CHAPTER IX. Growth and Extension

GROWTH AND EXTENSION

When the Eye Infirmary was first built in lower Moorfields in 1821 the district was an exceedingly quiet one; in front of it was a large open space, which had been the old Bethlehem Hospital burial-ground, but had not been used as such after the removal of that Hospital to the other side of the river in 1814.

In 1899, when the Eye Hospital was transferred to the City Road, the district had become one of the busiest and noisiest in the City of London. The cause of this change was the erection of the Broad Street and Liverpool Street Stations on the site of the old burial-ground, and on that of a large number of courts and alleys in its vicinity, which were cleared away for the purpose. Out of these terminal stations there poured forth every morning the various City workers, and back to them they streamed in the afternoons and evenings. The railway termini became the starting-points of various omnibuses, the roll of the wheels of which on stony streets and the clatter of the horses’ hoofs kept up a continuous roar. The erection of the London and North-Western Railway’s Goods Station, to the north of the Hospital on the opposite side of Eldon Street, added noises at night, as well as day, in the rattle and banging of milk-cans. To patients coming from country districts this continuous noise proved very disturbing and detrimental. In 1870 some mitigation of the trouble was obtained by the substitution of asphalt paving in the streets around the Hospital in place of cobble-stones.

The increased facilities which the railways and omnibuses afforded for approach to the Hospital tended largely to increase the number of patients coming to it for relief. In 1851 new out-patients numbered 11,384, and in 1878 they had increased to 19,177. To provide accommodation for this increase, and for the larger number of patients requiring operative treatment, it became obvious that a new wing would have to be added on the south side of the Hospital. A lease for the land on which it was to be erected had, through the foresight of Dr. Farre, been obtained in 1823 for a period of seventy-seven years from the Corporation of London. On it a stables had been built and let off until such time as the Hospital found it necessary to take possession. When the new building was contemplated, an attempt was made to obtain a freehold of the site from the Bridge House Estate, but owing to the Hospital not being an incorporated body the negotiations fell through.

The original London terminus of the Great Eastern Railway, opened in 1839, was at Shoreditch. In 1863 a Bill was introduced into the House of Lords to give the Great Eastern Railway power to extend their line to Finsbury Circus, and to make a station there which would absorb all the surrounding houses and the recently erected London Institution. It was obvious that such an undertaking would seriously interfere with the amenities of the Hospital, and the Committee of Management drew up a petition against the Bill pointing out how the work of the Hospital would be interfered with if it was passed. This petition they confided to Mr. Alfred Smee, who at that time resided in Finsbury Circus, to be forwarded to the Earl of Shaftesbury for presentation to the House of Lords.

The Bill was rejected and the Committee of the Hospital passed a vote of thanks to the Right Hon. the Earl of Shaftesbury for his important services in the matter.

Pending the final selection of sites by the different railways for their terminal stations, the Committee of the Hospital had to postpone their plans for enlargement, but ultimately, early in 1868, the long contemplated building was commenced; it did not, however, become ready for occupation until July, 1870; the total cost was £7,226, towards which Her Majesty the Queen graciously contributed £100.

The reform in hospital architecture which commenced after the Crimean War with the publication of Miss Nightingale’s celebrated Notes on Hospitals was then still in its infancy. St. Thomas’s Hospital, which was being erected on the Thames Embankment at the same time as the new wing at Moorfields, was the embodiment of her ideas; adequate cubic space, not only in the wards but also in the passages, being considered the most essential factor. It has been jokingly said that, at St. Thomas’s, so large and lofty is the children’s ward that it is difficult to find the children. Listerism, with its passion for aseptic cleanliness, rounded corners, and polished surfaces, had not then dawned.

The new wing at Moorfields was designed by Mr. Robert Brass, and consisted of three floors. The ground floor was devoted to out-patients. The first and second floor each contained three small six-bedded wards leading out of a long passage. Their arrangement was neither good for administration or for ventilation. The curious device was adopted of placing the fireplaces immediately beneath the windows, which necessitated an elbow-shaped bend in the chimneys. The consequence was that soot which collected in the bends caught fire, causing from time to time considerable consternation and excitement amongst the patients and resident staff.

