CHAPTER I. The Founders and Foundation

THE FOUNDERS AND FOUNDATION

In the board room of the Royal London Ophthalmic Hospital hangs a framed document in which the names of Saunders, Farre, and Battley are associated as being the first promoters of the institution.

Who were these three men? What brought them together? And how came they to establish an institution unlike any which had previously existed?

John Cunningham Saunders was born and bred in Devonshire; he first saw the light of day at Levistone on October 10th, 1773. He went to school at Tavistock and South Molton, and at the age of seventeen commenced a five years’ apprenticeship to Mr. John Hill, surgeon, of Barnstaple. It was during his apprenticeship that he had his first introduction to ophthalmic surgery, for Mr. Hill, though only a country practitioner, was bold enough in those pre-anæsthetic days to operate for cataract. It was from him also that Saunders first learnt the value of the use of belladonna for dilatation of the pupil. William Adams, who also became an ophthalmic surgeon, was likewise a pupil of Mr. John Hill, but of him more anon.

Saunders, at the expiration of his apprenticeship, came to London to complete his medical education at the then combined borough schools of St. Thomas’s and Guy’s Hospitals. The skill and diligence which he displayed in the dissecting room, together with his deftness as a draftsman, soon attracted the attention of Astley Cooper, who was then rapidly rising into fame. On Cooper’s election to the chair of anatomy in 1797, he offered to take Saunders into his house and make him a demonstrator of anatomy on the terms shown in the following letter:

“Dear Sir,

“I ought long since to have informed you of my plan for the winter, so far as it concerns you, and as I have been able to decide.

“It is my wish that you should lodge and board in my house. I have informed you that I live in a plain and economical style, and that you are only to expect a joint of meat and a pudding; if this will satisfy you, a bed will be ready whenever you return to London.

“I can say nothing about the salary you are to receive, for I have not been able to form any idea of what will be proper, or how much you may expect; all I can say is that the sum shall be annually increased, which at the same time as it may act as a stimulus to you, and make it an object to proceed in your career, will be more convenient to myself, because, if no stroke of adverse fortune prevents it, my income must be yearly improving.

“It is my wish that you should dissect for lecture-work in Comparative Anatomy, and assist in my preparations. With respect to the first of these, the labour is certain, and all other occupations and objects must yield to it; with regard to the latter, the quantum of employment shall be guided by your feelings. It is a duty I have performed, without injury to my health, with much amusement, and great advantage.

“I am in hopes that you will have no objection to giving me three months’ information if any other pursuit should lead you to quit the situation, as otherwise, I may be unable to procure a substitute, and suffer great inconvenience from the want of one.”

Saunders accepted the offer, and was shortly afterwards appointed the demonstrator of anatomy at St. Thomas’s Hospital. His association with Astley Cooper proved an exceedingly happy one, he on several occasions being entrusted with the charge of Cooper’s patients during his absence in the country. Saunders was evidently a good teacher, and possessed of a most attractive personality, so that he became exceedingly popular with the students, who on several occasions presented him with pieces of plate as a token of their regard.

John Richard Farre was two years younger than Saunders, being born in Barbados in 1775, where he was educated, and commenced the study of medicine under his father. He came to England in 1792 to complete his studies at St. Thomas’s and Guy’s Hospitals. The commencement of his acquaintance with Saunders and Battley may best be given in his own words:

“In 1792 I entered as a dresser at Guy’s Hospital. At that time Sir Astley Cooper had, by his open manner, become well known among the pupils, but I was not intimate with him, until after my return, in 1794, from the expedition in which I served under Lord Moria. I then became more particularly acquainted with him in the following manner.

“About the year 1798, Sir Astley excited great zeal in the prosecution of minute anatomy, and the order of the day became the injection of the absorbents, and the dissection of parts concerned in operations, especially those of hernia. It was at this time that my acquaintance commenced with Mr. Saunders and Mr. Battley, who were both engaged in the dissecting room. So earnest were we all in the pursuit of the subjects above described, that Mr. Saunders and myself became jaundiced, in consequence of the continually constrained position to which we were subjected, while leaning over bodies under dissection.

“Mr. Saunders also suffered from a punctured wound of the finger received while dissecting, which was followed by extensive inflammation of the arm; nor did this subside until nearly two hundred leeches had been applied.”

