attainments reference has already been made. By
+that time several of the assistant-surgeons, by acting as such for
+five years, had become eligible for promotion to surgeons; it was not,
+however, until the new wing was opened, which provided an additional
+thirty-six beds, that they were able to obtain the full advantages of
+such promotion.
+
+The establishment of special ophthalmic departments at the several
+general hospitals in London caused the Governors of Moorfields some
+alarm as to the ultimate welfare of their own institution, or as
+Critchett picturesquely put it, “they feared that the heart of the
+parent would be sucked out for the benefit of their children, without
+any corresponding advantage to the public.” It was for this reason that
+in 1864, at a meeting of the Governors, the following rule was passed:
+
+  “No surgeon of the Hospital shall hold an ophthalmic appointment
+  in any other institution, and if any surgeon, at the time when he
+  becomes such, holds any ophthalmic appointment, he shall resign the
+  same within three months.”
+
+The first time this rule came into operation was when Streatfield
+and Hulke became surgeons. The rule only applied to surgeons, not to
+assistant-surgeons. Streatfield held the post of ophthalmic surgeon at
+University College Hospital, and Hulke that of ophthalmic surgeon at
+Middlesex Hospital. On their promotion at Moorfields, the Committee of
+Management requested them to resign their appointments as ophthalmic
+surgeons elsewhere. Hulke readily complied with the request, as he was
+still able to maintain his connection as a general surgeon with the
+Middlesex. Streatfield, however, who only practised as an ophthalmic
+surgeon, was very reluctant to resign his connection with University
+College. On the matter being discussed by the Medical Council, it
+was found that its members were divided in their opinions: some,
+like Critchett, feared rivalry from the newly developing ophthalmic
+departments at general hospitals; others welcomed their up-growth, and
+saw that they were essential parts of such institutions, both from the
+patients’ and the students’ point of view. They considered it desirable
+that those who enjoyed the exceptional experience afforded as surgeons
+at Moorfields should be encouraged to join them, and that, as has
+proved to be the case, their connection with them would induce students
+requiring extended ophthalmic training to come to Moorfields. With such
+division of opinion on the surgical staff the Committee did not at that
+time consider themselves able to advise any alteration in the rule,
+and Streatfield had to resign his appointment at University College
+Hospital.
+
+When Couper and Soelberg Wells became eligible for promotion as
+surgeons in 1873, the matter again came under consideration; in the
+interval several members of the staff had altered their opinions, and
+the Medical Council unanimously recommended the abolition of the rule,
+stating that “it felt assured that the cultivation of intimate relation
+with General Hospitals through members of the staff is conducive to the
+interests of Moorfields.” A special meeting of the Governors was then
+summoned, at which the rule was rescinded. Streatfield was fortunate
+enough to be reappointed to the post he had had to resign at University
+College.
+
+James Dixon retired from the active staff of the Hospital in 1868,
+after having been connected with it for twenty-five years, and the
+senior surgeon for a period of twelve years. As such he had a seat on
+the Committee of Management, where he was a regular attendant and
+rendered valuable assistance. In 1870, owing to domestic bereavements,
+he gave up practice and lived in retirement, occupying himself with the
+study of English history and English literature. He published a small
+handbook, entitled _A Guide to the Practical Study of the Diseases of
+the Eye_, in which he said he aimed at supplying a useful guide to
+those commencing the study of eye diseases. That it fulfilled this
+purpose is shown by its having passed through three editions. The last
+which appeared in 1866, was brought well up to date with the numerous
+developments which had taken place since it first made its appearance.
+
+Dixon was particularly scathing on the dry and pedantic use of
+unnecessarily complicated names in the description of affections of the
+eye. Thus he writes:
+
+  “It requires a more intimate knowledge of Greek than one has a
+  right to expect from every student of medicine to recognise in
+  ‘Iridoperiphakitis’ an inflamed iris and capsule, or at once to
+  detect the operation for closing lacrymal fistula under such a
+  disguise as that of ‘Dacryocystosyringokatlesis.’”
+
+Though the world-wide reputation of Moorfields is mainly due to the
+skill and scientific attainments of the medical staff, its progress
+and prosperity have been to a large extent promoted by the services of
+the able and devoted workers who have in succession held the post of
+Chairman of the Committee of Management. Conspicuous among them for the
+interest they took in everything connected with the Institution were
+Mr. F. G. Sambrooke, who died in 1871, after having held the post for
+eleven years, and Mr. Philip Cazenove, who succeeded him.
+
+The medical staff of a hospital are the distributors of its benefits,
+but in order that benefits may be distributed a collecting department
+is essential, and the work of raising funds for its maintenance falls
+upon the Committee of Management and the secretary.
+
+Some individuals seem to have a special flair for begging successfully
+for funds for charitable purposes. The united efforts of Mr. Sambrooke,
+the Chairman at Moorfields, and of Mr. Mogford, its secretary, during
+the sixties, met with a most excellent response. In the early days of
+the Hospital funds were raised by means of festival dinners and special
+sermons; but during the sixties, without such aid, subscriptions flowed
+in both for the maintenance of the Institution and for its building
+fund. Mr. Mogford attributed his success in this matter entirely to
+his letters of appeal; but it must be remembered that it was a time of
+peace and considerable commercial prosperity, under which conditions
+philanthropic efforts stand the best chance of success. Excellent as
+Mr. Mogford was as a collector of funds, he had certain weaknesses
+which in 1872 necessitated his resignation, Mr. Robert J. Newstead
+being appointed to fill his place.
+
+In Mr. Sambrooke the medical staff had a most sympathetic supporter
+in the promotion of the scientific side of ophthalmology. During
+his chairmanship most liberal grants of money were made towards the
+development and upkeep of the Museum and Library. Thus a grant of £72
+was made in 1864 for the purchase of a collection of ophthalmoscopic
+drawings of the fundus of the eye, and when the new museum was
+completed in 1870 a grant of £235 was expended in book-cases and
+suitable fittings for the display of specimens.
+
+Charles Bader, who continued to hold the post of curator of the
+Museum up to 1867, as the outcome of his experiences published a
+book entitled _The Natural and Morbid Changes in the Human Eye_. He
+was very dexterous in the mounting of museum specimens of the eye,
+but unfortunately the only two methods then known of preserving such
+specimens were by means of spirit or by the use of glycerine. The
+former caused them to shrink and rendered the transparent parts opaque,
+and the latter, though to some extent preserving their transparency,
+caused them to swell. The introduction of the glycerine jelly method
+of preserving museum specimens of eyes by Nettleship in 1871, and
+elaborated by Priestley Smith in 1883, was a great improvement; but
+even with this method considerable care and attention was necessary to
+prevent deterioration. It was not until the introduction of formaline
+as a hardening and preserving agent, by Professor Leber in 1894, that
+a really satisfactory medium for museum specimens was found—one which
+would retain indefinitely the relative degrees of transparency and
+colour of the different parts which they presented during life.
+
+On the resignation of Bader of the post of curator, Bowater Vernon, who
+had been working as clinical assistant to Wordsworth, was appointed in
+his place with a salary of £50 per annum. The duties of the post were
+defined as follows:
+
+  “That he shall attend daily from 10 to 1, and on the evenings of the
+  ophthalmoscopic demonstrations, and at such other times as may be
+  necessary to put up and display the morbid specimens presented.
+
+  “That he be responsible for the due keeping, cataloguing and giving
+  out under regulations of the books and plates under his charge.
+
+  “That he shall prepare gradually a complete series of preparations
+  illustrating the normal anatomy of the human eye and its appendages,
+  and proceed as far as possible with a similar series illustrative of
+  the comparative anatomy and pathology of the same.
+
+  “That he shall be required to report upon the microscopic appearances
+  of all specimens requiring such examination and to keep a register of
+  such examinations, if possible, illustrated by drawings.”
+
+The evening ophthalmoscopic demonstrations above referred to had been
+started for the benefit of the students attending the Hospital in 1864,
+and were conducted in turn by the different members of the staff.
+
+In the records of pathological specimens, published by Vernon in the
+_Reports_ in 1868, is the description of what must have been one
+of the first cases of tubercle of the choroid which, having been
+seen ophthalmoscopically, was later examined microscopically. In
+1871 Vernon, being appointed ophthalmic surgeon to St. Bartholomew’s
+Hospital, resigned the post of curator of the Museum; he was succeeded
+by Edward Nettleship, who held it for two years in conjunction with
+that of clinical assistant to Jonathan Hutchinson. The extensive
+reports of the specimens committed to his care which Nettleship
+published in the _Hospital Reports_ for those years show with what care
+and diligence he discharged the duties of the office. This, together
+with the stimulating influence of his chief, Jonathan Hutchinson,
+formed an excellent training for the important work which Nettleship
+did in connection with ophthalmology in later years.
+
+In the middle of the nineteenth century a number of residential schools
+were established in London for the children of parents in receipt of
+Poor Law relief. Almost from their commencement outbreaks of ophthalmia
+became very prevalent in these schools. In 1870 Critchett was asked to
+visit and advise as to the ophthalmia in one of them at Anerley. He
+stated in his report that he
+
+  “found a large proportion of mild ophthalmia, which in most cases
+  did not render the patients incapable of following the usual
+  educational course, and he advised the establishment of a ward or
+  separate school, where all such cases might be kept for an indefinite
+  time until it was quite certain that they would not relapse, where
+  they might be under such hygienic and medical treatment as seemed
+  necessary, where their instruction and education should go on as
+  if they were in the body of the school, and where, by prolonged
+  isolation, they might be prevented from acting as sources of
+  contagion to the healthy children in the school.”
+
+PLATE XVII.
+
+[Illustration: EDWARD NETTLESHIP, F.R.S.]
+
+Action was taken in accordance with this advice in 1873, when 400
+children who showed signs of ophthalmia at the Anerley School were
+isolated in an unoccupied workhouse at Bow, which was kept going as
+a combined infirmary and school with an efficient staff of teachers and
+nurses for twelve months. Nettleship, having resigned his appointment
+as curator at Moorfields, acted as its resident superintendent.
+The experiment proved the soundness of Critchett’s advice, but it
+became obvious that in some cases, more especially those of trachoma,
+isolation and treatment would have to be continued for more than a
+year. In 1889 a special isolation school was erected for children
+affected with ophthalmia in the Central District School at Hanwell
+and placed under the charge of Sydney Stephenson. Here, again, the
+success of Critchett’s policy was so marked, that in 1897 the Local
+Government Board instructed the Metropolitan Asylums Board to provide
+accommodation for children suffering from ophthalmia in all the Poor
+Law Schools of London. The result has been a steady and continuous
+diminution in the number of cases to be dealt with and the practical
+extinction altogether in these schools of that at most intractable of
+all forms of ophthalmia—trachoma.
+
+The salary for the curator of the Museum, whilst Vernon and Nettleship
+held the office, seems to have been disproportionately small to the
+liberal grants made for the upkeep of the Museum itself. During his
+first year of office Nettleship’s salary was only £50 per annum; at the
+end of that time, “in consideration of his very valuable and arduous
+services in the work of the Museum,” it was raised to £75. When W. A.
+Brailey was appointed to the post in 1874 it was found necessary to
+increase the salary of it to £100, and in 1877 to £120. After increased
+accommodation was made in connection with the laboratory in 1879,
+courses of instruction in practical pathology of the eye were commenced
+by the curator.
+
+In 1870 ophthalmic science sustained a heavy loss by the death of
+Albert von Graefe, its most zealous and successful cultivator, in
+his forty-third year. His last extensive article dealing with “The
+Pathology and Treatment of Glaucoma” was translated and published in
+full in the _Ophthalmic Hospital Reports_ at the beginning of 1871.
+Much as Graefe did to extend our knowledge of the conditions which lead
+to an increased hardness of the eyeball, the disasters to which such
+hardness gives rise, and the means by which they may be avoided, much
+was still left unexplained. Even now, in spite of the reams which have
+since been written, there is still much in connection with the subject
+requiring further elucidation. In 1878 a stimulus was given to research
+in this country in connection with glaucoma by the Royal College of
+Surgeons setting as the subject for the Jacksonian Prize Essay for
+that year, “Glaucoma: its Causes, Symptoms, Pathology, and Treatment.”
+The prize was awarded to Priestley Smith, of Birmingham, and articles
+dealing with its causation were published in the _Hospital Reports_
+for 1881 by him, and by the curator of the Museum, W. A. Brailey. The
+following year Brailey resigned the curatorship on his being appointed
+assistant ophthalmic surgeon at Guy’s Hospital. His successor was W.
+Jennings Milles, who had previously been house surgeon; he, however,
+only held the post for eighteen months, resigning it to go to Shanghai.
+He thus carried the practice and training of Moorfields to the Far
+East, as others had done to all parts of the British Empire, and to
+many of the leading cities in the United States of America.
+
+In 1873 a Canadian, Frank Buller, was appointed house surgeon, and,
+returning subsequently to Montreal, became the pioneer of ophthalmic
+surgery in that colony. Incidentally, it is of interest to note that in
+doing so he forestalled another young Canadian named Osler (afterwards
+Sir William Osler, Bart.), who had come to Moorfields to study eye
+diseases with the same end in view, but, learning there of Buller’s
+intentions, he abandoned the practice of ophthalmology for that of
+general medicine.
+
+PLATE XVIII.
+
+[Illustration: THE HOSPITAL AT MOORFIELDS AFTER THE ADDITION OF A NEW
+WING IN 1868, AND A NEW STORY IN 1875.]
+
+The length of time which those holding office at Moorfields retained
+their posts, and the reluctance with which they resigned them, bears
+eloquent testimony to their interest in the work of the Institution.
+There was then no limit to the time that a house surgeon might retain
+his post, and some continued to do so for more than three years. In
+1870 Miss Boycott, who had held the post of matron for twenty-one
+years, died at the Hospital. Miss Harnet succeeded her, but not being
+herself a trained nurse did little to raise the standard of nursing,
+which remained during her term of office in a very primitive condition.
+
+As the number of new out-patients attending the Hospital continued
+to increase—from 19,177 in 1868 to 20,687 in 1875—it soon became
+evident that the newly erected wing did not supply all the in-patient
+accommodation that was required. In 1875 a plan was drawn up and
+adopted for the erection of another storey on the main building at
+a cost of £2,430. This was completed the following year, when the
+accommodation of the Hospital became increased to 45 beds for male
+patients, 51 for women and children, and 4 for occasional use.
+
+Bowman and Critchett were nearly of the same age, Bowman being a little
+the senior. So much had they done to add to the fame and reputation
+of Moorfields that as they approached the age of sixty, when in
+accordance with the rules of the Hospital they would have to retire
+from the active staff and become consulting surgeons, the Committee
+of Management became anxious to find some way in which their services
+could be retained. Both Bowman and Critchett, like many of those who
+have come after them, felt very reluctant to sever their intimate
+association with the Hospital’s work and welfare.
+
+Bowman, in writing to the Chairman of the Committee in July, 1876, to
+inform him that the time for his retirement was nearly due, requested
+that the duties of a consulting surgeon might be defined, as so far
+nothing had been laid down concerning them. Critchett also wrote at the
+same time as follows:
+
+  “I believe that Mr. Bowman is about to send in his resignation, and
+  I wish to reiterate my conviction that it will be a serious loss to
+  the Hospital. Every week I am a witness to the brilliant operations
+  he performs, they are to me and to a crowded theatre a source of
+  pleasure and profit; professors and students gather round him from
+  far and near; the prestige of the Hospital and its value both in a
+  scientific and benevolent aspect are enhanced by his presence, and by
+  the admirable work that he does. I am sure that if he had voluntarily
+  left us, or if he had been snatched from us, every one attached to
+  the Institution, whether lay or professional, would have felt that
+  they had sustained an irreparable loss. I would therefore suggest
+  that some effort should be made to retain his services. In appointing
+  him to be consulting surgeon, it seems desirable that he should have
+  a few beds placed at his disposal for the admission of cases that may
+  be sent up to him or that any of his professional colleagues may wish
+  to place under his care; also that he should be invited to continue
+  his clinical teaching and if possible give some clinical lectures at
+  stated times. This would be a great service to us all.”
+
+The Committee then, in accepting Bowman’s resignation, passed the
+following resolution:
+
+  “That in acknowledgment of his high reputation and long services to
+  this Institution the Committee request him to continue his clinical
+  instructions, which they are sure will be as acceptable to the staff
+  as to themselves, and for that purpose are pleased for the present to
+  place five beds at his disposal.”
+
+In passing this resolution and forwarding it to Bowman the Committee
+acted without first consulting the Medical Council. That body at once
+notified the Committee that it was unanimously of opinion that it was
+an infringement of the existing laws to assign beds thus to Bowman on
+his becoming consulting surgeon. The Committee replied by requesting
+the Medical Council to consider regulations as to the duties of a
+consulting surgeon. The Medical Council then proceeded to collect
+information as to the customs in force with reference to such officers
+at the principal Metropolitan Hospitals. It found that in all of them
+their duties were simply consultative, and that they attended only
+when specially summoned at the request of the officer in charge of
+the patient. The Medical Council then advised that a similar practice
+should be adhered to at Moorfields, and that arrangements might be made
+for the consulting surgeons to deliver clinical lectures. The Committee
+were very loath to withdraw the offer of the use of beds which they
+had made to Bowman, and had likewise extended to Critchett. The whole
+matter was discussed at the Annual Meeting of the Governors, with
+Sir John Lubbock, the President, in the Chair. In the end Bowman and
+Critchett withdrew from all active participation in the work of the
+Hospital with somewhat embittered feelings.
+
+Bowman died in 1892 at the age of seventy-six. In one of his obituary
+notices we read the following account of his doings after he left
+Moorfields:
+
+  “Fortunately, the opportunities for professional intercourse
+  with Bowman did not cease with his retirement from Moorfields.
+  Until some years later he held the leading place at all the chief
+  meetings connected with our specialty. In 1880, when the British
+  Medical Association held its Annual Meeting at Cambridge, Bowman
+  was President of the ophthalmological section. Donders was present
+  also. The Senate of the University conferred its honorary degree of
+  LL.D. on both. In the following year Bowman presided over a still
+  more important gathering in London—the ophthalmological section of
+  the Seventh International Medical Congress. The fine nature of the
+  man, his high ideals, simplicity, and modesty, are perhaps nowhere
+  more clearly shown than in the inaugural address given by him on that
+  occasion.
+
+  “The Ophthalmological Society of the United Kingdom was founded in
+  1880, and was fortunate in having Bowman as its president during
+  its first three years—it was largely through his influence that the
+  Society rose so rapidly into strength and importance. Its funds,
+  moreover, were largely increased by his generosity. He was an ideal
+  president: speaking little, but always with purpose and effect,
+  showing interest in every communication and encouraging every effort
+  at good work.
+
+  “In the year 1883 the Council of the Ophthalmological Society
+  resolved to establish an annual lecture—the Bowman lecture—‘in
+  recognition of Mr. Bowman’s distinguished scientific position in
+  ophthalmology and other branches of medicine, and in commemoration
+  of his valuable services to the Ophthalmological Society, of which
+  he was the first president.’ In the following year he was made a
+  baronet in recognition of his scientific attainments and professional
+  eminence. A little later, the suggestion that his portrait should be
+  painted and presented to him was welcomed by a large number of his
+  friends, in this and other countries, and the well-known portrait by
+  Ouless, which was exhibited in the Royal Academy in 1889, was the
+  result.
+
+  “Not until he was seventy years of age did Sir William Bowman
+  relinquish active practice, and even for some years longer he was
+  still at times accessible to those who specially desired his opinion
+  and advice.”
+
+Critchett died in 1882 at the age of sixty-five. After retiring
+from Moorfields he was appointed ophthalmic surgeon and lecturer on
+ophthalmology at the Middlesex Hospital, an appointment which he
+held for four years. It afforded him a few beds for needy patients,
+and his son Anderson assisted him with the out-patients. He soon
+endeared himself to the students there, who valued his teaching and
+the opportunity of watching his operative dexterity. For some years he
+suffered from enlarged prostate, cystitis, and granular kidney, but it
+did not prevent his attending to his practice with unabated vigour,
+and performing his numerous social engagements with his customary
+hospitality up to the time of his death.
+
+Several candidates who had acted as clinical assistants presented
+themselves for the appointments on the staff rendered vacant by the
+retirement of Bowman and Critchett, but all withdrew in favour of Waren
+Tay and James Adams, both of whom were assistant general surgeons at
+the London Hospital.
+
+After the publication of Donders’ great work in English _On the
+Anomalies of Accommodation and Refraction of the Eye_, by the New
+Sydenham Society in 1864, and Soelberg Wells’ smaller book, which
+embodied Donders’ teaching, _On Long, Short, and Weak Sight_,
+sight-testing and the correction of errors of refraction with glasses
+grew progressively in importance.