In 1866 the staff of the Hospital consisted of four surgeons and four assistant-surgeons, but Critchett was desirous of having an assistant-surgeon to work with him on his days of attendance, and it was mainly at his instigation that it was decided to appoint a fifth assistant-surgeon. To this post John Couper, who for several years had acted as Critchett’s clinical assistant, and who was an assistant-surgeon at the London Hospital, was unanimously elected.

In 1867 the President of the Hospital, Mr. William Cotton, D.C.L., F.R.S., died, and the Governors obtained the consent of the distinguished banker, scientist, and statesman, Sir John Lubbock, F.R.S., M.P. (afterwards Lord Avebury), to take his place.

In that year yet another addition was made to the surgical staff by the election as assistant-surgeon of John Soelberg Wells, to whose early career and scientific attainments reference has already been made. By that time several of the assistant-surgeons, by acting as such for five years, had become eligible for promotion to surgeons; it was not, however, until the new wing was opened, which provided an additional thirty-six beds, that they were able to obtain the full advantages of such promotion.

The establishment of special ophthalmic departments at the several general hospitals in London caused the Governors of Moorfields some alarm as to the ultimate welfare of their own institution, or as Critchett picturesquely put it, “they feared that the heart of the parent would be sucked out for the benefit of their children, without any corresponding advantage to the public.” It was for this reason that in 1864, at a meeting of the Governors, the following rule was passed:

“No surgeon of the Hospital shall hold an ophthalmic appointment in any other institution, and if any surgeon, at the time when he becomes such, holds any ophthalmic appointment, he shall resign the same within three months.”

The first time this rule came into operation was when Streatfield and Hulke became surgeons. The rule only applied to surgeons, not to assistant-surgeons. Streatfield held the post of ophthalmic surgeon at University College Hospital, and Hulke that of ophthalmic surgeon at Middlesex Hospital. On their promotion at Moorfields, the Committee of Management requested them to resign their appointments as ophthalmic surgeons elsewhere. Hulke readily complied with the request, as he was still able to maintain his connection as a general surgeon with the Middlesex. Streatfield, however, who only practised as an ophthalmic surgeon, was very reluctant to resign his connection with University College. On the matter being discussed by the Medical Council, it was found that its members were divided in their opinions: some, like Critchett, feared rivalry from the newly developing ophthalmic departments at general hospitals; others welcomed their up-growth, and saw that they were essential parts of such institutions, both from the patients’ and the students’ point of view. They considered it desirable that those who enjoyed the exceptional experience afforded as surgeons at Moorfields should be encouraged to join them, and that, as has proved to be the case, their connection with them would induce students requiring extended ophthalmic training to come to Moorfields. With such division of opinion on the surgical staff the Committee did not at that time consider themselves able to advise any alteration in the rule, and Streatfield had to resign his appointment at University College Hospital.

When Couper and Soelberg Wells became eligible for promotion as surgeons in 1873, the matter again came under consideration; in the interval several members of the staff had altered their opinions, and the Medical Council unanimously recommended the abolition of the rule, stating that “it felt assured that the cultivation of intimate relation with General Hospitals through members of the staff is conducive to the interests of Moorfields.” A special meeting of the Governors was then summoned, at which the rule was rescinded. Streatfield was fortunate enough to be reappointed to the post he had had to resign at University College.

James Dixon retired from the active staff of the Hospital in 1868, after having been connected with it for twenty-five years, and the senior surgeon for a period of twelve years. As such he had a seat on the Committee of Management, where he was a regular attendant and rendered valuable assistance. In 1870, owing to domestic bereavements, he gave up practice and lived in retirement, occupying himself with the study of English history and English literature. He published a small handbook, entitled A Guide to the Practical Study of the Diseases of the Eye, in which he said he aimed at supplying a useful guide to those commencing the study of eye diseases. That it fulfilled this purpose is shown by its having passed through three editions. The last which appeared in 1866, was brought well up to date with the numerous developments which had taken place since it first made its appearance.

Dixon was particularly scathing on the dry and pedantic use of unnecessarily complicated names in the description of affections of the eye. Thus he writes:

“It requires a more intimate knowledge of Greek than one has a right to expect from every student of medicine to recognise in ‘Iridoperiphakitis’ an inflamed iris and capsule, or at once to detect the operation for closing lacrymal fistula under such a disguise as that of ‘Dacryocystosyringokatlesis.’”

