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+ color: black; + font-size:smaller; + padding:0.5em; + margin-bottom:5em; + font-family:sans-serif, serif; +} + + +/* Illustration classes */ +.illowe21_8750 {width: 21.8750em;} +.illowe23_1250 {width: 23.1250em;} +.illowe4_3750 {width: 4.3750em;} +.illowe41_8750 {width: 41.8750em;} +.illowe41_2500 {width: 41.2500em;} +.illowe22_8125 {width: 22.8125em;} +.illowe23_4375 {width: 23.4375em;} +.illowe24_3750 {width: 24.3750em;} +.illowe21_2500 {width: 21.2500em;} +.illowe39_3750 {width: 39.3750em;} +.illowe34_7500 {width: 34.7500em;} +.illowe37_5000 {width: 37.5000em;} +.illowe25_0000 {width: 25.0000em;} + </style> +</head> + +<body> +<div style='text-align:center'>*** START OF THE PROJECT GUTENBERG EBOOK 78625 ***</div> + + +<div class="transnote"> +<p class="ti0"><b><a id="Transcribers_notes"></a>Transcriber’s notes</b>:</p> + +<p class="ti0">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.</p> + +<p>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. Plate XXIV has been rendered in normal text as the +original image is barely legible, and hyperlinks have been added to +assist readers navigate the text.</p> + +<p>New original cover art included with this eBook is granted to the +public domain.</p> +</div> + +<div class="halftitle"> + THE HISTORY AND TRADITIONS OF THE<br> + MOORFIELDS EYE HOSPITAL +</div> + +<p class="tac"><a id="PLATE_I"></a>PLATE I.</p> + +<figure class="figcenter" id="007" style="width: 370px;"> + <img src="images/007.jpg" width="370" height="452" alt=""> + <figcaption> + <p>JOHN CUNNINGHAM SAUNDERS.<br>From an engraving by Anthony Cardon, after a picture by A. W. Devis.</p> + </figcaption> +</figure> + + +<div class="titlepage"> +<h1><span class="t1">THE HISTORY & TRADITIONS</span><br> +<span class="t2">OF THE</span><br> +<span class="t1">MOORFIELDS EYE HOSPITAL</span></h1> + +<div class="tp1">ONE HUNDRED YEARS OF<br> +OPHTHALMIC DISCOVERY & DEVELOPMENT</div> + +<div class="tp2">BY</div> + +<div class="tp3">E. TREACHER COLLINS</div> + +<div class="tp4">CONSULTING SURGEON; MEMBER OF THE COMMITTEE OF MANAGEMENT;<br> +FORMERLY, CLINICAL ASSISTANT; JUNIOR AND SENIOR HOUSE<br> + SURGEON; CURATOR OF THE MUSEUM AND LIBRARIAN;<br> + ASSISTANT SURGEON AND SURGEON</div> + +<div class="tp5">WITH TWENTY-SEVEN PLATES</div> + + +<figure class="figcenter illowe4_3750" id="colophon"> + <img class="w100" src="images/colophon.jpg" alt=""> +</figure> + +<div class="tp6">LONDON<br> + +H. K. LEWIS CO. LTD.</div> + +<div class="tp7">1929</div> +</div> + + +<div class="dedication1">DEDICATED TO THE MEMORY</div> +<div class="dedication2">OF THE</div> +<div class="dedication3">MEMBERS OF THE SURGICAL STAFF</div> +<div class="dedication2">OF THE</div> +<div class="dedication3">MOORFIELDS EYE HOSPITAL</div> +<div class="dedication4">IN THE YEARS 1883 TO 1887</div> + +<div class="dedication5">TO WHOSE INFLUENCE AND INSTRUCTION<br> +THE AUTHOR IS SO DEEPLY INDEBTED</div> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_vii">vii</span></p> + <h2 class="nobreak" id="PREFACE"> + PREFACE + </h2> +</div> + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>For biographical details, the <i>Dictionary of National +Biography</i> has been consulted, and also the articles on the +<span class="pagenum" id="Page_viii">viii</span>“British Masters of Ophthalmology” which have been +published in the <i>British Journal of Ophthalmology</i>.</p> + +<p>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.</p> + +<p>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 <i>British Journal of +Ophthalmology</i> 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.</p> + + +<p><span class="pagenum" id="Page_ix">ix</span></p> +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="CONTENTS"> + CONTENTS + </h2> +</div> + +<table id="toc" class="fs90"> +<tr> +<td class="tal fs60"> +CHAPTER +</td> +<td> +</td> +<td class="tar fs60"> +PAGE +</td> +</tr> +<tr> +<td class="tar"> +<div>I.</div> +</td> +<td class="tal"> +THE FOUNDERS AND FOUNDATION +</td> +<td class="tar"><div><a href="#Page_1">1</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>II.</div> +</td> +<td class="tal"> +THE WORK OF JOHN CUNNINGHAM SAUNDERS +</td> +<td class="tar"><div><a href="#Page_17">17</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>III.</div> +</td> +<td class="tal"> +BENJAMIN TRAVERS AND SIR WILLIAM LAWRENCE +</td> +<td class="tar"><div><a href="#Page_33">33</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>IV.</div> +</td> +<td class="tal"> +REMOVAL TO MOORFIELDS +</td> +<td class="tar"><div><a href="#Page_48">48</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>V.</div> +</td> +<td class="tal"> +THE ROYAL LONDON OPHTHALMIC HOSPITAL +</td> +<td class="tar"><div><a href="#Page_67">67</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VI.</div> +</td> +<td class="tal"> +THE INTRODUCTION OF INHALATION ANÆSTHESIA AND OPHTHALMIC SURGERY +</td> +<td class="tar"><div><a href="#Page_82">82</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VII.</div> +</td> +<td class="tal"> +THE DISCOVERY OF THE OPHTHALMOSCOPE +</td> +<td class="tar"><div><a href="#Page_99">99</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VIII.</div> +</td> +<td class="tal"> +THE COMMENCEMENT OF “THE OPHTHALMIC HOSPITAL REPORTS” +</td> +<td class="tar"><div><a href="#Page_119">119</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>IX.</div> +</td> +<td class="tal"> +GROWTH AND EXTENSION +</td> +<td class="tar"><div><a href="#Page_132">132</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>X.</div> +</td> +<td class="tal"> +ANTISEPTICS, BACTERIOLOGY, AND LOCAL ANÆSTHESIA +</td> +<td class="tar"><div><a href="#Page_152">152</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XI.</div> +</td> +<td class="tal"> +THE SELECTION OF A NEW SITE, AND THE ERECTION OF THE NEW HOSPITAL +</td> +<td class="tar"><div><a href="#Page_168">168</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XII.</div> +</td> +<td class="tal"> +THE HOSPITAL IN THE CITY ROAD +</td> +<td class="tar"> +<div><a href="#Page_190">190</a></div> +</td> +</tr> +</table> + +<p><span class="pagenum" id="Page_xi">xi</span></p> + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="LIST_OF_PLATES"> + LIST OF PLATES + </h2> +</div> + + +<table id="loi" class="fs90"> +<tr> +<td class="tar fs60"> +PLATE +</td> +<td> +</td> +<td> +</td> +</tr> +<tr> +<td class="tar"> +<div>I.</div> +</td> +<td class="tal"> +JOHN CUNNINGHAM SAUNDERS +</td> +<td class="tar"> +<i>Frontispiece</i> +</td> +</tr> +<tr> +<td> +</td> +<td> +</td> +<td class="tar fs60"> +FACING PAGE +</td> +</tr> +<tr> +<td class="tar"> +<div>II.</div> +</td> +<td class="tal"> +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 +</td> +<td class="tar"><a href="#PLATE_II"><div>14</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>III.</div> +</td> +<td class="tal"> +SIR ASTLEY PASTON COOPER, BART., F.R.S. +</td> +<td class="tar"><a href="#PLATE_III"><div>34</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>IV.</div> +</td> +<td class="tal"> +BENJAMIN TRAVERS, F.R.S. +</td> +<td class="tar"><a href="#PLATE_IV"><div>38</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>V.</div> +</td> +<td class="tal"> +SIR WILLIAM LAWRENCE, BART., F.R.S. +</td> +<td class="tar"><a href="#PLATE_V"><div>44</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VI.</div> +</td> +<td class="tal"> +THE LONDON OPHTHALMIC INFIRMARY AS FIRST ERECTED AT MOORFIELDS IN 1822 +</td> +<td class="tar"><a href="#PLATE_VI"><div>52</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VII.</div> +</td> +<td class="tal"> +FREDERICK TYRRELL +</td> +<td class="tar"><a href="#PLATE_VII"><div>62</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>VIII.</div> +</td> +<td class="tal"> +JOHN SCOTT +</td> +<td class="tar"><a href="#PLATE_VIII"><div>65</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>IX.</div> +</td> +<td class="tal"> +DR. JOHN RICHARD FARRE +</td> +<td class="tar"><a href="#PLATE_IX"><div>73</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>X.</div> +</td> +<td class="tal"> +JOHN DALRYMPLE, F.R.S. +</td> +<td class="tar"><a href="#PLATE_X"><div>78</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XI.</div> +</td> +<td class="tal"> +GEORGE CRITCHETT +</td> +<td class="tar"><a href="#PLATE_XI"><div>86</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XII.</div> +</td> +<td class="tal"> +SIR WILLIAM BOWMAN, BART., F.R.S. +</td> +<td class="tar"><a href="#PLATE_XII"><div>94</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XIII.</div> +</td> +<td class="tal"> +WILLIAM CUMMING +</td> +<td class="tar"><a href="#PLATE_XIII"><div>102</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XIV.</div> +</td> +<td class="tal"> +JAMES DIXON<br>JOHN CAWOOD WORDSWORTH +</td> +<td class="tar"><a href="#PLATE_XIV"><div>105</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XV.</div> +</td> +<td class="tal"> +JOHN WHITAKER HULKE<br>GEORGE LAWSON +</td> +<td class="tar"><a href="#PLATE_XV"><div>111</a></div><span class="pagenum" id="Page_xii">xii</span> +</td> +</tr> +<tr> +<td class="tar"> +<div>XVI.</div> +</td> +<td class="tal"> +SIR JONATHAN HUTCHINSON, F.R.S. +</td> +<td class="tar"><a href="#PLATE_XVI"><div>123</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XVII.</div> +</td> +<td class="tal"> +EDWARD NETTLESHIP, F.R.S. +</td> +<td class="tar"><a href="#PLATE_XVII"><div>140</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XVIII.</div> +</td> +<td class="tal"> +THE HOSPITAL AT MOORFIELDS AFTER THE ADDITION OF A NEW WING IN 1868, AND A NEW STOREY IN 1875 +</td> +<td class="tar"><a href="#PLATE_XVIII"><div>143</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XIX.</div> +</td> +<td class="tal"> +WAREN TAY +</td> +<td class="tar"><a href="#PLATE_XIX"><div>151</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XX.</div> +</td> +<td class="tal"> +JOHN COUPER +</td> +<td class="tar"><a href="#PLATE_XX"><div>157</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXI.</div> +</td> +<td class="tal"> +R. MARCUS GUNN +</td> +<td class="tar"><a href="#PLATE_XXI"><div>160</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXII.</div> +</td> +<td class="tal"> +JAMES E. ADAMS +</td> +<td class="tar"><a href="#PLATE_XXII"><div>163</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXIII.</div> +</td> +<td class="tal"> +A. QUARRY SILCOCK +</td> +<td class="tar"><a href="#PLATE_XXIII"><div>167</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXIV.</div> +</td> +<td class="tal"> +THE PLEASURE BATH, PEERLESS POOL, CITY ROAD +</td> +<td class="tar"><a href="#PLATE_XXIV"><div>175</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXV.</div> +</td> +<td class="tal"> +THE ROYAL LONDON OPHTHALMIC HOSPITAL IN THE CITY ROAD, OPENED IN 1899 +</td> +<td class="tar"><a href="#PLATE_XXV"><div>190</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXVI.</div> +</td> +<td class="tal"> +SIR JOHN TWEEDY, LL.D. +</td> +<td class="tar"><a href="#PLATE_XXVI"><div>202</a></div> +</td> +</tr> +<tr> +<td class="tar"> +<div>XXVII.</div> +</td> +<td class="tal"> +WILLIAM LANG +</td> +<td class="tar"><a href="#PLATE_XXVII"><div>204</a></div> +</td> +</tr> +</table> + + + +<hr class="chap x-ebookmaker-drop"> + +<p><span class="pagenum" id="Page_1">1</span></p> + <p class="tac fs130 ws03em"> + THE HISTORY AND TRADITIONS OF THE<br> + MOORFIELDS EYE HOSPITAL + </p> + + +<div class="chapter"> + <h2 class="nobreak" id="CHAPTER_I"> + CHAPTER I + <br> + <span class="title">THE FOUNDERS AND FOUNDATION</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>Who were these three men? What brought them together? +And how came they to establish an institution +unlike any which had previously existed?</p> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_2">2</span>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:</p> + +<div class="blockquot"> +<p>“<span class="smcap">Dear Sir</span>,</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_3">3</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_4">4</span>same time as Saunders, a close and lasting intimacy sprang +up between the two men.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<p><span class="pagenum" id="Page_5">5</span></p> + +<div class="blockquot"> +<p class="tar pr3">“<span class="smcap">London</span>,</p> + +<p class="tar pr1">“<i>July</i> 28<i>th</i>, 1801.</p> + +<p>“<span class="smcap">Dear Sir</span>,</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“<i>Secondly</i>, 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.</p> + +<p>“<i>Thirdly</i>, 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.</p> + +<p>“I shall endeavour to make your situation comfortable +<span class="pagenum" id="Page_6">6</span>in a pecuniary point of view, but I had rather make that the +subject of conversation when I see you.</p> + +<p class="tac">“I am, dear Sir,</p> + +<p class="tar pr3">“Yours, with the utmost esteem,</p> + +<p class="tar pr1">“A. C. ”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Mr. Patrick Macgregor, surgeon to the Royal Military +Asylum, writes of the effects of the disease in the Army as +follows:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_7">7</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_8">8</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_9">9</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Such men were naturally looked upon as charlatans by +the medical profession, but that did not prevent them becoming +the recipients of royal favours.</p> + +<p>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 <i>Tatler</i> “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 +[<i>sic</i>] without blemish.” In 1705 he was knighted, “as +<span class="pagenum" id="Page_10">10</span>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.”</p> + +<p>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.</p> + +<p>George II. appointed as his oculist-in-ordinary John +Taylor, better known as “Chevalier Taylor,” of whom +Coats says:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_11">11</span></p> + +<p>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.</p> + +<p>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, <i>A Dissertation +on the Theory and Cure of Cataract</i>, 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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_12">12</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_13">13</span>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.</p> + +<p class="tar pr4">“<span class="smcap">J. C. Saunders</span>,</p> + +<p class="tar fs85">“<i>Surgeon and Demonstrator of Practical<br> +Anatomy at St. Thomas’s Hospital</i>. </p> + +<p>“24, <span class="smcap">Ely Place, Holborn</span>,</p> + +<p class="tal pl6">“<i>October</i> 1<i>st</i>, 1804.”</p> + +<p>“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.</p> + +<p class="ml1em">Signed:</p> + +<div class="tal"> +<table class=""> +<tr> +<td class="tac pr3"> +<i>Physicians of St. Thomas’s</i>. +</td> +<td class="tac"> +<i>Physicians of Guy’s</i>. +</td> +</tr> +<tr> +<td class="tal pl1"> +Wm. Lister, M.D. +</td> +<td class="tal"> +Wm. Babington, M.D. +</td> +</tr> +<tr> +<td class="tal pl1"> +W. C. Wills, M.D. +</td> +<td class="tal"> +James Curry, M.D. +</td> +</tr> +<tr> +<td class="tal pl1"> +Thos. Turner, M.D. +</td> +<td class="tal"> +M. Alexander, M.D. +</td> +</tr> +<tr> +<td class="tal pl1"> +G. Gilbert Currey, M.D. +</td> +<td class="tal"> +</td> +</tr> +<tr> +<td class="tal"> + +</td> +<td class="tal"> + +</td> +</tr> +<tr> +<td class="tal"> +<i>Surgeons of St. Thomas’s.</i> +</td> +<td class="tac"> +<i>Surgeons of Guy’s</i>. +</td> +</tr> +<tr> +<td class="tal pl1"> +G. Chander. +</td> +<td class="tal"> +T. Foster. +</td> +</tr> +<tr> +<td class="tal pl1"> +I. Birch. +</td> +<td class="tal"> +Wm. Lucas. +</td> +</tr> +<tr> +<td class="tal pl1"> +H. Cline. +</td> +<td class="tal"> +Astley Cooper.” +</td> +</tr> +</table> +</div> +</div> + +<p>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.</p> + +<p>This Mr. Benjamin Travers, Sen., in the keen pursuit +of knowledge, had attended Astley Cooper’s lectures on +<span class="pagenum" id="Page_14">14</span>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.</p> + +<p>At the meeting the following resolutions were moved and +unanimously agreed to:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.</p> + +<p>“That the Charity consist of a Treasurer, Governors, +Secretary, and Medical Officers.</p> + +<p>“That Henry Kensington, Esq., be appointed Treasurer.</p> + +<p>“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.</p> + +<p>“That patients admitted into the house be admitted according +to priority of recommendation, except in cases of emergency, +when the medical officers must determine.</p> + +<p>“That Mr. J. C. Saunders be appointed Surgeon of the +Dispensary, and that Dr. Farre be appointed Consulting +Physician in cases requiring medical aid.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_II"></a>PLATE II.</p> + +<figure class="figcenter illowe41_8750" id="032"> + <img class="w100" src="images/032.jpg" alt=""> + <figcaption> + <p>SHOWING THE SOUTH SIDE OF CHARTERHOUSE SQUARE AND NO. 40<br> + + Where the London Dispensary for Curing Diseases of the Eye and Ear + was first opened in 1805.</p> + </figcaption> +</figure> + + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_15">15</span></p> + +<p>On March 25th, 1805, <i>The London Dispensary for Curing +Diseases of the Eye and Ear</i> was opened for the reception of +patients.</p> + +<p>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 +of107 + the City became its Vice-Presidents.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_16">16</span>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_17">17</span></p> + + + <h2 class="nobreak" id="CHAPTER_II"> + CHAPTER II + <br> + <span class="title">THE WORK OF JOHN CUNNINGHAM SAUNDERS</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<div class="blockquot"> +<p class="ti0">1st year, 1805, admitted 600, cured 500.<br> +2nd year, 1806, admitted 1,526, cured 1,036.<br> +3rd year, 1807, admitted 2,126, cured 1,796.<br> +4th year, 1808, admitted 2,357, cured 1,970.</p> +</div> + +<p>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.</p> + +<p>Successful as the Institution proved to be in dealing +with eye disease, it was far less so in connection with ear +disease.</p> + +<p>Saunders’ first publication was a book entitled <i>The +Anatomy of the Ear: A Treatise on the Diseases of that Organ. +The Causes of Deafness and their Treatment</i>. 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:</p> + +<p><span class="pagenum" id="Page_18">18</span></p> + +<div class="blockquot"> +<p>“<span class="smcap">Gentlemen</span>,</p> + +<p>“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.</p> + +<p>“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. +<span class="pagenum" id="Page_19">19</span>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.</p> + +<p class="tar pr10">“I am, gentlemen,</p> + +<p class="tar pr3">“Your obedient servant,</p> + +<p class="tar pr1">“<span class="smcap">J. C. Saunders.</span>”</p> +</div> + +<p>After consideration of this letter by the Governors it was +resolved, at a General Meeting in the following January:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_20">20</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>So pleased were the Governors with this proof of the value +of their charitable institution that they directed that these +<span class="pagenum" id="Page_21">21</span>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.</p> + +<p>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.</p> + +<p>In a letter to the Committee, dated March, 1808, Saunders +wrote as follows with reference to his work in connection with +congenital cataract:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_22">22</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_23">23</span></p> + +<div class="blockquot"> +<p>“<span class="smcap">My dear Friend</span>,</p> + +<p>“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.