+
+The prescription of lotions or ointments for the eyes took far less
+time than the estimation of refractive errors and the prescription of
+glasses, and with the increase of sight-testing the length of time
+occupied in dealing with out-patients became considerably prolonged. At
+first it was only the correction of the grosser errors of refraction
+which received attention, but as the methods for their estimation
+improved, and the importance of even small errors became recognised,
+the amount of refractive work steadily increased.
+
+The length of time many out-patients had to wait before they received
+attention became a source of anxiety, extending over many years, not
+only to the Committee of Management, but also to the surgical staff.
+The surgeons’ time was fully occupied with the investigation of
+diseased conditions and with operating; they had to depend mainly for
+the carrying out of this refraction work on the devotion and goodwill
+of their clinical assistants, who, being purely voluntary workers,
+could not always be relied upon to stay for an indefinite time.
+
+Many measures were tried to overcome the difficulty. Hulke, who had a
+passion for punctuality, was never tired of urging the value of his
+special virtue on all concerned. Though a painfully punctual individual
+on a medical staff may at times be very trying to his colleagues
+and assistants it is no doubt that he is a valuable asset to the
+institution with which he is connected. Everybody knew at Moorfields
+that on Hulke’s days of attendance they had to be early risers, with
+the result that the work was finished more expeditiously.
+
+Much trouble in connection with the refraction work of the Hospital
+would probably have been avoided if the plan which has recently been
+adopted, of paying an honorarium to one clinical assistant for each
+surgeon, had been sooner resorted to. It was originally recommended by
+the Medical Council in 1877, but the Committee could not for a long
+time see its way to increase so considerably the Hospital’s annual
+expenditure.
+
+Jonathan Hutchinson, as has already been mentioned, was a man who took
+the widest interest in all diseased conditions; the one subject which
+did not specially attract him was refraction work. As the amount and
+importance of it increased, and after he became deprived of the zealous
+help of his two able assistants, Tay and Nettleship, he felt he could
+no longer conscientiously carry out all the duties of his post, and in
+1878 resigned his appointment on the staff.
+
+No man at Moorfields ever made more thorough and effectual use of the
+clinical work which it placed at his disposal than Jonathan Hutchinson.
+For several years he, together with Wordsworth, edited the _Hospital
+Reports_, and it was during that time that they were conducted with the
+highest degree of efficiency and regularity. The “Periscope” in those
+years, which was mainly the work of Waren Tay, formed an excellent and
+very complete review of foreign ophthalmic literature. Hutchinson’s
+own articles were numerous, containing groups of well-recorded cases,
+designed to illustrate new and interesting observations.
+
+In the November number of the _Reports_ for 1871 he published
+“Statistical Details of Four Years’ Experience in Respect to the Form
+of Amaurosis supposed to be due to Tobacco.” It was his third article
+on the subject; the first, in which he suggested a connection between
+excessive smoking and affections of the optic nerve, having appeared
+in 1864. His attention became attracted by the almost exclusive
+occurrence of what was then called “idiopathic symmetrical amaurosis”
+in the male sex. He considered all the possible causes which might
+account for such a prevalence in one sex only, and found the tobacco
+hypothesis the most probable. His researches showed that there was
+little evidence of any other affection of the nervous system in these
+cases, and that all of them were excessive smokers, most of them having
+used shag tobacco. Having watched them for some time, he discovered
+that when the disuse of tobacco was real and complete vision generally
+improved.
+
+The less frequent issue of the _Reports_ after Hutchinson’s departure,
+and the abandonment of the “Periscope,” was due to two things—the
+establishment of the Ophthalmological Society in 1881, and the
+commencement of the _Ophthalmic Review_ in 1882.
+
+The unexpected vacancy on the staff caused by Hutchinson’s resignation
+was filled by the election of John Tweedy who was a clinical assistant
+to Streatfield, and held the post of assistant ophthalmic surgeon at
+University College Hospital.
+
+In 1879 Philip Cazenove resigned the post of Chairman of the Committee
+of Management which he had held for eight years, and in doing so
+presented the Hospital with a gift of £1,000. Charles Gordon, whose
+name was, and is still, well known in connection with gin, was
+appointed to succeed him.
+
+The Hospital suffered a severe loss by the death of Soelberg Wells in
+December, 1879; his health had been failing for some time, and he had
+been granted repeated periods of leave from his work at the Hospital
+on account of it. His _Treatise on the Diseases of the Eye_, first
+published in 1869, ran through three editions, and was translated into
+German and French. It was for a long time the standard textbook on
+ophthalmology, having the supreme virtue of combining the best teaching
+and practice of continental writers on the subject with those of our
+own country, an undertaking for which Soelberg Wells was particularly
+well fitted, owing to his familiarity with the continental clinics and
+his linguistic abilities.
+
+Robert Lyell, who had worked as Hulke’s clinical assistant and who was
+an assistant general surgeon at the Middlesex Hospital, was elected
+in Wells’ place. He was a man who, as a student, had had a brilliant
+career and had obtained the highest qualifications and distinctions.
+With his appointments at the Middlesex and Moorfields, the way seemed
+open to him for a successful and prosperous future. Unfortunately, in
+the summer holiday of 1882, he contracted pneumonia, and the opening
+session at the Middlesex Hospital Medical School in October, at which
+he was to have delivered the Introductory Address, was saddened by the
+news of his death.
+
+For the vacancy created by Lyell’s death several candidates presented
+themselves, but ultimately withdrew their applications in favour
+of Nettleship, who already held the post of ophthalmic surgeon at
+St. Thomas’s Hospital. This was the last appointment on the staff
+at Moorfields which was created by a vote of the Governors. In 1883
+the Medical Council informed the Committee of Management that in its
+opinion “the present mode of election of the honorary medical officers
+did not secure the best interests of the Hospital.” A joint conference
+was held at which it was decided to recommend that in future the
+election of honorary officers should be invested in a committee, and
+that this election committee should consist of the Board of Management,
+together with six honorary medical officers, the quorum to consist of
+seven; and that canvassing should be prohibited on the part of any
+candidate under pain of disqualification. These recommendations were
+agreed to at a meeting of the Governors, and in this way all subsequent
+elections have been conducted. At the same time it was also agreed
+that the Fellowship of the Royal College of Surgeons of England should
+be the only requisite necessary for eligibility as a candidate for a
+post on the surgical staff.
+
+PLATE XIX.
+
+[Illustration: WAREN TAY]
+
+Manners and characteristics, besides being inherited by children
+from parents, are also often acquired by pupils from teachers. The
+latter most frequently occurs where the teacher possesses a strong
+and impressive personality, and the taught are earnest and devout.
+This transmission of traits is not uncommonly met with in the medical
+profession, where some dominating member of a hospital staff impresses
+his individuality on those who work under him. A conspicuous example
+of this occurred at Moorfields, where Waren Tay and Edward Nettleship,
+who worked as clinical assistants to Jonathan Hutchinson, acquired,
+probably quite unconsciously, not only his mannerisms, but even his
+method of speech. Tay, like Hutchinson, became skilled in the practice
+of several different branches of his profession; like him, he became a
+general surgeon at the London Hospital, a specialist in skin diseases
+at the Blackfriars’ Hospital and in eye diseases at Moorfields. It
+has already been mentioned how Hutchinson worked under Sir William
+Lawrence, and acquired from him the habit of collecting and collating
+the notes of clinical cases; in this most valuable method of advancing
+our knowledge of the natural history of disease Hutchinson found a most
+able disciple in Edward Nettleship, who, in the excellent field for
+its employment which Moorfields Hospital afforded him, made the most
+extensive use of it, more especially in tracing out the hereditary
+transmission of diseases and deformities.
+
+
+
+
+CHAPTER X
+
+ANTISEPTICS, BACTERIOLOGY, AND LOCAL ANÆSTHESIA
+
+
+Joseph Lister’s first paper on his method of preventing the access
+to wounds of germs which cause putrefaction appeared in the _Lancet_
+in 1867. It was not, however, until several years later that London
+surgeons began to adopt his methods, and it was not until the teaching
+and training of bacteriological laboratories exerted their influence
+that the practice of Listerian principles became generally and
+efficiently carried out.
+
+Wounds of the eye, due to the protective influence afforded by the
+eyelids, and to their continuous irrigation with tears, which normally
+possess bactericidal powers, were less liable to septic infection than
+those in other parts of the body. Hence, prior to the introduction of
+antiseptic methods, the operations of ophthalmic surgery were less
+frequently complicated by septic troubles than those of general surgery.
+
+Where the tear duct became obstructed and discharge from the tear sac
+regurgitated into the eye, and where contaminated instruments were
+introduced into the interior of the eyeball, wounds became infected and
+disastrous consequences ensued. The danger of operating for cataract
+when there was obstruction to the tear duct was soon recognised, and
+it became a routine practice to investigate the condition of the
+tear passages before embarking on such operations. It was not until
+some time after the introduction of antiseptic surgery that the
+sterilisation of the instruments used in ophthalmic operations became
+general.
+
+In the third edition of Soelberg Wells’ _Treatise on Eye Diseases_,
+published in 1873, which may certainly be taken as picturing the
+high-water mark of ophthalmic practice at that date, no mention is made
+of the use of any antiseptic precautions in connection with operations
+on the eye.
+
+The after-treatment of eyes operated on for extraction of cataract at
+Moorfields in 1876 is described by A. S. Morton, who was then house
+surgeon, as follows:
+
+  “As soon as the operation was completed the lids of each eye were
+  fastened by a very narrow vertical strip of plaster to prevent
+  involuntary opening of the eye during recovery from the anæsthetic,
+  then a piece of lint, on which was placed a layer of cotton-wool for
+  each eye, and over all a bandage. The eyes were dressed each morning
+  and evening after the operation, being gently bathed with tepid water
+  and the lids oiled with a soft brush to prevent the dressing sticking
+  to them. The patients were kept in bed till the third day, and the
+  lids never opened till the fourth or fifth day after the operation,
+  unless there were indications of mischief. About the end of a week
+  they were handed over to the nurse to dress, and in about nine or ten
+  days were allowed to have their eyes open, but very carefully shaded.”
+
+Confinement in a dark room was for a long time regarded as an essential
+part of the treatment of certain eye diseases. Some elderly people
+still retain vivid recollections of having to submit to this unpleasant
+form of treatment for some inflammatory eye affection in their youth.
+The admission of light to the eye during the first few days after
+an operation for cataract was believed to excite inflammation, and
+elaborate precautions were taken to avoid it.
+
+The cataract wards at Moorfields were darkened with double blinds, and
+when the dressings on the eyes were being changed, a nurse stood at
+the end of the bed holding a candle which she cautiously shaded with
+her hand to prevent any of its rays falling on the patient’s eyes.
+Some of the senior members of the staff received rather a shock when
+a venturesome house surgeon, mindful of Florence Nightingale’s dictum
+that “a dark room is always a dirty room,” had the blinds in the
+cataract wards drawn up, letting the sun’s blessed rays stream in,
+whilst the patient’s eyes were tied up or shaded with dark glasses.
+
+The practice with regard to the instruments in the pre-antiseptic days
+was for the nurse to wash them when used in ordinary tap-water, after
+which they were stored in their velvet-lined cases. From these they
+were transferred without further preparation, and handed to the surgeon
+for the next operation on a tray lined with green baize.
+
+Out-patients and in-patients were operated on in the same theatre, the
+former coming to it just as they presented themselves at the Hospital,
+without any change of clothing. The surgeons themselves made no change
+in their costume when operating, and the nurses wore no regular uniform.
+
+The former violent “antiphlogistic” treatment of extensive bleeding,
+sweating, vomiting, and purging, for inflammatory affections of
+the eyes, had in the seventies been given up, chief reliance being
+then placed on the use of belladonna and poppy-head fomentations,
+“astringents,” and the application of leeches, blisters, and setons to
+the temples.
+
+The year 1872 was an unusually disastrous one at Moorfields as regards
+operations for the removal of cataract, as many as 20 per cent.
+having resulted in failure. A joint meeting of the Committee and the
+medical staff was held to consider the matter, and the disasters were
+attributed to the presence in the Hospital at the time of a large
+number of infectious cases, changes in the nursing staff, and the
+absence of the house surgeon on a holiday. Measures to improve the
+ventilation of the wards were taken, an assistant house surgeon was
+appointed, and a long standing request of the Medical Council for the
+appointment of a special night nurse was at last acceded to.
+
+At the International Congress of Medicine held in London in 1881, a
+discussion took place at the ophthalmological section on the employment
+of antiseptics in ophthalmic surgery. Antiseptic surgery at that time
+consisted in the use of carbolic acid in the form of a spray, as a
+lotion, and in the dressings. Professor Horner of Zurich, who opened
+the discussion, quoted his statistics of cataract operations from
+1867 to 1881 to show that by the use of antiseptics there had been a
+decrease in the number of cases of suppuration from 6·6 to 1·1 per
+cent. Some speakers thought the good obtained from the use of carbolic
+acid was counter-balanced by its irritating properties. Bowman, who
+presided over the section, in his Inaugural Address, made the following
+wise remarks which may be taken as foreshadowing the adoption of
+aseptic as opposed to antiseptic measures:
+
+  “I presume that no one nowadays will question the evils we are so
+  familiar with in our practice, and which have so often marred the
+  intention of well-devised operations skilfully performed, but where,
+  as we hear it said, Nature has failed to do her part, to second the
+  effort of the surgeon by a process of repair. The study of the causes
+  of such failures and of the means of obviating them, constitutes far
+  the most brilliant page of modern surgery; and in other sections of
+  this Congress, while the name of Lister will be applauded, the wide
+  questions he has raised, and in raising has so often cleared up, will
+  receive the full consideration they call for.
+
+  “In the case of the organ of sight, specially constituted, and in
+  some respects screened from injury as it unquestionably is, there are
+  reasons why the application of precautionary antiseptic measures,
+  though the principle of them must still assert itself, should take a
+  somewhat special form. Owing to the local structural conditions they
+  may apparently be often more simple, though the possible need of the
+  more elaborate of them should never be allowed to fall out of view.
+
+  “The tears are a secretion as pure from extraneous particles as is
+  the filtered air in the recesses of the lungs. They are poured out
+  under cover, in the right place, in quantity suitable to the need;
+  while the lids diffuse them over the conjunctival surface ere they
+  escape to their proper channels. Their useful and multiple office is
+  performed in a way so simple and so perfect, that no art, however
+  skilful, could pretend to equal it. We should ponder well the deep
+  marvels of adaptation of means to ends, and take heed that we do
+  not hinder exquisite Nature by meddlesome or needless interference,
+  by the _nimia diligentia Chirurgorum_, but only lend it tender and
+  judicious help by our dressings and our methods. We should always
+  still be able to apply the words of our great poet, ‘The Art itself
+  is Nature.’”
+
+In 1876 A. S. Morton, the house surgeon at Moorfields, recorded
+that out of 146 cases of extraction of cataract 5·47 per cent, had
+suppurated, and that 12·3 per cent, had suffered from severe iritis.
+In an analysis of the results of cataract extraction at Moorfields
+for five years, from 1889 to 1893, the house surgeon, C. D. Marshall,
+records the number in which suppuration occurred as 1·69 per cent. The
+preparation and after-treatment of patients undergoing this operation
+during those years he describes as follows:
+
+  “I shall here only mention the special points connected with the
+  eye, the general examination and preparation of the patient being
+  precisely the same as that adopted previous to the performance
+  of any surgical operation. The lids and parts around the eye are
+  carefully washed with soap and hot water over-night, and a pad
+  which has been wrung out in a 1/4000 solution of the perchloride of
+  mercury is applied. On removing this the next morning one is able
+  to obtain a good idea as to the state of the conjunctiva; if the
+  lids be gummed together, the operation is deferred until a more
+  satisfactory state of things is obtained. If, however, there is
+  nothing to contraindicate the performance of the operation the eye is
+  anæsthetised with a 2 per cent. solution of freshly prepared cocaine
+  and the conjunctival sac is washed out with a good stream of either
+  warm boracic or perchloride lotion. The instruments are boiled before
+  being used and kept in carbolic acid lotion 1 to 40.
+
+  “After the operation both eyes are as a rule closed for a day or two,
+  and tied up with pads of Gamgee tissue made of the double cyanide
+  wool. The operated eye is kept bandaged for about a week, and after
+  that dark goggles are worn.”
+
+John Couper, who was a general surgeon at the London Hospital as
+well as an ophthalmic surgeon at Moorfields, was one of the earliest
+and most enthusiastic pioneers of antiseptic surgery, practising it
+consistently before Lister came to London. At Moorfields he was one of
+the first to welcome its application to ophthalmic surgery.
+
+PLATE XX.
+
+[Illustration: JOHN COUPER.]
+
+In the following appreciation, written by Sir John Tweedy, we have
+recorded a most faithful and striking word-picture of John Couper’s
+characteristics:
+
+  “When I first knew John Couper he was assistant-surgeon to the
+  London Hospital and assistant-surgeon to the Royal London Ophthalmic
+  Hospital, Moorfields. With his work as a general surgeon I was but
+  slightly acquainted, but I do know that he was one of the first and
+  most ardent of the disciples of the Listerian doctrine, and practised
+  the Listerian method with patient confidence. It was my happy
+  privilege to have as colleagues at Moorfields George Lawson and John
+  Couper, and to work side by side with them for many years. Lawson was
+  one of the best ophthalmic _surgeons_ I have ever known. Couper’s
+  gifts were of a different order. Although a good surgeon and skilled
+  operator, his qualities were those of an _ophthalmic physician_.
+  _Facile princeps_ among the ophthalmoscopists of the day, he was one
+  of the first in this country seriously and scientifically to study
+  problems of the errors of refraction, and especially of astigmatism.
+  His diagnostic skill and his careful method of investigation
+  attracted a body of thoughtful pupils, not a few of whom afterwards
+  attained a notable distinction. Couper’s was a charming personality;
+  he was gentle, courteous, conciliatory, but strong in opinion and
+  tenacious of principle. His mental temperament was essentially
+  sceptical. Not unbelief, not mis-belief, but hardness of belief was
+  his intellectual attitude to all surgical and scientific questions.
+  He did not believe easily or lightly, but only when convinced by
+  the force of reason and by the potency of well observed facts. His
+  scepticism may not have been an unmixed benefit as a teacher to
+  beginners, but it was a real advantage at a Hospital like Moorfields,
+  where many of the pupils, assistants, and visitors were actual or
+  potent experts. His hardness of belief often provoked keen but
+  friendly controversy, sharp but generous differences of opinion,
+  which rarely failed to elucidate truth, and open up fresh avenues
+  of knowledge. No man was ever the worse for a difference of opinion
+  with Couper, and most of us were often much the better. Thought was
+  stimulated, reasons were clarified, opinions modified and amended,
+  or maybe strengthened and confirmed; and, above all, a valuable
+  lesson was learnt in mutual respect and tolerance. Couper was indeed
+  a lovable man, a true friend, a staunch and loyal colleague. To
+  have known him, and to have been so long associated with him, is an
+  abiding satisfaction, and the recollection of a friendship unclouded
+  throughout many years is a precious possession.”
+
+John Couper was not only a pioneer in the use of antiseptics in
+ophthalmic surgery, but also in the accurate correction of even
+small errors of refraction with glasses. He was most emphatic and
+uncompromising in advising his patients to wear their glasses
+constantly. A young lady with a very pretty face, who felt very loath
+to detract from its charms by wearing glasses, asked pitifully:
+“Please, Mr. Couper, how long shall I have to wear these glasses?”
+Couper replied by asking her her age, which was eighteen. “Well,”
+said Couper, “the average age of woman is three score years and ten:
+eighteen from that makes how long?”
+
+Couper made use of his ophthalmoscope not only to explore the fundus
+of the eye, but also as an optometer for the estimation of refractive
+errors. He commenced to do so before the practice of “retinoscopy”
+came into use, and having acquired considerable skill in the method,
+continued to employ it in preference to the easier one. To render
+the ophthalmoscope as serviceable as possible as an optometer, he
+introduced several modifications in it. He found it most desirable
+to have only one lens to look through behind the sight hole in the
+mirror at a time, and to be able to bring the eye of the observer
+as near as possible to that of the one being examined. For these
+purposes he substituted a chain of lenses in place of the usual disc,
+and, as he considered it necessary to have as many separate lenses
+available as are contained in an ordinary trial case, the handle of his
+ophthalmoscope in which the lenses circulated became of considerable
+length. So long, indeed, was it that Couper had to arrange with his
+tailor for the construction of a special coat pocket in which he could
+carry it.