Though the world-wide reputation of Moorfields is mainly due to the skill and scientific attainments of the medical staff, its progress and prosperity have been to a large extent promoted by the services of the able and devoted workers who have in succession held the post of Chairman of the Committee of Management. Conspicuous among them for the interest they took in everything connected with the Institution were Mr. F. G. Sambrooke, who died in 1871, after having held the post for eleven years, and Mr. Philip Cazenove, who succeeded him.

The medical staff of a hospital are the distributors of its benefits, but in order that benefits may be distributed a collecting department is essential, and the work of raising funds for its maintenance falls upon the Committee of Management and the secretary.

Some individuals seem to have a special flair for begging successfully for funds for charitable purposes. The united efforts of Mr. Sambrooke, the Chairman at Moorfields, and of Mr. Mogford, its secretary, during the sixties, met with a most excellent response. In the early days of the Hospital funds were raised by means of festival dinners and special sermons; but during the sixties, without such aid, subscriptions flowed in both for the maintenance of the Institution and for its building fund. Mr. Mogford attributed his success in this matter entirely to his letters of appeal; but it must be remembered that it was a time of peace and considerable commercial prosperity, under which conditions philanthropic efforts stand the best chance of success. Excellent as Mr. Mogford was as a collector of funds, he had certain weaknesses which in 1872 necessitated his resignation, Mr. Robert J. Newstead being appointed to fill his place.

In Mr. Sambrooke the medical staff had a most sympathetic supporter in the promotion of the scientific side of ophthalmology. During his chairmanship most liberal grants of money were made towards the development and upkeep of the Museum and Library. Thus a grant of £72 was made in 1864 for the purchase of a collection of ophthalmoscopic drawings of the fundus of the eye, and when the new museum was completed in 1870 a grant of £235 was expended in book-cases and suitable fittings for the display of specimens.

Charles Bader, who continued to hold the post of curator of the Museum up to 1867, as the outcome of his experiences published a book entitled The Natural and Morbid Changes in the Human Eye. He was very dexterous in the mounting of museum specimens of the eye, but unfortunately the only two methods then known of preserving such specimens were by means of spirit or by the use of glycerine. The former caused them to shrink and rendered the transparent parts opaque, and the latter, though to some extent preserving their transparency, caused them to swell. The introduction of the glycerine jelly method of preserving museum specimens of eyes by Nettleship in 1871, and elaborated by Priestley Smith in 1883, was a great improvement; but even with this method considerable care and attention was necessary to prevent deterioration. It was not until the introduction of formaline as a hardening and preserving agent, by Professor Leber in 1894, that a really satisfactory medium for museum specimens was found—one which would retain indefinitely the relative degrees of transparency and colour of the different parts which they presented during life.

On the resignation of Bader of the post of curator, Bowater Vernon, who had been working as clinical assistant to Wordsworth, was appointed in his place with a salary of £50 per annum. The duties of the post were defined as follows:

“That he shall attend daily from 10 to 1, and on the evenings of the ophthalmoscopic demonstrations, and at such other times as may be necessary to put up and display the morbid specimens presented.

“That he be responsible for the due keeping, cataloguing and giving out under regulations of the books and plates under his charge.

“That he shall prepare gradually a complete series of preparations illustrating the normal anatomy of the human eye and its appendages, and proceed as far as possible with a similar series illustrative of the comparative anatomy and pathology of the same.

“That he shall be required to report upon the microscopic appearances of all specimens requiring such examination and to keep a register of such examinations, if possible, illustrated by drawings.”

The evening ophthalmoscopic demonstrations above referred to had been started for the benefit of the students attending the Hospital in 1864, and were conducted in turn by the different members of the staff.

In the records of pathological specimens, published by Vernon in the Reports in 1868, is the description of what must have been one of the first cases of tubercle of the choroid which, having been seen ophthalmoscopically, was later examined microscopically. In 1871 Vernon, being appointed ophthalmic surgeon to St. Bartholomew’s Hospital, resigned the post of curator of the Museum; he was succeeded by Edward Nettleship, who held it for two years in conjunction with that of clinical assistant to Jonathan Hutchinson. The extensive reports of the specimens committed to his care which Nettleship published in the Hospital Reports for those years show with what care and diligence he discharged the duties of the office. This, together with the stimulating influence of his chief, Jonathan Hutchinson, formed an excellent training for the important work which Nettleship did in connection with ophthalmology in later years.