</p> + +<p>“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....</p> + +<p>“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 <i>capsule must be divided at all events</i>. 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, +<span class="pagenum" id="Page_24">24</span>and I will gladly give you my sentiments as to repeating it.</p> + +<p>“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.</p> + +<p class="tar pr5">“With our united regards,</p> + +<p class="tar pr3">“I am yours faithfully,</p> + +<p class="tar pr1">“<span class="smcap">J. C. Saunders.</span>”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>The following is the commencement of an unfinished +medical report which Saunders had in preparation to +<span class="pagenum" id="Page_25">25</span>present to the Committee of the Infirmary at the time of +his death.</p> + +<div class="blockquot"> +<p>“<span class="smcap">Gentlemen</span>,</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_26">26</span>of sight in those in whom it had become impaired from +Egyptian ophthalmia.</p> + +<p>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.</p> + +<p>The book, entitled <i>A Treatise on some Practical Points +relating to the Diseases of the Eye</i>, 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 +<span class="pagenum" id="Page_27">27</span>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.</p> + +<p>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.”</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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, +<span class="pagenum" id="Page_28">28</span>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.”</p> +</div> + +<p>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.</p> + +<p>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 <i>Edinburgh Medical and Surgical +Journal</i>, 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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_29">29</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_30">30</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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]</p> + +<p class="ml2em ptb03 ti0 fs85"> +[A] It is due to this change of name that a writer of a life +of Sir William Adams, in Vol. II. of the <i>British Journal of</i> +<i>Ophthalmology</i>, failed to find a notice of him in the <i>Dictionary of National Biography</i>. +It is from the description there given of +Sir William Rawson that most of the above facts respecting him have +been taken. +</p> + +<p>John Stevenson, like Adams, worked under Saunders in +the dissecting room at St. Thomas’s Hospital and at the Eye +<span class="pagenum" id="Page_31">31</span>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.</p> + +<p>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.</p> + +<p>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 +<i>Dictionary of National Biography</i> it is stated that after 1844 +all trace of Stevenson is lost.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_32">32</span>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.</p> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_33">33</span></p> + + + <h2 class="nobreak" id="CHAPTER_III"> + CHAPTER III + <br> + <span class="title">BENJAMIN TRAVERS AND SIR WILLIAM LAWRENCE</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_34">34</span>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.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_III"></a>PLATE III.</p> + +<figure class="figcenter illowe21_8750" id="054"> + <img class="w100" src="images/054.jpg" alt=""> + <figcaption> + <p>SIR ASTLEY PASTON COOPER, BART., F.R.S.<br> + From an engraving by W. H. Mote, after a picture by Sir T. Lawrence, P.R.A.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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 <i>A Synopsis +of Disease of the Eye</i>, 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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_35">35</span></p> + +<p>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.</p> + +<p>Dr. Delafield later showed his appreciation of Travers’ +teaching by editing an edition of his <i>Synopsis of Diseases of +the Eye</i>, 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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_36">36</span>with complete success. The following is an interesting +description of this event, written by Dr. Edward Reynolds’ +grandson in 1910:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.”</p> + +<p>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 +<span class="pagenum" id="Page_37">37</span>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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_38">38</span>of anatomy and assistant surgeon to St. Bartholomew’s +Hospital, was appointed.</p> + +<p class="tac mt1em"><a id="PLATE_IV"></a>PLATE IV.</p> + +<figure class="figcenter illowe23_4375" id="060"> + <img class="w100" src="images/060.jpg" alt=""> + <figcaption> + <p>BENJAMIN TRAVERS, F.R.S.</p> + </figcaption> +</figure> + +<p>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 <i>A Synopsis of Diseases of the Eye</i>, 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.</p> + + +<p>From a writer of an obituary notice we get the following +description of Travers as a man:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Pressure of work, and some fears as to his health, necessitated +his retirement from the staff of the Eye Infirmary +<span class="pagenum" id="Page_39">39</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>The rapid increase in the work of the Infirmary, both in +<span class="pagenum" id="Page_40">40</span>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.</p> + +<p>His first and most important occupation is defined as +follows:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Regarding the quantity of blood to be drawn from the arm, +he says:</p> + +<p><span class="pagenum" id="Page_41">41</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>After venesection the next best method of taking blood is:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>With regard to the use of leeches he writes:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_42">42</span>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.</p> + +<p>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: <i>Physician</i>: that he be a Fellow or Licentiate +of the London College of Physicians, or a Bachelor of +Medicine of one of the English Universities. <i>Surgeon</i>: +that he be a Member of the College of Surgeons, and have +served an apprenticeship at one of the hospitals of this +Metropolis. <i>Apothecary</i>: 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.</p> + +<p>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.</p> + +<p>William Lawrence not only became the leading ophthalmic +<span class="pagenum" id="Page_43">43</span>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 <i>Comparative +Anatomy, Physiology, Zoology, and Natural History of Man</i>, +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 <i>Treatise on Diseases of +the Eye</i>, 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.</p> + +<p>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 +<span class="pagenum" id="Page_44">44</span>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 <i>Descriptio Anatomic Oculi +Humani</i>, and later Soemerring his <i>Icones Oculi Humani</i>, with +its beautiful and accurate engravings. Boerhaave of Leyden +made some study of the pathology of the eye in his <i>De Morbus +Oculorum</i>. 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.</p> + +<p class="tac mt1em"><a id="PLATE_V"></a>PLATE V.</p> + +<figure class="figcenter illowe23_1250" id="068"> + <img class="w100" src="images/068.jpg" alt=""> + <figcaption> + <p>SIR WILLIAM LAWRENCE BART., F.R.S. + From an engraving by E. R. Whitfield, after a picture by Pickersgill, R.A.</p> + </figcaption> +</figure> + + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Sir William Savory, Lawrence’s most devoted disciple, +who described him as “a model of intellectual beauty,” +speaks of</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_45">45</span></p> +<p>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 <i>Dictionary of +Surgery</i>, Henry Earle, surgeon of the Foundling Hospital +and assistant-surgeon to St. Bartholomew’s Hospital.</p> + +<p>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.</p> + +<p>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.</p> + +<p>After his retirement he published a book on <i>The Venereal +Diseases of the Eye</i>. 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.”</p> + +<p>In the first chapter of the book Lawrence says:</p> + +<div class="blockquot"> +<p>“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, +<span class="pagenum" id="Page_46">46</span>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.”</p> +</div> + +<p>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.</p> + +<p>In 1833 he published his <i>Treatise on Diseases of the Eye</i>, +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 <i>Lancet</i>. 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_47">47</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_48">48</span></p> + + + <h2 class="nobreak" id="CHAPTER_IV"> + CHAPTER IV + <br> + <span class="title">REMOVAL TO MOORFIELDS</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<p><span class="pagenum" id="Page_49">49</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“London Infirmary for Curing Diseases of the Eye, +founded by the late John Cunningham Saunders Esq., +<span class="lowercase smcap">A.D.</span> 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.</p> + + +<p><span class="pagenum" id="Page_50">50</span></p> + +<div class="center"> +<table class="mtb1em"> +<tr> +<td class="tac ptb03" colspan="2"> +<i>Patron</i>: Field-Marshal His Royal Highness<br>the Duke of York, K.G., etc. +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="2"> +<i>President</i>: William Mellish, Esq. +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="2"> +<i>Vice-Presidents</i>: +</td> +</tr> +<tr> +<td class="tal"> +St. Asaph, The Right Rev. +</td> +<td class="tal"> +Sir Charles Flower, Bart., Ald. +</td> +</tr> +<tr> +<td class="tal pl1"> +Lord Bishop of. +</td> +<td class="tal"> +Thos. F. Foster, Esq. +</td> +</tr> +<tr> +<td class="tal"> +John Ansley, Esq., Ald. +</td> +<td class="tal"> +Sir William Leighton, Ald. +</td> +</tr> +<tr> +<td class="tal"> +John Julius Angerstein, Esq. +</td> +<td class="tal"> +Sir Charles Price, Bart. +</td> +</tr> +<tr> +<td class="tal pr2"> +William Babington, M.D., F.R.S. +</td> +<td class="tal"> +Jeremiah Olive, Esq. +</td> +</tr> +<tr> +<td class="tal"> +George Bainbridge, Esq. +</td> +<td class="tal"> +Thomas Rowcroft, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Thomas Boddington, Esq. +</td> +<td class="tal"> +Sir James Shaw, Bart., Ald. +</td> +</tr> +<tr> +<td class="tal"> +George Byng, Esq., M.P. +</td> +<td class="tal"> +John Thompson, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Henry Cline, Esq, F.R.S. +</td> +<td class="tal"> +Benjamin Travers, Esq., F.R.S. +</td> +</tr> +<tr> +<td class="tal"> +Astley Cooper, Esq., F.R.S. +</td> +<td class="tal"> +Sir Robert Wingram, Bart. +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="2"> +<i>Treasurer</i>: Michael Bland, Esq., F.R.S. +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="2"> +<i>Medical Directors</i>. +</td> +</tr> +<tr> +<td class="tac" colspan="2"> +<i>Physician</i>: John Richard Farre, M.D. +</td> +</tr> +<tr> +<td class="tac" colspan="2"> +<i>Surgeons</i>: William Lawrence, Esq., F.R.S.<br>Frederick Tyrrell, Esq. +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="2"> +<i>Committee</i>: +</td> +</tr> +<tr> +<td class="tal"> +Aaron, Lewis, Esq. +</td> +<td class="tal"> +Kerr, Niven, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Bainbridge, John, Esq. +</td> +<td class="tal"> +Mackie, John, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Bonsor, Joseph, Esq. +</td> +<td class="tal"> +Mellish, Thos., Esq. +</td> +</tr> +<tr> +<td class="tal"> +Blades, John, Esq. +</td> +<td class="tal"> +Ommanney, Sir F. M. , M.P. +</td> +</tr> +<tr> +<td class="tal"> +Brandain, Samuel, Esq. +</td> +<td class="tal"> +Pearce, J. M. , Esq. +</td> +</tr> +<tr> +<td class="tal"> +Brown, Thomas, Esq. +</td> +<td class="tal"> +Price, Ralph, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Browning, William, Esq. +</td> +<td class="tal"> +Price, Richard, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Brydon, William, Esq. +</td> +<td class="tal"> +Price, Charles, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Battley, Richard, Esq. +</td> +<td class="tal"> +Russell, Rev. John, D.D. +</td> +</tr> +<tr> +<td class="tal"> +Cazenove, John, Esq. +</td> +<td class="tal"> +Read, Samuel, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Clarke, John, Esq. +</td> +<td class="tal"> +Row, William, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Cohen, Joseph, Esq. +</td> +<td class="tal"> +Rudge, Rev. Jas., D.D., F.R.S. +</td> +</tr> +<tr> +<td class="tal"> +Crawley, William, Esq. +</td> +<td class="tal"> +Smirke, Robert, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Croskey, J. D. , Esq. +</td> +<td class="tal"> +Solly, Thomas, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Curtis, Timothy, Esq. +</td> +<td class="tal"> +Sparks, R. W. , Esq. +</td> +</tr> +<tr> +<td class="tal"> +Dean, John, Esq. +</td> +<td class="tal"> +Towle, Thomas, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Elgie, William, Esq. +</td> +<td class="tal"> +Thomas, John, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Gamble, Robert, Esq. +</td> +<td class="tal"> +Tyrrell, John, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Hartshorne, John, Esq. +</td> +<td class="tal"> +Tyrrell, Timothy, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Heathfield, Richard, Esq. +</td> +<td class="tal"> +Warburton, Thos., Esq. +</td> +</tr> +<tr> +<td class="tal"> +Hodgkinson, John, Esq. +</td> +<td class="tal"> +Ward, Samuel, Esq. +</td> +</tr> +<tr> +<td class="tal"> +Horner, John, Esq. +</td> +<td class="tal"> +Yates, William, Jun., Esq.<span class="pagenum" id="Page_51">51</span> +</td> +</tr> +<tr> +<td class="tal pl3 pt03" colspan="2"> +<i>Hon. Chaplain</i>: The Rev. Thos. Gill, M.A. +</td> +</tr> +<tr> +<td class="tal pl3" colspan="2"> +<i>Solicitor</i>: Robert Pitches, Esq. +</td> +</tr> +<tr> +<td class="tal pl3" colspan="2"> +<i>Secretary</i>: Matthew Heathfield, Esq. +</td> +</tr> +<tr> +<td class="tal pl3" colspan="2"> +<i>Apothecary</i>: Mr. Charles Craddock. +</td> +</tr> +<tr> +<td class="tal pl3" colspan="2"> +<i>Architect</i>: Robert Smirke, Esq., F.R.S., F.A.S., R.A.” +</td> +</tr> +</table> +</div> +</div> + +<p>A prayer suitable to the occasion was offered up to Almighty +God by the Chaplain.</p> + +<p>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.</p> + +<p>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:</p> + +<p class="ti0 ml3em mtb1em fs90"> + “In Moor’s most pleasant Field, where Northern Lads<br> + With Western Youths contend for broken Heads,<br> + And where our Weal thy Citizens repair<br> + To lengthen out their Lives with wholesome Air;<br> + Jointing to Trotter’s famous Castle, stands<br> + A noted Mansion built by artful Hands;<br> + Where Young and Old, at small Expense can find<br> + Delightful Pastimes to refresh the Mind.<br> + Hither the sprightly Genius has recourse<br> + To practise Riding on the Flying-Horse;<br> + Where danger-free, he through the Air may scow’r,<br> + And, void the Wings, fly fifty miles an Hour;<br> + Nor that has this Courser, tho’ he runs so fast,<br> + One living Leg to expediate him hast,<br> + Yet carries double, treble, if requir’d,<br> + But never stumbles or is ever tir’d.<br> + As for the pregnant Wife, or tim’rous Maid,<br> + Here’s a true South-Sea Coach, that sporting flies<br> + Between the humble Earth and lofty skyes,<br> + Manag’d to rise and fall with little Pains,<br> +<span class="pagenum" id="Page_52">52</span> Like the uncertain Stock that turns our Brains.<br> + Liquors, the best, are also vended here,<br> + From Heav’nly Punch to Halsey’s Noble Beer,<br> + By gen’rous Whitehead, who deserves the Bays<br> + From all the Sons of Malt that Merit praise;<br> + Therefore, if any will prove the Poet just,<br> + Thither repair and you will surely find<br> + Your entertainment good and Landlord kind.” +</p> + +<p>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.</p> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_VI"></a>PLATE VI.</p> + +<figure class="figcenter illowe41_2500" id="078"> + <img class="w100" src="images/078.jpg" alt=""> + <figcaption> + <p>THE LONDON OPHTHALMIC INFIRMARY AS FIRST ERECTED AT MOORFIELDS IN 1822. + From an engraving by R. Acon, after a drawing by Tho. H. Shepherd.</p> + </figcaption> +</figure> + + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_53">53</span>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_54">54</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p class="ti0">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.</p> + +<p>By Dr. J. R. Farre, Physician to the Infirmary.</p> + +<hr class="r15"> + +<p class="ti0">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.</p> + +<p>By Mr. William Lawrence, F.R.S., Senior Surgeon to the +Infirmary.</p> + +<hr class="r15"> + +<p class="ti0">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.</p> + +<p>By Mr. F. Tyrrell, Junior Surgeon of the Infirmary.</p> + +<p><span class="pagenum" id="Page_55">55</span></p> + +<hr class="r15"> + +<p class="ti0">Lectures in Optics. To be given on Thursdays at 7 +o’clock in the evening.</p> + +<p>By the Rev. T. Gill, M.A., Hon. Chaplain to the Infirmary.</p> +</div> + +<hr class="r15"> + +<p>Dr. Farre concluded his announcement of these lectures +with the following remarks:</p> + +<div class="blockquot"> +<p>“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 <i>Liquor Opii Sedativus</i>, 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 <i>Digitalis Conium</i>, 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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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. +<span class="pagenum" id="Page_56">56</span>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.”</p> +</div> + +<p>The report of one of his lectures at the Infirmary in the +<i>Lancet</i> 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.</p> + +<p>Lawrence’s lectures were reported as they were delivered +in the <i>Lancet</i> 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.</p> + +<p>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.”</p> + +<p>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 +<span class="pagenum" id="Page_57">57</span>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.</p> + +<p>“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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_58">58</span></p> + +<p>John Dalrymple, who afterwards became a surgeon to +the Ophthalmic Infirmary, was appointed demonstrator and +secretary to the Academy.</p> + +<p>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 +<i>Lancet</i>, attacking members of the Committee of Management +and imputing to them the most base and degrading motives.</p> + +<p>The <i>Lancet</i> 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.”</p> + +<p>In 1825 Tyrrell summoned Wakley for libel, claiming +£2,000 damages, in that the <i>Lancet</i> 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.</p> + +<p>Gradually after this trial the policy of the <i>Lancet</i> became +directed to three main objects:</p> + +<p class="mt1em">(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.