+
+The method of estimating errors of refraction of the eye by what is
+now known as “retinoscopy” was first introduced as a systematic method
+by Cuignet in 1874, under the inappropriate name of “keratoscopy.”
+Bowman had, however, ten years previously called attention to the
+possibility of diagnosing regular astigmatism by using the mirror of
+the ophthalmoscope to reflect light into the eye, much in the same way
+as for detecting slight degrees of conical cornea.
+
+An article advocating the use of Cuignet’s method, by Litton Forbes,
+appeared in the _Ophthalmic Hospital Reports_ in 1880, and another,
+descriptive of its optical basis, by W. Charnley, in 1882.
+
+In 1883 John Cawood Wordsworth, having reached the age of sixty,
+retired from the active staff after thirty-one years of service, and
+died three years later from angina pectoris. He was described as
+an admirable example of the genuine “dignity and reputation of the
+profession,” and as “unobtrusive almost to a fault.” Though, together
+with Hutchinson, he was for several years editor of the _Hospital
+Reports_, he contributed but little himself to the literature of
+ophthalmology.
+
+He resided and commenced to practise in Finsbury Square; for some
+time his private patients were but few and far between. He employed
+a page boy who was instructed to fetch him from the Hospital if any
+patient should happen to come whilst he was engaged there. One day the
+boy came to the Hospital in hot haste to announce the arrival of a
+patient. “Will he wait until I get round?” Wordsworth asked the boy. “I
+am quite sure he will,” replied the boy, “for I have locked him in.”
+Wordsworth then explained to the house surgeon and his assistants how
+they must carry on the work for a time as he had been called away to
+see a private patient; they helped him on with his coat, and away he
+went with the boy. To their great surprise he returned after only a few
+minutes. Noting the surprised look in their faces, he sadly explained
+that it was only the tax collector.
+
+Marcus Gunn, who had previously been the house surgeon, was appointed
+to succeed Wordsworth; he was the first officer who had so served the
+Hospital to become elected as a member of its honorary staff. He had
+been a particularly able and energetic house surgeon, having instituted
+a new system of note-taking for the in-patients, which has proved so
+satisfactory that it is still in use at the present time. His intimate
+acquaintance with the nursing and domestic arrangements of the Hospital
+proved of considerable value in the reforms and general upheaval which
+took place shortly after he was appointed. Previous to his becoming
+house surgeon, he had studied ophthalmology in Vienna under Jaeger; so
+impressed was he with the systematic courses of instruction carried
+on at that school, that on his appointment as assistant-surgeon he at
+once set to work to institute more regular and systematic teaching at
+Moorfields. He himself conducted regular classes in ophthalmoscopic
+examination at stated intervals, which became so popular that the list
+of students which could be taken at any one class was always filled up
+some time in advance.
+
+PLATE XXI.
+
+[Illustration: R. MARCUS GUNN.]
+
+Early in 1884 Dr. Martin resigned the post of physician, and Dr.
+Stephen Mackenzie (afterwards Sir Stephen Mackenzie), a physician at
+the London Hospital, was appointed in his place. He resided at that
+time in Finsbury Square, and it was easy, therefore, for him to attend
+at the Hospital when requested to do so either by a member of the
+surgical staff or the house surgeon. He took a keen interest in
+medical ophthalmology, and contributed several communications on the
+subject to the Ophthalmological Society, of which he was one of the
+first secretaries.
+
+During a large part of the nineteenth century the district of Finsbury
+was a fashionable residential medical quarter of London; Finsbury
+Square, Finsbury Pavement, Finsbury Circus, Broad Street, and St.
+Helen’s Place, at one time swarmed with physicians and surgeons.
+The City and its adjacent districts were then largely inhabited
+by prosperous business folk and their families; as these migrated
+westwards, the doctors naturally followed suit. Many of the younger
+members of the staffs of St. Bartholomew’s, Guy’s and the London
+Hospital lingered on so as to be within easy distance of those
+Institutions. It gradually became the custom for those residing
+around Moorfields Hospital, who were interested in ophthalmology, to
+foregather there in the house surgeon’s room on certain evenings in
+the week to discuss cases and other matters of mutual interest. So far
+back as 1866 Jonathan Hutchinson records in the _Ophthalmic Hospital
+Reports_ how he read a paper at the “Moorfields Club,” It was at one
+of such informal meetings that early in 1880 a circular was drawn up
+suggesting the formation of an Ophthalmological Society. This was sent
+to the leading ophthalmic surgeons in the three divisions of the United
+Kingdom, and met with a cordial response. In June of that year the
+first meeting of “The Ophthalmological Society of the United Kingdom”
+was held, at which William Bowman, who had been appointed President,
+delivered an Inaugural Address.
+
+Pasteur’s researches on fermentation and putrefaction, and Lister’s
+application of them to the treatment of wounds, raised the study of
+bacteriology to the dignity of a science.
+
+Improvements in the microscope by the introduction of high power
+oil-immersion lenses made it possible to study the morphology of
+micro-organisms, and the introduction by Koch of improved methods for
+obtaining pure cultivations of them paved the way to the investigation
+of their life-history and bio-chemical reactions.
+
+During the eighth decade of the nineteenth century the connection
+of several different micro-organisms with diseases of the eye was
+discovered, which aided in the study of their natural history and
+treatment.
+
+In 1884 incubators and other bacteriological apparatus were installed
+in the pathological laboratory at Moorfields to allow of these new
+methods of investigation being carried out.
+
+In 1882 Koch demonstrated that a specific organism could be separated
+from tuberculous tissue and cultivated outside the body, which would
+reproduce tuberculosis when inoculated. A new test was thus supplied
+for the recognition of tuberculous lesions, and some affections of
+the eye, of which the real nature up to that time had been doubtful,
+were by its means proved to be tubercular. J. B. Lawford, who, on the
+resignation of Jennings Milles, had become curator of the Museum, was
+among the first to detect Koch’s bacillus in the tissues of the eye.
+
+In 1890 Koch introduced his original form of tuberculin treatment,
+which, before its effects had been adequately investigated, raised the
+greatest expectations, and caused a rush to Berlin of consumptives from
+all parts of the world. This treatment was tested in January, 1891, on
+a patient at Moorfields, under Waren Tay, with tubercular nodules in
+the iris at the margin of the pupil. So situated it was possible to
+watch the effects of the treatment on them with the greatest precision.
+The nodules, which were at first separate, gradually increased in
+size and became confluent, ultimately invading neighbouring parts and
+necessitating the removal of the eye. Besides demonstrating the failure
+of the treatment, this case was of interest, because the administration
+of an injection of the tuberculin after the eye was removed produced a
+general reaction, thus showing the presence of some other focus of
+tuberculosis which had not been detected, and from which most probably
+the eye had become secondarily affected.
+
+PLATE XXII.
+
+[Illustration: JAMES E. ADAMS.
+
+From a painting by a patient upon whom he had performed the operation
+of extraction of cataract.]
+
+The employment of bacteriological investigation in connection with the
+discharge from eyes affected with ophthalmia resulted in the discovery
+of two new forms of bacilli—the Koch-Weeks bacillus in 1887, and the
+Morax-Axenfeld diplo-bacillus in 1896—each receiving a dual name due to
+their independent and almost simultaneous recognition by two different
+workers.
+
+The recognition of these and other micro-organisms which had been
+discovered in connection with other affections (such as the gonococci,
+Klebs-Löffler bacilli, pneumococci, streptococci, and staphylococci),
+as the specific agents in the causation of the different forms of
+ophthalmia, led to a new means of classifying them, the previous
+classifications being based on the clinical appearances alone.
+
+The rapid advance in bacteriology, and the introduction of vaccine
+treatment arising out of it, tended to make its study and practice more
+and more a special branch of medicine. In 1907, after the Hospital
+had been removed to the City Road, it was found necessary to erect a
+special laboratory for its development and to appoint a special officer
+to take charge of it.
+
+The premature decease of several members of the surgical staff just
+as they had attained the acme of a successful career has already
+been referred to; the cruellest fate of all was that which befell
+James Adams, who, whilst engaged in restoring and saving the sight
+of others, was doomed to watch the gradual failure of his own to
+complete and irremediable blindness. This, too, whilst he was in the
+hey-day of life, a successful general surgeon at the London Hospital
+and ophthalmic surgeon at Moorfields. A man full of the joy of life,
+deservedly popular with his colleagues and students, he combined
+scientific with spotting interests, and was able to snatch a day here
+and there from his arduous duties to follow the hounds.
+
+A complete rest having failed to prove of any benefit to his gradually
+increasing darkness, he, in the latter part of 1884, found it necessary
+to resign all his appointments. William Lang, who had for some time
+worked with him as clinical assistant, and who held the appointment
+of ophthalmic surgeon at the Middlesex Hospital, was elected as his
+successor at Moorfields.
+
+Cocaine is derived from the leaves of a plant, _Erythroxylon coca_,
+which grows in Peru and Bolivia. It was originally named “khoka,”
+meaning “the tree of trees.” Joseph de Jussieu first sent a specimen
+of the plant to Europe in 1750. The practice of chewing its leaves as
+a means of appeasing hunger and thirst, and relieving fatigue, had
+for long been a custom among the natives of South America. The famous
+long-distance walker, Weston, employed them in this way when, in the
+seventies, he trudged round and round the Agricultural Hall in his
+efforts to cover the longest possible distance in the shortest possible
+time. In 1872 Dr. Hughes Bennett of Edinburgh showed that cocaine, when
+applied to a mucous membrane, produced anæsthesia, but no use was made
+of it in practice.
+
+It was Karl Roller of Vienna, in 1884, who first made applications of
+it to the eye, which resulted in its employment in ophthalmic surgery.
+Koller’s original article, describing the physiological effects of
+the drug on the eye, was so complete that there was but little left
+to be added. A description of it was given at the meeting of the
+Heidelberg Ophthalmological Society in 1884, and a solution of the
+drug was brought straight from there to Moorfields in the latter part
+of September of that year. The first operation performed under its
+influence in this country was a tattooing of the cornea by Marcus
+Gunn. Its employment soon became general in all operations on the eye
+in which there was not much congestion, and in which the tension of
+the globe was not increased. The supply at first was so small and the
+demand so great that its price rapidly rose to a guinea a grain.
+
+The substitution of local for general anæsthesia in cataract
+operations aided materially in their safety and success. The dreaded
+effects on the eye of vomiting and reaching on the recovery from the
+administration of ether or chloroform were avoided, and the aid of
+the patient in turning the eye in any direction did away with the
+necessity of dragging it into suitable positions, which was frequently
+requisite when the patient was unconscious. The immediate result was
+a considerable decrease in the number of cases in which the vitreous
+humour escaped, and the possibility of greater precision in the
+adjustment of parts after the removal of the cataract.
+
+At first nothing was known of its toxic effects, and the small amount
+absorbed when dropped into the eye did not give rise to them. It was
+only when attempts were made to anæsthetise large areas of the skin by
+subcutaneous injection that they became manifest.
+
+In 1884 the surgical staff had become so dissatisfied with the system
+of nursing at the Hospital, and with the standard of the nurses
+employed, that they requested a conference with the Committee of
+Management on the matter. At this conference it was agreed that no
+satisfactory improvement could be effected without having at the head
+of the establishment a lady who had herself been efficiently trained as
+a nurse. Miss Harnet, who then held the post of matron, was advised to
+tender her resignation. This she did, a pension being granted her. The
+new matron, selected from a number of candidates for the post, was Mrs.
+Peel, who had been trained at the London Hospital, where she had also
+held the post of sister: later she had been matron at the Newcastle
+Infirmary.
+
+Shortly after her appointment, the head nurse was detected receiving
+money from a patient; this being her second offence of the sort she
+was at once dismissed. After her departure it was discovered to have
+been a common form of corruption, notwithstanding the warning notices
+concerning it posted about the Hospital. The forced resignation of
+the former matron and the summary dismissal of the head nurse caused
+consternation amongst the other members of the nursing staff, who
+combined together to make things unpleasant for the new matron. She
+received, however, the support of the medical staff and the Committee
+of Management, and ultimately a complete change of the nursing staff
+was effected, fully trained nurses being engaged to fill all the most
+important posts.
+
+In April, 1885, occurred the sudden and unexpected death of
+Streatfield, who was at that time the senior surgeon. As has already
+been mentioned, he was a most dexterous operator, and also possessed
+of considerable ingenuity, which manifested itself sometimes in
+peculiar ways. A few years before his death he had had constructed a
+gigantic model of an eye, on which he could demonstrate to students
+mechanically the various stages of operative procedures. As he truly
+pointed out, in operations on the eye, the smallness of the organ and
+of the parts dealt with renders it impossible for any, except those in
+close proximity to the operator, to see clearly what is taking place.
+He, therefore, devised this model, constructed with all its dimensions
+ten times the size of the normal eye. The eyelids and sclerotic were
+of white felt spread over wire, the cornea of glass, the iris of
+indiarubber, the lens of xylonite, and the external muscles of the eye
+of linen. Models of the instruments employed were of wood, also ten
+times their actual size, except as regards their handles, which to
+allow of the manipulation of such weapons had to be reduced. By various
+artfully arranged mechanical contrivances, the lens could be made to
+present and escape from the eye above the cornea when a certain spot on
+the sclerotic was touched, and the cornea then roll back into position.
+Ingenious as all these contrivances were, the effect of the model
+when exhibited was to excite mirth more than anything else. It passed
+into the possession of the Hospital after Streatfield’s death, but no
+further use was made of it.
+
+PLATE XXIII.
+
+[Illustration: A. QUARRY SILCOCK.]
+
+A. Quarry Silcock was elected to succeed Streatfield; besides being
+an ophthalmic surgeon he was a general surgeon attached to St.
+Mary’s Hospital. At one time, as has been shown, all members of the
+surgical staff of the Hospital had to be either a general surgeon or a
+demonstrator of anatomy connected with a general hospital. This rule
+had, however, been altered, it being thought only necessary to insist
+on candidates possessing the diploma of Fellowship of the College of
+Surgeons of England, as a guarantee that they had attained a high
+standard of general surgical efficiency. Silcock was the last member
+of the staff appointed who combined the practice of ophthalmology
+with that of general surgery; all those since appointed, though
+Fellows of the College of Surgeons, have restricted their practice
+to ophthalmology. With the growth of knowledge the speciality of
+ophthalmology had come to consist of much besides mere dexterity in the
+performance of certain surgical operations. Here may be aptly quoted
+what the late Dr. James Anderson wrote with reference to it in 1889:
+
+  “It seems to me the best and most hopeful feature of ophthalmology
+  that it has relations, closer or more remote, with every branch of
+  medicine and surgery—indeed, with almost every branch of science.”
+
+
+
+
+CHAPTER XI
+
+THE SELECTION OF A NEW SITE, AND THE ERECTION OF THE NEW HOSPITAL
+
+
+The condition of the Moorfields Hospital in 1884 may be compared to
+that of a man wearing a suit of clothes fitted to him in his youth,
+which had since been added to, patched, and darned, to cover his
+nakedness. The result was that he not only presented an incongruous
+appearance, but lived in constant fear of fresh dilapidations.
+
+To carry the analogy still further, those who would be called upon
+to find funds for a fresh suit, and who had taken pains to make the
+patches, desired to leave matters as they were. Whilst the man himself,
+who had to wear and work in his old-fashioned clothes, was all agog for
+a new rig-out.
+
+The Hospital erected in 1821 was in keeping with the conceptions of
+the time and adapted for the accommodation then required. With the
+new ideas which arose out of Florence Nightingale’s teaching, and
+later as the outcome of bacteriological investigations, the general
+principles for hospital construction became completely changed. Though
+the original Moorfields Hospital was added to and altered to meet new
+requirements, it became obvious to the rising generation of medical
+men working there that it could never be converted into an up-to-date
+institution. It took time, however, before the Committee of Management
+as a body could be induced to look at the matter in the same light,
+especially its older members who had taken part in raising funds and
+arranging for the additions.
+
+In 1884 a piece of building land in Eldon Street to the west of the
+Hospital became vacant, and the Controller of the City of London
+offered to lay any proposal the Committee of Management might feel
+inclined to make concerning it before the Bridge House Estates
+Committee. Though urged by the Medical Council to acquire it, the
+Committee of Management replied that it did not feel able to tender.
+
+During the next three years circumstances arose which gradually
+convinced the Committee that there were irremediable defects in the
+Hospital as regards accommodation, ventilation and sanitation. The beds
+were always full, and the waiting-list of patients requiring in-patient
+treatment grew in dimensions. The cubic space per patient in the wards
+was very deficient, and no cross-ventilation of them was possible.
+There were no day rooms in which patients not confined to bed could
+take their meals. There was no passenger lift to convey patients who
+had been operated on to the upper floors, so that they had to walk up
+a narrow staircase. There were no bath rooms, and very inefficient
+accommodation, for the resident staff. The drainage, laid down without
+any general plan, and in piecemeal fashion, was constantly being
+attended to and tinkered with.
+
+In 1887 the Medical Council complained of the defective sanitation
+of the Hospital, and requested that a sanitary expert might be asked
+to examine the drainage and advise in the matter. At the same time
+it submitted to the Committee a report entitled, _Some Defects in
+the Royal London Ophthalmic Hospital_, in which the above mentioned
+deficiencies and others were set out in detail. From the consideration
+of this report, and that received from the sanitary expert, it became
+obvious that nothing but a new building would meet all the requirements.
+
+The building land in the rear of the Hospital facing Eldon Street still
+remained temptingly vacant, and, in 1887, a suggestion was received,
+emanating from the City architect, that an exchange might possibly be
+effected—i.e., the taking of the existing site of the Hospital for the
+vacant site in Eldon Street together with a sum of £15,000.
+
+Though this suggestion did not come to anything, it served to awaken
+the Committee of Management to the valuable assets the Hospital
+possessed in the greatly enhanced value of its freehold and leasehold
+properties, due to the changes which had taken place in its environment
+since it was first built—unearned increment, which was eventually put
+to the best possible use by an extension of the means for the relief of
+suffering in the community.
+
+Mr. Lander, the Hospital’s surveyor, was then requested to obtain
+valuations of the Hospital’s site and of that of the vacant land
+adjoining it. No very precise figures were obtained, the site of the
+Hospital being valued at anything between £50,000 and £100,000. The
+Committee still, however, hesitated to make any tender for the vacant
+land.
+
+In July, 1888, after a consultation of representatives of the Medical
+Council with Sir John Lubbock, the President of the Hospital, he
+agreed to introduce a deputation to the Lord Mayor to request him to
+use his influence in obtaining for the Hospital a gift of the vacant
+land adjoining it from the Corporation. The Lord Mayor pointed out
+that it was trust property held by the Bridge House Estates, which had
+no power to comply with the appeal of the deputation “so earnestly
+and reasonably made.” The deputation next waited on the Bridge House
+Estates Committee, who replied that it was unable to pledge itself not
+to accept any tender, but the matter would receive its most favourable
+consideration.
+
+Matters were still further advanced in that year: firstly, by the
+receipt of an unsolicited donation of fifty guineas from the trustees
+of St. Stephen’s, Coleman Street, towards a Building Fund, which led to
+the opening of such a fund for subscriptions, to which the surgeons of
+the Hospital in the following year promised a gift of £1,000; secondly,
+by the desire of the City to effect a street improvement, so as to
+widen the junction of Blomfield Street and Eldon Street, which would
+necessitate a surrender of a slice of the Hospital’s ground.
+
+A complication arose, due to the Hospital’s land not directly adjoining
+that vacant in Eldon Street—a Welsh chapel, with a lease of four years
+yet to run, intervening between them.
+
+Ultimately, the Bridge House Estates Committee offered the Hospital
+the vacant area, including that of the Welsh chapel, comprising in all
+7,180 feet, on lease for ninety-nine years at a peppercorn rent of
+£311 per annum until the chapel’s lease expired, and then at £388 per
+annum, with, however, the provision that the Committee of the Hospital
+or its trustees were made personally responsible for the payment of the
+rent and the observance of the conditions of the lease. This provision
+neither the members of the Committee nor the trustees of the Hospital
+were prepared to accept, and the whole of the year 1889 was spent in
+endeavouring to come to terms with the Law Guarantee and Trust Society
+to take on these responsibilities. These negotiations not proving
+satisfactory, it was decided, in 1890, that application should be made
+to the Privy Council for a Charter of Incorporation. A Petition for
+Incorporating the Hospital by Royal Charter was prepared and presented
+to Her Majesty the Queen in Council, together with a draft form of the
+Charter which would empower the Hospital to hold land in mortmain,
+and thereby enable it to proceed with negotiations for the lease. The
+Charter of Incorporation under the Great Seal was passed in December,
+1890, to which a common seal, that had been designed for the Hospital,
+was appended.