Richard Battley was older than his two friends, having been born at Wakefield in 1770; he was educated at the Grammar School there, and subsequently became the pupil of a physician in that town. For a while he studied at the Infirmary in Newcastle-on-Tyne, and came to London in 1795. Entering as a pupil at St. Thomas’s Hospital at the same time as Saunders, a close and lasting intimacy sprang up between the two men.

Having thus brought these three men together from Devonshire, Bermuda, and Wakefield to the dissecting room at St. Thomas’s Hospital, it next becomes necessary to trace the circumstances which led them to start the “London Dispensary for Curing Diseases of the Eye and Ear,” the name by which the present “Royal London Ophthalmic Hospital” was first known.

In 1800, when twenty-seven years of age, Saunders became anxious about his future prospects. His ambition prompted him with the desire to practise as a surgeon in London; probably also about this time influences began to work which made him desire to settle down with an assured income, so that he might enter into the state of matrimony. There was little prospect of his obtaining any higher appointment than that of demonstrator of anatomy in the hospital at which he was working, the custom in the old-established hospitals at that time being to select for the staff appointments a pupil of one of their surgeons, and one who had been articled at the Royal College of Surgeons for at least six years. Saunders had not been so articled, having served his apprenticeship in the country. He was not, therefore, eligible to compete against those who had proceeded in the recognised manner, no matter how great his merits. This was pointed out to him by Astley Cooper, who advised him in his own interests to seek some other means of support. Saunders then resigned his post as demonstrator of anatomy and took over the practice of a surgeon in Gravesend.

Astley Cooper, however, soon began to miss his able assistant, and found that the other arrangements he had made, which had to some extent caused Saunders to take offence, did not work smoothly. He therefore wrote him the following letter, and induced Saunders’ friend Battley to go to Gravesend to use his influence in persuading him to resume his old post:

“LONDON,

“July 28th, 1801.

“Dear Sir,

“I have so often explained my reasons for the change which I made last winter at the Hospital, that I consider it as almost unnecessary to say anything further upon the subject. The trial has been made; Mr. D——has been weighed against you in the balance, and been found wanting.

“His excessive vanity has disgusted, his want of perseverance has disappointed me, and I feel most thoroughly convinced that his abilities are inadequate to the task which has been assigned to him.

“I felt it my duty to act as I have done, and my conduct, I fear, has been the cause of uneasiness to you; but as our separation was not the effect of misconduct upon your part, or of any disapprobation on mine, I hope we shall be again united in the pursuit of medical science, and that we shall entertain for each other that respect and esteem which I must ever feel for you.

“As I told you in our last conversation, I have ever felt a degree of veneration for your acquirements and abilities, which has made me diffident in expressing my wishes. But as you have now courted it, I will say, that I have wished to see you join in the debates of Guy’s Medical Society. The capability of expressing our ideas in public is a source of more power than anything with which I am acquainted. It is the road to bring a public teacher to character and to fortune.

“Secondly, I should much wish for your assistance in making experiments upon animals. I am certain that everything valuable in physiology is only to be so obtained. What is every day under observation of the senses is well known, but few men have sufficient knowledge of anatomy to be capable of making the interior parts of the body the subject of inquiry.

“Thirdly, you will do me a favour by making my collection in comparative anatomy more complete. This, I am aware, is the greatest favour I can ask, as you are neither captivated by its splendour nor convinced of its utility; but as I have embarked on it, you will confer an obligation upon me by assisting me in making it complete.

“I shall endeavour to make your situation comfortable in a pecuniary point of view, but I had rather make that the subject of conversation when I see you.

“I am, dear Sir,

“Yours, with the utmost esteem,

“A. C. ”

Battley had a high appreciation of his friend’s talents, and felt strongly that they would not have sufficient scope in such a confined sphere as Gravesend. The combined effect of his persuasive influence, and of Cooper’s letter, ultimately induced Saunders to resume the duties of demonstrator of anatomy at St. Thomas’s.

Shortly afterwards he took a house in Ely Place, with the intention of practising as a surgeon, and on April 7th, 1803, married Miss Jane Louisa Colkett.

During the last years of the eighteenth and the first years of the nineteenth centuries England was at war with France. Farre, in 1793, went with Lord Moira’s expedition to France, returning, however, to London on its failure. Battley for a time served in the Navy as an assistant surgeon, and was present at several engagements under Sir Sidney Smith.