</p> + +<p>(2) A fight against nepotism in the matter of staff appointments +at the Hospitals.</p> + +<p class="mb1em">(3) An exposure of, what Wakley delighted in calling, +a “Hole in the Corner Policy” by members of Hospital +Staffs—<i>i.e</i>., the employment of secretive methods in their +practice.</p> + +<p>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.</p> + +<p>For the unauthorised publication in his Journal of the notes +<span class="pagenum" id="Page_59">59</span>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.</p> + +<p>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 <i>Lancet</i>.</p> + +<p>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 +<i>Lancet</i>’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.</p> + +<p>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. +<span class="pagenum" id="Page_60">60</span>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.</p> + +<p>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.</p> + +<p>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 <i>Edinburgh +Medical and Surgical Journal</i>, 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.</p> + +<p>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:</p> + +<p><span class="pagenum" id="Page_61">61</span></p> + +<div class="blockquot"> +<p class="tac">“<span class="smcap">London Ophthalmic Infirmary, Moorfields</span>.</p> + +<p>“At a meeting of the Committee, 6th November, 1826, +Ralph Price, Esq., in the Chair, five numbers of a weekly +publication, called the <i>Lancet</i>, dated the 7th, 14th, 21st and +28th October last, and 4th instant, and <i>The Times</i> 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 <i>The Times</i>’ 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.</p> + +<p>That, this Resolution, signed by the Chairman, be +inserted in four of the Morning and two of the Evening +Papers.</p> + +<p class="tar pr1">“<span class="smcap">Ralph Price</span>, <i>Chairman</i>.”</p> +</div> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“It is a great mistake to suppose that it is necessary to +take away large quantities of blood; or to bleed to such an +<span class="pagenum" id="Page_62">62</span>extent as to occasion faintness, in order to check severe local +disease: I am confident that more harm than good results +from such practice.”</p> +</div> + +<p>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.”</p> + +<p>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 <i>Cataract and its +Treatment</i>, published by Scott in 1843, he writes:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_VII"></a>PLATE VII.</p> + +<figure class="figcenter illowe22_8125" id="090"> + <img class="w100" src="images/090.jpg" alt=""> + <figcaption> + <p>FREDERICK TYRRELL.</p> + </figcaption> +</figure> + +<p>An anonymous writer has recorded his personal recollections +of Tyrrell thus:</p> + +<div class="blockquot"> +<p>“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 <i>sang froid</i> that no one +who had not seen the breaking of the knife would have +known that anything untoward had occurred.</p> + +<p>“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.</p> + +<p>“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!”</p> +</div> + +<p>In 1840 he published a book in two volumes entitled +<i>A Practical Work on the Diseases of the Eye and their Treatment, +Medically, Topically, and by Operation</i>. 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.</p> + +<p>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.</p> + +<p>In 1828 a body of ladies interested in the Charity carried +<span class="pagenum" id="Page_64">64</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>John Scott, shortly after his appointment as surgeon to +<span class="pagenum" id="Page_65">65</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_VIII"></a>PLATE VIII.</p> + +<figure class="figcenter illowe23_1250" id="095"> + <img class="w100" src="images/095.jpg" alt=""> + <figcaption> + <p>JOHN SCOTT. + From an engraving, after a picture by H. Howard, R.A.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>Another writer who knew him says:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_66">66</span></p> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_67">67</span></p> + + + <h2 class="nobreak" id="CHAPTER_V"> + CHAPTER V + <br> + <span class="title">THE ROYAL LONDON OPHTHALMIC HOSPITAL</span> + </h2> +</div> + + +<p class="ti0">His Royal Highness the Duke of York, the Infirmary’s first +Patron, died in 1827.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_68">68</span>the Throne, requesting their gracious permission to place +the Institution under their august patronage.</p> + +<p>In response to this petition the following letters were +received:</p> + +<div class="blockquot"> +<p class="tar pr3">“<span class="smcap">Kensington Palace</span>,</p> + +<p class="tar pr1">“12<i>th March</i>, 1836.</p> + +<p>“<span class="smcap">My dear Sir</span>,</p> + +<p>“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.</p> + +<p>“Her Royal Highness is very happy to find an occasion +to meet a wish of yours.</p> + +<p class="tar pr6">“Believe me always, my dear Sir,</p> + +<p class="tar pr4">“Yours very faithfully,</p> + +<p class="tar pr2">“<span class="smcap">John Conroy</span>.</p> + +<p>“<span class="smcap">The Rev. Dr. Blomberg</span>.”</p> +</div> + +<div class="blockquot"> +<p class="tar pr3">“<span class="smcap">Kensington Palace</span>,</p> + +<p class="tar pr1">“12<i>th March</i>, 1836.</p> + +<p>“<span class="smcap">Sir</span>,</p> + +<p>“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.</p> + +<p class="tar pr6">“I have the honour to be, Sir,</p> + +<p class="tar pr3">“Your most obedient servant,</p> + +<p class="tar pr1">“<span class="smcap">John Conroy</span>.</p> + +<p>“<span class="smcap">Wm. Mellish, Esq</span>.,</p> + +<p>“112, <span class="smcap">Bishopsgate Street Without</span>.”</p> +</div> + +<p>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.”</p> + +<p>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, +<span class="pagenum" id="Page_69">69</span>to ascertain Her Majesty’s pleasure as to continuing +Patroness of the Hospital, and received from him the following +reply:</p> + +<div class="blockquot"> +<p class="tar pr3">“<span class="smcap">Whitehall</span>,</p> + +<p class="tar pr1">“<i>August</i> 29<i>th</i>, 1837.</p> + +<p><span class="smcap">Sir</span>,</p> + +<p>“I have the honour to lay before the Queen the +petition of the Committee of Management of the Royal +Ophthalmic Hospital.</p> + +<p>“And I have the satisfaction to inform you that Her +Majesty has been graciously pleased to be the Patroness of +that Hospital.</p> + +<p class="tar pr6">“I have the honour to be, Sir,</p> + +<p class="tar pr3">“Your obedient servant,</p> + +<p class="tar pr1">“<span class="smcap">J. Russell</span>.</p> + +<p><span class="smcap">The Rev. J. Russell, D.D</span>., etc.,</p> + +<p class="tal pl2">“<span class="smcap">Rectory House</span>,</p> + +<p class="tal pl4">“<span class="smcap">Devonshire Square</span>.”</p> +</div> + +<p>The Patronage of the Queen, thus commenced, continued +throughout the whole of her long reign.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_70">70</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_71">71</span></p> + +<p>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.</p> + +<p>It was entitled, <i>Journal of Morbid Anatomy, Ophthalmic +Medicine and Pharmaceutical Analysis, with Medico-Botanical +Transactions communicated by the Medico-Botanical +Society</i>.</p> + +<p>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 <span class="nowrap">instituted—</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>It was announced that:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>These good intentions were, however, not realised, no +further number of the Journal being issued.</p> + +<p><span class="pagenum" id="Page_72">72</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p class="tar pr3">“<span class="smcap">London</span>, 18<i>th August</i>, 1838.</p> + +<p class="tar pr1">“34, <span class="smcap">Montagu Square</span>.</p> + +<p>“<span class="smcap">Gentlemen</span>,</p> + +<p>“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.</p> + +<p>“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.</p> + +<p class="tar pr10">“I am, Gentlemen,</p> + +<p class="tar pr3">“Your most obedient servant,</p> + +<p class="tar pr1">“<span class="smcap">J. Roach Bovell</span>.</p> + +<p>“<span class="smcap">The President, Vice-Presidents,<br> + Treasurer and Committee of the R.L.O.H.</span>”</p> +</div> + +<p>On receiving it the Committee passed the following +resolution:</p> +<span class="pagenum" id="Page_73">73</span> +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_IX"></a>PLATE IX.</p> + +<figure class="figcenter illowe24_3750" id="105"> + <img class="w100" src="images/105.jpg" alt=""> + <figcaption> + <p>DR. JOHN RICHARD FARRE.</p> + <p>From an engraving by Frank Bromley, after a picture by Thomas Phillips, R.A.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<i>The Adventures of Philip</i> as Sampson Major, the cock of the +whole school.</p> + +<p>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 +<span class="pagenum" id="Page_74">74</span>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.</p> + +<p>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.</p> + + +<div class="center"> +<table class="mb1em"> +<tr> +<td class="tal"> +Out-patients: +</td> +<td> +</td> +<td> +</td> +</tr> +<tr> +<td class="tal pl1"> +Dr. F. Farre +</td> +<td class="tar"> +<div>607</div> +</td> +<td class="tal"> +(one day a week) +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Tyrrell +</td> +<td class="tar"> +<div>1,090</div> +</td> +<td> +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Scott +</td> +<td class="tar"> +<div>1,037</div> +</td> +<td class="tal"> +(two days a week) +</td> +</tr> +<tr> +<td class="tal pl1 pr4"> +Mr. Mackmurdo +</td> +<td class="tar"> +<div>1,274</div> +</td> +<td> +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Dalrymple +</td> +<td class="tar"> +<div>1,714</div> +</td> +<td> +</td> +</tr> +</table> +</div> + + +<div class="center"> +<table class="mb1em"> +<tr> +<td class="tal"> +Operations performed: +</td> +<td> +</td> +<td> +</td> +<td> +</td> +</tr> +<tr class="fs85"> +<td> +</td> +<td class="tac"> +<i>Extraction of<br>Cataract.</i> +</td> +<td class="tac prl1"> +<i>Needling of<br>Cataract.</i> +</td> +<td class="tac"> +<i>Artificial<br>Pupil.</i> +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Tyrrell +</td> +<td class="tac"> +42 +</td> +<td class="tac"> +20 +</td> +<td class="tac"> +7 +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Scott +</td> +<td class="tac"> +29 +</td> +<td class="tac"> + 9 +</td> +<td class="tac"> +7 +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Mackmurdo +</td> +<td class="tac"> + 0 +</td> +<td class="tac"> + 4 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal pl1"> +Mr. Dalrymple +</td> +<td class="tac"> + 0 +</td> +<td class="tac"> + 5 +</td> +<td class="tac"> +0 +</td> +</tr> +</table> +</div> + +<p>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.</p> + +<p>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. +<span class="pagenum" id="Page_75">75</span>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.</p> + +<p>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.</p> + +<p>The candidates for the two posts of assistant-surgeon +were:</p> + +<p>Mr. James Dixon, who had been articled as apprentice +to Tyrrell, and who was demonstrator of anatomy at St. +Thomas’s Hospital.</p> + +<p>Mr. George Critchett, who had been articled to Scott, +and who was demonstrator of anatomy at the London +Hospital.</p> + +<p>Mr. William Bowman, who had served his apprenticeship +at the Birmingham Hospital, and who was demonstrator of +anatomy at King’s College Hospital.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_76">76</span>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.</p> + +<p>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.</p> + +<p>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 <i>Anatomy of the Human Eye</i>, 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.</p> + +<p>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 +<span class="pagenum" id="Page_77">77</span>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.</p> + +<p>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.</p> + +<p>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 <i>Pathology of the Eye</i>. 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 +<span class="pagenum" id="Page_78">78</span>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.</p> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_X"></a>PLATE X.</p> + +<figure class="figcenter illowe21_8750" id="112"> + <img class="w100" src="images/112.jpg" alt=""> + <figcaption> + <p>JOHN DALRYMPLE, F.R.S.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_79">79</span>from John Churchill, the publisher, with the following +inscription on the flyleaf:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p class="tar pr1">“(Signed) <span class="smcap">John Churchill</span>.</p> + +<p>“6<i>th October</i>, 1856.”</p> +</div> + +<p>At the Annual General Meeting of the Governors of the +Hospital, after the death of Richard Battley, the following +resolution was passed:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“That this memorial be engraved and placed in the +committee room of the Hospital with the portraits of his +early friends, Saunders and Farre.”</p> +</div> + +<p>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. +<span class="pagenum" id="Page_80">80</span>The last appointment gave him for many years a handsome +salary, with a commensurate retiring allowance.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“Her salary to be 30 guineas a year, with an allowance +of £5 for tea and sugar.”</p> +</div> + +<p>As the fame of the Hospital extended there was a rapid +increase in the patients who came to it seeking relief. The +<span class="pagenum" id="Page_81">81</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_82">82</span></p> + + + <h2 class="nobreak" id="CHAPTER_VI"> + CHAPTER VI + <br> + <span class="title">THE INTRODUCTION OF INHALATION ANÆSTHESIA<br> + AND OPHTHALMIC SURGERY</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>In a review of Haynes Walton’s textbook on eye diseases +in 1853, an anonymous writer says:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Hulke, writing of his reminiscences of Sir William +Bowman’s work, said:</p> + +<p><span class="pagenum" id="Page_83">83</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 <i>Guide to the Practical +Study of the Diseases of the Eye</i>:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_84">84</span>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.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>White Cooper, who was a great friend and follower of +Dalrymple, wrote in 1853 as follows:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_85">85</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<p><span class="pagenum" id="Page_86">86</span></p> + +<div class="blockquot"> +<p>“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!”</p> +</div> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_XI"></a>PLATE XI.</p> + +<figure class="figcenter illowe21_8750" id="122"> + <img class="w100" src="images/122.jpg" alt=""> + <figcaption> + <p>GEORGE CRITCHETT</p> + </figcaption> +</figure> + +<p>In 1844 Lawrence wrote:</p> + +<div class="blockquot"> +<p>“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.”</p> + + +</div> + + +<p><span class="pagenum" id="Page_87">87</span></p> +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Disorders arising in connection with the drainage apparatus +for the passage of the tears from the eye to the nose +<span class="pagenum" id="Page_88">88</span>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.</p> + +<p>Gibson of Manchester (as mentioned in <a href="">Chapter</a> 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.</p> + +<p>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 +<span class="pagenum" id="Page_89">89</span>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</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_90">90</span>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_91">91</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_92">92</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_93">93</span></p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Bowman, in describing Donders’ visit to London that +year, says:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_94">94</span>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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_XII"></a>PLATE XII.</p> + +<figure class="figcenter illowe24_3750" id="132"> + <img class="w100" src="images/132.jpg" alt=""> + <figcaption> + <p>SIR WILLIAM BOWMAN, BART., F.R.S.</p> + </figcaption> +</figure> + +<p>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,” +<span class="pagenum" id="Page_95">95</span>in which he demonstrated, simultaneously with and independently +of Bruecke, the structure and function of the +ciliary muscle.</p> + +<p>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 <i>Annales d’Oculistiques</i> in 1855.</p> + +<p>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, <i>On the Anomalies +of Accommodation and Refraction of the Eye</i>:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>Dr. Bader, the curator and registrar at Moorfields, +wrote in 1859:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_96">96</span>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.”</p> +</div> + +<p>In the second number of the <i>Ophthalmic Hospital Reports</i>, +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.</p> + +<p>Some years later Bowman wrote the following description +of the introduction of the operation into this country:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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. +<span class="pagenum" id="Page_97">97</span>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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_98">98</span>attendance at which course enabled students to comply +with the rules of the Royal College of Surgeons for obtaining +a certificate.</p> + +<p>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 <span class="nowrap">1854—</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_99">99</span></p> + + + <h2 class="nobreak" id="CHAPTER_VII"> + CHAPTER VII + <br> + <span class="title">THE DISCOVERY OF THE OPHTHALMOSCOPE</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <i>Manual of Physiological +Optics</i>.</p> + +<p>The ophthalmoscope was, he said,</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_100">100</span></p> + +<p>In speaking of his discovery in later years he said:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“(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.”</p> +</div> + +<p>With remarkable prospection he foreshadowed some of +the results which were ultimately obtained from the use of +the ophthalmoscope; thus he wrote:</p> + +<p><span class="pagenum" id="Page_101">101</span></p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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:</p> + +<p><span class="pagenum" id="Page_102">102</span></p> + +<div class="blockquot"> +<p class="tar pr3">“2, <span class="smcap">Vittoria Place, Limehouse</span>,</p> + +<p class="tar pr1">“<i>November</i> 11<i>th</i>, 1862.</p> + +<p>“<span class="smcap">Sir</span>,</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“He died in 1855 at the early age of 33 years.