+
+In the lease obtained for the ground in Eldon Street it was laid down
+that building was to commence before January, 1893, and it became
+necessary at once to appoint a suitable architect to draw up plans.
+Messrs. Lander and Bedell were at that time acting as surveyors to
+the Hospital, but hospital construction had developed into a very
+specialised branch of architecture, and it was thought desirable to
+employ for the new building one who had a large experience of that kind
+of work. In August, 1891, Mr. Keith Young, who had already designed
+several hospitals, was appointed, to be assisted by Mr. Lander, and
+after his death in 1892 by Mr. Bedell.
+
+After due and deliberate consideration, the architects arrived at the
+opinion that the site, even including that of the Welsh chapel, would
+not allow of sufficient space to meet all the requirements of the new
+Hospital. They suggested that a larger one might be acquired in a less
+valuable locality. Investigations were made, and a site which seemed to
+offer many advantages was discovered in the City Road. Many of those
+associated with the Hospital felt very loath to move the Institution
+from the neighbourhood of Moorfields, with which it had become so
+intimately associated. The matter was discussed at length at a joint
+meeting of the Committee of Management and the medical staff, and in
+July, 1892, the latter passed the following resolution:
+
+  “That considering the alleged great value of the present site and the
+  difficulty of constructing a suitable building upon it, the Medical
+  Council is of opinion that the present site should be sold and that,
+  so far as the information at present at its disposal goes, the City
+  Road site is best adapted for a new Hospital provided that the whole
+  of that site can be acquired.”
+
+With the sanction of the Bridge House Estates Committee, the lease of
+the Eldon Street site with all its obligation was transferred to a
+substantial tenant, who was willing to pay the Hospital a premium of
+£1,000.
+
+The lease was then obtained for 999 years from March, 1894, of what was
+termed the City Road and Peerless Street site of some 35,000 feet, in
+the parish of St. Luke’s, Old Street, in the county of Middlesex, at a
+rent of £1,210 per annum, from the Ecclesiastical Commissioners.
+
+It is rather a remarkable coincidence that another hospital, which
+was originally situated at Moorfields, should have previously removed
+to the neighbourhood of the City Road, and not very far from the
+Peerless Street site. St. Luke’s Hospital, which, though independent
+of Bethlehem Hospital, dealt with the same class of ailments, was
+originally established in 1750 on the north side of Moorfields. In 1782
+a new building was erected near the junction of Old Street and the City
+Road, it being recorded that at that time green fields could be seen in
+every direction. The building continued as a hospital for the mentally
+defective until the time of the Great War, when it was taken over by
+the Bank of England, of which it continues to be a branch.
+
+Peerless Street runs between the City Road and Bath Street. It is lined
+by a row of small, mean houses, which, but for the Rent Restriction
+Act, would have been swept away ere this by the ground landlord, St.
+Bartholomew’s Hospital. Anyone unacquainted with the history of the
+neighbourhood may well wonder how such a poverty-stricken street could
+have acquired such a high-sounding name. It is the last remaining
+sign of the delectable attractions which formerly existed in its
+neighbourhood.
+
+In ancient times some springs overflowed and formed a pond between
+what is now Peerless Street and St. Luke’s Hospital; from it water was
+conducted through pipes to Lothbury for the benefit of the inhabitants
+of that district. Stowe describes it in 1603 as “cleare water called
+the Perilous Pond because divers youths by swimming therein have been
+drowned.” In consequence of such accidents (the inhabitants of Lothbury
+having obtained water from elsewhere), the Perilous Pond was entirely
+filled in. In 1743 Mr. William Kemp, an eminent jeweller and citizen
+of London, having derived relief from violent pains in the head from
+which he had suffered for several years by bathing in the water from
+the spring, converted it into what William Maitland, in his _History
+of London_, 1775, describes as “the completest swimming bath in the
+whole world.” “He spared,” Maitland says, “no expense nor contrivances
+to render it quite private and retired from public inspection,
+decent in its regulations and as genteel in its furniture as such a
+place could be made.” At the same time he changed its name from the
+disagreeable one of the “Perilous Pond,” which it no longer was, to
+the pleasing one of the “Peerless Pool,” which, owing to its size and
+surroundings, it had undoubtedly become. The swimming bath measured
+170 feet in length and 100 feet in width, and varied from 5 to 3 feet
+in depth. The entrance to it was through a marble pavilion 30 feet
+in length and across a bowling green; it was surrounded by dressing
+compartments, outside which were lofty banks covered with shrubs and
+a terraced walk planted with lime trees. Four pairs of marble steps
+descended to the bath, which had a fine gravel bottom. Besides this
+open swimming bath, there was a covered cold bath, supplied with water
+from a specially cold spring, faced with marble and paved with stone.
+The most remarkable feature, however, of the Peerless Pool was “a noble
+fish pond constructed by Kemp due east and west. It was 320 feet long,
+93 feet broad, and 11 feet deep, stocked with carp, tench, and a great
+variety of the finney tribe, wherein subscribers and frequenters of
+either the pleasure or the cold bath were privileged to angle.” William
+Hone, in his _Every-day Book_, published in 1831, gives engravings of
+the fish pond (showing the lime walk and Kemp’s house in the distance)
+and of the swimming bath, made by Mr. John Cleghorn, an architectural
+draftsman and engraver, who for many years resided near the Pool.
+
+PLATE XXIV
+
+[Illustration: *THE PLEASURE BATH, PEERLESS POOL, CITY ROAD.*]
+
+  *TERMS OF SUBSCRIPTION*
+
+  PLEASURE BATH
+                 £. s. d.
+  Month          0  9  0
+  Two Months     0 10  0
+  Year           1  1  0
+
+  Single Bathe}
+  with Towels }  0  1  0
+  and Box     }
+  Ditto without  0  0  6
+
+
+  COLD BATH
+                 £. s. d.
+  Month          0 10  0
+  Two Months     0 17  0
+  Year           1 10  0
+
+  Single Bathe   0  1  0
+
+  [Illustration: Map of location]
+
+  1 Bath Buildings; Entrance—2. Baldwyn
+  Street Entrance—3. Cold Bath—4.
+  Pleasure Bath—5. Dressing Boxes—6.
+  Shrubberies
+
+*THE PLEASURE BATH OF PEERLESS POOL,*
+
+The largest in England, is situated in the immediate neighbourhood of
+the heart of the City, within Ten minutes direct walk of the bank and
+Exchange, (vide plan.) Surrounded by trees and shrubberies, open to the
+air, although entirely screened from observation, and most ample in
+its dimensions—*170* feet in length, by *108* in breadth—it offers to the
+Bather the very advantages he would least expect to find at so short a
+distance from the centre of the metropolis. Its depth, which increases
+gradually from 3 feet 6 inches to 4 feet 8 inches, is such as to afford
+free scope to the Swimmer, while it precludes all fear of accident
+to any and the temperature of the water rises to a height sufficient
+to ensure all the comfort and luxury of Bathing, without the risk of
+injury to health, from a too violent contrast with the external air.
+
+*THE COLD BATH,*
+
+Thirty-Six feet by Eighteen, is the largest of its kind in London,
+and both Baths are entirely supplied by Springs, which are constantly
+overflowing.
+
+_The City Road is the line from all parts of the West End to the City.
+Omnibuses pass both ways nearly every minute throughout the day_.
+
+BILL OF PEERLESS POOL. _Circ_. 1846.
+
+In the Daily Advertiser of August, 1748, are some doggerel verses
+extolling the attractions of the Peerless Pool, and also a statement
+that—
+
+  “any gentleman, who subscribes only one guinea per annum, is entitled
+  to the pleasure and cold bath, and to the diversion of angling and
+  skating at proper seasons; and that if any occasional visitor,
+  who must pay 2s. each time he bathes, thinks proper to become a
+  subscriber in the fourteen days from his first visit, he shall be
+  allowed that he has paid it as part of his subscription.”
+
+After Kemp’s death the Pool seems to have changed hands several times.
+On the expiration of the lease in 1805, a new one was obtained from St.
+Bartholomew’s Hospital by Mr. Joseph Watt, at an annual rental of £600.
+To remunerate himself Mr. Watt drained the fish pond, felled the trees
+around it, and built Baldwin Street, which lies just south of Peerless
+Street, on its former site. He also erected Bath Buildings on the
+ground occupied by Kemp’s orchard, but left the pleasure bath intact.
+In 1831 William Hone wrote:
+
+  “The pleasure bath is still a pleasant spot, and both that and the
+  cold bath retain their ancient capabilities. Indeed, the attractions
+  of the pleasure bath are undiminished. Its size is the same as in
+  Kemp’s time, and trees enough remain to shade the visitor from the
+  heat of the sun while on the brink, irresolute whether to plunge
+  gloriously in, or ignobly walk down the steps.... Every fine Thursday
+  and Saturday afternoon in the summer, columns of blue-coat boys, more
+  than three score in each, headed by their respective beadles, arrive,
+  and some half strip themselves ere they reach their destination; the
+  rapid plunge they make into the pool, and their hilarity in the bath,
+  testify their enjoyment of the tepid fluid.”
+
+The Peerless Pool continued in existence as a public bath until 1850,
+the site occupied by it being built over between that date and 1860.
+
+Out of the City Road, on the opposite side to Peerless Street, leads
+Shepherdess Walk, which marks the site of the Shepherd and Shepherdess
+ale-house and tea-garden, built some time before 1745. The gardens were
+frequented by visitors who regaled themselves with cream, cakes and
+fromity. Invalids sometimes stayed at the inn to benefit by the pure
+air of the neighbourhood.
+
+  “To the Shepherd and Shepherdess then they go
+  To tea with their wives, for a constant rule;
+  And next cross the road to the Fountain also,
+  And there they all sit, so pleasant and cool,
+  And see, in and out,
+  The folk walk about,
+  And the gentlemen angling in Peerless Pool.”
+
+In Baldwin Street there is still a public-house called “The Fountain,”
+which is probably the survival of the one referred to in this old
+rhyme, and of one which Franklin wrote of, “a very genteel public house
+at the east end of Kemp’s garden.”
+
+The City Road, which was opened in 1761, cut through the meadow grounds
+which surrounded the Shepherd and Shepherdess, so that the place lost
+its rural isolation. The inn was pulled down in 1825, and the Eagle
+Tavern, which formed the nucleus of the famous Eagle establishment,
+with its Grecian saloon and theatre, and its garden and dancing
+pavilion, was erected near its site. It was this establishment which
+was celebrated in the refrain of the popular song;
+
+  “Up and down the City Road,
+  In and out the Eagle,
+  That’s the way the money goes,
+  Pop goes the weasel.”
+
+It has been suggested that this refrain might be paraphrased by those
+employed at the Moorfields Hospital as follows:
+
+  “Up and down the City Road,
+  In and out Moorfields,
+  That’s the way we spend our lives,
+  Oh! the joy it yields.”
+
+Whilst the above discussions and negotiations with regard to the
+erection of a new Hospital were in progress several changes took place
+in the personnel of the staff.
+
+In 1890 John Whitaker Hulke, having reached the age of sixty, retired.
+He died five years later whilst holding the highest position in his
+profession, that of President of the Royal College of Surgeons in
+England. John Browning Lawford, who had already held the posts of house
+surgeon and of curator of the Museum, was elected in his place.
+
+In 1891 George Lawson also had to retire under the age limit rule. In
+1869 he had published a _Manual on Diseases and Injuries of the Eye_,
+which, owing to its practical character, became exceedingly popular
+amongst medical students, and rapidly ran through five editions. Lawson
+endeared himself to his patients by the personal interest he manifested
+in their welfare. His treatment went far beyond the mere prescription
+of drugs or the performance of operations. He would instruct a mother
+how to feed, clothe, and train her child. He would tell a patient,
+for whom nothing could be done to restore the lost sight, what his
+future might be and how to get to work to earn a livelihood. Many of
+those engaged in seeing out-patients often wish they could prescribe
+food for them instead of medicine. Lawson actually did this, having an
+arrangement with a neighbouring butcher by which he could at his own
+expense order patients so many pounds of meat. Nor did his generosity
+to Hospital patients end with supplying sound advice and meat; many to
+whom some unusually disastrous circumstance had occurred would be led
+quietly aside and return with a smiling face and a closed palm.
+
+In 1886 Lawson was appointed surgeon oculist to Her Majesty Queen
+Victoria, which appointment he held until her death. He himself died
+in 1903 at the age of seventy-two, having had the satisfaction of
+seeing his son Arnold (now Sir Arnold Lawson) appointed on the staff at
+Moorfields, where he himself had worked for so long.
+
+The vacancy caused by Lawson’s retirement was filled by the election
+of A. Stanford Morton, who was educated at Edinburgh University. He
+had served the Hospital first as house surgeon and later as clinical
+assistant for a period of sixteen years. He did not take the necessary
+qualification of the Fellowship of the Royal College of Surgeons
+of England, which would qualify him as a candidate for the staff,
+until 1888, and was forty-eight years of age at the time of his
+election. His name has become widely known throughout the ophthalmic
+world in connection with the very serviceable and popular pattern of
+ophthalmoscope which he had constructed for him by Messrs. Curry and
+Paxton. It happily combined all the best features and adaptations which
+had previously been suggested.
+
+For dexterity and neatness as an operator on the eye Morton was
+unsurpassed in his time. He enthusiastically instructed others in
+the art, holding classes of operative ophthalmic surgery in which he
+employed pigs’ eyes fixed in a frame to enable students to obtain the
+necessary manipulative dexterity. Whilst he was working as a clinical
+assistant, the practice of retinoscopy for the correction of errors of
+refraction came into use, and he wrote a small book on _Refraction of
+the Eye_, describing it in such an easily assimilated manner that the
+book had a large sale, several editions being called for.
+
+Being a good draftsman, and having an excellent eye for colour, Morton
+made many beautiful coloured drawings of ophthalmoscopic changes, the
+originals of which he presented to the Hospital on his retirement.
+The extreme care which he took in their production often necessitated
+several sittings on the part of the patient. In one interesting
+and complicated case, the drawing of which took a very long time,
+Morton found it necessary to remunerate the patient liberally after
+each sitting to ensure his subsequent attendance. When the drawing
+was finished the man found that Morton’s interest in his case had
+evaporated, and, being hard up, appeared at the Hospital one morning
+offering to sell him one of his eyes if he would like to take it out—an
+offer which it is perhaps needless to say was not accepted. The man
+afterwards went about to various ophthalmic clinics calling himself
+the celebrated Moorfields case, and he informed those who examined him
+“that gentlemen generally gave him something after looking at the backs
+of his eyes,”
+
+Though it had been the custom for a long time to print on the letters
+given to patients, and to have posted up in the out-patient department,
+a notice to the effect that the Hospital was only open for the
+reception of really indigent patients, it was a rule which the medical
+staff found very difficult to enforce, and which was obviously very
+frequently infringed. In 1893 on the advice of the Medical Council, the
+Committee of Management adopted the plan in use at several of the other
+London hospitals of appointing an “inquiry officer” to attend daily and
+make necessary inquiries, so that “no person should be admitted in the
+first instance to Hospital relief who can afford to pay a fee of one
+guinea for a consultation (except in cases of accident)” The officer
+appointed for this Purpose was one selected by the Charity Organisation
+Society, who had been trained under its superintendance. As the result
+of his investigations, from about 500 applicants were refused yearly,
+it being found that they were able to pay a surgeon’s fee, many of them
+stating that they were unaware that the Hospital was open for the poor
+only.
+
+John Couper’s time for retirement from the staff came in 1895. He
+continued in active practice for several years afterwards, and died in
+1918, in his eighty-third year. He had always been a firm supporter of
+the movement for the admission of women to the medical profession, and
+welcomed Miss Elizabeth Garrett (afterwards Mrs. Garrett Anderson) as
+an onlooker at his clinic at Moorfields. It was not, however, until
+after he had left the staff, in 1898, that the eligibility of women to
+become pupils and clinical assistants at the Hospital became officially
+recognised.
+
+E. Treacher Collins, who, like Lawford, had been both house surgeon
+and curator of the Museum at the Hospital was appointed as Couper’s
+successor.
+
+The premature and unexpected resignation from the staff of Edward
+Nettleship took place in 1898; his keen interest in the scientific
+side of ophthalmology, however, did not slacken. He gave the Hospital
+a donation of £250, to be expended on scientific apparatus and
+appliances for the laboratory in the new building. With more time at
+his disposal for research work, his valuable scientific contributions
+increased in number. With indefatigable ardour and strenuous accuracy
+he worked out pedigrees of hereditary diseases, the value of which
+work was recognised in 1912 by his election as a Fellow of the Royal
+Society. On his retirement from practice in 1901, his friends and
+pupils inaugurated a fund to found the “Edward Nettleship Prize” for
+the encouragement of scientific ophthalmic work. It took the form of a
+Gold Medal to be awarded at intervals, at the discretion of the Council
+of the Ophthalmological Society, British subjects alone being eligible.
+He died in October, 1913, being actively employed up to the time of his
+death, in conjunction with Karl Pearson and C. H. Usher, on a large
+monograph upon “Albinism in Man.”
+
+To fill the surprise vacancy caused by Nettleship’s retirement, W. T.
+Holmes Spicer was appointed.
+
+Three matrons at the Hospital resigned from ill-health in the course
+of a few years, and, in 1895, Miss Ada Robertson, a former sister at
+the London Hospital, was appointed to the post. She not only carried
+through the difficult task of transferring the work of the Hospital
+from the old to the new building, but also, with skill and tact, raised
+the nursing to a higher standard of efficiency than it had reached
+before.
+
+In 1897 Mr. Charles Gordon, who had acted as Chairman of the Committee
+of Management for eighteen years, and who had taken an active part in
+all the negotiations for the removal of the Hospital to a new site, on
+the eve of the laying of the foundation stone, found it incumbent upon
+him to resign owing to his advanced years; he died two years later.
+Thus, like Moses, having led his colleagues to within sight of the
+promised land, he left it for them to enter into its occupation.
+
+Mr. H. P. Sturgis, a director of the London and Westminster Bank, was
+elected Chairman in his place.
+
+About the same time, Mr. Robert J. Newstead, after twenty-five years’
+service as secretary, had to resign from ill-health, and died at the
+end of the year. Mr. Robert J. Bland was appointed as his successor.
+
+On the 28th of May, 1897, the work of clearing and preparing the
+foundations being sufficiently advanced His Royal Highness the Prince
+of Wales (afterwards King Edward VII.), on behalf of Her Majesty
+Queen Victoria, laid the foundation stone of the new Hospital. His
+Royal Highness was accompanied by their Royal Highnesses the Princess
+of Wales (afterwards Queen Alexandra) and Princess Victoria, the
+former graciously consenting to receive purses containing donations
+in aid of the Hospital. The silver trowel used on the occasion, which
+was provided by Mr. E. Hogg, one of the members of the Committee of
+Management, was presented to His Royal Highness, who stated “it is Her
+Majesty’s great and earnest wish that this Hospital may be prosperous
+and successful in every way.” Her Majesty further manifested her
+continual interest in the Charity by giving a donation of £100 to
+the Budding Fund. The Prince of Wales on his departure signified his
+intention to become a Patron of the Hospital.
+
+In the removal of the Hospital from a prominent situation which had
+developed into a great business centre to a less known district easily
+accessible to those to whose needs it ministered the Committee of
+Management hoped to defray the cost of the building by the proceeds of
+the sale of the old site, and in doing so it was not far out in its
+reckoning. The old Hospital was sold for £78,500, and the new Hospital
+cost about £80,000. To provide the funds for the new building, whilst
+the work was being carried on in the old one, large loans had to be
+negotiated on the security of its freehold and leasehold property.
+In addition to the cost of the building the Committee had to provide
+funds for furnishing the new building, and equipping it with appliances
+and apparatus in keeping with its position as the leading ophthalmic
+institution in the British Empire. For this purpose it made a special
+appeal which was liberally responded to by the Corporation of the City
+of London and the following City Companies: The Worshipful Company of
+Carpenters, of Clothworkers, of Drapers, of Dyers, of Fishmongers, of
+Goldsmiths, of Grocers, of Leather Sellers, of Mercers, of Merchant
+Taylors, of Sadlers, of Salters, and of Skinners.
+
+The fund was further augmented by a festival dinner held at the Grand
+Hotel, Charing Cross, on the 6th of May, 1898, over which His Royal
+Highness the Duke of Cambridge graciously presided, he himself making
+a liberal contribution to the cause for which he pleaded. In the
+following year a large and influential number of ladies promoted a ball
+in the Empress Rooms at the Royal Palace Hotel, Kensington, on the
+Hospital’s behalf, and Sir Squire Bancroft generously gave to it the
+proceeds of one of his inimitable readings.