In the middle of the nineteenth century a number of residential schools were established in London for the children of parents in receipt of Poor Law relief. Almost from their commencement outbreaks of ophthalmia became very prevalent in these schools. In 1870 Critchett was asked to visit and advise as to the ophthalmia in one of them at Anerley. He stated in his report that he

“found a large proportion of mild ophthalmia, which in most cases did not render the patients incapable of following the usual educational course, and he advised the establishment of a ward or separate school, where all such cases might be kept for an indefinite time until it was quite certain that they would not relapse, where they might be under such hygienic and medical treatment as seemed necessary, where their instruction and education should go on as if they were in the body of the school, and where, by prolonged isolation, they might be prevented from acting as sources of contagion to the healthy children in the school.”

PLATE XVII.

Action was taken in accordance with this advice in 1873, when 400 children who showed signs of ophthalmia at the Anerley School were isolated in an unoccupied workhouse at Bow, which was kept going as a combined infirmary and school with an efficient staff of teachers and nurses for twelve months. Nettleship, having resigned his appointment as curator at Moorfields, acted as its resident superintendent. The experiment proved the soundness of Critchett’s advice, but it became obvious that in some cases, more especially those of trachoma, isolation and treatment would have to be continued for more than a year. In 1889 a special isolation school was erected for children affected with ophthalmia in the Central District School at Hanwell and placed under the charge of Sydney Stephenson. Here, again, the success of Critchett’s policy was so marked, that in 1897 the Local Government Board instructed the Metropolitan Asylums Board to provide accommodation for children suffering from ophthalmia in all the Poor Law Schools of London. The result has been a steady and continuous diminution in the number of cases to be dealt with and the practical extinction altogether in these schools of that at most intractable of all forms of ophthalmia—trachoma.

The salary for the curator of the Museum, whilst Vernon and Nettleship held the office, seems to have been disproportionately small to the liberal grants made for the upkeep of the Museum itself. During his first year of office Nettleship’s salary was only £50 per annum; at the end of that time, “in consideration of his very valuable and arduous services in the work of the Museum,” it was raised to £75. When W. A. Brailey was appointed to the post in 1874 it was found necessary to increase the salary of it to £100, and in 1877 to £120. After increased accommodation was made in connection with the laboratory in 1879, courses of instruction in practical pathology of the eye were commenced by the curator.

In 1870 ophthalmic science sustained a heavy loss by the death of Albert von Graefe, its most zealous and successful cultivator, in his forty-third year. His last extensive article dealing with “The Pathology and Treatment of Glaucoma” was translated and published in full in the Ophthalmic Hospital Reports at the beginning of 1871. Much as Graefe did to extend our knowledge of the conditions which lead to an increased hardness of the eyeball, the disasters to which such hardness gives rise, and the means by which they may be avoided, much was still left unexplained. Even now, in spite of the reams which have since been written, there is still much in connection with the subject requiring further elucidation. In 1878 a stimulus was given to research in this country in connection with glaucoma by the Royal College of Surgeons setting as the subject for the Jacksonian Prize Essay for that year, “Glaucoma: its Causes, Symptoms, Pathology, and Treatment.” The prize was awarded to Priestley Smith, of Birmingham, and articles dealing with its causation were published in the Hospital Reports for 1881 by him, and by the curator of the Museum, W. A. Brailey. The following year Brailey resigned the curatorship on his being appointed assistant ophthalmic surgeon at Guy’s Hospital. His successor was W. Jennings Milles, who had previously been house surgeon; he, however, only held the post for eighteen months, resigning it to go to Shanghai. He thus carried the practice and training of Moorfields to the Far East, as others had done to all parts of the British Empire, and to many of the leading cities in the United States of America.

In 1873 a Canadian, Frank Buller, was appointed house surgeon, and, returning subsequently to Montreal, became the pioneer of ophthalmic surgery in that colony. Incidentally, it is of interest to note that in doing so he forestalled another young Canadian named Osler (afterwards Sir William Osler, Bart.), who had come to Moorfields to study eye diseases with the same end in view, but, learning there of Buller’s intentions, he abandoned the practice of ophthalmology for that of general medicine.