In 1799 Napoleon invaded Egypt, and after the destruction of his fleet by Nelson at the Battle of the Nile, English troops under Sir Ralph Abercrombie were landed at Aboukir, in 1800. Almost all were attacked by what was called “Egyptian ophthalmia,” but which we now know must have been a mixed infection of purulent ophthalmia and trachoma. After the evacuation of Egypt by the English in 1803, the troops were disbanded, and spread this very infectious form of eye disease in all the stations at which they stopped and throughout Great Britain.

Mr. Patrick Macgregor, surgeon to the Royal Military Asylum, writes of the effects of the disease in the Army as follows:

“The progress of the ophthalmia since its first introduction into this country in the year 1800 has, in the Army, been very rapid and extensive, and has at different periods materially interfered with its discipline and efficiency. It has crippled many of our best regular regiments to such a degree as for a time to render them unfit for service; and though the regiments which were in Egypt have, in general, suffered most from the disease, yet it has prevailed extensively in others which have never served in that country.”

The terribly destructive character of the disease may be shown by its effects on the second battalion of the 52nd Light Infantry, which are recorded by Dr. Vetch: out of 636 cases 50 were dismissed with the loss of both eyes, and 40 with that of one.

The spread of the disease was not confined to the Army, but extended widely throughout the country in the towns and villages, when the disbanded troops returned to their homes carrying infection with them.

That the medical men and the hospitals in this country were badly prepared to deal with such an immense increase in eye diseases may be shown by quoting a description of the condition of things which then existed, written by Sir William Lawrence some thirty years later:

“The diseases of the eye, in general hospitals, are inadequate, from the smallness of their number, to the purposes of practical study, particularly that of exemplifying the various operations. Thus these institutions have been inefficient in reference to this important department. As the general body of surgeons did not understand diseases of the eye, the public naturally resorted to ‘oculists’” [in speaking of “oculists” he refers to those that have bestowed that title on themselves without having had any regular medical training] “who, seeing such cases in greater numbers, became better acquainted with the symptoms, diagnosis, and treatment; and especially more skilful in the operative department. At the same time, the subject, being imperfectly understood, was neglected in the general surgical courses, in which many important affections were entirely unnoticed, and the whole very inadequately explained. Thus students, who resorted to London for the completion of their professional studies, had no means of learning this important department of the profession, which was tacitly abandoned, even by the hospital surgeons, and turned over to the ‘oculists.’ The latter, not being conversant with the principles derived from anatomy, physiology, and general pathology, attended merely to the organ, and relied almost exclusively on what is comparatively of little importance, local treatment. Hence ophthalmic surgery, being in a manner dismembered from the general science, was reduced to a very low ebb. Until within a few years, it was, in this country at least, in a state of almost total darkness.”

It will thus be seen that at the time Saunders established himself as a surgeon in London there was an immense increase in the amount of eye disease, but that very few medical men were in any way trained or competent to deal with it, and scanty, if any, provision was made for its treatment in the hospitals.

Saunders’ attention had early in his career been attracted to diseases of the eye during his apprenticeship under Mr. John Hill, and his studies in the dissecting room had afforded him a sound basis for their treatment, in an intimate knowledge of the anatomy of the organ and its surrounding structures. His association with Astley Cooper had also led him to devote special attention to the anatomy of the ear and to disorders of hearing. Astley Cooper in 1800 made a communication to the Royal Society, on the effects of destruction of the tympanic membrane of the ear. He had found that considerable openings might be made in it without impairment of the hearing power, and was thereby led to perform the operation of puncturing the membrane in cases of deafness resulting from obstruction in the Eustachian tube, with a remarkably good result in the restoration of hearing, in the first cases in which he employed it. Subsequent experience, however, showed it not to be so generally useful as he had originally anticipated. He made a second communication on the same subject in the following year, and in 1802 was elected a Fellow of the Royal Society, and awarded the Copley Medal.

Whilst these papers were being written the subject of them must have been much discussed by Cooper and his assistant Saunders, the latter’s interest in ear disease being thereby awakened.