</p> + +<p class="tar pr10">“I am, etc.,</p> + +<p class="tar pr1">“<span class="smcap">John Stewart Cumming</span>.”</p> +</div> + +<p>This portrait still hangs in the Board Room of the +Hospital.</p> + +<p class="tac mt1em"><a id="PLATE_XIII"></a>PLATE XIII.</p> + +<figure class="figcenter illowe21_2500" id="142"> + <img class="w100" src="images/142.jpg" alt=""> + <figcaption> + <p>WILLIAM CUMMING.</p> + <p>From a painting in the Board Room of the Hospital.</p> + </figcaption> +</figure> + +<p>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 <i>Medico-Chirurgical +Review</i>. He wrote:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_103">103</span>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.</p> + +<p>Anyhow, he gave Babbage no encouragement, and the +instrument was laid aside as a mere toy.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>The increasing number of operative procedures performed +at the Hospital, and the coming of the ophthalmoscope, +<span class="pagenum" id="Page_104">104</span>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.</p> + +<p>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.</p> + +<p>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 <span class="nowrap">that—</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>At the same time the title of the resident medical officer +was changed from apothecary to house surgeon.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_105">105</span></p> + +<p class="tac mt1em"><a id="PLATE_XIV"></a>PLATE XIV.</p> + +<figure class="figcenter illowe39_3750" id="147"> + <img class="w100" src="images/147.jpg" alt=""> + <figcaption> + <p> JAMES DIXON. JOHN CAWOOD WORDSWORTH.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>On the conclusion of the war, at the annual general meeting +of the Governors, the following resolutions were passed:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>Miss Nightingale and Mr. Sydney Herbert both replied +accepting with pleasure these nominations.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_106">106</span>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.”</p> + +<p>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.</p> + +<p>Dr. Robert Martin, an assistant-physician at St. Bartholomew’s +Hospital, being the only candidate, was elected +physician.</p> + +<p>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.”</p> + +<p>There were four candidates, and, at the close of the poll, +the scrutineers announced that the votes had been distributed +as follows:</p> + +<div class="center"> +<table class="mtb1em"> +<tr> +<td class="tal"> +Mr. J. S. Gamgee +</td> +<td class="tar"> +<div>3</div> +</td> +</tr> +<tr> +<td class="tal"> +Mr. J. W. Hulke +</td> +<td class="tar"> +<div>148</div> +</td> +</tr> +<tr> +<td class="tal pr4"> +Mr. J. F. Streatfield +</td> +<td class="tar"> +<div>214</div> +</td> +</tr> +<tr> +<td class="tal"> +Mr. Walter Tyrrell +</td> +<td class="tar"> +<div>93</div> +</td> +</tr> +</table> +</div> + +<p><span class="pagenum" id="Page_107">107</span></p> +<p>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.</p> + +<p>The Governors consisted of “Life Governors”—<i>i.e</i>. 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.</p> + +<p>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.</p> + +<p>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. +<span class="pagenum" id="Page_108">108</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_109">109</span>had been introduced were being codified, the following +rule became included amongst those governing the Institution:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>In 1856 this Medical Council made the following proposal +to the Committee which led to the establishment of the posts +of clinical assistants:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p><span class="pagenum" id="Page_110">110</span></p> + +<p>The following rule with regard to these appointments +became embodied in the laws of the Hospital in 1861:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<i>Ophthalmic Hospital Reports</i>, 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.</p> + +<p>The interpretation of the nature of the changes revealed +<span class="pagenum" id="Page_111">111</span>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p class="tac mt1em"><a id="PLATE_XV"></a>PLATE XV.</p> + +<figure class="figcenter illowe34_7500" id="155"> + <img class="w100" src="images/155.jpg" alt=""> + <figcaption> + <p>JOHN WHITAKER HULKE, F.R.S. GEORGE LAWSON </p> + </figcaption> +</figure> + +<p>In 1859 the Royal College of Surgeons chose as the subject +for the Jacksonian Prize Essay of that year:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_112">112</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Hulke, in some reminiscences of his youth, remarked:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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, <i>On the Anomalies of +Accommodation and Refraction of the Eye</i>, which was published +in English by the New Sydenham Society in 1864.</p> + +<p><span class="pagenum" id="Page_113">113</span></p> + +<p>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 (<i>vide</i> Chapter I., +<a href="#Page_11">p. 11</a>). 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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_114">114</span>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.”</p> +</div> + +<p>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:</p> + +<p class="ml4em mtb1em ti0 fs90"> + “All day the vacant eye without fatigue<br> + Strays o’er the heaven and earth; but long intent<br> + On microscopic arts, its vigour fails.” +</p> + +<p>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 <i>Ophthalmic Hospital Reports</i> in 1858.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_115">115</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_116">116</span>differently; but I have doubt, that if the leading opticians +would adopt a certain standard, the others would soon +follow their example.”</p> +</div> + +<p>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.</p> + +<p>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>i.e</i>., 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.</p> + +<p>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 +<span class="pagenum" id="Page_117">117</span>Bank of England and to the Central London Ophthalmic +Hospital, in a book entitled <i>Vision in Health and Disease; +the Value of Glasses for its Restoration and the Mischief +caused by their Abuse</i>, 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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Mr. F. G. Sambrooke was appointed Chairman in his place.</p> + +<p>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 <a href="#Page_47">Chapter III</a>.) of the +sum of £19,841 Three per Cent. Stock, subject to 10 per cent. +<span class="pagenum" id="Page_118">118</span>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_119">119</span></p> + + + <h2 class="nobreak" id="CHAPTER_VIII"> + CHAPTER VIII + <br> + <span class="title">THE COMMENCEMENT OF “THE OPHTHALMIC HOSPITAL REPORTS”</span> + </h2> +</div> + + +<p class="ti0">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 <i>Ophthalmic +Hospital Reports</i>, as the journal was called, was published +in October, 1857. Its origin and aims were set forth as +follows:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_120">120</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <a href="#Page_88">Chapter VI</a>. 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 <i>Reports</i> 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:</p> + +<div class="blockquot"> +<p>“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, +<span class="pagenum" id="Page_121">121</span>except to put before the jury the real nature of the +injuries inflicted.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“Poland had a remarkable power of gathering together +detailed knowledge, including dry facts and figures, so that +<span class="pagenum" id="Page_122">122</span>his essays are complete treaties on the subjects in hand, +and are of permanent value.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“His marriage a few years before his death was a misalliance, +and added much to his misfortunes.”</p> +</div> + +<p>One of the most conspicuous features of the <i>Reports</i> +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.</p> + +<p>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 +<span class="pagenum" id="Page_123">123</span>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.”</p> + +<p class="tac mt1em"><a id="PLATE_XVI"></a>PLATE XVI.</p> + +<figure class="figcenter illowe24_3750" id="169"> + <img class="w100" src="images/169.jpg" alt=""> + <figcaption> + <p>SIR JONATHAN HUTCHINSON, F.R.S.</p> + </figcaption> +</figure> + +<p>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 <i>Diseases of the Eye and Ear +consequent on Inherited Syphilis</i>, published in 1863, consisting +mainly of his reprinted articles in the <i>Ophthalmic +Hospital Reports</i>.</p> + +<p>It has already been mentioned in <a href="#Page_88">Chapter III</a>. 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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p><span class="pagenum" id="Page_124">124</span></p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_125">125</span></p> + +<p>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 <i>Reports</i> 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 <i>Injuries of the Eye, Orbit, and Eyelids</i>. 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.</p> + +<p>In Part III. of the <i>Reports</i>, 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.</p> + +<p>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.</p> + +<p>Amongst the numerous interesting articles in the second +<span class="pagenum" id="Page_126">126</span>volume of the <i>Reports</i> are some short contributions from +the celebrated Glasgow ophthalmic surgeon, William +Mackenzie, then in his fifty-ninth year, whose masterly +<i>Practical Treatise on the Diseases of the Eye</i> 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 <i>Reports</i> 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.</p> + +<p>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 <i>Reports</i>, 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 +<span class="pagenum" id="Page_127">127</span>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 <i>Ophthalmic +Hospital Reports</i>, which in its early days was not restricted +to work carried on at Moorfields.</p> + +<p>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 <i>Tables of +Logarithms</i> 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_128">128</span>the great accuracy and value of which he was able to +testify.</p> + +<p>In the third volume of the <i>Reports</i> 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.</p> + +<p>After the issue of the thirteenth number of the <i>Reports</i>, +Streatfield resigned his editorship, and in April, 1861, what +was termed a New Series was commenced, with the following +prefatory remarks:</p> + +<div class="blockquot"> +<p>“The first number was issued October, 1857, and the +publication, though not strictly quarterly, has subsequently +appeared with regularity sufficient to complete two volumes.</p> + +<p>“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.</p> + +<p>“It will be edited by members of the staff, and appear +under the title <i>Ophthalmic Hospital Reports, and Journal of +Ophthalmic Medicine and Surgery</i>.”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_129">129</span></p> + +<p>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 <i>Reports</i> he described +some cases, as he says, “to illustrate some forms of limitation +of the field of vision.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>The discovery of the ophthalmoscope opened up a new +<span class="pagenum" id="Page_130">130</span>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>Dr. Hughlings Jackson contributed many most valuable +papers to the <i>Reports</i> 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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_131">131</span></p> + +<p>He was never tired of impressing on physicians the value +of the routine use of the ophthalmoscope. Thus he wrote +in 1889:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>In 1863 Dr. Argyll Robertson contributed a paper from +Edinburgh to the <i>Reports</i>, “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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_132">132</span></p> + + + <h2 class="nobreak" id="CHAPTER_IX"> + CHAPTER IX + <br> + <span class="title">GROWTH AND EXTENSION</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>The increased facilities which the railways and omnibuses +afforded for approach to the Hospital tended largely to +<span class="pagenum" id="Page_133">133</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_134">134</span>until July, 1870; the total cost was £7,226, towards which +Her Majesty the Queen graciously contributed £100.</p> + +<p>The reform in hospital architecture which commenced +after the Crimean War with the publication of Miss +Nightingale’s celebrated <i>Notes on Hospitals</i> 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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>In 1867 the President of the Hospital, Mr. William +<span class="pagenum" id="Page_135">135</span>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_136">136</span>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.</p> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_137">137</span>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 <i>A Guide to the +Practical Study of the Diseases of the Eye</i>, 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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.’”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_138">138</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <i>The Natural and Morbid Changes +in the Human Eye</i>. 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 +<span class="pagenum" id="Page_139">139</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“That he be responsible for the due keeping, cataloguing +and giving out under regulations of the books and plates +under his charge.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>In the records of pathological specimens, published by +Vernon in the <i>Reports</i> in 1868, is the description of what +<span class="pagenum" id="Page_140">140</span>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 <i>Hospital +Reports</i> 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.</p> + +<p class="tac mt1em"><a id="PLATE_XVII"></a>PLATE XVII.</p> + +<figure class="figcenter illowe24_3750" id="188"> + <img class="w100" src="images/188.jpg" alt=""> + <figcaption> + <p>EDWARD NETTLESHIP, F.R.S.</p> + </figcaption> +</figure> + +<p>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</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_141">141</span>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.</p> + +<p>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.</p> + +<p>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” +<span class="pagenum" id="Page_142">142</span>was translated and published in full in the <i>Ophthalmic +Hospital Reports</i> 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 +<i>Hospital Reports</i> 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.</p> + +<p>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.</p> + +<p>The length of time which those holding office at Moorfields +retained their posts, and the reluctance with which +<span class="pagenum" id="Page_143">143</span>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.</p> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_XVIII"></a>PLATE XVIII.</p> + +<figure class="figcenter illowe37_5000" id="193"> + <img class="w100" src="images/193.jpg" alt=""> + <figcaption> + <p>THE HOSPITAL AT MOORFIELDS AFTER THE ADDITION OF A NEW WING IN 1868, AND + A NEW STORY IN 1875.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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:</p> + +<p><span class="pagenum" id="Page_144">144</span></p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>The Committee then, in accepting Bowman’s resignation, +passed the following resolution:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_145">145</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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 +<span class="pagenum" id="Page_146">146</span>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.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_147">147</span>both of whom were assistant general surgeons at the London +Hospital.</p> + +<p>After the publication of Donders’ great work in English +<i>On the Anomalies of Accommodation and Refraction of the +Eye</i>, by the New Sydenham Society in 1864, and Soelberg +Wells’ smaller book, which embodied Donders’ teaching, +<i>On Long, Short, and Weak Sight</i>, sight-testing and the +correction of errors of refraction with glasses grew progressively +in importance.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_148">148</span>that on Hulke’s days of attendance they had to be early +risers, with the result that the work was finished more +expeditiously.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <i>Hospital Reports</i>, +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.</p> + +<p>In the November number of the <i>Reports</i> 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 +<span class="pagenum" id="Page_149">149</span>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.</p> + +<p>The less frequent issue of the <i>Reports</i> 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 +<i>Ophthalmic Review</i> in 1882.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <i>Treatise on the Diseases of the Eye</i>, first published +in 1869, ran through three editions, and was translated into +German and French. It was for a long time the standard +<span class="pagenum" id="Page_150">150</span>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_151">151</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_XIX"></a>PLATE XIX.</p> + +<figure class="figcenter illowe23_1250" id="203"> + <img class="w100" src="images/203.jpg" alt=""> + <figcaption> + <p>WAREN TAY</p> + </figcaption> +</figure> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_152">152</span></p> + + + <h2 class="nobreak" id="CHAPTER_X"> + CHAPTER X + <br> + <span class="title">ANTISEPTICS, BACTERIOLOGY, AND LOCAL ANÆSTHESIA</span> + </h2> +</div> + + +<p class="ti0">Joseph Lister’s first paper on his method of preventing +the access to wounds of germs which cause putrefaction +appeared in the <i>Lancet</i> 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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>In the third edition of Soelberg Wells’ <i>Treatise on Eye +<span class="pagenum" id="Page_153">153</span>Diseases</i>, 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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_154">154</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_155">155</span>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.</p> + +<p>“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, +<span class="pagenum" id="Page_156">156</span>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 <i>nimia diligentia Chirurgorum</i>, +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.’”</p> +</div> + +<p>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:</p> + +<div class="blockquot"> +<p>“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 <span class="nowrap"><span class="fraction"><span class="fnum">1</span><span class="bar">/</span><span class="fden">4000</span></span></span> 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.