PLATE XVIII.

The length of time which those holding office at Moorfields retained their posts, and the reluctance with which they resigned them, bears eloquent testimony to their interest in the work of the Institution. There was then no limit to the time that a house surgeon might retain his post, and some continued to do so for more than three years. In 1870 Miss Boycott, who had held the post of matron for twenty-one years, died at the Hospital. Miss Harnet succeeded her, but not being herself a trained nurse did little to raise the standard of nursing, which remained during her term of office in a very primitive condition.

As the number of new out-patients attending the Hospital continued to increase—from 19,177 in 1868 to 20,687 in 1875—it soon became evident that the newly erected wing did not supply all the in-patient accommodation that was required. In 1875 a plan was drawn up and adopted for the erection of another storey on the main building at a cost of £2,430. This was completed the following year, when the accommodation of the Hospital became increased to 45 beds for male patients, 51 for women and children, and 4 for occasional use.

Bowman and Critchett were nearly of the same age, Bowman being a little the senior. So much had they done to add to the fame and reputation of Moorfields that as they approached the age of sixty, when in accordance with the rules of the Hospital they would have to retire from the active staff and become consulting surgeons, the Committee of Management became anxious to find some way in which their services could be retained. Both Bowman and Critchett, like many of those who have come after them, felt very reluctant to sever their intimate association with the Hospital’s work and welfare.

Bowman, in writing to the Chairman of the Committee in July, 1876, to inform him that the time for his retirement was nearly due, requested that the duties of a consulting surgeon might be defined, as so far nothing had been laid down concerning them. Critchett also wrote at the same time as follows:

“I believe that Mr. Bowman is about to send in his resignation, and I wish to reiterate my conviction that it will be a serious loss to the Hospital. Every week I am a witness to the brilliant operations he performs, they are to me and to a crowded theatre a source of pleasure and profit; professors and students gather round him from far and near; the prestige of the Hospital and its value both in a scientific and benevolent aspect are enhanced by his presence, and by the admirable work that he does. I am sure that if he had voluntarily left us, or if he had been snatched from us, every one attached to the Institution, whether lay or professional, would have felt that they had sustained an irreparable loss. I would therefore suggest that some effort should be made to retain his services. In appointing him to be consulting surgeon, it seems desirable that he should have a few beds placed at his disposal for the admission of cases that may be sent up to him or that any of his professional colleagues may wish to place under his care; also that he should be invited to continue his clinical teaching and if possible give some clinical lectures at stated times. This would be a great service to us all.”

The Committee then, in accepting Bowman’s resignation, passed the following resolution:

“That in acknowledgment of his high reputation and long services to this Institution the Committee request him to continue his clinical instructions, which they are sure will be as acceptable to the staff as to themselves, and for that purpose are pleased for the present to place five beds at his disposal.”

In passing this resolution and forwarding it to Bowman the Committee acted without first consulting the Medical Council. That body at once notified the Committee that it was unanimously of opinion that it was an infringement of the existing laws to assign beds thus to Bowman on his becoming consulting surgeon. The Committee replied by requesting the Medical Council to consider regulations as to the duties of a consulting surgeon. The Medical Council then proceeded to collect information as to the customs in force with reference to such officers at the principal Metropolitan Hospitals. It found that in all of them their duties were simply consultative, and that they attended only when specially summoned at the request of the officer in charge of the patient. The Medical Council then advised that a similar practice should be adhered to at Moorfields, and that arrangements might be made for the consulting surgeons to deliver clinical lectures. The Committee were very loath to withdraw the offer of the use of beds which they had made to Bowman, and had likewise extended to Critchett. The whole matter was discussed at the Annual Meeting of the Governors, with Sir John Lubbock, the President, in the Chair. In the end Bowman and Critchett withdrew from all active participation in the work of the Hospital with somewhat embittered feelings.