On starting in practice at Ely Place, Saunders decided to devote himself to the treatment of diseases of the eye and ear, a decision which must have required considerable courage at that time by one who wished to remain of good repute with other members of his profession. Up to that time the treatment of eye diseases had been mainly in the hands of itinerant quacks, who dubbed themselves oculists.

George Coats, who has written an account of the lives and practices of many of these worthies, has well described the condition of things which then existed. He says:

“In the eighteenth century ophthalmology had not yet vindicated, in England, its position as a separate branch of practice. It was the province of a set of ambulant practitioners who toured the country accompanied by all the apparatus of shameless advertisement (including ‘monkies,’ we are told), couching cataracts, and selling infallible salves and eyewashes. This taint of quackery appears to have deterred respectable surgeons from meddling much with the subject; their operative experience was probably small, and the procedure of couching, attended frequently with brilliant immediate, but disastrous after, results, was likely to be performed with fewer scruples by itinerant oculists, here to-day and gone to-morrow, than by settled practitioners who had to abide the consequences of their handiwork.”

Such men were naturally looked upon as charlatans by the medical profession, but that did not prevent them becoming the recipients of royal favours.

One William Read, who commenced life as a tailor, and became a mountebank and itinerant quack oculist, settled in London in 1694, advertising in the Tatler “that he had been thirty-five years in the practice of couching cataracts, taking off all sorts of wens, curing wry necks and hair-lips [sic] without blemish.” In 1705 he was knighted, “as a mark of royal favour for his great services, done in curing great numbers of seamen and soldiers of blindness gratis”; and about the same time was appointed oculist-in-ordinary to Queen Anne. It is stated that the wealth he acquired enabled him to mix with the best literary society of the day. Swift, in writing to Stella, commented on the quality of his punch which he served in golden vessels. One sample of his methods of treatment need only be quoted—“the putting of a louse into the eye when it is dull and obscure, and wanteth humours and spirits. This,” he says, “tickleth and pricketh, so that it maketh the eye moist and rheumatick and quickeneth the spirits.”

On Sir William Read’s death in 1715, his rival, Roger Grant, succeeded to the post of oculist to Queen Anne, and afterwards to George I. Grant, originally a cobbler and later a Baptist minister, lost one eye as a soldier in the service of the German Emperor, and then set up as an oculist in Mouse Alley, Wapping. He advertised profusely in the journals of the day, giving accounts of his cures, with certificates attached from the patients themselves and others.

George II. appointed as his oculist-in-ordinary John Taylor, better known as “Chevalier Taylor,” of whom Coats says:

“Amongst travelling quacks the name of the ‘Chevalier’ Taylor stands pre-eminent for unblushing effrontery, blatant self-laudation, and all the methods of the charlatan, but also for mental endowments far above the average of his tribe, and for real acquaintance with the contemporary state of ophthalmic knowledge. His fame extended to every country in Europe; his boast of having conversed with kings and princes is no idle one; he had an acquaintance, not always felicitous, with some of the best known men, medical and lay, of his time; counting translations and minor works he was the author of nearly fifty books; and in later life he wrote an autobiography, which, if it gives few and unreliable particulars as to his actions, does much to reveal the character of the man.”

The Chevalier’s talents seem to have been hereditary, for his son and two grandsons followed the same line of practice, and were each in turn the recipients of royal favours.

It was with such prating mountebanks that Saunders ran the risk of being confused in devoting himself specially to the treatment of eye diseases. He was not, however, the first reputable medical practitioner in London to specialise in this line of work, having been preceded by both Wathen and James Ware. Dr. Wathen published, in 1785, A Dissertation on the Theory and Cure of Cataract, and held the appointment of oculist to George III. He took Ware when a young man into partnership with him, a partnership which lasted for fourteen years, during which time Ware acquired such a liking for eye work that he decided to devote himself exclusively to it.

Ware, like Saunders, had studied at St. Thomas’s Hospital, and held there the post of demonstrator of anatomy, so it would seem highly probable that his example may have had some influence in determining Saunders to take up surgery of the eye as a special branch of practice.

In 1801 Ware contributed to the Royal Society a paper dealing with the case of a boy of seven years of age upon whom he had operated for cataract, and as the result of this communication he was elected a Fellow of the Royal Society. It was one of Saunders’ most noteworthy achievements, as we shall see later, to introduce an operation for cataract in infants who are born blind.