</p> + +<p>“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.”</p> +</div> + +<p><span class="pagenum" id="Page_157">157</span></p> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_XX"></a>PLATE XX.</p> + +<figure class="figcenter illowe21_2500" id="211"> + <img class="w100" src="images/211.jpg" alt=""> + <figcaption> + <p>JOHN COUPER.</p> + </figcaption> +</figure> + +<p>In the following appreciation, written by Sir John Tweedy, +we have recorded a most faithful and striking word-picture +of John Couper’s characteristics:</p> + +<div class="blockquot"> +<p>“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 <i>surgeons</i> 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 <i>ophthalmic physician</i>. <i>Facile princeps</i> +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 +<span class="pagenum" id="Page_158">158</span>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.”</p> +</div> + +<p>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?”</p> + +<p>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, +<span class="pagenum" id="Page_159">159</span>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.</p> + +<p>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.</p> + +<p>An article advocating the use of Cuignet’s method, by +Litton Forbes, appeared in the <i>Ophthalmic Hospital Reports</i> +in 1880, and another, descriptive of its optical basis, by +W. Charnley, in 1882.</p> + +<p>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 +<i>Hospital Reports</i>, he contributed but little himself to the +literature of ophthalmology.</p> + +<p>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 +<span class="pagenum" id="Page_160">160</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_XXI"></a>PLATE XXI.</p> + +<figure class="figcenter illowe21_8750" id="216"> + <img class="w100" src="images/216.jpg" alt=""> + <figcaption> + <p>R. MARCUS GUNN.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_161">161</span>interest in medical ophthalmology, and contributed several +communications on the subject to the Ophthalmological +Society, of which he was one of the first secretaries.</p> + +<p>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 <i>Ophthalmic Hospital Reports</i> 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_162">162</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_163">163</span>presence of some other focus of tuberculosis which had not +been detected, and from which most probably the eye had +become secondarily affected.</p> + +<p class="tac mt1em"><a id="PLATE_XXII"></a>PLATE XXII.</p> + +<figure class="figcenter illowe21_8750" id="221"> + <img class="w100" src="images/221.jpg" alt=""> + <figcaption> + <p>JAMES E. ADAMS.</p> + <p>From a painting by a patient upon whom he had performed the + operation of extraction of cataract.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_164">164</span>and was able to snatch a day here and there from his arduous +duties to follow the hounds.</p> + +<p>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.</p> + +<p>Cocaine is derived from the leaves of a plant, <i>Erythroxylon +coca</i>, 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.</p> + +<p>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 +<span class="pagenum" id="Page_165">165</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Shortly after her appointment, the head nurse was detected +receiving money from a patient; this being her second +<span class="pagenum" id="Page_166">166</span>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.</p> + +<p>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 +<span class="pagenum" id="Page_167">167</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_XXIII"></a>PLATE XXIII.</p> + +<figure class="figcenter illowe25_0000" id="227"> + <img class="w100" src="images/227.jpg" alt=""> + <figcaption> + <p>A. QUARRY SILCOCK.</p> + </figcaption> +</figure> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_168">168</span></p> + + + <h2 class="nobreak" id="CHAPTER_XI"> + CHAPTER XI + <br> + <span class="title">THE SELECTION OF A NEW SITE, AND THE<br> + ERECTION OF THE NEW HOSPITAL</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>In 1884 a piece of building land in Eldon Street to the +west of the Hospital became vacant, and the Controller of +<span class="pagenum" id="Page_169">169</span>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.</p> + +<p>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.</p> + +<p>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, <i>Some Defects in the Royal London +Ophthalmic Hospital</i>, 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.</p> + +<p>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 +<span class="pagenum" id="Page_170">170</span>taking of the existing site of the Hospital for the vacant site +in Eldon Street together with a sum of £15,000.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_171">171</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_172">172</span>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_173">173</span>Street, in the county of Middlesex, at a rent of £1,210 per +annum, from the Ecclesiastical Commissioners.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_174">174</span>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 <i>History of London</i>, 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 +<i>Every-day Book</i>, 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.</p> + + +<p>In the Daily Advertiser of August, 1748, are some doggerel +verses extolling the attractions of the Peerless Pool, and +also a statement <span class="nowrap">that—</span></p> + +<span class="pagenum" id="Page_175">175</span> +<div class="blockquot"> +<p>“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.”</p> +</div> +<p class="tac mt1em"><a id="PLATE_XXIV"></a>PLATE XXIV</p> + +<p class="tac fs140 ws03em"><b>THE PLEASURE BATH,<br> +PEERLESS POOL, CITY ROAD.</b></p> + +<div class="center"> +<table> +<tr> +<td class="vat"> +<table class="fs80"> +<tr> +<td class="tac" colspan="5"> +<b>TERMS OF</b> +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td class="tac" colspan="5"> +PLEASURE BATH +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td> +</td> +<td> +</td> +<td class="tac"> +£. +</td> +<td class="tac prl1"> +s. +</td> +<td class="tac"> +d. +</td> +</tr> +<tr> +<td class="tal"> +Month +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> + 9 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal"> +Two Months +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +10 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal"> +Year +</td> +<td> +</td> +<td class="tac"> +1 +</td> +<td class="tac"> + 1 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td class="tal"> +Single Bathe +</td> +<td class="tal vab" rowspan="3"> +<img src="images/47x8br.png" width="8" height="47" alt="" > +</td> +<td> +</td> +<td> +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +with Towels +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +1 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal"> +and Box +</td> +<td> +</td> +<td> +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Ditto without +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +6 +</td> +</tr> +</table> +</td> + +<td> +<img src="images/237a.jpg" width="313" height="231" alt="" > +</td> + +<td class="vat"> +<table class="fs80"> +<tr> +<td class="tac" colspan="5"> +<b>SUBSCRIPTION</b> +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td class="tac" colspan="5"> +COLD BATH +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td> +</td> +<td> +</td> +<td class="tac"> +£. +</td> +<td class="tac prl1"> +s. +</td> +<td class="tac"> +d. +</td> +</tr> +<tr> +<td class="tal"> +Month +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +10 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal pr1"> +Two Months +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +17 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tal"> +Year +</td> +<td> +</td> +<td class="tac"> +1 +</td> +<td class="tac"> + 1 +</td> +<td class="tac"> +0 +</td> +</tr> +<tr> +<td class="tac ptb03" colspan="5"> +────── +</td> +</tr> +<tr> +<td class="tal"> +Single Bathe +</td> +<td> +</td> +<td class="tac"> +0 +</td> +<td class="tac"> +1 +</td> +<td class="tac"> +0 +</td> +</tr> +</table> +</td> +</tr> +</table> +</div> + +<div class="center"> +<table id="peerless"> +<col style="width: 40%"> +<col style="width: 60%"> +<tr> +<td class="pr1" rowspan="4"> +<img src="images/237bb.jpg" width="236" height="404" alt="" > +</td> +<td class="fs80 tac pb1"> +<b><span class="fs140">THE PLEASURE BATH</span><br> +OF PEERLESS POOL,</b> +</td> +</tr> +<tr> +<td class="taj"> +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—<b>170</b> feet +in length, by <b>108</b> 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. +</td> +</tr> +<tr> +<td class="fs80 tac pt1b05"> +<b>THE COLD BATH,</b> +</td> +</tr> +<tr> +<td class="taj pb1"> +<span class="smcap">Thirty-Six</span> feet by <span class="smcap">Eighteen</span>, is the largest of its kind in +London, and both Baths are entirely supplied by Springs, +which are constantly overflowing. +</td> +</tr> +<tr> +<td class="fs80 taj pr1"> +1 Bath Buildings; Entrance—2. Baldwyn +Street Entrance—3. Cold Bath—4. +Pleasure Bath—5. Dressing Boxes—6. +Shrubberies +</td> +<td class="taj"> +<i>The City Road is the line from all parts of the <span class="smcap">West +End</span> to the City. Omnibuses pass both ways nearly +every minute throughout the day</i>. +</td> +</tr> +</table> +</div> + +<p class="tac fs80 mtb1em">BILL OF PEERLESS POOL. <i>Circ</i>. 1846.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_176">176</span>fromity. Invalids sometimes stayed at the inn to benefit +by the pure air of the neighbourhood.</p> + +<div class="container"> +<div class="content"> +<p class="fs85 mtb1em ti0"> +“To the Shepherd and Shepherdess then they go<br> +To tea with their wives, for a constant rule;<br> +And next cross the road to the Fountain also,<br> +And there they all sit, so pleasant and cool,<br> + And see, in and out,<br> + The folk walk about,<br> +And the gentlemen angling in Peerless Pool.” +</p> +</div> +</div> + +<p>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.”</p> + +<p>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;</p> + +<div class="container"> +<div class="content"> +<p class="fs85 mtb1em ti0"> + “Up and down the City Road,<br> + In and out the Eagle,<br> + That’s the way the money goes,<br> + Pop goes the weasel.” +</p> +</div> +</div> + +<p>It has been suggested that this refrain might be paraphrased +by those employed at the Moorfields Hospital as +follows:</p> + +<div class="container"> +<div class="content"> +<p class="fs85 mtb1em ti0"> + “Up and down the City Road,<br> + In and out Moorfields,<br> + That’s the way we spend our lives,<br> + Oh! the joy it yields.” +</p> +</div> +</div> + +<p>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.</p> + +<p><span class="pagenum" id="Page_177">177</span></p> + +<p>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.</p> + +<p>In 1891 George Lawson also had to retire under the age +limit rule. In 1869 he had published a <i>Manual on Diseases +and Injuries of the Eye</i>, 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_178">178</span>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.</p> + +<p>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 <i>Refraction of the Eye</i>, describing it in such an +easily assimilated manner that the book had a large sale, +several editions being called for.</p> + +<p>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. +<span class="pagenum" id="Page_179">179</span>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,”</p> + +<p>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.</p> + +<p>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.</p> + +<p>E. Treacher Collins, who, like Lawford, had been both +<span class="pagenum" id="Page_180">180</span>house surgeon and curator of the Museum at the Hospital +was appointed as Couper’s successor.</p> + +<p>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.”</p> + +<p>To fill the surprise vacancy caused by Nettleship’s retirement, +W. T. Holmes Spicer was appointed.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_181">181</span>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.</p> + +<p>Mr. H. P. Sturgis, a director of the London and Westminster +Bank, was elected Chairman in his place.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_182">182</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_183">183</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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. +<span class="pagenum" id="Page_184">184</span>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.</p> + +<p>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 +<span class="pagenum" id="Page_185">185</span>quite such a uniform and satisfactory area of illumination +for these examinations as the old argand gas burner.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_186">186</span></p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_187">187</span>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.</p> + +<p>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.</p> + +<p>In the <i>Hospital Reports</i>, 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>i.e</i>., 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.</p> + +<p>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 +<span class="pagenum" id="Page_188">188</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_189">189</span>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.</p> + +<p>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.</p> + +<p>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.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_190">190</span></p> + + + <h2 class="nobreak" id="CHAPTER_XII"> + CHAPTER XII + <br> + <span class="title">THE HOSPITAL IN THE CITY ROAD</span> + </h2> +</div> + + +<p class="ti0">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.</p> + +<p>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. +<span class="pagenum" id="Page_191">191</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_XXV"></a>PLATE XXV.</p> + +<figure class="figcenter illowe37_5000" id="254"> + <img class="w100" src="images/254.jpg" alt=""> + <figcaption> + <p>THE ROYAL LONDON OPHTHALMIC HOSPITAL IN THE CITY ROAD, OPENED IN 1899.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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.</p> + +<p>The Duke of York said:</p> + +<div class="blockquot"> +<p>“Sir John Lubbock, Mr. Sturgis, Ladies and Gentlemen, +I am grateful to Sir John Lubbock for the kind words he +<span class="pagenum" id="Page_192">192</span>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.)</p> +</div> + +<p>Their Royal Highnesses then left the building, and were +heartily cheered by a large crowd in the street as they drove +away.</p> + +<p>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.</p> + +<p>The hopes expressed by Mr. Sturgis, the Chairman of the +<span class="pagenum" id="Page_193">193</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_194">194</span>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.</p> + +<p>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.</p> + +<p>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—<i>e.g</i>., the Drapers’ Company, +<span class="pagenum" id="Page_195">195</span>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:</p> + +<div class="blockquot"> +<p class="tac">“THE PRINCE OF WALES’ HOSPITAL FUND FOR +LONDON.</p> + +<p class="tar pr3">“<span class="smcap">The Bank of England</span>,</p> + +<p class="tar pr1">“27<i>th December</i>, 1901.</p> + +<p>“<span class="smcap">The Treasurer</span>,</p> + +<p class="pl1">“<span class="smcap">Royal London Ophthalmic Hospital</span></p> + +<p class="pl6">“<span class="smcap">City Road, E.C</span>.</p> + +<p>“<span class="smcap">Sir</span>,</p> + +<p>“By the desire of His Royal Highness, the President, +I have the honour to enclose a cheque for £2,850.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“Kindly acknowledge the receipt of the above.</p> + +<p class="tar pr10">“Yours faithfully,</p> + +<p class="tar pr3">“(Signed) <span class="smcap">S. Crossley</span>,</p> + +<p class="tar pr1">“<i>Honorary Secretary</i>.”</p> +</div> + +<p>In June, 1902, His Majesty the King himself became an +annual subscriber of ten guineas to the Hospital.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“<span class="smcap">Sir</span>,</p> + +<p>“I am directed by His Royal Highness the President +to enclose a cheque for £4,500.</p> + +<p><span class="pagenum" id="Page_196">196</span></p> + +<p>“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.</p> + +<p>“Kindly acknowledge the receipt of the above.</p> + +<p class="tar pr10">“Yours faithfully,</p> + +<p class="tar pr3">“(Signed) <span class="smcap">Savile Crossley</span>,</p> + +<p class="tar pr1">“<i>Honorary Secretary</i>.”</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_197">197</span>found that an annual amount of £1,150 could be obtained in +this way, without giving any offence to those solicited for help.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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. +<span class="pagenum" id="Page_198">198</span>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.”</p> +</div> + +<p>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.</p> + +<p><span class="pagenum" id="Page_199">199</span></p> + +<p>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>i.e</i>., 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.</p> + +<p>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, +<span class="pagenum" id="Page_200">200</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>In 1896 courses of lectures given by members of the +<span class="pagenum" id="Page_201">201</span>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.</p> + +<p>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.</p> + +<p>Graefe, in his work on the ocular muscles, described what +are termed latent squints—<i>i.e</i>., 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 +<span class="pagenum" id="Page_202">202</span>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.</p> + +<p class="tac mt1em"><a id="PLATE_XXVI"></a>PLATE XXVI.</p> + +<figure class="figcenter illowe23_1250" id="268"> + <img class="w100" src="images/268.jpg" alt=""> + <figcaption> + <p>SIR JOHN TWEEDY, LL.D.</p> + </figcaption> +</figure> + +<p>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.</p> + +<p>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 <i>Lancet</i>, 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 +<span class="pagenum" id="Page_203">203</span>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.”</p> + +<p>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.</p> + +<p>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 <i>Medical Ophthalmoscopy</i>, 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:</p> + +<div class="blockquot"> +<p>“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 +<span class="pagenum" id="Page_204">204</span>observation is one of the most ready clinical +means for the early detection of important arterial +changes.”</p> +</div> + +<p>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.</p> + +<p class="tac mt1em"><a id="PLATE_XXVII"></a>PLATE XXVII.</p> + +<figure class="figcenter illowe24_3750" id="272"> + <img class="w100" src="images/272.jpg" alt=""> + <figcaption> + <p>WILLIAM LANG</p> + </figcaption> +</figure> + +<p>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 +<span class="pagenum" id="Page_205">205</span>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.</p> + +<p>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 <i>Hospital Reports</i>.