+
+When the clearance of the site for the new Hospital in the City Road
+was commenced, a Building Committee was appointed, consisting of
+certain members of the Committee of Management, with Mr. H. Davidson
+as chairman, and three representatives of the Medical Council, Tweedy,
+Gunn, and its honorary secretary, at first Morton, and later Treacher
+Collins.
+
+One of the first questions this Committee had to consider was the dual
+one of the ventilation and warming of the new building. Was the system
+of ventilation to be “natural” or “artificial”? If artificial, was it
+to take the form of propulsion or extraction, or a combination of
+both? It has been well said “that theories in ventilation and warming
+are as numerous as trees in a forest,” and so the Building Committee
+discovered when they commenced to consider the problem. Several
+hospitals in which artificial ventilation was in use were inspected;
+ultimately it was decided that artificial ventilation on the planum
+system should be adopted for the out-patient department, and that
+natural ventilation should be relied upon for the wards.
+
+The air forced into the out-patient department is first filtered, and
+then warmed or cooled as required. A shaft is provided which allows the
+foul air to escape. The force employed is a large rotating fan-wheel
+which propels the air along underground passages, and through gratings
+which open into the various compartments. It is filtered by passing
+through a coke-screen, which is cleaned with a stream of water flowing
+over it automatically at periodic intervals. It is warmed by passing
+over hot-water radiators situated close to the gratings opening into
+the compartments. It can be cooled by substituting blocks of ice placed
+on the radiators for the hot water contained in them.
+
+In the wards the position of the windows is arranged to allow of cross
+ventilation, and the main sources of heat are open fires. Additional
+sources for warmth and ventilation are provided by hot water radiators,
+past which fresh air is allowed to enter through gratings near the
+floor. A separate sanitary block running through the centre of the
+building is cut off from it by cross-ventilation lobbies.
+
+Only those who worked in the old Hospital in Blomfield Street can fully
+appreciate the amenities afforded by the new one in the City Road.
+Daily at noon the whole in-patient department in the old building
+became permeated with the odour of cooked meat. In the new Hospital all
+such disagreeable smells have been avoided by having the kitchen placed
+on the top floor. Most of the cooking is carried on by steam, supplied
+from boilers in the basement. A special service lift conveys goods to
+the kitchen, and also permits of the distribution of food and fuel to
+various parts of the building. Both this lift and the passenger lift
+are worked by hydraulic power; the latter allows of the conveyance of
+a patient on a wheeled trolley, in the recumbent position, to his bed
+from the operating table.
+
+The lighting arrangements in the out-patient department, for the
+examination of the patients and the testing of their eyesight, and
+in the operating theatre to meet its varied requirements, engaged
+the architect’s and the Committee’s prolonged consideration. For the
+examination of patients in the first instance, and for many operations,
+uninterrupted direct skylight from a northern aspect was regarded as
+essential, and the new building was so planned as to allow of this in
+the large consulting room and in the operating theatre. As the work
+of the Hospital has to be carried out on dark days as well as bright
+ones, adequate means for the examination of patients by artificial
+light, in the absence of daylight, had to be provided. In the old
+Hospital, where gas was the main source of artificial illumination,
+there were various contrivances rendering it more or less efficient
+by the use of reflectors. In the operating theatre, a device used
+by the Nottingham lace workers had been employed. It consisted of a
+large hollow glass globe filled with water and suspended from the
+ceiling, which concentrated light from a lamp placed behind it on to
+the face of a patient lying on the operating table. The introduction
+of electricity for illuminating purposes throughout the new building
+simplified matters considerably. In the consulting room, movable
+flexes and adjustments permit light being easily brought into the most
+suitable position in which to conduct an examination. The employment
+of electric light globes for ophthalmoscopic examinations in the dark
+room, in place of argand gas burners, renders the atmosphere in it far
+more healthy and pleasant to work in, but it is doubtful if any form of
+electric bulb supplies quite such a uniform and satisfactory area of
+illumination for these examinations as the old argand gas burner.
+
+The electric current supplied to the Hospital for lighting purposes is
+an alternating one; fortunately a constant current was also available
+in the district, being used in neighbouring factories. One of the chief
+purposes for which it is required is for working electro-magnets for
+the extraction of chips of iron or steel implanted in the interior of
+the eyeball.
+
+It has been already mentioned how in 1858 Dixon tried unsuccessfully
+to remove a chip off the edge of a chisel, seen floating in the
+vitreous chamber, by a permanent magnet. In a similar case, McKeown of
+Belfast, in 1874, succeeded in the removal of the foreign body by the
+introduction of the tip of a permanent magnet into the interior of the
+eye.
+
+In 1878 Malcolm McHardy, who was later ophthalmic surgeon to King’s
+College Hospital, employed for the first time an electro-magnet, and
+with it successfully removed a chip of steel which had become embedded
+in the crystalline lens. A few years later, Snell of Sheffield,
+Hirschberg of Berlin, and Bradford of Boston, U.S.A., had constructed
+electro-magnets which could be held in the hand, and have suitable
+terminals attached to them for introduction into the interior of the
+eye. Considerable success attended the use of such instruments when
+fragments of iron were situated in the front parts of the eye, but only
+on rare occasions when they had become deeply placed in the vitreous
+humour. In these latter cases, the foreign body was often hid from
+view, due to opacity of the lens caused by the injury, so that its
+exact position was unknown, and there was some doubt as to whether it
+had lodged in the eyeball or not. It was only when the nozzle of the
+hand magnet came close to the foreign body that it possessed sufficient
+traction power to draw it out, and in searching for it much damage was
+liable to be inflicted on the structures in the interior of the eyeball.
+
+On the discovery of the X-rays by Professor Röntgen in 1895 it occurred
+to many ophthalmic surgeons that they might be utilised for the
+detection of foreign bodies in the eye. Two practical difficulties at
+first presented themselves, both of which were ultimately overcome.
+One was the density of the bony structures around the eyeball, and the
+other that of locating accurately the position of a foreign body when
+detected. It was found that excellent skiagrams, showing exceedingly
+minute pieces of metallic substances in the orbit, could be obtained
+if the sensitive plate was placed against the temple on the side of
+the injured eye, and the Crookes tube 10 to 15 mm. distant from the
+opposite temple. The most accurate localisation of foreign bodies
+implanted in the body was effected by an ingenious device of Mackenzie
+Davidson’s in which, after superimposing two skiagrams taken at
+slightly different positions, he followed the tract taken by the rays
+from the Crookes tube to the foreign body by means of threads, noting
+where they crossed in relation to the position of other known points.
+
+Mackenzie Davidson (afterwards Sir James Mackenzie Davidson) worked
+at Moorfields as clinical assistant, and subsequently practised as an
+ophthalmic surgeon in Aberdeen. Soon after the discovery of X-rays, he
+removed to London and devoted himself specially to their application
+to surgery and medicine. His combined interest in ophthalmology and
+X-rays made him desirous of testing his method of localising foreign
+bodies in connection with eye injuries. Several members of the staff
+at Moorfields sent cases to him to report on, and such accurate and
+helpful information did he supply, not only as to the presence or
+absence of a foreign body in the eye, but also as to the exact position
+in which, when present, it could be found, that a desire arose to
+establish a special X-ray department and to secure his services in
+connection therewith. On the recommendation of the Medical Council,
+this was agreed to by the Committee of Management in November, 1898,
+£80 being voted for the cost of apparatus and an annual expenditure
+of £20 for the working expenses of the department. Mackenzie Davidson
+consented to accept the appointment of honorary medical officer in
+charge of the X-ray department, and a special room was fitted up in the
+new Hospital with the necessary conveniences for carrying on the work.
+
+The introduction of the constant electric current into the operating
+theatre allowed of the employment of far more powerful magnets for the
+extraction of fragments of iron from the eyeball than had previously
+been used in this country. These powerful magnets have appropriately
+been described as “giant magnets”: they were originally introduced into
+ophthalmic practice by Professor Haab of Zurich. Their traction force
+is so great that a chip of iron hidden in the back part of the eyeball
+can be drawn forward into view in the front part.
+
+In the _Hospital Reports_, H. V. McKenzie, the house surgeon in 1895,
+collected notes of all the cases in which a foreign body had been
+removed from the eye by the small hand magnet—_i.e_., prior to the
+introduction of X-ray localisation, and found that in 26 per cent, of
+those in which it was lodged in the vitreous the eye was saved. In 1902
+the house surgeon, A. F. MacCallan, tabulated the results obtained
+by the use of Haab’s Giant Magnet, and found that in a similar class
+of cases by its use 58 per cent. of the eyes were saved, and that in
+half of these good vision was obtained. If accurate localisation of
+the foreign body by X-rays was carried out previous to the use of the
+magnet, a still larger percentage of success resulted.
+
+The operating theatre in the new Hospital has been designed to make
+possible the practice of aseptic surgery. Antiseptic surgery, as first
+introduced, relied on the destruction of micro-organisms by chemical
+agents, and it was thought essential, whilst an operation was in
+progress, to have a spray of carbolic acid playing to prevent aerial
+infection of the wound. Later, as the result of experience gained in
+bacteriological laboratories, it became realised that such a precaution
+was unnecessary; micro-organisms being like dust particles subject
+to the law of gravitation, all that was required was to prevent any
+accumulation of dust and to avoid currents of air.
+
+To avoid any accumulation of dust in the new operating theatre, its
+walls, ceilings, and floor are so constructed that at any time they
+can be washed over with a hose. The wall and ceiling are lined with
+glass tiles, technically known as “opalite,” the floor is paved with
+terazzo, and all the corners are rounded. All the pipes are of copper,
+and the radiators of the same metal. The latter are constructed so that
+they can be swung out on a pivot, and no dirt be allowed to accumulate
+behind them; they are in three divisions, which allow of variations in
+the amount of warmth given out as may be required.
+
+To permit as many onlookers as possible being able to watch the
+operator’s procedures, without inconveniencing him or his assistants,
+fixed stands are erected on each side of the operating table, each
+stand being composed of three tiers, and each tier accommodating four
+persons.
+
+The colour of the tiles on the walls and ceiling is a creamy-white with
+a dado of pale green. As some operations have to be conducted in a
+darkened room by artificial light concentrated on the eye, a dark blind
+is provided which can be drawn up from below, being enclosed when not
+in use in a brass box.
+
+The case in which the instruments are stored is constructed entirely of
+brass and glass, and apparatus is provided to allow of the instruments
+being sterilised by boiling them before use. A special steriliser for
+dressings is also provided, with an outer jacket for steam, which
+permits of them being delivered dry when required for use.
+
+In the wards, passages, and other parts of the building, all possible
+precautions are taken to avoid any lodgments for the accumulation of
+dust, the floors of all the wards being constructed of polished teak,
+and wherever possible the corners are rounded. All cupboards have
+sloping tops, and are fixed to the walls at such a height that the
+highest part of them is easily within reach. Arrangements are made for
+the storage of the patients’ clothes, when in bed, in special cupboards
+outside the wards, and the small marble-topped lockers placed beside
+their beds were specially designed just to contain a few of their
+possessions.
+
+A special eye hospital differs from a general hospital in the large
+proportion of its patients who are able to be up out of bed during the
+daytime. It is, therefore, desirable to have special day rooms in which
+they can congregate away from the wards, and have their meals. In the
+new Hospital, on each floor, such day room accommodation is provided.
+
+Notwithstanding the enormous amount of work involved in the removal to
+the new building, it was effected with scarcely any interruption in
+the routine work of the Institution. The new building was opened for
+the reception of patients on September 4th, 1899, the work in the old
+Hospital being carried on for in-patients up to August 19th, and for
+out-patients up to August 26th.
+
+
+
+
+CHAPTER XII
+
+THE HOSPITAL IN THE CITY ROAD
+
+
+On June 28th, 1899, the now dreary neighbourhood of the former
+“Peerless Pool” once again awoke to life and notoriety with a visit
+from their present Majesties King George V. and Queen Mary, then the
+Duke and Duchess of York, to open the new “Peerless” Eye Hospital.
+A lengthy description of the ceremony appeared in The Times on the
+following day.
+
+The Duke and Duchess of York, attended by Sir Charles Cust and Lady
+Katherine Coke, arrived at the Hospital shortly after half-past 3
+o’clock, and were received by Sir John Lubbock, the President, Mr.
+H. P. Sturgis, Chairman of the Committee of Management, and the
+architects, Messrs. Keith Young and H. Hall. The Duke, who received a
+gold key from the architects, unlocked the door of the main entrance
+hall, where the surgeons of the Hospital, the matron, Miss Robinson,
+and the secretary, Mr. R. J. Bland, were presented to their Royal
+Highnesses. The Royal party were then conducted over the building, and
+after completing their inspection they entered the out-patients’ hall,
+which had been prettily decorated for the opening ceremony, and where a
+large company had assembled. Among the visitors, in addition to those
+already named, were the Lord Mayor and Lady Mayoress, Mr. Alderman
+and Sheriff Alliston, Lieutenant-Colonel and Sheriff Probyn and Mrs.
+Probyn, the Bishop of Islington and Mrs. Turner, the Rev. Prebendary
+Whittington (chaplain), Sir J. Whittaker Ellis and Lady Ellis, Lady
+Faudel-Phillips, Sir Squire and Lady Bancroft, Mr. J. Lea Smith
+(trustee), Mrs. Sturgis, Sir T. Lipton, and the Rev. Dr. Hermann Adler
+and Mrs. Adler, Mr. H. Davison (chairman of the Building Committee)
+and Mrs. Davison, Mr. A. G. Pollock (chairman of the Special Appeal
+Committee) and Mrs. Pollock. The little daughter of Mr. John Tweedy,
+the senior surgeon, presented a handsome bouquet of pink roses to the
+Duchess, who was dressed in pale green eau de Nil silk with a toque of
+pink roses. Prayers having been said by the Bishop of Islington, Sir
+John Lubbock called upon Mr. Sturgis to make a statement.
+
+PLATE XXV.
+
+[Illustration: THE ROYAL LONDON OPHTHALMIC HOSPITAL IN THE CITY ROAD,
+OPENED IN 1899.]
+
+Mr. Sturgis said that they valued extremely the presence of the Duke
+and Duchess of York, inasmuch as their Royal Highnesses represented
+the fourth generation of the Royal Family who had shown interest in
+the Hospital. He related the circumstances which had necessitated its
+removal from its old site at Moorfields and the erection of the present
+building, which the Committee had endeavoured to make as perfect as
+possible, and which they would come into free from debt. This, however,
+he went on to say, was only the beginning of their task. They had to
+consider the maintenance of the establishment. The cost of maintenance
+at the old building was about £8,000 a year, and their regular income,
+including grants from the Hospital funds, did not reach the sum of
+£3,000 a year, so that they had to make up the difference in other
+ways. But the cost of maintenance in the new building would be as
+much as £11,000 a year. He hoped their income would increase to a
+corresponding extent. What they wanted more than anything else was an
+increase in annual subscriptions, and they wished to raise a fund of
+£50,000 which would be a guarantee for the large ground rent which they
+now had to pay.
+
+Sir John Lubbock, after expressing indebtedness to all those concerned
+in the work of the Institution, asked the Duke of York to declare the
+building open.
+
+The Duke of York said:
+
+  “Sir John Lubbock, Mr. Sturgis, Ladies and Gentlemen, I am grateful
+  to Sir John Lubbock for the kind words he has used with regard to
+  our coming here to-day, and I have been very much interested in all
+  I have heard from Mr. Sturgis, the Chairman of the Committee. I
+  thank you all in the Duchess’ name as well as my own for the very
+  kind reception you have given us. It is an especial pleasure to
+  the Duchess and myself to come here to-day, as my father laid the
+  foundation stone of the new building in 1897, and therefore we are
+  completing the work, so to speak, which he inaugurated.” (Cheers.)
+  “As Mr. Sturgis told us just now, of late years the number of
+  patients increased so enormously that the old buildings were found
+  quite inadequate to their wants, and the Committee were compelled to
+  seek a larger site for this new building. And, if I may be allowed to
+  do so, I wish to congratulate the architects on the excellent result
+  of their labours, and I also wish to congratulate the Committee and
+  the medical staff on occupying a new Hospital designed and equipped
+  according to the most modern requirements. The cost of maintenance of
+  these new buildings, which cover three-quarters of an acre, will be,
+  I fear, as Mr. Sturgis has just told us, very heavy, but I am sure
+  the Committee deserve the generous support of the charitable public
+  to enable them to continue the useful work that has been so ably
+  carried out by this Hospital for nearly a century, and I can only say
+  that I trust that the public will come forward and help this Hospital
+  and prevent it from getting into debt by their annual subscriptions.
+  I have now much pleasure in declaring this new building open, and the
+  Duchess joins with me in wishing the Royal London Ophthalmic Hospital
+  continued prosperity in this new building, and a long career in its
+  great and important work.” (Cheers.)
+
+Their Royal Highnesses then left the building, and were heartily
+cheered by a large crowd in the street as they drove away.
+
+As a lasting memorial of the visit of their Royal Highnesses the
+Children’s Ward was named the “Princess May” Ward. After their visit,
+they consented to become Patrons, and presented copies of their
+portraits to the Hospital, with their autographs attached.
+
+The hopes expressed by Mr. Sturgis, the Chairman of the Committee,
+at this opening ceremony, that increased financial support would be
+forthcoming to meet the additional annual expenditure, were completely
+shattered for a time by the outbreak of the South African War. As at
+the time of the Crimean War, the sympathies and contributions of the
+public became diverted to funds for soldiers and sailors, and the
+donations and new subscriptions to the Hospital almost ceased to come
+in, the result being that the Hospital, in September, 1900, found
+itself £5,000 in debt.
+
+One of the largest and most unforeseen items in increased expenditure,
+resulting from the removal of the Hospital, was the enormous addition
+to the amount in rates which it was called upon to pay. The Hospital at
+Moorfields was assessed by the City of London Union at a nominal amount
+the rates for the year 1897 being only £88. The Holborn Union, in whose
+area the new building was situated, adopted a different course, and
+the rates for 1900 amounted to £870 nearly an eleventh part of the
+Hospital’s annual total expenditure. In 1901 they increased to £948,
+and in 1902 to £972. No other hospital in London was assessed so highly
+in proportion to its income and size, St. Thomas’s and Guy’s being the
+only London hospitals paying heavier rates.
+
+In answer to an appeal against such excessive rating the authorities
+replied that, as the Hospital relieves patients from every part of
+London, as well as many parts of the country, they could not treat it
+on the footing of a local charity.
+
+In 1900 the Hospital, owing to its embarrassed financial condition,
+was in arrears with the payment of two instalments of rates, amounting
+to £324, and a summons was served on it. The Justice of the Peace who
+had to deal with the matter stated “that he had no other course but
+to order payment within fourteen days.” This summons became widely
+reported and commented on in the public press; considerable sympathy
+with the Hospital was thereby evoked, and in the course of three days
+donations and subscriptions came in, amounting to £300, which enabled
+it temporarily to meet its difficulties. Ever since, however, the
+annual amount which it has had to pay in rates has fluctuated between
+£800 and £1,000. Thus this Institution, which every year rescues
+numbers of people from loss of sight and from becoming rate-supported,
+has to raise this large sum in voluntary contributions from the
+benevolent public to pay out in rates.
+
+Until the year 1875 hospitals were not regarded as ratable, as there
+was no obvious person connected with them to be assessed. In that year,
+however, the House of Lords ruled that voluntary hospitals had no right
+to such exemption and must pay rates as other premises, though no one’s
+sense of justice had appeared to be offended. If, as they so frequently
+profess, public bodies wish to aid and support the work of voluntary
+hospitals, no more efficient method could be found than to exempt
+them again from this inconsistent and burdensome form of taxation. In
+connection with the Rating and Valuation Bill, which was before the
+House of Commons in July, 1928, a discussion on the rating of hospitals
+took place, being raised in connection with an amendment proposed by
+Mr. Harris, Member for South-West Bethnal Green, and seconded by Mr.
+Briant, Member for North Lambeth. The Minister of Health, Mr. Neville
+Chamberlain, whilst expressing his sympathy with the matter, did not
+consider the Bill to be one in which relief of that kind to hospitals
+could be given effect, it being for the stimulation of industries,
+and he refused to consider that the maintenance of the health of the
+community was likely to give such stimulation.