The suggestion that Saunders should start a special institution for the treatment of diseases of the eye and ear is stated by Battley to have originated with Astley Cooper, whose own experience, in the treatment of diseases of the ear, had shown him what insufficient accommodation the General Hospitals offered for the treatment of diseases of the special organs. As his letters show, he held a very high opinion of Saunders’ professional abilities, and he saw only too clearly that the nature of Saunders’ apprenticeship would prevent him being promoted to any surgical post at either of the Borough Hospitals. Consequently the idea suggested itself to him that a special hospital might be established for diseases of the eye and ear, at which Saunders might find a suitable field for the exercise of his skill and ingenuity.

Before taking any action in the matter, Saunders first sought the advice of the physicians and surgeons of St. Thomas’s and Guy’s Hospitals, and having obtained from them a testimonial of their approbation, on October 1st, 1804, he published the following proposal for instituting “A Dispensary for the Poor afflicted with Diseases of the Eye and Ear,” with their testimonial attached:

“Among the many charitable institutions which mark the wisdom and benevolence of the inhabitants of this Metropolis there is none particularly appropriated to the relief of the poor afflicted with diseases of the Eye and Ear. No diseases which do not affect the life of the patient are more distressing than such as are incident to these organs or demand greater dexterity and skill in their treatment. The structure of the Eye and Ear is so delicate and complex and their irritability under injury so extreme, that they cannot easily be treated but by those who make them the objects of peculiar study and attention. The acknowledged difficulty in the treatment of the diseases to which they are liable has induced a few to separate themselves from the general practice of professional duties and to devote themselves to the exercise of this branch alone, a fact which sufficiently establishes the necessity of making them the objects of a specific institution. Every surgeon must allow that most unremitting care and attention is necessary after some of the capital operations on the eye, and that through the want of it some of the most dexterous operations are frequently defeated. In large hospitals and dispensaries which embrace a variety of objects, where the medical attendants are deeply interested in the most formidable and excruciating diseases, it can rarely happen that sufficient leisure is afforded for the exercise of that strict care and attention which operations on the eye demand, much less will it happen, when patients are the subjects of fortuitous operations and retire afterwards to their own homes where they experience a miserable want of every comfort and convenience, that such operation can be successful. Impressed with these considerations the author of this address, who devotes himself to the treatments of diseases of the Eye and the Ear, solicits the public to patronise an institution which will enable him to extend relief to the poor afflicted with these diseases. An institution of this kind will be the means of restoring to society the exertions of many industrious individuals and will be established and carried on at a very moderate expense. The author of this address offers his services to the Charity without any emolument to himself and he pledges himself to the promoters of the institution, that the public shall reap the fruits of their beneficence.

“J. C. SAUNDERS,

“Surgeon and Demonstrator of Practical Anatomy at St. Thomas’s Hospital.

“24, Ely Place, Holborn,

“October 1st, 1804.”

“We are of the opinion that the establishment of the dispensary will prove beneficial, and is therefore worthy of public support, and that the author of the proposal is qualified to procure the accomplishment of its object.

Signed:

Physicians of St. Thomas’s. Physicians of Guy’s. Wm. Lister, M.D. Wm. Babington, M.D. W. C. Wills, M.D. James Curry, M.D. Thos. Turner, M.D. M. Alexander, M.D. G. Gilbert Currey, M.D.

Surgeons of St. Thomas’s. Surgeons of Guy’s. G. Chander. T. Foster. I. Birch. Wm. Lucas. H. Cline. Astley Cooper.”

As the outcome of the issue of this circular a committee was formed which held its first meeting at the City Coffee House on January 4th, 1805, Mr. Benjamin Travers, a wealthy City merchant and the father of the surgeon of the same name, being in the chair.

This Mr. Benjamin Travers, Sen., in the keen pursuit of knowledge, had attended Astley Cooper’s lectures on anatomy, and had become so interested in them and the lecturer, that he apprenticed his son to him as a pupil, and later extended his patronage to the project of founding an eye dispensary put forward by Cooper’s demonstrator and protégé.

At the meeting the following resolutions were moved and unanimously agreed to:

“That a dispensary be instituted under the name of the London Dispensary for the Relief of the Poor afflicted with Diseases of the Eye and the Ear, where they may apply and obtain advice and medicines gratis.