</p> + +<p>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.</p> + +<p>C. Devereux Marshall, who held the post of curator of +<span class="pagenum" id="Page_206">206</span>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.</p> + +<p>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.”</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_207">207</span></p> + +<p>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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>On the death of Queen Victoria, who had been a Patron +throughout the whole of her long reign, in 1901, King +<span class="pagenum" id="Page_208">208</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_209">209</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_210">210</span>Nettleship, and others have been able to make their most +valuable contributions to our knowledge of the natural +history of eye diseases.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_211">211</span>—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.</p> + +<p>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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <i>On the Anomalies of Accommodation and Refraction of +the Eye, with a Preliminary Essay on Physiological Dioptrics</i>, +<span class="pagenum" id="Page_212">212</span>published by the New Sydenham Society in 1844, writes +as follows:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.</p> + +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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.</p> + +<p>It is to Wassermann that we owe the possibility of a +<span class="pagenum" id="Page_213">213</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.”</p> + +<p>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 +<span class="pagenum" id="Page_214">214</span>specially constructed for such purposes, furnished +with the most up-to-date contrivances, and with a staff +efficiently trained to meet all emergencies.</p> + +<p>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:</p> + +<div class="blockquot"> +<p>“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.</p> + +<p>“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.”</p> +</div> + +<p>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 +<span class="pagenum" id="Page_215">215</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_216">216</span></p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_217">217</span></p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + + <h2 class="nobreak" id="APPENDIX"> + APPENDIX + </h2> +</div> +<div class="center"><table class="fs90"> +<tr> +<td class="tac pt15b05" colspan="3"> +<span class="smcap">Presidents</span> +</td> +</tr> +<tr> +<td> +</td> +<td class="tac prl03"> +<i>Date of<br>Appointment</i>. +</td> +<td class="tac prl03"> +<i>Date of<br>Resignation</i>. +</td> +</tr> +<tr> +<td class="tal"> +Sir Charles Price, Bart. +</td> +<td class="tac"> +1804 +</td> +<td class="tac"> +1818 +</td> +</tr> +<tr> +<td class="tal"> +Mr. William Mellish +</td> +<td class="tac"> +1818 +</td> +<td class="tac"> +1838 +</td> +</tr> +<tr> +<td class="tal"> +Rt. Hon. Earl Fitzwilliam +</td> +<td class="tac"> +1838 +</td> +<td class="tac"> +1856 +</td> +</tr> +<tr> +<td class="tal"> +Mr. William Cotton, D.C.L., F.R.S. +</td> +<td class="tac"> +1857 +</td> +<td class="tac"> +1867 +</td> +</tr> +<tr> +<td class="tal"> +Sir John Lubbock, F.R.S., M.P.<br> (afterwards Lord Avebury) +</td> +<td class="tac vab"> +1867 +</td> +<td class="tac vab"> +1913 +</td> +</tr> +<tr> +<td class="tal"> +His Royal Highness Prince Arthur<br> of Connaught, K.G. +</td> +<td class="tac vab"> +1914 +</td> +<td> +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<span class="smcap">Chairmen of the Committee of Management</span> +</td> +</tr> +<tr> +<td class="tal"> +Mr. Harry Sedgwick +</td> +<td class="tac"> +1804 +</td> +<td class="tac"> +1818 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Ralph Price +</td> +<td class="tac"> +1818 +</td> +<td class="tac"> +1830 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Stuart Donaldson +</td> +<td class="tac"> +1831 +</td> +<td class="tac"> +1837 +</td> +</tr> +<tr> +<td class="tal"> +Rev. J. Russell, D.D. +</td> +<td class="tac"> +1837 +</td> +<td class="tac"> +1857 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Richard Heathfield +</td> +<td class="tac"> +1857 +</td> +<td class="tac"> +1859 +</td> +</tr> +<tr> +<td class="tal"> +Mr. F. G. Sambrooke +</td> +<td class="tac"> +1860 +</td> +<td class="tac"> +1871 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Philip Cazenove +</td> +<td class="tac"> +1871 +</td> +<td class="tac"> +1879 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Charles Gordon +</td> +<td class="tac"> +1879 +</td> +<td class="tac"> +1897 +</td> +</tr> +<tr> +<td class="tal"> +Mr. H. P. Sturgis +</td> +<td class="tac"> +1897 +</td> +<td class="tac"> +1921 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Theodore W. Luling +</td> +<td class="tac"> +1921 +</td> +<td> +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<span class="smcap">Honorary Medical and Surgical Officers</span> +</td> +</tr> +<tr> +<td class="tac" colspan="3"> +<i>Physicians</i> +</td> +</tr> +<tr> +<td class="tal"> +John Richard Farre, M.D. +</td> +<td class="tac"> +1805 +</td> +<td class="tac"> +1857 +</td> +</tr> +<tr> +<td class="tal"> +Frederick J. Farre, M.D. +</td> +<td class="tac"> +1843 +</td> +<td class="tac"> +1880 +</td> +</tr> +<tr> +<td class="tal"> +Robert Martin, M.D. +</td> +<td class="tac"> +1856 +</td> +<td class="tac"> +1884 +</td> +</tr> +<tr> +<td class="tal"> +Sir Stephen Mackenzie, M.D. +</td> +<td class="tac"> +1884 +</td> +<td class="tac"> +1905<span class="pagenum" id="Page_218">218</span> +</td> +</tr> +<tr> +<td class="tal"> +James Taylor, C.B.E., M.D. +</td> +<td class="tac"> +1899 +</td> +<td class="tac"> +1919 +</td> +</tr> +<tr> +<td class="tal"> +Gordon M. Holmes, C.M.G., C.B.E., M.D. +</td> +<td class="tac"> +1914 +</td> +<td class="tac"> +1927 +</td> +</tr> +<tr> +<td class="tal"> +William J. Adie, M.D. +</td> +<td class="tac"> +1927 +</td> +<td> +</td> +</tr> +<tr> +<td class="tac pt1" colspan="3"> +<i>Surgeons</i> +</td> +</tr> +<tr> +<td class="tal"> +J. Cunningham Saunders<br> (Founder) +</td> +<td class="tac vab"> +1804 +</td> +<td class="tac vab"> +Died 1810 +</td> +</tr> +<tr> +<td class="tal"> +Benjamin Travers, F.R.S. +</td> +<td class="tac"> +1810 +</td> +<td class="tac"> +1817 +</td> +</tr> +<tr> +<td class="tal"> +Sir William Lawrence, Bart., F.R.S. +</td> +<td class="tac"> +1814 +</td> +<td class="tac"> +1826 +</td> +</tr> +<tr> +<td class="tal"> +Frederick Tyrrell +</td> +<td class="tac"> +1817 +</td> +<td class="tac"> +Died 1843 +</td> +</tr> +<tr> +<td class="tal"> +John Scott +</td> +<td class="tac"> +1826 +</td> +<td class="tac"> +1846 +</td> +</tr> +<tr> +<td class="tal"> +Gilbert Mackmurdo, F.R.S. +</td> +<td class="tac"> +1830 +</td> +<td class="tac"> +1856 +</td> +</tr> +<tr> +<td class="tal"> +John Dalrymple, F.R.S. +</td> +<td class="tac"> +1832 +</td> +<td class="tac"> +1849 +</td> +</tr> +<tr> +<td class="tal"> +James Dixon +</td> +<td class="tac"> +1843 +</td> +<td class="tac"> +1868 +</td> +</tr> +<tr> +<td class="tal"> +George Critchett +</td> +<td class="tac"> +1843 +</td> +<td class="tac"> +1877 +</td> +</tr> +<tr> +<td class="tal"> +Sir William Bowman, Bart., F.R.S. +</td> +<td class="tac"> +1846 +</td> +<td class="tac"> +1876 +</td> +</tr> +<tr> +<td class="tal"> +Alfred Poland +</td> +<td class="tac"> +1848 +</td> +<td class="tac"> +1861 +</td> +</tr> +<tr> +<td class="tal"> +H. H. Mackmurdo +</td> +<td class="tac"> +1851 +</td> +<td class="tac"> +1852 +</td> +</tr> +<tr> +<td class="tal"> +John C. Wordsworth +</td> +<td class="tac"> +1852 +</td> +<td class="tac"> +1883 +</td> +</tr> +<tr> +<td class="tal"> +J. F. Streatfield +</td> +<td class="tac"> +1856 +</td> +<td class="tac"> +Died 1886 +</td> +</tr> +<tr> +<td class="tal"> +J. W. Hulke, F.R.S. +</td> +<td class="tac"> +1858 +</td> +<td class="tac"> +1890 +</td> +</tr> +<tr> +<td class="tal"> +George Lawson +</td> +<td class="tac"> +1862 +</td> +<td class="tac"> +1891 +</td> +</tr> +<tr> +<td class="tal"> +Sir Jonathan Hutchinson, F.R.S. +</td> +<td class="tac"> +1862 +</td> +<td class="tac"> +1878 +</td> +</tr> +<tr> +<td class="tal"> +John Couper +</td> +<td class="tac"> +1866 +</td> +<td class="tac"> +1895 +</td> +</tr> +<tr> +<td class="tal"> +J. Soelberg Wells +</td> +<td class="tac"> +1867 +</td> +<td class="tac"> +Died 1880 +</td> +</tr> +<tr> +<td class="tal"> +Waren Tay +</td> +<td class="tac"> +1877 +</td> +<td class="tac"> +1904 +</td> +</tr> +<tr> +<td class="tal"> +James E. Adams +</td> +<td class="tac"> +1877 +</td> +<td class="tac"> +1884 +</td> +</tr> +<tr> +<td class="tal"> +Sir John Tweedy, LL.D. +</td> +<td class="tac"> +1878 +</td> +<td class="tac"> +1900 +</td> +</tr> +<tr> +<td class="tal"> +Robert Lyall +</td> +<td class="tac"> +1880 +</td> +<td class="tac"> +Died 1882 +</td> +</tr> +<tr> +<td class="tal"> +Edward Nettleship, F.R.S. +</td> +<td class="tac"> +1882 +</td> +<td class="tac"> +1898 +</td> +</tr> +<tr> +<td class="tal"> +R. Marcus Gunn +</td> +<td class="tac"> +1883 +</td> +<td class="tac"> +1909 +</td> +</tr> +<tr> +<td class="tal"> +W. Lang +</td> +<td class="tac"> +1884 +</td> +<td class="tac"> +1912 +</td> +</tr> +<tr> +<td class="tal"> +A. Quarry Silcock +</td> +<td class="tac"> +1886 +</td> +<td class="tac"> +Died 1904 +</td> +</tr> +<tr> +<td class="tal"> +J. B. Lawford, LL.D. +</td> +<td class="tac"> +1890 +</td> +<td class="tac"> +1918 +</td> +</tr> +<tr> +<td class="tal"> +A. Stanford Morton +</td> +<td class="tac"> +1891 +</td> +<td class="tac"> +1909 +</td> +</tr> +<tr> +<td class="tal"> +E. Treacher Collins +</td> +<td class="tac"> +1895 +</td> +<td class="tac"> +1922 +</td> +</tr> +<tr> +<td class="tal"> +W. T. Holmes Spicer +</td> +<td class="tac"> +1898 +</td> +<td class="tac"> +1920 +</td> +</tr> +<tr> +<td class="tal"> +Percy Fleming +</td> +<td class="tac"> +1900 +</td> +<td class="tac"> +1919 +</td> +</tr> +<tr> +<td class="tal"> +J. Herbert Fisher +</td> +<td class="tac"> +1900 +</td> +<td class="tac"> +1927<span class="pagenum" id="Page_219">219</span> +</td> +</tr> +<tr> +<td class="tal"> +Sir Arnold Lawson, K.B.E. +</td> +<td class="tac"> +1900 +</td> +<td class="tac"> +1914 +</td> +</tr> +<tr> +<td class="tal"> +C. Devereux Marshall +</td> +<td class="tac"> +1900 +</td> +<td class="tac"> +Died on active<br>service, 1918 +</td> +</tr> +<tr> +<td class="tal"> +Sir William T. Lister, K.C.M.G. +</td> +<td class="tac"> +1904 +</td> +<td class="tac"> +1905 +</td> +</tr> +<tr> +<td> + +</td> +<td class="tac"> +1919 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Sir John Herbert Parsons, C.B.E., F.R.S. +</td> +<td class="tac"> +1905 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Claud Worth +</td> +<td class="tac"> +1905 +</td> +<td class="tac"> +1921 +</td> +</tr> +<tr> +<td class="tal"> +W. Ilbert Hancock +</td> +<td class="tac"> +1909 +</td> +<td class="tac"> +Died 1910 +</td> +</tr> +<tr> +<td class="tal"> +George Coats +</td> +<td class="tac"> +1909 +</td> +<td class="tac"> +Died 1915 +</td> +</tr> +<tr> +<td class="tal"> +Malcolm L. Hepburn +</td> +<td class="tac"> +1910 +</td> +<td class="tac"> +1926 +</td> +</tr> +<tr> +<td class="tal"> +A. Cyril Hudson +</td> +<td class="tac"> +1913 +</td> +<td class="tac"> +1928 +</td> +</tr> +<tr> +<td class="tal"> +R. Foster Moore, O.B.E. +</td> +<td class="tac"> +1914 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +R. Affleck Greeves +</td> +<td class="tac"> +1915 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +F. A. Juler +</td> +<td class="tac"> +1918 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Charles Goulden, O.B.E. +</td> +<td class="tac"> +1919 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +B. T. Lang +</td> +<td class="tac"> +1920 +</td> +<td class="tac"> +Died 1928 +</td> +</tr> +<tr> +<td class="tal"> +M. H. Whiting, O.B.E +</td> +<td class="tac"> +1921 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +P. G. Doyne +</td> +<td class="tac"> +1922 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Humphrey Neame +</td> +<td class="tac"> +1926 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Miss Ida C. Mann +</td> +<td class="tac"> +1927 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +W. Stewart Duke-Elder +</td> +<td class="tac"> +1928 +</td> +<td> +</td> +</tr> +<tr> +<td class="tal"> +Rupert S. Scott +</td> +<td class="tac"> +1928 +</td> +<td> +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<i>Ear, Nose, and Throat Surgeon</i> +</td> +</tr> +<tr> +<td class="tal"> +G. Seccombe Hett +</td> +<td class="tac"> +1923 +</td> +<td class="tac"> +1929 +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<i>Medical Officer to the X-Ray Department</i> +</td> +</tr> +<tr> +<td class="tal"> +Sir James Mackenzie Davidson +</td> +<td class="tac"> +1899 +</td> +<td class="tac"> +1910 +</td> +</tr> +<tr> +<td class="tal"> +Albert Bowie +</td> +<td class="tac"> +1910 +</td> +<td class="tac"> + +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<i>Dental Surgeons</i> +</td> +</tr> +<tr> +<td class="tal"> +Arthur E. Relph +</td> +<td class="tac"> +1913 +</td> +<td class="tac"> +1915 +</td> +</tr> +<tr> +<td class="tal"> +R. M. Fickling +</td> +<td class="tac"> +1915 +</td> +<td class="tac"> +1928 +</td> +</tr> +<tr> +<td class="tal"> +Stanley A. Riddett +</td> +<td class="tac"> +1928 +</td> +<td class="tac"> + +</td> +</tr> +<tr> +<td class="tac pt15b05" colspan="3"> +<i>Medical Officer to the Ultra-Violet Ray Department</i> +</td> +</tr> +<tr> +<td class="tal"> +W. Stewart Duke-Elder +</td> +<td class="tac"> +1927<span class="pagenum" id="Page_220">220</span> +</td> +<td class="tac"> + +</td> +</tr><tr> +<td class="tac pt15b05" colspan="3"> +<i>Secretaries</i> +</td> +</tr> +<tr> +<td class="tal"> +Mr. Richard Battley +</td> +<td class="tac"> +1804 +</td> +<td class="tac"> +1818 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Matthew Heathfield +</td> +<td class="tac"> +1818 +</td> +<td class="tac"> +1834 +</td> +</tr> +<tr> +<td class="tal"> +Mr. William Bircham +</td> +<td class="tac"> +1835 +</td> +<td class="tac"> +1844 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Robert Francis Dalrymple +</td> +<td class="tac"> +1844 +</td> +<td class="tac"> +1846 +</td> +</tr> +<tr> +<td class="tal"> +Mr. F. A. Curling +</td> +<td class="tac"> +1846 +</td> +<td class="tac"> +1856 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Charles Gordelier +</td> +<td class="tac"> +1856 +</td> +<td class="tac"> +1860 +</td> +</tr> +<tr> +<td class="tal"> +Mr. J. Mogford +</td> +<td class="tac"> +1860 +</td> +<td class="tac"> +1872 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Robert J. Newstead +</td> +<td class="tac"> +1872 +</td> +<td class="tac"> +1897 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Robert J. Bland +</td> +<td class="tac"> +1897 +</td> +<td class="tac"> +1923 +</td> +</tr> +<tr> +<td class="tal"> +Mr. Arthur J. M. Tarrant +</td> +<td class="tac"> +1923 +</td> +<td> +</td> +</tr> +</table> +</div> + +<p><span class="pagenum" id="Page_221">221</span></p> + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + + <h2 class="nobreak" id="INDEX"> + INDEX + </h2> +</div> + +<div class="center"> +<p class="hide"><a id="alpha-table"></a>alpha-table</p> +<table id="alpha" class="mb1em"> +<tr class="center"> + <td><div><a href="#IX_A">A</a></div></td> + <td><div><a href="#IX_B">B</a></div></td> + <td><div><a href="#IX_C">C</a></div></td> + <td><div><a href="#IX_D">D</a></div></td> + <td><div><a href="#IX_E">E</a></div></td> + <td><div><a href="#IX_F">F</a></div></td> + <td><div><a href="#IX_G">G</a></div></td> + <td><div><a href="#IX_H">H</a></div></td> + <td><div><a href="#IX_I">I</a></div></td> + <td><div><a href="#IX_J">J</a></div></td> + <td><div><a href="#IX_K">K</a></div></td> + <td><div><a href="#IX_L">L</a></div></td> + <td><div><a href="#IX_M">M</a></div></td> +</tr> +<tr class="center"> + <td><div><a href="#IX_N">N</a></div></td> + <td><div><a href="#IX_O">O</a></div></td> + <td><div><a href="#IX_P">P</a></div></td> + <td><div><a href="#IX_Q">Q</a></div></td> + <td><div><a href="#IX_R">R</a></div></td> + <td><div><a href="#IX_S">S</a></div></td> + <td><div><a href="#IX_T">T</a></div></td> + <td><div><a href="#IX_U">U</a></div></td> + <td><div><a href="#IX_V">V</a></div></td> + <td><div><a href="#IX_W">W</a></div></td> + <td><div><a href="#IX_X">X</a></div></td> + <td><div><a href="#IX_Y">Y</a></div></td> + <td><div><a href="#IX_Z">Z</a></div></td> +</tr> +</table> +</div> + +<ul class="index fs95"> +<li class="abet"><span class="alpha"><a id="IX_A"></a><a href="#alpha-table">A</a></span></li> <li class="ifrst">Abercrombie, Sir Ralph, <a href="#Page_6">6</a></li> + + <li class="indx">Adams, James, <a href="#Page_146">146</a></li> + <li class="isub1">his loss of sight, <a href="#Page_163">163</a></li> + + <li class="indx">Adams, Sir William, <a href="#Page_1">1</a>, <a href="#Page_22">22</a>, <a href="#Page_28">28</a></li> + <li class="isub1">at Exeter, <a href="#Page_29">29</a></li> + <li class="isub1">monetary grant to, and change of name, <a href="#Page_30">30</a></li> + + <li class="indx">Airy, the Astronomer Royal, <a href="#Page_115">115</a>, <a href="#Page_212">212</a></li> + + <li class="indx">Alexander, Charles, <a href="#Page_15">15</a>, <a href="#Page_16">16</a></li> + + <li class="indx">Amasis, King of Egypt, <a href="#Page_43">43</a></li> + + <li class="indx">Anæsthesia, general, <a href="#Page_82">82</a></li> + <li class="isub1">local, <a href="#Page_165">165</a></li> + + <li class="indx">Anatomy of the human eye, <a href="#Page_94">94</a></li> + + <li class="indx">Anderson, Mrs. Garrett, <a href="#Page_179">179</a></li> + + <li class="indx">Anderson, Dr. James, <a href="#Page_167">167</a></li> + + <li class="indx">Ansley, Alderman, <a href="#Page_39">39</a></li> + + <li class="indx">Antiseptics in ophthalmology, <a href="#Page_154">154</a></li> + + <li class="indx">Arlt, of Vienna, <a href="#Page_96">96</a>, <a href="#Page_114">114</a></li> + + <li class="indx">Artificial eyes, <a href="#Page_86">86</a></li> + + <li class="indx">Artificial pupil, operations for, <a href="#Page_89">89–91</a></li> + + <li class="indx">Aseptic surgery, <a href="#Page_187">187</a></li> + + <li class="indx">Asthenopia, <a href="#Page_114">114</a></li> + + <li class="indx">Astigmatism, <a href="#Page_114">114</a></li> + + <li class="indx">Avebury, Lord, <a href="#Page_135">135</a>, <a href="#Page_217">217</a></li> + + <li class="indx">Avicenna, <a href="#Page_89">89</a></li> + +<li class="abet"><span class="alpha"><a id="IX_B"></a><a href="#alpha-table">B</a></span></li> + <li class="ifrst">Babbage, Charles, his ophthalmoscope, <a href="#Page_102">102</a>, <a href="#Page_127">127</a></li> + + <li class="indx">Bacteriology, <a href="#Page_202">202</a></li> + + <li class="indx">Bader, Charles, <a href="#Page_95">95</a></li> + <li class="isub1">appointed curator, <a href="#Page_110">110</a>, <a href="#Page_122">122</a>, <a href="#Page_138">138</a></li> + + <li class="indx">Bancroft, Sir Squire, <a href="#Page_182">182</a></li> + + <li class="indx">Barth, Joseph, of Vienna, <a href="#Page_44">44</a></li> + + <li class="indx">Battley, Richard, early life, <a href="#Page_3">3</a>, <a href="#Page_6">6</a>, <a href="#Page_11">11</a></li> + <li class="isub1">appointed secretary, <a href="#Page_14">14</a>, <a href="#Page_30">30</a>, <a href="#Page_46">46</a></li> + <li class="isub1">and materia medica, <a href="#Page_55">55–57</a>, <a href="#Page_59">59</a>, <a href="#Page_71">71</a></li> + <li class="isub1">death of, <a href="#Page_79">79</a>, <a href="#Page_220">220</a></li> + + <li class="indx">Bedell, hospitals surveyor, <a href="#Page_172">172</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Beer, Professor, of Vienna, <a href="#Page_44">44</a></li> + + <li