Bowman died in 1892 at the age of seventy-six. In one of his obituary notices we read the following account of his doings after he left Moorfields:

“Fortunately, the opportunities for professional intercourse with Bowman did not cease with his retirement from Moorfields. Until some years later he held the leading place at all the chief meetings connected with our specialty. In 1880, when the British Medical Association held its Annual Meeting at Cambridge, Bowman was President of the ophthalmological section. Donders was present also. The Senate of the University conferred its honorary degree of LL.D. on both. In the following year Bowman presided over a still more important gathering in London—the ophthalmological section of the Seventh International Medical Congress. The fine nature of the man, his high ideals, simplicity, and modesty, are perhaps nowhere more clearly shown than in the inaugural address given by him on that occasion.

“The Ophthalmological Society of the United Kingdom was founded in 1880, and was fortunate in having Bowman as its president during its first three years—it was largely through his influence that the Society rose so rapidly into strength and importance. Its funds, moreover, were largely increased by his generosity. He was an ideal president: speaking little, but always with purpose and effect, showing interest in every communication and encouraging every effort at good work.

“In the year 1883 the Council of the Ophthalmological Society resolved to establish an annual lecture—the Bowman lecture—‘in recognition of Mr. Bowman’s distinguished scientific position in ophthalmology and other branches of medicine, and in commemoration of his valuable services to the Ophthalmological Society, of which he was the first president.’ In the following year he was made a baronet in recognition of his scientific attainments and professional eminence. A little later, the suggestion that his portrait should be painted and presented to him was welcomed by a large number of his friends, in this and other countries, and the well-known portrait by Ouless, which was exhibited in the Royal Academy in 1889, was the result.

“Not until he was seventy years of age did Sir William Bowman relinquish active practice, and even for some years longer he was still at times accessible to those who specially desired his opinion and advice.”

Critchett died in 1882 at the age of sixty-five. After retiring from Moorfields he was appointed ophthalmic surgeon and lecturer on ophthalmology at the Middlesex Hospital, an appointment which he held for four years. It afforded him a few beds for needy patients, and his son Anderson assisted him with the out-patients. He soon endeared himself to the students there, who valued his teaching and the opportunity of watching his operative dexterity. For some years he suffered from enlarged prostate, cystitis, and granular kidney, but it did not prevent his attending to his practice with unabated vigour, and performing his numerous social engagements with his customary hospitality up to the time of his death.

Several candidates who had acted as clinical assistants presented themselves for the appointments on the staff rendered vacant by the retirement of Bowman and Critchett, but all withdrew in favour of Waren Tay and James Adams, both of whom were assistant general surgeons at the London Hospital.

After the publication of Donders’ great work in English On the Anomalies of Accommodation and Refraction of the Eye, by the New Sydenham Society in 1864, and Soelberg Wells’ smaller book, which embodied Donders’ teaching, On Long, Short, and Weak Sight, sight-testing and the correction of errors of refraction with glasses grew progressively in importance.

The prescription of lotions or ointments for the eyes took far less time than the estimation of refractive errors and the prescription of glasses, and with the increase of sight-testing the length of time occupied in dealing with out-patients became considerably prolonged. At first it was only the correction of the grosser errors of refraction which received attention, but as the methods for their estimation improved, and the importance of even small errors became recognised, the amount of refractive work steadily increased.

The length of time many out-patients had to wait before they received attention became a source of anxiety, extending over many years, not only to the Committee of Management, but also to the surgical staff. The surgeons’ time was fully occupied with the investigation of diseased conditions and with operating; they had to depend mainly for the carrying out of this refraction work on the devotion and goodwill of their clinical assistants, who, being purely voluntary workers, could not always be relied upon to stay for an indefinite time.

Many measures were tried to overcome the difficulty. Hulke, who had a passion for punctuality, was never tired of urging the value of his special virtue on all concerned. Though a painfully punctual individual on a medical staff may at times be very trying to his colleagues and assistants it is no doubt that he is a valuable asset to the institution with which he is connected. Everybody knew at Moorfields that on Hulke’s days of attendance they had to be early risers, with the result that the work was finished more expeditiously.

Much trouble in connection with the refraction work of the Hospital would probably have been avoided if the plan which has recently been adopted, of paying an honorarium to one clinical assistant for each surgeon, had been sooner resorted to. It was originally recommended by the Medical Council in 1877, but the Committee could not for a long time see its way to increase so considerably the Hospital’s annual expenditure.