+
+What at first seemed likely to be a most severe blow to the Hospital’s
+means of maintenance ultimately resulted in its salvation. This was
+the establishment of the Prince of Wales’ Hospital Fund (afterwards
+King Edward’s Hospital Fund), and the diversion to it of annual
+subscriptions previously paid to the Hospital—_e.g_., the Drapers’
+Company, which had for several years given a subscription of ten
+guineas, notified in 1900 that it would in future be discontinued as
+the Company was subscribing annually to the Prince of Wales’ Fund. The
+receipt of the following letter was, therefore, a source of immense
+relief and satisfaction to all connected with the Hospital:
+
+  “THE PRINCE OF WALES’ HOSPITAL FUND FOR LONDON.
+
+  “THE BANK OF ENGLAND,
+
+  “27_th December_, 1901.
+
+  “THE TREASURER,
+
+  “ROYAL LONDON OPHTHALMIC HOSPITAL
+
+  “City Road, E.C.
+
+  “Sir,
+
+  “By the desire of His Royal Highness, the President, I have the
+  honour to enclose a cheque for £2,850.
+
+  “Of this sum, £900 is an annual grant to open eighteen closed beds,
+  on the condition that by the opening of these beds eighteen more are
+  made available for the sick poor in your Hospital; and the balance of
+  £1,250 is a special donation for this year.
+
+  “I am also directed to inform you that your building is reported on
+  as a very fine new building. The Visitors state that all the Wards,
+  Operating Rooms, etc., are thoroughly practical and up-to-date, and
+  that your very complete Hospital requires considerable additional
+  funds to carry on its useful work.
+
+  “Kindly acknowledge the receipt of the above.
+
+  “Yours faithfully,
+
+  “(Signed) S. CROSSLEY,
+
+  “_Honorary Secretary_.”
+
+In June, 1902, His Majesty the King himself became an annual subscriber
+of ten guineas to the Hospital.
+
+In December, 1902, a still more liberal grant was made by the King
+Edward’s Hospital Fund for London, as shown by the following letter:
+
+  “Sir,
+
+  “I am directed by His Royal Highness the President to enclose a
+  cheque for £4,500.
+
+  “Of this sum, £900 is an annual grant to support 18 beds opened by
+  the aid of this Fund. The balance, which consists of £1,100 as an
+  annual grant and £2,500 as a special donation for this year, is given
+  on the condition that 30 more beds are opened in your Hospital so
+  that by opening those beds 30 more are made available for the sick
+  poor in your Institution.
+
+  “Kindly acknowledge the receipt of the above.
+
+  “Yours faithfully,
+
+  “(Signed) SAVILE CROSSLEY,
+
+  “_Honorary Secretary_.”
+
+The wards in the new Hospital were constructed to hold 138 beds, but at
+first, owing to its serious financial deficiency, only 70 could be made
+available for use. By the help of the King’s Hospital Fund in 1901, 18
+more were opened up, and, in the following year, by the help of the
+same fund, an additional 30, leaving only 20 vacant. The opening of the
+wards containing the additional 30 beds in 1902 was made a ceremonial
+occasion by the visit to the Hospital in state of the Lord Mayor and
+some of the Sheriffs of the City of London.
+
+In order to pay off its liabilities, the Committee of Management,
+during 1902, had to obtain a loan of £5,000 on the security of the
+Harry Sedgwick Trust Fund, £7,000 of which was retained by the Charity
+Commissioners until such time as the compound interest on it had
+sufficiently accumulated to repay the loan. The annual income of the
+Hospital was thereby temporarily reduced by the interest on these
+two amounts. In 1909, by the realisation of certain legacies, the
+Hospital was enabled to repay this loan, the dividends on the fund then
+reverting to it.
+
+To find some fresh source of income it was agreed, at a joint meeting
+of the Committee of Management and the Medical Council, to try
+experimentally what could be obtained by asking each out-patient on
+admission to make a voluntary contribution, no compulsion to do so
+on any account being used. At the end of three months it was found
+that an annual amount of £1,150 could be obtained in this way, without
+giving any offence to those solicited for help.
+
+The way in which the new building was constructed necessitated some
+changes in the customs of the staff. The out-patient department was
+entirely separated from the in-patients, and it was thought desirable
+that the two classes of patients should be kept completely apart. This
+necessitated a second operating room specially for out-patients, for
+which provision had been made, and over which a special sister was
+appointed to preside. In the immaculate in-patient operating theatre it
+became the established custom for the surgeons working there to wear
+sterilised white cotton coats, instead of their ordinary ones, as they
+had done previously.
+
+It may also be noted how customs have changed with regard to the
+hirsute appendages of the face in the members of the medical staff at
+different epochs. In the first half of the nineteenth century, all the
+members of the staff wore side whiskers. During the Crimean War our
+soldiers grew beards, and on their return beards became the fashion of
+the time. The surgeons at Moorfields, from the middle of the century up
+to the commencement of what may be described as the aseptic era, all
+wore beards. No surgeon on the staff now wears a beard; they are all
+either clean-shaven, or at most wear a closely-cut moustache.
+
+The costume of the in-patients when taken into the operating theatre
+also needed consideration, and in the provision for them of special
+overalls the idea of a ladies’ working guild first originated. The
+following description of its commencement and early progress was given
+in its Fifth Annual Report, dated December 31st, 1904:
+
+  “In the winter of the year 1900, Mrs. Quarry Silcock, Mrs. Treacher
+  Collins, and the matron, Miss Richards, with a few other ladies who
+  had special opportunities of knowing the difficulties with which the
+  Hospital had to contend for lack of funds and public interest, banded
+  themselves together and determined to help the Institution. They
+  formed themselves into a Committee under the Presidency of Lady John
+  Tweedy, and were fortunate in inducing many of their friends to join
+  them. They determined to take upon themselves the essentially womanly
+  task of supplying all the clothing, house and bed linen required in
+  the Hospital for the use of the patients, and so successful were
+  they that, not only were they able to do this, but by the end of
+  the second year they were in a position to hand the sum of £50 to
+  the general funds. The movement has since so far grown that many
+  more necessaries have been added. The beds in the new wards, opened
+  in 1903, were supplied with blankets, coverlets, and sheets from
+  the fund, and the Guild has for the past two years maintained a
+  Cot and a Woman’s bed in the wards. It also extends its operations
+  in other directions that can be of help to the Hospital. Through
+  the consideration of several members, the Nurses’ library has been
+  replenished with interesting and useful books. Other members have
+  rendered personal service by visiting at the Hospital, and have thus
+  relieved the monotony of the hours spent by the suffering patients by
+  reading pleasant books, entering into kindly conversation with them,
+  and amusing them with singing and music. The cheering effect of such
+  visits and the assistance they are in the work of recovery cannot be
+  overestimated.”
+
+Extensive as were the improvements in the new Hospital over the old,
+in course of time fresh requirements cropped up, and it was discovered
+that some of the arrangements might have been better still. Any
+imperfections cannot, however, be attributed to oversight on the part
+of the architect, but rather to want of foresight and imagination on
+the part of those from whom he received instructions as to what to
+provide for. When first the rebuilding of the Hospital was decided on,
+the question was discussed as to whether the out-patient consulting
+room should be constructed to allow for accommodation of an increase
+in the number of the surgical staff, and the decision was deliberately
+arrived at that no such increase was desirable or likely to be required.
+
+By the appointment of Soelberg Wells as an additional assistant-surgeon
+in 1867, the number of the surgical staff became increased to nine.
+Three surgeons attended each day and each came twice a week. Such an
+evenly balanced arrangement worked satisfactorily for a number of
+years. In 1867 the number of new out-patients was 17,211; in 1900
+the number had increased to 36,932—_i.e_., more than double. The
+work entailed in dealing with this large increase of patients was,
+however, far more than double in amount to what it was in 1867, because
+sight-testing and the correction of errors of refraction had increased
+both in extent and accuracy. It is not surprising, therefore, that
+those surgeons who had but few clinical assistants found themselves
+unable to cope with all the demands made on them. In 1890 the post of
+paid refraction assistant had been created to aid the staff in that
+class of work. T. Phillips held this post for a number of years: he
+attended daily and became exceedingly expert in dealing with a large
+number of cases in a very short time. When, however, he was absent
+on a holiday or from illness, those who relied upon his assistance
+experienced great difficulties in getting through their work, patients
+even sometimes having to be sent away unseen.
+
+In 1900 the Committee of Management determined that some fresh
+arrangement was essential, and advocated the appointment of additional
+assistant-surgeons: after considerable discussion this was agreed to,
+and the surgical staff was increased to twelve. The three new members
+to be appointed were to rank as assistant-surgeons, and their work
+was to be confined to the out-patients, except in the absence of the
+surgeon of the day. This was a reversion to a former plan, which after
+a short trial broke down, each member of the staff again attending to
+both out- and in-patients. Fortunately at that time there were a large
+number of able clinical assistants, who became candidates for the new
+posts, from amongst whom Percy Flemming, assistant ophthalmic surgeon
+at University College Hospital, J. Herbert Fisher, assistant ophthalmic
+surgeon at St. Thomas’s Hospital, and Arnold Lawson (afterwards Sir
+Arnold, and ophthalmic surgeon at the Middlesex Hospital) were elected.
+
+The result of this increase of the staff was that the out-patient
+consulting room, originally designed to accommodate three surgeons and
+their clinical assistants, had to accommodate four.
+
+When the number of beds in use became increased to 118, the services
+of a third house surgeon were found requisite, those of the two senior
+being required for the in-patients, and those of the junior being
+confined to the out-patients. No accommodation had been made in the new
+building for an increase in the resident staff, and some reconstruction
+of rooms became necessary.
+
+The accommodation required for the nursing staff had been sadly
+underestimated, and a part of the building which had been designed as
+an isolation quarters for sick nurses had to be taken into general use.
+At the present time, even with these additional rooms, it would be
+impossible to make use of all the beds for in-patients with which the
+Hospital is provided without first securing increased accommodation for
+nurses.
+
+A nurse may have completed three years’ training at a general hospital
+and have acquired sufficient theoretical knowledge to pass the
+examination which is considered essential before she is granted a
+certificate, and yet be incompetent to nurse a case of eye disease.
+
+Moorfields Hospital has become, not only a special training school for
+ophthalmic surgeons, but also for ophthalmic nurses. Many who have
+been trained there have subsequently been appointed to take charge of
+ophthalmic institutions or departments in various parts of the United
+Kingdom, in the Colonies, and in America.
+
+In 1896 courses of lectures given by members of the surgical staff
+were instituted for nurses, in addition to the instruction which they
+received from the matron: such courses have been regularly carried on
+ever since. In 1907 arrangements were made with the authorities of the
+Queen Victoria’s Jubilee Institute for Nurses to allow of the district
+nurses employed by them to attend at the Hospital and receive practical
+instruction in ophthalmic nursing free of charge. Fifty-three such
+nurses attended at the Hospital in 1907, and fresh ones have continued
+to attend ever since.
+
+A large room was set apart in the new Hospital as a lecture theatre,
+and, as the teaching became more systematised and the number of
+students steadily increased, it became desirable to have a Dean
+appointed to advise the students as to their studies, and to
+superintend the classes: to this post W. T. Holmes Spicer was elected
+in 1899. The teaching at Moorfields up to 1920, when the Royal Colleges
+of Physicians and Surgeons established a Diploma of Ophthalmology, had
+been post-graduate and almost entirely clinical and pathological, the
+laboratory and museum affording excellent facilities for the latter.
+In order to obtain the Diploma of Ophthalmology it became necessary
+for students to pass a first examination in optics, and in the anatomy
+and physiology of the parts concerned in ophthalmic surgery. To meet
+the requirements of candidates for this examination, Moorfields then
+instituted special courses of instruction in these scientific subjects,
+upon which the practice of ophthalmology must always be based. In so
+doing it has become a complete school of ophthalmology.
+
+Graefe, in his work on the ocular muscles, described what are termed
+latent squints—_i.e_., squints which only become manifest when the
+desire to see singly with the two eyes is removed. Increased attention
+to them was awakened in 1886 when Stevens of New York suggested
+a convenient form of nomenclature to describe their different
+varieties, and in 1890 when Maddox of Bournemouth introduced a simple
+and expeditious method for their detection and measurement. Some
+enthusiasts at first tended to exaggerate the importance of these
+defects in the balance of the ocular muscles, attributing to them
+numerous ills to which the flesh is heir, and practising operative
+procedures for their correction. On the other hand, some were slow
+in devoting sufficient attention to them. Had more importance been
+attached to them at Moorfields, at the time the new building was under
+construction, better provision might have been made in it for their
+investigation.
+
+In the closing years of the nineteenth century the science of
+bacteriology increased both in its importance and in its technique
+by leaps and bounds. In 1901 the medical staff, finding that more
+bacteriological investigations were required than the pathologist
+had time to devote to them in association with his other duties,
+recommended the establishment of a special bacteriological department
+and the appointment of a special bacteriologist. This entailed the
+provision of additional laboratory accommodation, and it was not until
+six years later that the Committee could see their way to the erection
+of a new laboratory above that part of the pathological department
+occupied by the Museum and curator’s room, part of a legacy left to the
+Hospital by the late Mr. Samuel Lewis being used to defray the cost.
+
+PLATE XXVI.
+
+[Illustration: SIR JOHN TWEEDY, LL.D.]
+
+John Tweedy, who had been elected on the staff at the comparatively
+early age of twenty-nine, resigned in 1900 at the age of fifty-one, and
+was appointed consulting surgeon, the Committee of Management putting
+on record at the time its appreciation of the “numerous occasions he
+had pleaded the cause of the Hospital in powerful and most interesting
+public addresses, endorsing his advocacy with liberal donations to
+its funds.” Tweedy was a fluent and learned writer; he served for a
+long time on the editorial staff of the _Lancet_, so that most of
+his contributions appeared anonymously. He did not contribute much
+to the literature of ophthalmology, though he had had a very large
+experience and was frequently called into consultation by his
+colleagues in difficult cases. An American student once asked him
+which he considered the best textbook on ophthalmology. Tweedy took a
+deep breath, with which, on account of some chest affection, he always
+preceded any oratorical remark, and, with a dramatic wave of the arm
+towards a crowd of patients that were waiting to see him, said: “There,
+that is the best textbook.”
+
+Three years after his retirement from the staff of the Hospital, he
+became President of the Royal College of Surgeons; he held that post
+for three years, and was knighted in 1906. He possessed remarkable
+administrative capacity, and was skilful in putting through the
+business of a meeting with efficiency and dispatch. He also presided
+over the Ophthalmological and Medico-Legal Societies, the Medical
+Defence Union, and the Royal Medical Benevolent Fund. He died in 1924
+at the age of seventy-five.
+
+With the discovery of the ophthalmoscope the interests of
+ophthalmologists became largely medical as well as surgical; though
+they still style themselves ophthalmic surgeons, some might more aptly
+be termed ophthalmic physicians; Marcus Gunn was one of these. The
+distinguished neurologist, Sir William Gowers, in 1879, wrote a book
+on _Medical Ophthalmoscopy_, which was the leading manual of its kind
+for many years; its third edition, which appeared in 1890, was edited
+by Marcus Gunn. He was a most careful ophthalmoscopic observer, and for
+several years devoted his attention to certain changes in the retinal
+bloodvessels. Writing on the outcome of these observations in 1898, he
+said:
+
+  “The chief importance of this retinal arterial change lies in its
+  association with a more general arterial disease of a similar nature,
+  particularly in the kidneys and brain, and in its prognostic value in
+  regard to the results which may follow in cerebral vessels. It has
+  been well said that ‘a man is as old as his arteries.’ I would urge
+  that ophthalmoscopic observation is one of the most ready clinical
+  means for the early detection of important arterial changes.”
+
+Rheumatism is a term which is applied to a multiple of ills, and
+during the nineteenth century a number of cases of inflammation of
+the iris were so classified. The most typical and well-defined form
+of rheumatism is rheumatic fever or acute articular rheumatism, and
+investigations of a number of such cases at general hospitals, and of
+cases of iritis at Moorfields, showed that the two affections were but
+rarely associated. Iritis not uncommonly occurs in connection with
+inflammation of the joints due to gonorrhœa, which is sometimes termed
+“gonorrhœal rheumatism,” but a very large number of cases of iritis
+are met with unassociated with any joint affection or any venereal
+disease. Of recent years, largely as the outcome of the observations
+and teaching of William Lang, it has become recognised that such cases
+are secondary to some focus of inflammation elsewhere in the body, very
+often a septic condition in connection with the teeth. Seeing how many
+people suffer from septic teeth who never develop iritis, considerable
+scepticism at first prevailed as to its being the cause of the disease.
+The satisfactory way in which iritis subsides and ceases to recur after
+the septic focus in the mouth has been removed seems, however, to
+have definitely established the relation of the one to the other, and
+provided a means of eradicating a very potent cause of suffering and
+destruction of sight.
+
+The reawakening of the importance of the medical side of ophthalmology
+made the surgical staff desirous in 1899 of securing for their patients
+at the Hospital the aid and assistance of a physician who had had a
+special training as a neurologist. For this purpose, it was decided
+to appoint a second physician who should be required to attend the
+Hospital once a week to examine and report on such cases as were
+selected for him by the surgical staff. Dr. James Taylor, who had
+studied under Dr. Hughlings Jackson, and who may be regarded as one of
+his most ardent disciples, was elected to this post.
+
+PLATE XXVII.
+
+[Illustration: WILLIAM LANG]
+
+The systematic and orderly keeping at Moorfields of the clinical
+records of in-patients, and of the pathological examination of the
+eyes removed, over a number of years by successive house surgeons
+and curators of the Museum, has provided a large amount of valuable
+material for the investigation of the natural history of certain
+diseases from which useful inferences as to their incidence and
+prognosis can be drawn. Such method of investigation has been applied
+by a succession of workers, over a period of fifty-seven years, to the
+different forms of malignant growths originating in the eyeball, and
+has added considerably to our knowledge concerning them, the results
+being published in the _Hospital Reports_.
+
+A distinguished ophthalmic surgeon from New York who visited Moorfields
+went away much impressed by Nettleship, because he showed and discussed
+with him nothing but his failures. Most operating surgeons like to
+exhibit their successes and keep their disasters in the background,
+but by the study of our failures lies the road to future success.
+The curator of the Museum at Moorfields, or pathologist as he is now
+called, has the opportunity of examining critically all the eyes
+removed after the failure of operative procedures by the various
+members of the staff. From such examinations much valuable information
+has been collected and published, both in connection with operations
+for the removal of cataract and for the relief of glaucoma. To have had
+the advantage of carrying out these examinations must necessarily be an
+excellent training for one who is to become an operator himself. It is
+not, therefore, surprising that all those who have in recent years held
+the post of pathologist have subsequently been promoted to the surgical
+staff.
+
+C. Devereux Marshall, who held the post of curator of the Museum
+from 1894 to 1899, was elected assistant- surgeon on the retirement
+of Tweedy from the staff. William T. Lister (now Sir William Lister,
+K.C.M.G.) was the curator from 1899 to 1901, and was elected
+assistant-surgeon on the retirement of Waren Tay in 1904. John Herbert
+Parsons (now Sir John Parsons, C.B., F.R.S.) was curator from 1901 to
+1905, and was elected assistant-surgeon to fill the vacancy caused by
+the death of A. Quarry Silcock in 1904.
+
+When, in 1891, elementary education was made universal and compulsory,
+those responsible for the measure little realised all that it would
+involve. They little thought that in 1927 it would lead to the
+provision of 16,000,000 meals for school-children, and the medical
+examination of 2,000,000, involving the employment of about 2,000
+doctors, 600 dentists, and 5,000 nurses, or that it would develop
+into what Sir George Newman, the chief medical officer of the Board
+of Education, describes as “the grand inquest of the nation directed
+towards laying the foundation of the nation’s health.”
+
+It soon became evident that it was futile to compel children to study
+if their physical condition was such that they would not profit
+thereby, or if it was likely to lead to their physical deterioration.
+The question of their eyesight and its possible impairment from study
+early attracted attention. At first the teachers of the London School
+Board were given instructions to test the children’s eyesight, and to
+give the parents of those in whom they found it defective a printed
+paper, stating that their child was suffering from a defect of vision,
+and, in the child’s interests, they were strongly advised to consult an
+oculist without delay. To this notice was attached a list of hospitals
+with eye clinics and the times at which they were open for patients.
+The periodic rush of school-children with their parents to these
+clinics created chaos in their ordinary working routine.
+
+In 1908 the Board of Education issued a circular stating that
+suitable provision can be made by a local education authority for the
+prescription and purchase of spectacles; and that, in this connection,
+the Board will be prepared to entertain proposals for contributions
+to the funds of hospitals on terms of adequate advantage, and the
+contributions are specially desirable in the case of eye hospitals.