class="indx">Belladonna, <a href="#Page_1">1</a>, <a href="#Page_19">19</a>, <a href="#Page_23">23</a></li> + + <li class="indx">Bennett, Dr. Hughes, <a href="#Page_164">164</a></li> + + <li class="indx">Bethlehem, Royal Hospital, <a href="#Page_52">52</a></li> + <li class="isub1">its burial ground, <a href="#Page_132">132</a></li> + + <li class="indx">Bircham, Francis William, <a href="#Page_66">66</a>, <a href="#Page_78">78</a>, <a href="#Page_220">220</a></li> + + <li class="indx">Bircham and Co., solicitors to the Hospital, <a href="#Page_66">66</a></li> + + <li class="indx">Blomberg, Rev. Dr., <a href="#Page_67">67</a>, <a href="#Page_68">68</a></li> + + <li class="indx">Blood, withdrawal of, <a href="#Page_40">40–41</a></li> + + <li class="indx">Boerhaave, of Leyden, <a href="#Page_44">44</a></li> + + <li class="indx">Bonnet, of France, <a href="#Page_86">86</a></li> + + <li class="indx">Bovell, J. Roach, <a href="#Page_72">72</a></li> + + <li class="indx">Bowman, Sir William, candidature, <a href="#Page_75">75</a></li> + <li class="isub1">employment of chloroform, <a href="#Page_83">83</a></li> + <li class="isub1">operation on lacrymal passages, <a href="#Page_88">88</a>, <a href="#Page_120">120</a></li> + <li class="isub1">operation for artificial pupil, <a href="#Page_89">89–91</a></li> + <li class="isub1">meeting with Graefe and Donders, <a href="#Page_93">93–95</a></li> + <li class="isub1">iridectomy for glaucoma, <a href="#Page_96">96–97</a>, <a href="#Page_112">112</a></li> + <li class="isub1">retirement from Hospital, <a href="#Page_143">143–144</a></li> + <li class="isub1">later life, <a href="#Page_145">145–146</a></li> + <li class="isub1">and antiseptics, <a href="#Page_155">155</a>, <a href="#Page_159">159</a>, <a href="#Page_161">161</a></li> + + <li class="indx">Boycott, Miss, <a href="#Page_143">143</a></li> + + <li class="indx">Bradford, of Boston, U.S.A., <a href="#Page_185">185</a></li> + + <li class="indx">Brailey, W. A. , curator, <a href="#Page_141">141</a>, <a href="#Page_142">142</a></li> + + <li class="indx">Brass, Robert, architect, <a href="#Page_134">134</a></li> + + <li class="indx">Bruecke, <a href="#Page_95">95</a>, <a href="#Page_112">112</a></li> + + <li class="indx">Buller, Frank, <a href="#Page_142">142</a></li> + +<li class="abet"><span class="alpha"><a id="IX_C"></a><a href="#alpha-table">C</a></span></li> + <li class="ifrst">Calabar bean, <a href="#Page_131">131</a></li> + + <li class="indx">Cambridge, H.R.H. Duke of, <a href="#Page_108">108</a>, <a href="#Page_182">182</a></li> + + <li class="indx">Cataract, congenital, <a href="#Page_11">11</a>, <a href="#Page_19">19–24</a>, <a href="#Page_27">27</a>, <a href="#Page_60">60</a>, <a href="#Page_62">62</a>, + <a href="#Page_88">88</a></li> + <li class="isub1">after-treatment, <a href="#Page_153">153</a>, <a href="#Page_156">156</a></li> + + <li class="indx">Cazenove, Philip, <a href="#Page_137">137</a>, <a href="#Page_149">149</a></li> + + <li class="indx">Charnley, W., <a href="#Page_159">159</a></li> + + <li class="indx">Charter, granting of, <a href="#Page_171">171</a></li> + + <li class="indx">Charterhouse Square, <a href="#Page_14">14</a>, <a href="#Page_48">48</a></li> + + <li class="indx">Chloroform, <a href="#Page_84">84–85</a></li> + + <li class="indx">Churchill, John, <a href="#Page_77">77</a>, <a href="#Page_79">79</a></li> + + <li class="indx">City Companies, donations, from, <a href="#Page_182">182</a></li> + + <li class="indx">City Road site, <a href="#Page_172">172</a></li> + + <li class="indx">Clark, Sarah, <a href="#Page_15">15</a></li> + + <li class="indx">Clinical assistants, institution of, <a href="#Page_109">109</a></li> + + <li class="indx">Coats, George, <a href="#Page_9">9</a>, <a href="#Page_10">10</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Cocaine, <a href="#Page_164">164</a></li> + + <li class="indx">Colkett, Miss Jane Louisa, <a href="#Page_6">6</a></li> + + <li class="indx">Collins, E. Treacher, <a href="#Page_179">179</a>, <a href="#Page_182">182</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Conjunctiva, inflammation of,</li> + <li class="isub1">in infants, <a href="#Page_22">22</a></li> + + <li class="indx">Conradi, <a href="#Page_20">20</a>, <a href="#Page_27">27</a></li> + + <li class="indx">Consulting surgeons, duties of, <a href="#Page_144">144–145</a></li> + + <li class="indx">Cooper, Sir Astley, connection with Saunders, <a href="#Page_2">2–8</a></li> + <li class="isub1">suggestion for a special institution, <a href="#Page_11">11</a>, <a href="#Page_13">13</a></li> + <li class="isub1">description of, by Travers, <a href="#Page_33">33</a>, <a href="#Page_38">38</a></li> + <li class="isub1">his pupils and relatives, <a href="#Page_59">59</a>, <a href="#Page_75">75</a></li> + + <li class="indx">Cooper, Samuel, <a href="#Page_45">45</a></li> + + <li class="indx">Cooper, White, <a href="#Page_84">84</a>, <a href="#Page_127">127</a></li> + + <li class="indx">Cork Street, Infirmary in, <a href="#Page_15">15</a></li> + + <li class="indx">Cotton, William, <a href="#Page_108">108</a>, <a href="#Page_135">135</a>, <a href="#Page_217">217</a></li> + + <li class="indx">Couper, John, <a href="#Page_109">109</a></li> + <li class="isub1">appointed assistant-surgeon, <a href="#Page_134">134</a>, <a href="#Page_136">136</a></li> + <li class="isub1">word picture of, <a href="#Page_157">157–158</a></li> + <li class="isub1">his ophthalmoscope, <a href="#Page_158">158–159</a>, <a href="#Page_179">179</a>, <a href="#Page_213">213</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Cramer, <a href="#Page_112">112</a></li> + + <li class="indx">Crimean War, <a href="#Page_104">104</a>, <a href="#Page_125">125</a>, <a href="#Page_197">197</a></li> + + <li class="indx">Critchett, Sir Anderson, <a href="#Page_97">97</a>, <a href="#Page_146">146</a></li> + + <li class="indx">Critchett, George, <a href="#Page_75">75</a>, <a href="#Page_85">85</a></li> + <li class="isub1">and excision of the eyeball, <a href="#Page_86">86</a></li> + <li class="isub1">and operation for squint, <a href="#Page_87">87</a></li> + <li class="isub1">and operation for artificial pupil, <a href="#Page_89">89–91</a></li> + <li class="isub1">for glaucoma, <a href="#Page_96">96–97</a>, <a href="#Page_108">108</a>, <a href="#Page_134">134</a></li> + <li class="isub1">and duties of consulting surgeons, <a href="#Page_143">143–145</a></li> + <li class="isub1">on Poor Law schools, <a href="#Page_140">140–141</a>, <a href="#Page_146">146</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Cuignet, <a href="#Page_159">159</a></li> + + <li class="indx">Cumming, William, <a href="#Page_100">100</a>, <a href="#Page_101">101</a>, <a href="#Page_102">102</a></li> + + <li class="indx">Curie, Madame, <a href="#Page_212">212</a></li> + + <li class="indx">Curling, F. A. , <a href="#Page_78">78</a>, <a href="#Page_220">220</a></li> + + <li class="indx">Cyrus, King of Persia, <a href="#Page_43">43</a></li> + +<li class="abet"><span class="alpha"><a id="IX_D"></a><a href="#alpha-table">D</a></span></li> + <li class="ifrst">Dalrymple, John, secretary to academy, <a href="#Page_58">58</a></li> + <li class="isub1">assistant surgeon, <a href="#Page_64">64</a>, <a href="#Page_73">73</a>, <a href="#Page_74">74</a></li> + <li class="isub1">early training 75–76</li> + <li class="isub1">atlas of pathology of the eye, <a href="#Page_77">77–78</a>, <a href="#Page_81">81</a>, <a href="#Page_118">118</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Dalrymple, Robert Francis, <a href="#Page_78">78</a>, <a href="#Page_220">220</a></li> + + <li class="indx">Dalrymple, William, <a href="#Page_75">75–76</a></li> + + <li class="indx">Davidson, H., <a href="#Page_182">182</a>, <a href="#Page_191">191</a></li> + + <li class="indx">Davidson, Sir James Mackenzie, <a href="#Page_186">186</a>, <a href="#Page_187">187</a>, <a href="#Page_211">211</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Daviel, <a href="#Page_19">19</a></li> + + <li class="indx">Dean, appointment of, <a href="#Page_201">201</a></li> + + <li class="indx">Delafield, Dr. Edward, <a href="#Page_35">35</a>, <a href="#Page_38">38</a></li> + + <li class="indx">Desmarres, of Paris, <a href="#Page_96">96</a></li> + + <li class="indx">Devis, portrait of Saunders by, <a href="#Page_32">32</a></li> + + <li class="indx">Diet, <a href="#Page_41">41</a></li> + + <li class="indx">Diploma of Ophthalmology, <a href="#Page_201">201</a></li> + + <li class="indx">Dispensary for diseases of the eye and ear proposed, <a href="#Page_12">12</a></li> + + <li class="indx">Dodson, Mrs., <a href="#Page_80">80</a></li> + + <li class="indx">Donders, Franz Cornelius, first meeting with Graefe and Bowman, <a href="#Page_92">92–94</a>, <a href="#Page_95">95</a>, <a href="#Page_96">96</a>, <a href="#Page_99">99</a></li> + <li class="isub1">on Helmholtz, <a href="#Page_103">103</a></li> + <li class="isub1">and anomalies of refraction and accommodation, <a href="#Page_112">112–114</a>, <a href="#Page_145">145</a>, <a href="#Page_147">147</a>, <a href="#Page_211">211</a></li> + + <li class="indx">Doublet, Thomas, <a href="#Page_116">116</a></li> + +<li class="abet"><span class="alpha"><a id="IX_E"></a><a href="#alpha-table">E</a></span></li> + <li class="ifrst">Ear, anatomy of, <a href="#Page_17">17</a></li> + + <li class="indx">Earle, Henry, <a href="#Page_45">45</a></li> + + <li class="indx">East India Company, <a href="#Page_34">34</a>, <a href="#Page_36">36</a></li> + + <li class="indx">Egerton, C. J. , <a href="#Page_37">37</a></li> + + <li class="indx">Egyptian ophthalmia, <a href="#Page_6">6</a>, <a href="#Page_29">29</a></li> + + <li class="indx">Ehrlich, <a href="#Page_213">213</a></li> + + <li class="indx">Eldon Street, negotiations regarding site in, <a href="#Page_169">169–171</a></li> + + <li class="indx">Electro-magnets, <a href="#Page_185">185</a></li> + + <li class="indx">Ether, <a href="#Page_82">82</a></li> + + <li class="indx">Excision of the eyeball, <a href="#Page_85">85–86</a></li> + + <li class="indx">Exeter Eye Infirmary, <a href="#Page_29">29</a></li> + +<li class="abet"><span class="alpha"><a id="IX_F"></a><a href="#alpha-table">F</a></span></li> + <li class="ifrst">Farre, Dr. Arthur, <a href="#Page_106">106</a></li> + + <li class="indx">Farre, Dr. Frederick J., <a href="#Page_60">60</a>, <a href="#Page_70">70</a>, <a href="#Page_72">72</a>, <a href="#Page_73">73</a>, <a href="#Page_75">75</a>, + <a href="#Page_106">106</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Farre, Dr. John Richard, early life, <a href="#Page_3">3</a></li> + <li class="isub1">consulting physician, <a href="#Page_14">14</a>, <a href="#Page_24">24</a></li> + <li class="isub1">edits Saunders’ writings, <a href="#Page_26">26–28</a>, <a href="#Page_38">38</a>, <a href="#Page_45">45</a>, <a href="#Page_53">53</a></li> + <li class="isub1">courses of instruction, <a href="#Page_54">54–56</a></li> + <li class="isub1">and Saunderian Institution, <a href="#Page_56">56–57</a></li> + <li class="isub1">attacks on, in Lancet, <a href="#Page_59">59–61</a></li> + <li class="isub1">his journal, <a href="#Page_71">71</a></li> + <li class="isub1">his portrait, <a href="#Page_72">72–73</a> 74, <a href="#Page_75">75</a>, <a href="#Page_81">81</a>, <a href="#Page_106">106</a>, <a href="#Page_215">215</a>, + <a href="#Page_217">217</a></li> + + <li class="indx">Finsbury, neighbourhood of, <a href="#Page_161">161</a></li> + + <li class="indx">Fisher, J. Herbert, <a href="#Page_200">200</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Fitzwilliam, Earl, <a href="#Page_69">69</a>, <a href="#Page_108">108</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Fixation forceps, <a href="#Page_126">126</a></li> + + <li class="indx">Flemming, Percy, <a href="#Page_199">199</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Forbes, Litton, <a href="#Page_159">159</a></li> + + <li class="indx">Forster, <a href="#Page_129">129</a></li> + + <li class="indx">France, Mr., <a href="#Page_126">126</a></li> + + <li class="indx">Fraser, Dr. Thomas R., <a href="#Page_131">131</a></li> + +<li class="abet"><span class="alpha"><a id="IX_G"></a><a href="#alpha-table">G</a></span></li> + <li class="ifrst">Gamgee, J. S. , <a href="#Page_106">106</a></li> + + <li class="indx">General hospitals, ophthalmic departments in, <a href="#Page_126">126</a>, <a href="#Page_135">135</a></li> + + <li class="indx">Gibson, Benjamin, <a href="#Page_28">28</a>, <a href="#Page_60">60</a>, <a href="#Page_88">88</a></li> + + <li class="indx">Gill, Rev. T. , <a href="#Page_51">51</a>, <a href="#Page_55">55</a>, <a href="#Page_56">56</a></li> + + <li class="indx">Glaucoma, operations for and treatment of, <a href="#Page_91">91–93</a>, <a href="#Page_126">126</a>, <a href="#Page_141">141–142</a></li> + + <li class="indx">Gordon, Charles, <a href="#Page_149">149</a>, <a href="#Page_180">180</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Governors, privileges of, <a href="#Page_107">107</a></li> + + <li class="indx">Graefe, A. von, operation for glaucoma, <a href="#Page_91">91</a></li> + <li class="isub1">meeting with Bowman and Donders, <a href="#Page_93">93–94</a>, <a href="#Page_103">103</a>, <a href="#Page_127">127</a></li> + <li class="isub1">and perimetry, <a href="#Page_129">129</a></li> + <li class="isub1">death of, <a href="#Page_141">141</a></li> + <li class="isub1">and latent squints, <a href="#Page_201">201</a></li> + + <li class="indx">Grant, Roger, <a href="#Page_10">10</a></li> + + <li class="indx">Greek writers, <a href="#Page_43">43</a></li> + + <li class="indx">Green, <a href="#Page_27">27</a>, <a href="#Page_59">59</a></li> + + <li class="indx">Gunn, Marcus, <a href="#Page_160">160</a>, <a href="#Page_203">203</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Guthrie, <a href="#Page_15">15</a></li> + +<li class="abet"><span class="alpha"><a id="IX_H"></a><a href="#alpha-table">H</a></span></li> + <li class="ifrst">Haab, of Zurich, <a href="#Page_187">187</a></li> + + <li class="indx">Harkness, <a href="#Page_109">109</a></li> + + <li class="indx">Harnet, Miss, <a href="#Page_143">143</a>, <a href="#Page_165">165</a></li> + + <li class="indx">Hawes, Alfred, <a href="#Page_116">116</a></li> + + <li class="indx">Hawes, William, <a href="#Page_116">116</a></li> + + <li class="indx">Helmholtz, Professor von, <a href="#Page_99">99</a>, <a href="#Page_103">103</a>, <a href="#Page_211">211</a></li> + + <li class="indx">Herbert, Sydney, <a href="#Page_105">105</a></li> + + <li class="indx">Herodotus, <a href="#Page_43">43</a></li> + + <li class="indx">Hey, <a href="#Page_23">23</a></li> + + <li class="indx">Hill, John, <a href="#Page_1">1</a>, <a href="#Page_8">8</a>, <a href="#Page_29">29</a></li> + + <li class="indx">Hirschberg, of Berlin, <a href="#Page_185">185</a></li> + + <li class="indx">Hogg, E., <a href="#Page_181">181</a></li> + + <li class="indx">Horner, Professor, of Zurich, <a href="#Page_155">155</a></li> + + <li class="indx">Hulke, John Whitaker, <a href="#Page_82">82</a>, <a href="#Page_85">85</a>, <a href="#Page_106">106</a>, <a href="#Page_109">109</a></li> + <li class="isub1">microscopical and scientific work, <a href="#Page_111">111</a>, <a href="#Page_112">112</a></li> + <li class="isub1">career, <a href="#Page_124">124–125</a></li> + <li class="isub1">and the perimeter, <a href="#Page_129">129</a>, <a href="#Page_135">135</a>, <a href="#Page_147">147</a>, <a href="#Page_177">177</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Hutchinson, Sir Jonathan, <a href="#Page_109">109</a>, <a href="#Page_112">112</a></li> + <li class="isub1">work on inherited syphilis, <a href="#Page_122">122–123</a>, <a href="#Page_130">130</a></li> + <li class="isub1">on tobacco amaurosis, <a href="#Page_148">148–149</a> 151, <a href="#Page_159">159</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Hypermetropia, <a href="#Page_113">113</a></li> + +<li class="abet"><span class="alpha"><a id="IX_I"></a><a href="#alpha-table">I</a></span></li> + <li class="ifrst">Inquiry officer, <a href="#Page_179">179</a></li> + + <li class="indx">Iriddesis, <a href="#Page_90">90–91</a></li> + + <li class="indx">Iris, essay on inflammation of, <a href="#Page_19">19</a></li> + +<li class="abet"><span class="alpha"><a id="IX_J"></a><a href="#alpha-table">J</a></span></li> + <li class="indx">Jackson, Dr. Hughlings, <a href="#Page_109">109</a>, <a href="#Page_130">130</a>, <a href="#Page_205">205</a></li> + + <li class="indx">Jacksonian Prize Essay, for 1859, <a href="#Page_111">111</a></li> + <li class="isub1">for 1878, <a href="#Page_142">142</a></li> + + <li class="indx">Jaeger, Edward von, <a href="#Page_117">117</a>, <a href="#Page_160">160</a></li> + + <li class="indx">Janin, <a href="#Page_44">44</a></li> + + <li class="indx">Jeafferson, <a href="#Page_37">37</a></li> + + <li class="indx">Jones, Wharton, <a href="#Page_102">102</a>, <a href="#Page_115">115</a>, <a href="#Page_127">127</a></li> + + <li class="indx"><i>Journal of Morbid Anatomy, etc</i>., <a href="#Page_71">71</a></li> + + <li class="indx">Jussieu, Joseph de, <a href="#Page_164">164</a></li> + +<li class="abet"><span class="alpha"><a id="IX_K"></a><a href="#alpha-table">K</a></span></li> + <li class="ifrst">Kemp, William, <a href="#Page_174">174</a></li> + + <li class="indx">Kensington, Henry, <a href="#Page_14">14</a></li> + + <li class="indx">Kent, the Duchess of, <a href="#Page_67">67</a>, <a href="#Page_68">68</a></li> + + <li class="indx">Kepler, <a href="#Page_114">114</a></li> + + <li class="indx">King Edward VII., <a href="#Page_208">208</a></li> + + <li class="indx">King Edward’s Hospital Fund, <a href="#Page_195">195</a>, <a href="#Page_214">214</a></li> + + <li class="indx">King George I., oculist to, <a href="#Page_10">10</a></li> + + <li class="indx">King George II., oculist to, <a href="#Page_10">10</a></li> + + <li class="indx">King George III., oculist to, <a href="#Page_11">11</a>, <a href="#Page_15">15</a></li> + + <li class="indx">King William IV., oculist to, <a href="#Page_31">31</a></li> + + <li class="indx">Koller, Karl, <a href="#Page_164">164</a></li> + +<li class="abet"><span class="alpha"><a id="IX_L"></a><a href="#alpha-table">L</a></span></li> + <li class="ifrst">Ladies’ Working Guild, <a href="#Page_197">197–198</a></li> + + <li class="indx">Lancet, <a href="#Page_46">46</a>, <a href="#Page_56">56</a>, <a href="#Page_58">58</a>, <a href="#Page_59">59</a>, <a href="#Page_202">202</a></li> + + <li class="indx">Lander, the hospitals surveyor, <a href="#Page_170">170</a>, <a href="#Page_172">172</a></li> + + <li class="indx">Lang, William, <a href="#Page_164">164</a>, <a href="#Page_204">204</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Laquer, <a href="#Page_131">131</a></li> + + <li class="indx">Lawford, J. B. , <a href="#Page_162">162</a>, <a href="#Page_177">177</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Lawrence, Sir William, treatment of eye diseases at general hospitals, <a href="#Page_7">7</a>, <a href="#Page_33">33</a>, <a href="#Page_37">37</a></li> + <li class="isub1">the withdrawal of blood, <a href="#Page_40">40–41</a></li> + <li class="isub1">history of ophthalmology, <a href="#Page_43">43–44</a></li> + <li class="isub1">estimates of, <a href="#Page_44">44</a></li> + <li class="isub1">and venereal diseases of the eye, <a href="#Page_45">45–46</a>, <a href="#Page_54">54</a>, <a href="#Page_55">55</a></li> + <li class="isub1">and <i>Lancet</i>, <a href="#Page_58">58–59</a>, <a href="#Page_61">61</a></li> + <li class="isub1">influence of one eye on the other, <a href="#Page_86">86</a></li> + <li class="isub1">obstruction of tear duct, <a href="#Page_88">88</a>, <a href="#Page_114">114</a>, <a href="#Page_123">123</a>, <a href="#Page_151">151</a>, <a href="#Page_209">209</a>, + <a href="#Page_218">218</a></li> + + <li class="indx">Lawson, Sir Arnold, <a href="#Page_200">200</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Lawson, George, <a