Jonathan Hutchinson, as has already been mentioned, was a man who took the widest interest in all diseased conditions; the one subject which did not specially attract him was refraction work. As the amount and importance of it increased, and after he became deprived of the zealous help of his two able assistants, Tay and Nettleship, he felt he could no longer conscientiously carry out all the duties of his post, and in 1878 resigned his appointment on the staff.

No man at Moorfields ever made more thorough and effectual use of the clinical work which it placed at his disposal than Jonathan Hutchinson. For several years he, together with Wordsworth, edited the Hospital Reports, and it was during that time that they were conducted with the highest degree of efficiency and regularity. The “Periscope” in those years, which was mainly the work of Waren Tay, formed an excellent and very complete review of foreign ophthalmic literature. Hutchinson’s own articles were numerous, containing groups of well-recorded cases, designed to illustrate new and interesting observations.

In the November number of the Reports for 1871 he published “Statistical Details of Four Years’ Experience in Respect to the Form of Amaurosis supposed to be due to Tobacco.” It was his third article on the subject; the first, in which he suggested a connection between excessive smoking and affections of the optic nerve, having appeared in 1864. His attention became attracted by the almost exclusive occurrence of what was then called “idiopathic symmetrical amaurosis” in the male sex. He considered all the possible causes which might account for such a prevalence in one sex only, and found the tobacco hypothesis the most probable. His researches showed that there was little evidence of any other affection of the nervous system in these cases, and that all of them were excessive smokers, most of them having used shag tobacco. Having watched them for some time, he discovered that when the disuse of tobacco was real and complete vision generally improved.

The less frequent issue of the Reports after Hutchinson’s departure, and the abandonment of the “Periscope,” was due to two things—the establishment of the Ophthalmological Society in 1881, and the commencement of the Ophthalmic Review in 1882.

The unexpected vacancy on the staff caused by Hutchinson’s resignation was filled by the election of John Tweedy who was a clinical assistant to Streatfield, and held the post of assistant ophthalmic surgeon at University College Hospital.

In 1879 Philip Cazenove resigned the post of Chairman of the Committee of Management which he had held for eight years, and in doing so presented the Hospital with a gift of £1,000. Charles Gordon, whose name was, and is still, well known in connection with gin, was appointed to succeed him.

The Hospital suffered a severe loss by the death of Soelberg Wells in December, 1879; his health had been failing for some time, and he had been granted repeated periods of leave from his work at the Hospital on account of it. His Treatise on the Diseases of the Eye, first published in 1869, ran through three editions, and was translated into German and French. It was for a long time the standard textbook on ophthalmology, having the supreme virtue of combining the best teaching and practice of continental writers on the subject with those of our own country, an undertaking for which Soelberg Wells was particularly well fitted, owing to his familiarity with the continental clinics and his linguistic abilities.

Robert Lyell, who had worked as Hulke’s clinical assistant and who was an assistant general surgeon at the Middlesex Hospital, was elected in Wells’ place. He was a man who, as a student, had had a brilliant career and had obtained the highest qualifications and distinctions. With his appointments at the Middlesex and Moorfields, the way seemed open to him for a successful and prosperous future. Unfortunately, in the summer holiday of 1882, he contracted pneumonia, and the opening session at the Middlesex Hospital Medical School in October, at which he was to have delivered the Introductory Address, was saddened by the news of his death.

For the vacancy created by Lyell’s death several candidates presented themselves, but ultimately withdrew their applications in favour of Nettleship, who already held the post of ophthalmic surgeon at St. Thomas’s Hospital. This was the last appointment on the staff at Moorfields which was created by a vote of the Governors. In 1883 the Medical Council informed the Committee of Management that in its opinion “the present mode of election of the honorary medical officers did not secure the best interests of the Hospital.” A joint conference was held at which it was decided to recommend that in future the election of honorary officers should be invested in a committee, and that this election committee should consist of the Board of Management, together with six honorary medical officers, the quorum to consist of seven; and that canvassing should be prohibited on the part of any candidate under pain of disqualification. These recommendations were agreed to at a meeting of the Governors, and in this way all subsequent elections have been conducted. At the same time it was also agreed that the Fellowship of the Royal College of Surgeons of England should be the only requisite necessary for eligibility as a candidate for a post on the surgical staff.

PLATE XIX.

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.