+Also that “it is permissible to include among the conditions of
+contribution a provision allocating a reasonable remuneration to the
+medical men working for such institutions.”
+
+In the following year, in response to the invitation of the London
+County Council Education Committee, the Committee of the Hospital
+agreed to co-operate with it for the treatment of children whose eyes
+required attention, on the basis that not less than 3,000 nor more than
+6,000 children be sent during the year, and that the Council would pay
+for the extra assistants which the Committee would have to appoint to
+carry out the work.
+
+When the new Hospital was built, a portion of it on the ground floor
+had been left uncompleted, it being thought that it might ultimately
+be used as a chapel. The chaplain found it most convenient to conduct
+his services in the day wards. So, in 1909, through the generous
+help of some friends of the Hospital, donations were collected for
+the special purposes of carrying out certain alterations to this
+unoccupied part of the building to provide and equip a refraction
+department for school-children, separate from the other out-patients.
+This school-children’s department was completed and became ready for
+use in 1910. While the majority of the children which attend require
+spectacles for the correction of errors of refraction, some are found
+to be suffering from some other affections of the eye, and these are
+referred for treatment to the ordinary out-patient department.
+
+On the death of Queen Victoria, who had been a Patron throughout the
+whole of her long reign, in 1901, King Edward VII, and Queen Alexandra
+consented to continue the patronage of the Institution which they had
+extended to it as Prince and Princess of Wales. In the same way, the
+Prince and Princess of Wales agreed to continue the patronage which
+they had bestowed on it when Duke and Duchess of York.
+
+On the removal to the new Hospital, it had been foreseen that special
+steps would have to be taken to provide for the payment of the ground
+rent of £1,210 a year, and in 1899 John Tweedy started the “Rent Fund”
+with a generous donation of £150, to which he later added a further
+donation of £50. Owing, however, to the South African War and the
+pressing need to defray current expenses, but very slow progress was
+made in the collection of donations to this fund. In 1904, to celebrate
+the centenary of the foundation of the Hospital, the Committee decided
+to change the name of the fund to that of the “Centenary Fund,” and
+to make a special appeal for contributions to it, all donations to be
+invested and the interest on it devoted to the payment of the rent.
+
+A Centenary Festival Dinner was held at the Hotel Cecil on May 10th,
+over which Sir Charles Wyndham presided, delivering a most eloquent
+appeal on behalf of the Charity. The following ladies kindly acted as
+hostesses on the occasion: Princess Alexis Dolgorouki, the Hon. Helen
+Henniker, Lady Critchett, Lady Burnand, Lady Wyndham, Lady Walker, Mrs.
+Marcus Gunn, Mrs. Widenham Fosbery, Mrs. Edward Nettleship, Mrs. F. C.
+Scotter, Mrs. Beerbohm Tree, Mrs. Brooman-White of Arddaroch, Mrs. J.
+S. Wood. Three hundred guests were present, and the proceeds of the
+dinner, amounting to £2,270, were added to the Centenary Fund.
+
+In former times it was the custom to end a story by drawing a moral;
+all such moral conclusions are nowadays regarded as out of fashion,
+and even a plot is no longer considered as essential in a story. All
+that is required is just to describe a slice out of life, beginning
+anywhere and ending when the requisite number of pages have been
+filled. This story of the Moorfields Eye Hospital describes a slice out
+of the life of an institution, commencing with its foundation in 1804,
+and ending, whilst it is still full of progressive vigour, with the
+celebration of its centenary.
+
+Most people will agree that the chief object of raking over the ashes
+of the past should be to acquire inspirations for the future; and so,
+though it may be hopelessly out of fashion, this story will conclude
+with some maxims which may be deduced from all that has gone before.
+
+The general principle on which the Hospital was established was that
+the treatment of diseases of the eye and visual disorders should be
+recognised as a branch of medicine and surgery, and not left in the
+hands of unqualified and imperfectly trained practitioners. With
+this end in view, it has always been insisted on that the members of
+its medical staff should hold the highest possible qualifications
+as physicians and surgeons, and that every encouragement should be
+given to qualified medical men to come to it to study the treatment
+of eye diseases as a branch of medicine and surgery. The necessity
+for the recognition of this general principle, now in 1929, is just
+as necessary as in 1804, there being, as then, no short road to the
+efficient treatment of visual defects apart from a complete training as
+a medical practitioner.
+
+The question is sometimes asked: Do special hospitals justify their
+existence? The perusal of this book, it is hoped, will at any rate show
+that the Moorfields Eye Hospital has justified its existence.
+
+One of the incomparable advantages afforded by a special hospital is
+the field which it offers for mass observation, both clinical and
+pathological. It was by taking advantage of the extensive opportunities
+for clinical research which Moorfields Hospital affords that Sir
+William Lawrence, Sir Jonathan Hutchinson, Dr. Hughlings Jackson,
+Edward Nettleship, and others have been able to make their most
+valuable contributions to our knowledge of the natural history of eye
+diseases.
+
+Pathological research in connection with eye disease depends almost
+entirely on the investigation of eyes which have had to be removed
+during life, and at Moorfields the custom of placing the mass of such
+material at the disposal of one man, the curator of the Museum, whilst
+he holds office, has proved to be of inestimable advantage in the
+promotion of that line of research.
+
+To arrive at an accurate estimate of the benefits to be derived from
+any special line of treatment or from some operative procedure, it is
+necessary that it should be tried in the various varieties and phases
+of a disease; inferences drawn from isolated cases must always prove
+fallible. The mass of cases provided by a special hospital allows of
+reliable estimates being arrived at.
+
+The facilities for mass observation which a special hospital affords
+are of as great advantage to the student as to the investigator. It
+enables him, not only to get a comprehensive picture of a disease in
+all its manifestations firmly impressed on his mind, but also to see
+in a comparatively short time several examples of what, in a more
+restricted sphere, would be regarded as rare affections. It has been
+the recognition of such advantages that has induced medical men from
+all parts of the world, for over a hundred years, to congregate at
+Moorfields to gain instruction and experience.
+
+It has not, however, been only the size of the clinic which has
+attracted students of ophthalmology to Moorfields, but also to a large
+extent the personnel of its medical staff. To listen to discussions on
+debatable matters by able exponents, holding forth day after day from
+the same pulpits, and to watch varying forms of procedure on similar
+conditions carried out in the same theatre by different operators,
+stimulates students to observe and to think for themselves —a form
+of training which is far preferable to the absorption of dogmatic
+aphorisms from a single teacher, or the attendance at courses of
+didactic oratory.
+
+Medicine and surgery are not exact sciences, and probably never will
+be; any increase in exactitude in connection with them may, however,
+be regarded as synonymous with progress. The immense increase in
+exactitude in connection with ophthalmology which has taken place
+since the discovery of the ophthalmoscope can be realised, if we
+consider the number of well understood conditions which are now
+differentiated, and which were formerly grouped under the vague heading
+of “Amaurosis.” Ophthalmology is closely associated with such exact
+sciences as mathematics, chemistry, and physics. It was, indeed, from
+the association of the latter with ophthalmology that the discovery
+of the ophthalmoscope resulted; for, as Helmholtz himself said, “When
+a well-trained physicist came and grasped the importance of such an
+instrument, nothing more was wanted, since all the knowledge had been
+developed which was required for its construction.”
+
+William Cumming had grasped the possibilities of such a discovery,
+but, lacking himself the necessary training in physics and failing to
+consult anyone who had, missed the way to the end for which he was
+striving.
+
+It was the fortunate circumstance of Sir James Mackenzie Davidson being
+interested in both physics and ophthalmology, at the time of Professor
+Röntgen’s discovery of the X-rays in 1895, that led to their early
+employment at Moorfields in connection with foreign bodies implanted
+in the eyeball, and the introduction of an accurate method for their
+localisation.
+
+Of the intimate association of mathematics with ophthalmology we
+have evidence in Helmholtz’s great work on physiological dioptrics.
+Donders, in the preface to his book _On the Anomalies of Accommodation
+and Refraction of the Eye, with a Preliminary Essay on Physiological
+Dioptrics_, published by the New Sydenham Society in 1844, writes as
+follows:
+
+  “In the doctrine of the anomalies of refraction and accommodation,
+  the connection between science and practice is more closely drawn
+  together than in any part of medicine.
+
+  “Science here celebrates her triumph, for it is at her hand that
+  this branch has acquired the exact character which makes it also
+  worthy of the attention of natural philosophers and physiologists.
+  It is, indeed, satisfactory to see, how in the accurate distinction
+  between anomalies of refraction and accommodation with exclusion of
+  every condition foreign to those anomalies, the system assumed, as if
+  spontaneously, an elegant simplicity; and how the cause and mode of
+  origin of many an obscure type of disease emerged into the clearest
+  light.
+
+  “Practice, in connection with science, here enjoys the rare but
+  splendid satisfaction of not only being able to give infallible
+  precepts based upon fixed rules, but also of being guided by a clear
+  insight into the principles of her actions— advantages the more
+  highly to be estimated as the anomalies in question are of more
+  frequent occurrence, and as they more deeply affect the use and
+  functions of the eyes.
+
+  “Is it, then, strange that the study and treatment of my subject
+  have been to me a labour of love? the more so, as I felt proud in
+  having been called upon to elaborate it for a country in which Young,
+  Wells, Ware, Brewster, and Airy have pointed out to us the track
+  which we had only to follow, and happy in being able to offer my work
+  in this form to my highly esteemed friends and colleagues, whose
+  proofs of kindness and affection have left with me the most agreeable
+  recollections of my visits to England.”
+
+In its indebtedness to chemistry, ophthalmology shares with all
+other branches of medicine and surgery. It was to the chemist Louis
+Pasteur that we owe the upgrowth of the new science of bacteriology.
+It is to Madame Curie’s chemical researches that we are indebted for
+radium, which promises to be the most effectual means for dealing with
+malignant neoplasms apart from operations.
+
+It is to Wassermann that we owe the possibility of a chemical means of
+diagnosing syphilis, and to Ehrlich a chemical compound which will kill
+the invading organism without damaging the tissue of the infected host.
+
+From what has gone before it would seem that measures, which tend
+to bring about a close association between the clinical work in the
+Hospital and the laboratory work of the trained observers in these
+exact sciences, are those most likely to prove fruitful in the
+promotion of the progress of ophthalmology in the future.
+
+Hospitals in the first part of the nineteenth century were institutions
+founded and supported by the rich for the relief of suffering in the
+indigent poor, the inmates admitted to which were given everything for
+nothing.
+
+Under altered conditions, they are now rapidly becoming institutions
+for the relief of suffering in the community at large, supported in
+part by donations from munificent persons, and in part by contributions
+from those who receive benefits in them.
+
+In former times the word “hospital” raised in the mind a picture of a
+barrack-like building, associated with pain and suffering, with poverty
+and death.
+
+John Couper, when senior surgeon at the London Hospital, was journeying
+to it down the Mile End Road in one of the old horse-drawn omnibuses,
+and asked the conductor to put him down at the London Hospital; the
+conductor shouted out to the driver, “Stop at the slaughter-house Bill.”
+
+Since the introduction of anæsthetics and antiseptics hospitals are
+no longer regarded as slaughter-houses by the general public, but as
+places where pain and suffering are relieved, and health and vigour
+are restored. No longer are they forbidding barrack-like structures,
+but temples of hygienic cleanliness. No longer is it a luxury to be
+ill, or to have an operation performed in one’s own home, where all the
+necessary appliances have to be imported or improvised. Far preferable
+has it become to go to an institution specially constructed for such
+purposes, furnished with the most up-to-date contrivances, and with a
+staff efficiently trained to meet all emergencies.
+
+In a Report of a Special Committee of the King Edward’s Hospital Fund
+for London on “Pay Beds,” dated July, 1928, the present relation of
+various sections of the general public to hospitals is set out as
+follows:
+
+  “During recent years there has been a considerable extension,
+  both of the classes included amongst Voluntary Hospital patients
+  and of the payments made by ordinary patients. There was a time
+  when the Hospitals were only called upon to provide comparatively
+  simple treatments for the necessitous poor, which meant those who
+  were unable to pay for medical attendance. With the development of
+  expensive methods of treatment and diagnoses, large numbers of the
+  middle and professional classes are now unable to pay the full cost
+  of these services, some of which, according to our evidence, are
+  often difficult to obtain outside the Hospital.
+
+  “At the same time, experience has shown that large numbers of the
+  ordinary Hospital patients are both able and willing to contribute
+  towards their cost. At present, therefore, there is a demand for
+  Hospital treatment from several different classes which may be
+  grouped into three: First, those who cannot afford to pay anything,
+  and who receive, when in the ordinary wards, free maintenance and
+  treatment; second, those who can and do contribute according to their
+  means towards their cost of maintenance in the ordinary wards, though
+  still receiving free medical attendance from the visiting staff of
+  physicians and surgeons; third, those whose standard of living causes
+  them to desire better accommodation, or at all events more privacy,
+  than is provided in the ordinary wards, and who are prepared to
+  pay for it according to their means, and also to pay something for
+  medical attendance. Beyond these, there is a fourth class, those who
+  can afford to obtain their treatment in private nursing homes and to
+  pay full medical fees.”
+
+Institutions, like individuals, if they wish to survive in the struggle
+for existence, have to obey the universal law of adaptation to
+environment. Moorfields Hospital, during the first hundred years of
+its existence, has undergone reconstruction, had additions made to it,
+and has twice been removed to a new site, in response to the demands
+made upon it by the increasing number of patients attending for relief,
+and to the developments and discoveries in the methods of applying
+relief.
+
+To be capable of such frequent fresh adaptations, an institution
+must be prepared to obey another biological law—that of retaining a
+high degree of plasticity, which, in the case of an institution, is
+equivalent to maintaining a big margin for expansion.
+
+As has been shown, Moorfields is largely indebted to the foresight
+of its architects for having retained such a margin for expansion
+to meet new requirements. When first a new Hospital was erected
+on the Moorfields site, Sir Robert Smirke, the architect, advised
+the Committee to secure the freehold of a piece of vacant ground
+immediately behind the Hospital, upon which, after the discovery of the
+ophthalmoscope, a new out-patient department with a large dark-room
+was built. It was also, probably by his advice, that Dr. Farre secured
+the lease of the piece of ground on its south side, part of which he
+for a time let off for a stables and in part used for the Saunderian
+Institute, but upon which a new wing of the Hospital was subsequently
+built, when the demand for more in-patient accommodation became urgent,
+after the introduction of anæsthetics and the great increase in the
+number of operative procedures. When the removal to a new site again
+became necessary, it was the proceeds derived from the greatly enhanced
+value of these sites, which had been so fortunately obtained, that
+supplied the funds for the erection of the new building.
+
+It was due to the advice of the architects, Keith Young and Bedell,
+that the large site in the City Road was chosen for the present
+Hospital, instead of the cramped one in Eldon Street adjoining the
+former building, to which at the time sentiment made a strong appeal.
+
+In the twenty-five years which have elapsed since the celebration
+of the Hospital’s centenary, fresh discoveries and altered economic
+conditions have produced further changes in environment, calling
+for more expansion in one direction and another. Fortunately, the
+plasticity of the present large site is by no means exhausted, and with
+suitable adaptation it is capable of providing all the demands likely
+to be made upon it for several years to come.
+
+The last maxim, however, to be drawn from the past history of the
+Hospital is the necessity of keeping ever alert for adaptations to meet
+fresh changes in its environment as they arise.
+
+
+
+
+  APPENDIX
+
+
+  PRESIDENTS
+                                           _Date of_        _Date of_
+                                         _Appointment_.   _Resignation_.
+  Sir Charles Price, Bart.                    1804            1818
+  Mr. William Mellish                         1818            1838
+  Rt. Hon. Earl Fitzwilliam                   1838            1856
+  Mr. William Cotton, D.C.L., F.R.S.          1857            1867
+  Sir John Lubbock, F.R.S., M.P.