href="#Page_109">109</a></li> + <li class="isub1">his career, <a href="#Page_124">124</a>, <a href="#Page_125">125</a>, <a href="#Page_157">157</a></li> + <li class="isub1">treatment of out-patients, <a href="#Page_177">177</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Leber, Professor, <a href="#Page_139">139</a></li> + + <li class="indx">Leeches, <a href="#Page_41">41</a></li> + + <li class="indx">Lenses, system of numbering, <a href="#Page_116">116</a></li> + + <li class="indx">Library, <a href="#Page_72">72</a></li> + + <li class="indx">Lighting of new Hospital, <a href="#Page_184">184</a></li> + + <li class="indx">Lister, Joseph, <a href="#Page_152">152</a></li> + + <li class="indx">Lister, Sir William T., <a href="#Page_206">206</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Liston, Robert, <a href="#Page_82">82</a></li> + + <li class="indx">Little Portland Street, Infirmary in, <a href="#Page_31">31</a></li> + + <li class="indx">Livingstone, <a href="#Page_98">98</a></li> + + <li class="indx">Lubbock, Sir John, <a href="#Page_145">145</a>, <a href="#Page_170">170</a>, <a href="#Page_191">191</a>, <a href="#Page_217">217</a></li> + + <li class="indx">Lyell, Robert, <a href="#Page_150">150</a>, <a href="#Page_218">218</a></li> + +<li class="abet"><span class="alpha"><a id="IX_M"></a><a href="#alpha-table">M</a></span></li> + <li class="ifrst">MacCallan, A. F. , <a href="#Page_187">187</a></li> + + <li class="indx">Macgregor, Patrick, <a href="#Page_6">6</a></li> + + <li class="indx">McHardy, Malcolm, <a href="#Page_185">185</a></li> + + <li class="indx">McKenzie, H. V. , <a href="#Page_187">187</a></li> + + <li class="indx">Mackenzie, of Glasgow, <a href="#Page_82">82</a>, <a href="#Page_126">126</a></li> + + <li class="indx">Mackenzie, Sir Stephen, <a href="#Page_160">160</a>, <a href="#Page_215">215</a></li> + + <li class="indx">McKeown, of Belfast, <a href="#Page_185">185</a></li> + + <li class="indx">Mackmurdo, Gilbert, <a href="#Page_64">64</a>, <a href="#Page_73">73</a>, <a href="#Page_74">74</a>, <a href="#Page_79">79</a>, <a href="#Page_106">106</a>, + <a href="#Page_218">218</a></li> + + <li class="indx">Mackmurdo, H. H. , <a href="#Page_81">81</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Maddox, of Bournemouth, <a href="#Page_201">201</a></li> + + <li class="indx">Madras Eye Infirmary, <a href="#Page_37">37</a></li> + + <li class="indx">Magnet operations, <a href="#Page_125">125</a>, <a href="#Page_187">187</a></li> + + <li class="indx">Maitre-Jan, <a href="#Page_44">44</a></li> + + <li class="indx">Mansion House, sale at, <a href="#Page_64">64</a></li> + + <li class="indx">Marshall, C. D. , <a href="#Page_156">156</a>, <a href="#Page_205">205</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Martin, Dr. Robert, <a href="#Page_106">106</a>, <a href="#Page_129">129</a>, <a href="#Page_160">160</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Massachusetts Charitable Eye and Ear Infirmary, <a href="#Page_36">36</a></li> + + <li class="indx">Medical Council, formation of, <a href="#Page_108">108–109</a></li> + + <li class="indx">Medical-legal observations, <a href="#Page_120">120</a></li> + + <li class="indx">Mellish, William, <a href="#Page_47">47</a>, <a href="#Page_49">49</a>, <a href="#Page_64">64</a>, <a href="#Page_68">68</a>, <a href="#Page_69">69</a>, + <a href="#Page_215">215</a></li> + + <li class="indx">Milles, W. Jennings, <a href="#Page_142">142</a></li> + + <li class="indx">Missionaries, admitted to study at Hospital, <a href="#Page_98">98</a></li> + + <li class="indx">Mogford, J., <a href="#Page_138">138</a>, <a href="#Page_220">220</a></li> + + <li class="indx">Moorfields, <a href="#Page_48">48–53</a></li> + + <li class="indx">“Moorfields Club,” <a href="#Page_161">161</a></li> + + <li class="indx">Morax-Axenfeld bacillus, <a href="#Page_163">163</a></li> + + <li class="indx">Morton, A. Stanford, after-treatment of cataract operations, <a href="#Page_153">153</a>, <a href="#Page_156">156</a>, <a href="#Page_177">177</a></li> + <li class="isub1">his ophthalmoscopic drawings, <a href="#Page_178">178</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Muscles of eye, paralytic affections of, <a href="#Page_127">127</a></li> + + <li class="indx">Myopia, <a href="#Page_114">114</a></li> + +<li class="abet"><span class="alpha"><a id="IX_N"></a><a href="#alpha-table">N</a></span></li> + <li class="ifrst">Nagel, <a href="#Page_116">116</a></li> + + <li class="indx">Nettleship, Edward, <a href="#Page_139">139</a></li> + <li class="isub1">appointed curator, <a href="#Page_140">140</a>, <a href="#Page_148">148</a>, <a href="#Page_150">150</a>, <a href="#Page_151">151</a></li> + <li class="isub1">his scientific work, <a href="#Page_180">180</a>, <a href="#Page_205">205</a>, <a href="#Page_210">210</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Newman, Sir George, <a href="#Page_206">206</a></li> + + <li class="indx">Newstead, Robert J., <a href="#Page_138">138</a>, <a href="#Page_181">181</a>, <a href="#Page_220">220</a></li> + + <li class="indx">New York Eye and Ear Infirmary, <a href="#Page_35">35</a></li> + + <li class="indx">Nightingale, Miss Florence, <a href="#Page_105">105</a>, <a href="#Page_134">134–153</a></li> + + <li class="indx">Nunn, T. N. , <a href="#Page_81">81</a></li> + + <li class="indx">Nurses, Queen Victoria’s Jubilee Institute of, <a href="#Page_201">201</a></li> + + <li class="indx">Nursing, changes in, <a href="#Page_165">165</a>, <a href="#Page_166">166</a></li> + + <li class="indx">Nursing, School of, <a href="#Page_200">200</a></li> + +<li class="abet"><span class="alpha"><a id="IX_O"></a><a href="#alpha-table">O</a></span></li> + <li class="ifrst">O’Ferrall, of Dublin, <a href="#Page_86">86</a></li> + + <li class="indx">Ophthalmological Society, <a href="#Page_145">145</a>, <a href="#Page_149">149</a>, <a href="#Page_161">161</a></li> + + <li class="indx">Ophthalmoscope, discovery of, <a href="#Page_99">99</a></li> + + <li class="indx">Osler, Sir William, <a href="#Page_142">142</a></li> + +<li class="abet"><span class="alpha"><a id="IX_P"></a><a href="#alpha-table">P</a></span></li> + <li class="ifrst">Paget, Sir James, <a href="#Page_44">44</a></li> + + <li class="indx">Palmerston, Lord, <a href="#Page_30">30</a></li> + + <li class="indx">Parsons, Sir John, <a href="#Page_206">206</a>, <a href="#Page_219">219</a></li> + + <li class="indx">Pasteur, <a href="#Page_161">161</a>, <a href="#Page_212">212</a></li> + + <li class="indx">Pay beds, report on, <a href="#Page_214">214</a></li> + + <li class="indx">Pearson, Karl, <a href="#Page_180">180</a></li> + + <li class="indx">Peel, Mrs., <a href="#Page_165">165</a></li> + + <li class="indx">Peerless Pool, <a href="#Page_174">174–175</a></li> + + <li class="indx">Peerless Street, <a href="#Page_173">173</a></li> + + <li class="indx">Peninsular War, <a href="#Page_39">39</a></li> + + <li class="indx">Perimetry, <a href="#Page_129">129</a></li> + + <li class="indx">Periscope, <a href="#Page_128">128</a>, <a href="#Page_148">148</a>, <a href="#Page_149">149</a></li> + + <li class="indx">Pharmacopœia, <a href="#Page_72">72</a></li> + + <li class="indx">Phillips, T., <a href="#Page_199">199</a></li> + + <li class="indx">Phillips, Thomas, R.A., <a href="#Page_72">72</a>, <a href="#Page_73">73</a></li> + + <li class="indx">Price, Sir Charles, <a href="#Page_15">15</a>, <a href="#Page_21">21</a>, <a href="#Page_39">39</a>, <a href="#Page_47">47</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Price, Ralph, <a href="#Page_61">61</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Prichard, of Bristol, <a href="#Page_87">87</a></li> + + <li class="indx">Prince and Princess of Wales, <a href="#Page_181">181</a>, <a href="#Page_208">208</a></li> + + <li class="indx">Prince of Wales’ Hospital fund, <a href="#Page_195">195</a></li> + + <li class="indx">Poor Law children and ophthalmia, <a href="#Page_140">140</a>, <a href="#Page_141">141</a></li> + +<li class="abet"><span class="alpha"><a id="IX_Q"></a><a href="#alpha-table">Q</a></span></li> + <li class="ifrst">Queen Alexandra, <a href="#Page_208">208</a></li> + + <li class="indx">Queen Anne, oculist to, <a href="#Page_10">10</a></li> + + <li class="indx">Queen Victoria, <a href="#Page_39">39</a>, <a href="#Page_46">46</a>, <a href="#Page_69">69</a>, <a href="#Page_177">177</a>, <a href="#Page_207">207</a></li> + +<li class="abet"><span class="alpha"><a id="IX_R"></a><a href="#alpha-table">R</a></span></li> + <li class="indx">Railway termini, <a href="#Page_132">132</a>, <a href="#Page_133">133</a></li> + + <li class="indx">Rating and Valuation Bill, <a href="#Page_194">194</a></li> + + <li class="indx">Rating of new Hospital, <a href="#Page_193">193</a>, <a href="#Page_194">194</a></li> + + <li class="indx">Rawson, Sir William, <a href="#Page_30">30</a></li> + + <li class="indx">Read, Sir William, <a href="#Page_9">9</a>, <a href="#Page_10">10</a></li> + + <li class="indx">Reports, Ophthalmic Hospital, <a href="#Page_119">119</a></li> + <li class="isub1">colour of paper in, <a href="#Page_127">127</a></li> + + <li class="indx">Retinal arteries, changes in, <a href="#Page_203">203</a></li> + + <li class="indx">Retinoscopy, <a href="#Page_159">159</a></li> + + <li class="indx">Reynolds, Dr. Edward, <a href="#Page_35">35</a></li> + + <li class="indx">Rheumatic affections of the eyes, <a href="#Page_204">204</a></li> + + <li class="indx">Richardson, R., <a href="#Page_37">37</a></li> + + <li class="indx">Robertson, Miss Ada, <a href="#Page_180">180</a></li> + + <li class="indx">Robertson, Dr. Argyll, <a href="#Page_131">131</a></li> + + <li class="indx">Rodgers, Dr. J. Kearney, <a href="#Page_35">35</a></li> + + <li class="indx">Roman Emperors, <a href="#Page_43">43</a></li> + + <li class="indx">Röntgen, Professor, <a href="#Page_186">186</a></li> + + <li class="indx">Royal Westminster Ophthalmic Hospital, <a href="#Page_15">15</a></li> + +<li class="abet"><span class="alpha"><a id="IX_S"></a><a href="#alpha-table">S</a></span></li> + <li class="ifrst">St. Ives, <a href="#Page_44">44</a></li> + + <li class="indx">Sambrooke, F. G. , <a href="#Page_117">117</a>, <a href="#Page_137">137</a>, <a href="#Page_138">138</a>, <a href="#Page_217">217</a></li> + + <li class="indx">Saunders, John Cunningham, early life, <a href="#Page_1">1</a></li> + <li class="isub1">association with Astley Cooper, <a href="#Page_2">2–6</a>, <a href="#Page_11">11</a></li> + <li class="isub1">proposal to start dispensary, <a href="#Page_11">11–14</a>, <a href="#Page_16">16</a></li> + <li class="isub1">and diseases of the ear, <a href="#Page_17">17–19</a></li> + <li class="isub1">operation for congenital cataract, <a href="#Page_19">19–24</a></li> + <li class="isub1">death of, <a href="#Page_25">25</a>, <a href="#Page_26">26</a>, <a href="#Page_28">28</a>, <a href="#Page_29">29</a>, <a href="#Page_32">32</a>, <a href="#Page_49">49</a>, + <a href="#Page_57">57</a>, <a href="#Page_60">60</a>, <a href="#Page_81">81</a>, <a href="#Page_118">118</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Saunderian Institution, <a href="#Page_56">56</a>, <a href="#Page_57">57</a>, <a href="#Page_70">70</a></li> + + <li class="indx">Saunders, Mrs., <a href="#Page_26">26</a></li> + + <li class="indx">Savory, Sir William, <a href="#Page_44">44</a></li> + + <li class="indx">Scarpa, <a href="#Page_23">23</a>, <a href="#Page_28">28</a></li> + + <li class="indx">Schmidt, <a href="#Page_44">44</a></li> + + <li class="indx">School-children, sight-testing of, <a href="#Page_206">206</a>, <a href="#Page_207">207</a></li> + + <li class="indx">School of Ophthalmology, opening of, <a href="#Page_34">34</a></li> + + <li class="indx">Schweizer, <a href="#Page_110">110</a></li> + + <li class="indx">Scott, John, <a href="#Page_61">61</a>; monograph on cataract, <a href="#Page_62">62</a>, <a href="#Page_64">64</a></li> + <li class="isub1">obituary notice, <a href="#Page_65">65</a>; 74, <a href="#Page_75">75</a>, <a href="#Page_77">77</a>, <a href="#Page_81">81</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Sedgwick, Harry, <a href="#Page_47">47</a></li> + <li class="isub1">trust fund, <a href="#Page_117">117</a>, <a href="#Page_118">118</a>, <a href="#Page_196">196</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Shepherdess Walk, <a href="#Page_175">175</a>, <a href="#Page_176">176</a></li> + + <li class="indx">Silcock, A. Quarry, <a href="#Page_167">167</a>, <a href="#Page_206">206</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Simpson, Sir Janies, <a href="#Page_82">82</a></li> + + <li class="indx">Smee, Alfred, <a href="#Page_116">116</a>, <a href="#Page_133">133</a></li> + + <li class="indx">Smirke, Sir Robert, <a href="#Page_49">49</a>, <a href="#Page_51">51</a>, <a href="#Page_53">53</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Smith, Priestley, <a href="#Page_139">139</a>, <a href="#Page_142">142</a></li> + + <li class="indx">Snell, of Sheffield, <a href="#Page_185">185</a></li> + + <li class="indx">Snellen, of Utrecht, <a href="#Page_117">117</a></li> + + <li class="indx">Soemerring, <a href="#Page_44">44</a></li> + + <li class="indx">South African War, <a href="#Page_193">193</a>, <a href="#Page_208">208</a></li> + + <li class="indx">Spicer, W. T. Holmes, <a href="#Page_180">180</a>, <a href="#Page_201">201</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Squint, operation for, <a href="#Page_87">87</a></li> + + <li class="indx">Squints, latent, <a href="#Page_201">201</a></li> + + <li class="indx">Stanley, Edward, <a href="#Page_45">45</a></li> + + <li class="indx">Stephenson, Sydney, <a href="#Page_141">141</a></li> + + <li class="indx">Stevens, of New York, <a href="#Page_201">201</a></li> + + <li class="indx">Stevenson, John, <a href="#Page_22">22</a>, <a href="#Page_28">28</a>, <a href="#Page_30">30</a>, <a href="#Page_31">31</a>, <a href="#Page_33">33</a></li> + + <li class="indx">Streatfield, J. F. , <a href="#Page_106">106</a>; his career, <a href="#Page_107">107–108</a></li> + <li class="isub1">editor of the Reports, <a href="#Page_119">119</a>, <a href="#Page_125">125</a>, <a href="#Page_127">127</a>, <a href="#Page_135">135</a>, <a href="#Page_136">136</a></li> + <li class="isub1">gigantic model of eye, <a href="#Page_166">166</a>, <a href="#Page_218">218</a></li> + +<li class="abet"><span class="alpha"><a id="IX_T"></a><a href="#alpha-table">T</a></span></li> + <li class="indx">Tarsus, excision of, <a href="#Page_22">22</a>, <a href="#Page_29">29</a></li> + + <li class="indx">Tay, Waren, <a href="#Page_146">146</a>, <a href="#Page_148">148</a>, <a href="#Page_151">151</a>, <a href="#Page_162">162</a>, <a href="#Page_206">206</a>, + <a href="#Page_218">218</a></li> + + <li class="indx">Taylor, “Chevalier,” <a href="#Page_10">10</a></li> + + <li class="indx">Taylor, Dr. James, <a href="#Page_205">205</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Teale, Pridgin, jun., <a href="#Page_88">88</a></li> + + <li class="indx">Tear duct, operations on, <a href="#Page_88">88</a></li> + <li class="isub1">affections of, <a href="#Page_152">152</a></li> + + <li class="indx">Tobacco, amaurosis due to, <a href="#Page_148">148</a></li> + + <li class="indx">Travers, Benjamin, <a href="#Page_33">33</a></li> + <li class="isub1">early career of, <a href="#Page_34">34</a></li> + <li class="isub1">and East India Company, <a href="#Page_36">36–37</a></li> + <li class="isub1">his treatise on eye diseases, <a href="#Page_38">38</a>, <a href="#Page_42">42</a>, <a href="#Page_59">59</a>, <a href="#Page_64">64</a>, <a href="#Page_70">70</a>, + <a href="#Page_218">218</a></li> + + <li class="indx">Travers, Benjamin, sen., <a href="#Page_13">13</a></li> + + <li class="indx">Tubercle of the eye, <a href="#Page_140">140</a>, <a href="#Page_162">162</a></li> + + <li class="indx">Tweedy, Sir John, <a href="#Page_149">149</a>, <a href="#Page_157">157</a></li> + <li class="isub1">career of, <a href="#Page_202">202–203</a>, <a href="#Page_206">206</a></li> + <li class="isub1">starts rent fund, <a href="#Page_208">208</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Tyrrell, Frederick, <a href="#Page_45">45</a>, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li> + <li class="isub1">and Wakley, <a href="#Page_58">58–59</a></li> + <li class="isub1">description of, <a href="#Page_62">62–63</a>, <a href="#Page_64">64</a>, <a href="#Page_65">65</a>, <a href="#Page_74">74</a>, <a href="#Page_76">76</a>, <a href="#Page_104">104</a>, + <a href="#Page_114">114</a>, <a href="#Page_218">218</a></li> + + <li class="indx">Tyrrell, John, <a href="#Page_48">48</a>, <a href="#Page_50">50</a></li> + + <li class="indx">Tyrrell, Timothy, <a href="#Page_48">48</a>, <a href="#Page_50">50</a></li> + + <li class="indx">Tyrrell, Walter, <a href="#Page_106">106</a>, <a href="#Page_109">109</a></li> + +<li class="abet"><span class="alpha"><a id="IX_U"></a><a href="#alpha-table">U</a></span></li> + <li class="ifrst">Usher, C. H. , <a href="#Page_180">180</a></li> + +<li class="abet"><span class="alpha"><a id="IX_V"></a><a href="#alpha-table">V</a></span></li> + <li class="ifrst">Venereal diseases of the eye, <a href="#Page_45">45</a></li> + + <li class="indx">Ventilation of new Hospital, <a href="#Page_182">182–183</a></li> + + <li class="indx">Vernon, Bowater, <a href="#Page_139">139</a></li> + + <li class="indx">Vetch, Dr., <a href="#Page_7">7</a></li> + + <li class="indx">Victoria, H.R.H. the Princess, <a href="#Page_67">67–68</a></li> + +<li class="abet"><span class="alpha"><a id="IX_W"></a><a href="#alpha-table">W</a></span></li> + <li class="ifrst">Wakley, Thomas, <a href="#Page_58">58</a>, <a href="#Page_59">59</a>, <a href="#Page_60">60</a></li> + + <li class="indx">Walton, Haynes, <a href="#Page_82">82</a></li> + + <li class="indx">Ware, James, <a href="#Page_11">11</a>, <a href="#Page_20">20</a>, <a href="#Page_28">28</a>, <a href="#Page_113">113</a>, <a href="#Page_212">212</a></li> + + <li class="indx">Wassermann, <a href="#Page_212">212</a></li> + + <li class="indx">Wathen, Dr., <a href="#Page_11">11</a>, <a href="#Page_15">15</a>, <a href="#Page_31">31</a></li> + + <li class="indx">Weber, Adolph, <a href="#Page_131">131</a></li> + + <li class="indx">Weekes, Henry, bust of Saunders by, <a href="#Page_32">32</a>, <a href="#Page_118">118</a></li> + + <li class="indx">Wells, J. Soelberg, <a href="#Page_109">109</a></li> + <li class="isub1">and sight-testing, <a href="#Page_115">115</a></li> + <li class="isub1">description of, <a href="#Page_127">127–128</a> 136, <a href="#Page_147">147</a></li> + <li class="isub1">his treatise on diseases of the eye, <a href="#Page_149">149–150</a>, <a href="#Page_152">152</a>, <a href="#Page_199">199</a>, <a href="#Page_212">212</a>, + <a href="#Page_218">218</a></li> + + <li class="indx">Women become eligible as pupils and clinical assistants, <a href="#Page_179">179</a></li> + + <li class="indx">Wyndham, Sir Charles, <a href="#Page_208">208</a></li> + +<li class="abet"><span class="alpha"><a id="IX_X"></a><a href="#alpha-table">X</a></span></li> + <li class="ifrst">X-rays, <a href="#Page_186">186</a></li> + +<li class="abet"><span class="alpha"><a id="IX_Y"></a><a href="#alpha-table">Y</a></span></li> + <li class="indx">York, H.R.H. the Duke of, <a href="#Page_30">30</a>, <a href="#Page_49">49</a>, <a href="#Page_67">67</a></li> + + <li class="indx">York Hospital, Chelsea, <a href="#Page_29">29</a></li> + + <li class="indx">Young, Keith, <a href="#Page_172">172</a>, <a href="#Page_190">190</a>, <a href="#Page_215">215</a></li> + + <li class="indx">Young, Thomas, <a href="#Page_114">114</a></li> + +<li class="abet"><span class="alpha"><a id="IX_Z"></a><a href="#alpha-table">Z</a></span></li> + <li class="ifrst">Zinn, Professor, <a href="#Page_44">44</a></li> +</ul> + + +<p>H. K. Lewis and Co., Ltd., 28, Gower Place, London, W.C.1.</p> +<div style='text-align:center'>*** END OF THE PROJECT GUTENBERG EBOOK 78625 ***</div> +</body> +</html> |