“That the dispensary be situated in a central part of this city and contain beds for the reception of patients who undergo the operation for the cataract or any other operation of the eye requiring minute care.

“That the Charity consist of a Treasurer, Governors, Secretary, and Medical Officers.

“That Henry Kensington, Esq., be appointed Treasurer.

“That a person contributing an annual subscription of one guinea be a governor and have the right of recommending and keeping under the care of the charity one out-patient, and if two guineas, two out-patients, and so in proportion to his subscription.

“That patients admitted into the house be admitted according to priority of recommendation, except in cases of emergency, when the medical officers must determine.

“That Mr. J. C. Saunders be appointed Surgeon of the Dispensary, and that Dr. Farre be appointed Consulting Physician in cases requiring medical aid.”

Richard Battley, who was then practising as an apothecary in St. Paul’s Churchyard, undertook the duties of Secretary, which he continued to discharge in an honorary capacity, with the utmost assiduity, for fourteen years.

Many City merchants, with whom Saunders had no previous acquaintance, became subscribers, and sufficient funds were soon forthcoming to provide for the purchase of the lease of No. 40, Charterhouse Square, for eighteen years, for the sum of £300 and an annual rental of £65.

PLATE II.

Where the London Dispensary for Curing Diseases of the Eye and Ear was first opened in 1805.]

On March 25th, 1805, The London Dispensary for Curing Diseases of the Eye and Ear was opened for the reception of patients.

Sir Charles Price, Bart., a former Lord Mayor, and Member of Parliament for the City of London, accepted the post of President of the Institution, and several of the Aldermen of the City became its Vice-Presidents.

One Sarah Clark was appointed nurse and housekeeper, she being required to act under the control of the Surgeon, who had power to dismiss her for misconduct. She was allowed coals and candles and a gratuity at the end of the year “such as the Committee may deem proportionate to her services.” Her husband was subsequently engaged to dispense drugs, and the two of them received £50 a year for their services, together with the aforesaid coals and candles.

In 1804, after Saunders had brought forward his proposal for the establishment of an Eye Dispensary, Mr. Wathen (afterwards Sir Wathen Waller), an oculist of eminence, described to King George III. the sad state of the soldiers and sailors who had returned from the campaign in Egypt suffering from ophthalmia, and suggested the desirability of establishing an Infirmary exclusively for eye diseases: “Their Majesties and the Royal Family graciously and humanely approved of the plan, and honoured it with their patronage and benefactions.” Such was the origin of the Royal Infirmary for Diseases of the Eye, in Cork Street, which commenced under Mr. Wathen, and was subsequently carried on as a comparatively private institution, under the charge of Mr. Charles Alexander, up to the time of his death in 1872.

This institution must not be confused with that started in the Western district of London, by the Army surgeon Guthrie, in 1816, which exists to-day as the Royal Westminster Ophthalmic Hospital.

That Wathen’s Infirmary was opened for the reception of patients three months before the London Dispensary, though the proposal for its establishment was not made until after the publication of Saunders’ circular, evidently caused the latter considerable annoyance, for in a letter addressed to the Committee of the Dispensary in 1808 Saunders writes:

“Subsequently to the date of my Proposal, a similar Institution, honoured with the Royal Patronage, was formed and established in Westminster. Although the Prospectus of the Royal Infirmary was not heard of until many months after the Publication of my Proposal, yet it must be admitted that that Institution first appeared before the Public in a regular and organised form, and this, which is the original, is consequently considered by all who are unacquainted with the facts as the copy. Apprehensive of this impression, I immediately claimed by public advertisements, which were never answered, the priority of my Proposal.

“I should be excused for thus obtruding on your notice if I sought merely the indulgence of honest pride, by maintaining this just claim to respect, but I shall yet more readily be excused, when you reflect, that if I had abandoned this claim, the Public would continue to regard me as an humble copyist.”

This Royal Infirmary, whose rivalry at its commencement caused Saunders so much annoyance, continued in existence until Alexander’s death in 1872. It was then resolved at a meeting of its Life Governors and Subscribers to close the Institution and to hand over the balance of its funds, after the settlement of all its liabilities, to the Royal London Ophthalmic Hospital. Two hundred pounds was ultimately received by the Hospital, and three of the Committee of the old Infirmary were elected as Life Governors, one of them being a relative of the late Mr. Alexander.