+    (afterwards Lord Avebury)                 1867            1913
+  His Royal Highness Prince Arthur
+    of Connaught, K.G.                        1914
+
+
+  CHAIRMEN OF THE COMMITTEE OF MANAGEMENT
+
+  Mr. Harry Sedgwick                          1804            1818
+  Mr. Ralph Price                             1818            1830
+  Mr. Stuart Donaldson                        1831            1837
+  Rev. J. Russell, D.D.                       1837            1857
+  Mr. Richard Heathfield                      1857            1859
+  Mr. F. G. Sambrooke                         1860            1871
+  Mr. Philip Cazenove                         1871            1879
+  Mr. Charles Gordon                          1879            1897
+  Mr. H. P. Sturgis                           1897            1921
+  Mr. Theodore W. Luling                      1921
+
+
+  HONORARY MEDICAL AND SURGICAL OFFICERS
+
+  _Physicians_
+
+  John Richard Farre, M.D.                    1805            1857
+  Frederick J. Farre, M.D.                    1843            1880
+  Robert Martin, M.D.                         1856            1884
+  Sir Stephen Mackenzie, M.D.                 1884            1905
+  James Taylor, C.B.E., M.D.                  1899            1919
+  Gordon M. Holmes, C.M.G., C.B.E., M.D.      1914            1927
+  William J. Adie, M.D.                       1927
+
+
+  _Surgeons_
+
+  J. Cunningham Saunders
+  (Founder)                                   1804       Died 1810
+  Benjamin Travers, F.R.S.                    1810            1817
+  Sir William Lawrence, Bart., F.R.S.         1814            1826
+  Frederick Tyrrell                           1817       Died 1843
+  John Scott                                  1826            1846
+  Gilbert Mackmurdo, F.R.S.                   1830            1856
+  John Dalrymple, F.R.S.                      1832            1849
+  James Dixon                                 1843            1868
+  George Critchett                            1843            1877
+  Sir William Bowman, Bart., F.R.S.           1846            1876
+  Alfred Poland                               1848            1861
+  H. H. Mackmurdo                             1851            1852
+  John C. Wordsworth                          1852            1883
+  J. F. Streatfield                           1856       Died 1886
+  J. W. Hulke, F.R.S.                         1858            1890
+  George Lawson                               1862            1891
+  Sir Jonathan Hutchinson, F.R.S.             1862            1878
+  John Couper                                 1866            1895
+  J. Soelberg Wells                           1867       Died 1880
+  Waren Tay                                   1877            1904
+  James E. Adams                              1877            1884
+  Sir John Tweedy, LL.D.                      1878            1900
+  Robert Lyall                                1880       Died 1882
+  Edward Nettleship, F.R.S.                   1882            1898
+  R. Marcus Gunn                              1883            1909
+  W. Lang                                     1884            1912
+  A. Quarry Silcock                           1886       Died 1904
+  J. B. Lawford, LL.D.                        1890            1918
+  A. Stanford Morton                          1891            1909
+  E. Treacher Collins                         1895            1922
+  W. T. Holmes Spicer                         1898            1920
+  Percy Fleming                               1900            1919
+  J. Herbert Fisher                           1900            1927
+  Sir Arnold Lawson, K.B.E.                   1900            1914
+  C. Devereux Marshall                        1900       Died on active
+                                                         service, 1918
+  Sir William T. Lister, K.C.M.G.             1904            1905
+                                              1919
+  Sir John Herbert Parsons, C.B.E., F.R.S.    1905
+  Claud Worth                                 1905            1921
+  W. Ilbert Hancock                           1909       Died 1910
+  George Coats                                1909       Died 1915
+  Malcolm L. Hepburn                          1910            1926
+  A. Cyril Hudson                             1913            1928
+  R. Foster Moore, O.B.E.                     1914
+  R. Affleck Greeves                          1915
+  F. A. Juler                                 1918
+  Charles Goulden, O.B.E.                     1919
+  B. T. Lang                                  1920       Died 1928
+  M. H. Whiting, O.B.E                        1921
+  P. G. Doyne                                 1922
+  Humphrey Neame                              1926
+  Miss Ida C. Mann                            1927
+  W. Stewart Duke-Elder                       1928
+  Rupert S. Scott                             1928
+
+
+  _Ear, Nose, and Throat Surgeon_
+
+  G. Seccombe Hett                            1923            1929
+
+
+  _Medical Officer to the X-Ray Department_
+
+  Sir James Mackenzie Davidson                1899            1910
+  Albert Bowie                                1910
+
+
+  _Dental Surgeons_
+
+  Arthur E. Relph                             1913            1915
+  R. M. Fickling                              1915            1928
+  Stanley A. Riddett                          1928
+
+
+  _Medical Officer to the Ultra-Violet Ray Department_
+
+  W. Stewart Duke-Elder                       1927
+  Mr. Richard Battley                         1804            1818
+  Mr. Matthew Heathfield                      1818            1834
+  Mr. William Bircham                         1835            1844
+  Mr. Robert Francis Dalrymple                1844            1846
+  Mr. F. A. Curling                           1846            1856
+  Mr. Charles Gordelier                       1856            1860
+  Mr. J. Mogford                              1860            1872
+  Mr. Robert J. Newstead                      1872            1897
+  Mr. Robert J. Bland                         1897            1923
+  Mr. Arthur J. M.  Tarrant
+
+
+
+INDEX
+
+
+  Abercrombie, Sir Ralph, 6
+
+  Adams, James, 146
+    his loss of sight, 163
+
+  Adams, Sir William, 1, 22, 28
+    at Exeter, 29
+    monetary grant to, and change of name, 30
+
+  Airy, the Astronomer Royal, 115, 212
+
+  Alexander, Charles, 15, 16
+
+  Amasis, King of Egypt, 43
+
+  Anæsthesia, general, 82
+    local, 165
+
+  Anatomy of the human eye, 94
+
+  Anderson, Mrs. Garrett, 179
+
+  Anderson, Dr. James, 167
+
+  Ansley, Alderman, 39
+
+  Antiseptics in ophthalmology, 154
+
+  Arlt, of Vienna, 96, 114
+
+  Artificial eyes, 86
+
+  Artificial pupil, operations for, 89–91
+
+  Aseptic surgery, 187
+
+  Asthenopia, 114
+
+  Astigmatism, 114
+
+  Avebury, Lord, 135, 217
+
+  Avicenna, 89
+
+
+  Babbage, Charles, his ophthalmoscope, 102, 127
+
+  Bacteriology, 202
+
+  Bader, Charles, 95
+    appointed curator, 110, 122, 138
+
+  Bancroft, Sir Squire, 182
+
+  Barth, Joseph, of Vienna, 44
+
+  Battley, Richard, early life, 3, 6, 11
+    appointed secretary, 14, 30, 46
+    and materia medica, 55–57, 59, 71
+    death of, 79, 220
+
+  Bedell, hospitals surveyor, 172, 215
+
+  Beer, Professor, of Vienna, 44
+
+  Belladonna, 1, 19, 23
+
+  Bennett, Dr. Hughes, 164
+
+  Bethlehem, Royal Hospital, 52
+    its burial ground, 132
+
+  Bircham, Francis William, 66, 78, 220
+
+  Bircham and Co., solicitors to the Hospital, 66
+
+  Blomberg, Rev. Dr., 67, 68
+
+  Blood, withdrawal of, 40–41
+
+  Boerhaave, of Leyden, 44
+
+  Bonnet, of France, 86
+
+  Bovell, J. Roach, 72
+
+  Bowman, Sir William, candidature, 75
+    employment of chloroform, 83
+    operation on lacrymal passages, 88, 120
+    operation for artificial pupil, 89–91
+    meeting with Graefe and Donders, 93–95
+    iridectomy for glaucoma, 96–97, 112
+    retirement from Hospital, 143–144
+    later life, 145–146
+    and antiseptics, 155, 159, 161
+
+  Boycott, Miss, 143
+
+  Bradford, of Boston, U.S.A., 185
+
+  Brailey, W. A. , curator, 141, 142
+
+  Brass, Robert, architect, 134
+
+  Bruecke, 95, 112
+
+  Buller, Frank, 142
+
+
+  Calabar bean, 131
+
+  Cambridge, H.R.H. Duke of, 108, 182
+
+  Cataract, congenital, 11, 19–24, 27, 60, 62, 88
+    after-treatment, 153, 156
+
+  Cazenove, Philip, 137, 149
+
+  Charnley, W., 159
+
+  Charter, granting of, 171
+
+  Charterhouse Square, 14, 48
+
+  Chloroform, 84–85
+
+  Churchill, John, 77, 79
+
+  City Companies, donations, from, 182
+
+  City Road site, 172
+
+  Clark, Sarah, 15
+
+  Clinical assistants, institution of, 109
+
+  Coats, George, 9, 10, 219
+
+  Cocaine, 164
+
+  Colkett, Miss Jane Louisa, 6
+
+  Collins, E. Treacher, 179, 182, 218
+
+  Conjunctiva, inflammation of,
+    in infants, 22
+
+  Conradi, 20, 27
+
+  Consulting surgeons, duties of, 144–145
+
+  Cooper, Sir Astley, connection with Saunders, 2–8
+    suggestion for a special institution, 11, 13
+    description of, by Travers, 33, 38
+    his pupils and relatives, 59, 75
+
+  Cooper, Samuel, 45
+
+  Cooper, White, 84, 127
+
+  Cork Street, Infirmary in, 15
+
+  Cotton, William, 108, 135, 217
+
+  Couper, John, 109
+    appointed assistant-surgeon, 134, 136
+    word picture of, 157–158
+    his ophthalmoscope, 158–159, 179, 213, 218
+
+  Cramer, 112
+
+  Crimean War, 104, 125, 197
+
+  Critchett, Sir Anderson, 97, 146
+
+  Critchett, George, 75, 85
+    and excision of the eyeball, 86
+    and operation for squint, 87
+    and operation for artificial pupil, 89–91
+    for glaucoma, 96–97, 108, 134
+    and duties of consulting surgeons, 143–145
+    on Poor Law schools, 140–141, 146, 218
+
+  Cuignet, 159
+
+  Cumming, William, 100, 101, 102
+
+  Curie, Madame, 212
+
+  Curling, F. A. , 78, 220
+
+  Cyrus, King of Persia, 43
+
+
+  Dalrymple, John, secretary to academy, 58
+    assistant surgeon, 64, 73, 74
+    early training 75–76
+    atlas of pathology of the eye, 77–78, 81, 118, 218
+
+  Dalrymple, Robert Francis, 78, 220
+
+  Dalrymple, William, 75–76
+
+  Davidson, H., 182, 191
+
+  Davidson, Sir James Mackenzie, 186, 187, 211, 219
+
+  Daviel, 19
+
+  Dean, appointment of, 201
+
+  Delafield, Dr. Edward, 35, 38
+
+  Desmarres, of Paris, 96
+
+  Devis, portrait of Saunders by, 32
+
+  Diet, 41
+
+  Diploma of Ophthalmology, 201
+
+  Dispensary for diseases of the eye and ear proposed, 12
+
+  Dodson, Mrs., 80
+
+  Donders, Franz Cornelius, first meeting with Graefe and Bowman,
+        92–94, 95, 96, 99
+    on Helmholtz, 103
+    and anomalies of refraction and accommodation, 112–114, 145, 147,
+        211
+
+  Doublet, Thomas, 116
+
+
+  Ear, anatomy of, 17
+
+  Earle, Henry, 45
+
+  East India Company, 34, 36
+
+  Egerton, C. J. , 37
+
+  Egyptian ophthalmia, 6, 29
+
+  Ehrlich, 213
+
+  Eldon Street, negotiations regarding site in, 169–171
+
+  Electro-magnets, 185
+
+  Ether, 82
+
+  Excision of the eyeball, 85–86
+
+  Exeter Eye Infirmary, 29
+
+
+  Farre, Dr. Arthur, 106
+
+  Farre, Dr. Frederick J., 60, 70, 72, 73, 75, 106, 215
+
+  Farre, Dr. John Richard, early life, 3
+    consulting physician, 14, 24
+    edits Saunders’ writings, 26–28, 38, 45, 53
+    courses of instruction, 54–56
+    and Saunderian Institution, 56–57
+    attacks on, in Lancet, 59–61
+    his journal, 71
+    his portrait, 72–73 74, 75, 81, 106, 215, 217
+
+  Finsbury, neighbourhood of, 161
+
+  Fisher, J. Herbert, 200, 218
+
+  Fitzwilliam, Earl, 69, 108, 215
+
+  Fixation forceps, 126
+
+  Flemming, Percy, 199, 218
+
+  Forbes, Litton, 159
+
+  Forster, 129
+
+  France, Mr., 126
+
+  Fraser, Dr. Thomas R., 131
+
+
+  Gamgee, J. S. , 106
+
+  General hospitals, ophthalmic departments in, 126, 135
+
+  Gibson, Benjamin, 28, 60, 88
+
+  Gill, Rev. T. , 51, 55, 56
+
+  Glaucoma, operations for and treatment of, 91–93, 126, 141–142
+
+  Gordon, Charles, 149, 180, 215
+
+  Governors, privileges of, 107
+
+  Graefe, A. von, operation for glaucoma, 91
+    meeting with Bowman and Donders, 93–94, 103, 127
+    and perimetry, 129
+    death of, 141
+    and latent squints, 201
+
+  Grant, Roger, 10
+
+  Greek writers, 43
+
+  Green, 27, 59
+
+  Gunn, Marcus, 160, 203, 218
+
+  Guthrie, 15
+
+
+  Haab, of Zurich, 187
+
+  Harkness, 109
+
+  Harnet, Miss, 143, 165
+
+  Hawes, Alfred, 116
+
+  Hawes, William, 116
+
+  Helmholtz, Professor von, 99, 103, 211
+
+  Herbert, Sydney, 105
+
+  Herodotus, 43
+
+  Hey, 23
+
+  Hill, John, 1, 8, 29
+
+  Hirschberg, of Berlin, 185
+
+  Hogg, E., 181
+
+  Horner, Professor, of Zurich, 155
+
+  Hulke, John Whitaker, 82, 85, 106, 109
+    microscopical and scientific work, 111, 112
+    career, 124–125
+    and the perimeter, 129, 135, 147, 177, 218
+
+  Hutchinson, Sir Jonathan, 109, 112
+    work on inherited syphilis, 122–123, 130
+    on tobacco amaurosis, 148–149 151, 159, 218
+
+  Hypermetropia, 113
+
+
+  Inquiry officer, 179
+
+  Iriddesis, 90–91
+
+  Iris, essay on inflammation of, 19
+
+  Jackson, Dr. Hughlings, 109, 130, 205
+
+  Jacksonian Prize Essay, for 1859, 111
+    for 1878, 142
+
+  Jaeger, Edward von, 117, 160
+
+  Janin, 44
+
+  Jeafferson, 37
+
+  Jones, Wharton, 102, 115, 127
+
+  _Journal of Morbid Anatomy, etc_., 71
+
+  Jussieu, Joseph de, 164
+
+
+  Kemp, William, 174
+
+  Kensington, Henry, 14
+
+  Kent, the Duchess of, 67, 68
+
+  Kepler, 114
+
+  King Edward VII., 208
+
+  King Edward’s Hospital Fund, 195, 214
+
+  King George I., oculist to, 10
+
+  King George II., oculist to, 10
+
+  King George III., oculist to, 11, 15
+
+  King William IV., oculist to, 31
+
+  Koller, Karl, 164
+
+
+  Ladies’ Working Guild, 197–198
+
+  Lancet, 46, 56, 58, 59, 202
+
+  Lander, the hospitals surveyor, 170, 172
+
+  Lang, William, 164, 204, 218
+
+  Laquer, 131
+
+  Lawford, J. B. , 162, 177, 218
+
+  Lawrence, Sir William, treatment of eye diseases at general
+        hospitals, 7, 33, 37
+    the withdrawal of blood, 40–41
+    history of ophthalmology, 43–44
+    estimates of, 44
+    and venereal diseases of the eye, 45–46, 54, 55
+    and _Lancet_, 58–59, 61
+    influence of one eye on the other, 86
+    obstruction of tear duct, 88, 114, 123, 151, 209, 218
+
+  Lawson, Sir Arnold, 200, 219
+
+  Lawson, George, 109
+    his career, 124, 125, 157
+    treatment of out-patients, 177, 218
+
+  Leber, Professor, 139
+
+  Leeches, 41
+
+  Lenses, system of numbering, 116
+
+  Library, 72
+
+  Lighting of new Hospital, 184
+
+  Lister, Joseph, 152
+
+  Lister, Sir William T., 206, 219
+
+  Liston, Robert, 82
+
+  Little Portland Street, Infirmary in, 31
+
+  Livingstone, 98
+
+  Lubbock, Sir John, 145, 170, 191, 217
+
+  Lyell, Robert, 150, 218
+
+
+  MacCallan, A. F. , 187
+
+  Macgregor, Patrick, 6
+
+  McHardy, Malcolm, 185
+
+  McKenzie, H. V. , 187
+
+  Mackenzie, of Glasgow, 82, 126
+
+  Mackenzie, Sir Stephen, 160, 215
+
+  McKeown, of Belfast, 185
+
+  Mackmurdo, Gilbert, 64, 73, 74, 79, 106, 218
+
+  Mackmurdo, H. H. , 81, 218
+
+  Maddox, of Bournemouth, 201
+
+  Madras Eye Infirmary, 37
+
+  Magnet operations, 125, 187
+
+  Maitre-Jan, 44
+
+  Mansion House, sale at, 64
+
+  Marshall, C. D. , 156, 205, 219
+
+  Martin, Dr. Robert, 106, 129, 160, 215
+
+  Massachusetts Charitable Eye and Ear Infirmary, 36
+
+  Medical Council, formation of, 108–109
+
+  Medical-legal observations, 120
+
+  Mellish, William, 47, 49, 64, 68, 69, 215
+
+  Milles, W. Jennings, 142
+
+  Missionaries, admitted to study at Hospital, 98
+
+  Mogford, J., 138, 220
+
+  Moorfields, 48–53
+
+  “Moorfields Club,” 161
+
+  Morax-Axenfeld bacillus, 163
+
+  Morton, A. Stanford, after-treatment of cataract operations, 153,
+        156, 177
+    his ophthalmoscopic drawings, 178, 218
+
+  Muscles of eye, paralytic affections of, 127
+
+  Myopia, 114
+
+
+  Nagel, 116
+
+  Nettleship, Edward, 139
+    appointed curator, 140, 148, 150, 151
+    his scientific work, 180, 205, 210, 218
+
+  Newman, Sir George, 206
+
+  Newstead, Robert J., 138, 181, 220
+
+  New York Eye and Ear Infirmary, 35
+
+  Nightingale, Miss Florence, 105, 134–153
+
+  Nunn, T. N. , 81
+
+  Nurses, Queen Victoria’s Jubilee Institute of, 201
+
+  Nursing, changes in, 165, 166
+
+  Nursing, School of, 200
+
+
+  O’Ferrall, of Dublin, 86
+
+  Ophthalmological Society, 145, 149, 161
+
+  Ophthalmoscope, discovery of, 99
+
+  Osler, Sir William, 142
+
+
+  Paget, Sir James, 44
+
+  Palmerston, Lord, 30
+
+  Parsons, Sir John, 206, 219
+
+  Pasteur, 161, 212
+
+  Pay beds, report on, 214
+
+  Pearson, Karl, 180
+
+  Peel, Mrs., 165
+
+  Peerless Pool, 174–175
+
+  Peerless Street, 173
+
+  Peninsular War, 39
+
+  Perimetry, 129
+
+  Periscope, 128, 148, 149
+
+  Pharmacopœia, 72
+
+  Phillips, T., 199
+
+  Phillips, Thomas, R.A., 72, 73
+
+  Price, Sir Charles, 15, 21, 39, 47, 215
+
+  Price, Ralph, 61, 215
+
+  Prichard, of Bristol, 87
+
+  Prince and Princess of Wales, 181, 208
+
+  Prince of Wales’ Hospital fund, 195
+
+  Poor Law children and ophthalmia, 140, 141
+
+
+  Queen Alexandra, 208
+
+  Queen Anne, oculist to, 10
+
+  Queen Victoria, 39, 46, 69, 177, 207
+
+  Railway termini, 132, 133
+
+  Rating and Valuation Bill, 194
+
+  Rating of new Hospital, 193, 194
+
+  Rawson, Sir William, 30
+
+  Read, Sir William, 9, 10
+
+  Reports, Ophthalmic Hospital, 119
+    colour of paper in, 127
+
+  Retinal arteries, changes in, 203
+
+  Retinoscopy, 159
+
+  Reynolds, Dr. Edward, 35
+
+  Rheumatic affections of the eyes, 204
+
+  Richardson, R., 37
+
+  Robertson, Miss Ada, 180
+
+  Robertson, Dr. Argyll, 131
+
+  Rodgers, Dr. J. Kearney, 35
+
+  Roman Emperors, 43
+
+  Röntgen, Professor, 186
+
+  Royal Westminster Ophthalmic Hospital, 15
+
+
+  St. Ives, 44
+
+  Sambrooke, F. G. , 117, 137, 138, 217
+
+  Saunders, John Cunningham, early life, 1
+    association with Astley Cooper, 2–6, 11
+    proposal to start dispensary, 11–14, 16
+    and diseases of the ear, 17–19
+    operation for congenital cataract, 19–24
+    death of, 25, 26, 28, 29, 32, 49, 57, 60, 81, 118, 218
+
+  Saunderian Institution, 56, 57, 70
+
+  Saunders, Mrs., 26
+
+  Savory, Sir William, 44
+
+  Scarpa, 23, 28
+
+  Schmidt, 44
+
+  School-children, sight-testing of, 206, 207
+
+  School of Ophthalmology, opening of, 34
+
+  Schweizer, 110
+
+  Scott, John, 61; monograph on cataract, 62, 64
+    obituary notice, 65; 74, 75, 77, 81, 218
+
+  Sedgwick, Harry, 47
+    trust fund, 117, 118, 196, 215
+
+  Shepherdess Walk, 175, 176
+
+  Silcock, A. Quarry, 167, 206, 218
+
+  Simpson, Sir Janies, 82
+
+  Smee, Alfred, 116, 133
+
+  Smirke, Sir Robert, 49, 51, 53, 215
+
+  Smith, Priestley, 139, 142
+
+  Snell, of Sheffield, 185
+
+  Snellen, of Utrecht, 117
+
+  Soemerring, 44
+
+  South African War, 193, 208
+
+  Spicer, W. T. Holmes, 180, 201, 218
+
+  Squint, operation for, 87
+
+  Squints, latent, 201
+
+  Stanley, Edward, 45
+
+  Stephenson, Sydney, 141
+
+  Stevens, of New York, 201
+
+  Stevenson, John, 22, 28, 30, 31, 33
+
+  Streatfield, J. F. , 106; his career, 107–108
+    editor of the Reports, 119, 125, 127, 135, 136
+    gigantic model of eye, 166, 218
+
+  Tarsus, excision of, 22, 29
+
+  Tay, Waren, 146, 148, 151, 162, 206, 218
+
+  Taylor, “Chevalier,” 10
+
+  Taylor, Dr. James, 205, 218
+
+  Teale, Pridgin, jun., 88
+
+  Tear duct, operations on, 88
+    affections of, 152
+
+  Tobacco, amaurosis due to, 148
+
+  Travers, Benjamin, 33
+    early career of, 34
+    and East India Company, 36–37
+    his treatise on eye diseases, 38, 42, 59, 64, 70, 218
+
+  Travers, Benjamin, sen., 13
+
+  Tubercle of the eye, 140, 162
+
+  Tweedy, Sir John, 149, 157
+    career of, 202–203, 206
+    starts rent fund, 208, 218
+
+  Tyrrell, Frederick, 45, 48, 54
+    and Wakley, 58–59
+    description of, 62–63, 64, 65, 74, 76, 104, 114, 218
+
+  Tyrrell, John, 48, 50
+
+  Tyrrell, Timothy, 48, 50
+
+  Tyrrell, Walter, 106, 109
+
+
+  Usher, C. H. , 180
+
+
+  Venereal diseases of the eye, 45
+
+  Ventilation of new Hospital, 182–183
+
+  Vernon, Bowater, 139
+
+  Vetch, Dr., 7
+
+  Victoria, H.R.H. the Princess, 67–68
+
+
+  Wakley, Thomas, 58, 59, 60
+
+  Walton, Haynes, 82
+
+  Ware, James, 11, 20, 28, 113, 212
+
+  Wassermann, 212
+
+  Wathen, Dr., 11, 15, 31
+
+  Weber, Adolph, 131
+
+  Weekes, Henry, bust of Saunders by, 32, 118
+
+  Wells, J. Soelberg, 109
+    and sight-testing, 115
+    description of, 127–128 136, 147
+    his treatise on diseases of the eye, 149–150, 152, 199, 212, 218
+
+  Women become eligible as pupils and clinical assistants, 179
+
+  Wyndham, Sir Charles, 208
+
+
+  X-rays, 186
+
+  York, H.R.H. the Duke of, 30, 49, 67
+
+  York Hospital, Chelsea, 29
+
+  Young, Keith, 172, 190, 215
+
+  Young, Thomas, 114
+
+
+  Zinn, Professor, 44
+
+
+
+H. K. Lewis and Co., Ltd., 28, Gower Place, London, W.C.1.
+
+
+
+*** END OF THE PROJECT GUTENBERG EBOOK 78625 ***