CHAPTER XI. The Selection of a New Site, and the Erection of the New Hospital

THE SELECTION OF A NEW SITE, AND THE ERECTION OF THE NEW HOSPITAL

The condition of the Moorfields Hospital in 1884 may be compared to that of a man wearing a suit of clothes fitted to him in his youth, which had since been added to, patched, and darned, to cover his nakedness. The result was that he not only presented an incongruous appearance, but lived in constant fear of fresh dilapidations.

To carry the analogy still further, those who would be called upon to find funds for a fresh suit, and who had taken pains to make the patches, desired to leave matters as they were. Whilst the man himself, who had to wear and work in his old-fashioned clothes, was all agog for a new rig-out.

The Hospital erected in 1821 was in keeping with the conceptions of the time and adapted for the accommodation then required. With the new ideas which arose out of Florence Nightingale’s teaching, and later as the outcome of bacteriological investigations, the general principles for hospital construction became completely changed. Though the original Moorfields Hospital was added to and altered to meet new requirements, it became obvious to the rising generation of medical men working there that it could never be converted into an up-to-date institution. It took time, however, before the Committee of Management as a body could be induced to look at the matter in the same light, especially its older members who had taken part in raising funds and arranging for the additions.

In 1884 a piece of building land in Eldon Street to the west of the Hospital became vacant, and the Controller of the City of London offered to lay any proposal the Committee of Management might feel inclined to make concerning it before the Bridge House Estates Committee. Though urged by the Medical Council to acquire it, the Committee of Management replied that it did not feel able to tender.

During the next three years circumstances arose which gradually convinced the Committee that there were irremediable defects in the Hospital as regards accommodation, ventilation and sanitation. The beds were always full, and the waiting-list of patients requiring in-patient treatment grew in dimensions. The cubic space per patient in the wards was very deficient, and no cross-ventilation of them was possible. There were no day rooms in which patients not confined to bed could take their meals. There was no passenger lift to convey patients who had been operated on to the upper floors, so that they had to walk up a narrow staircase. There were no bath rooms, and very inefficient accommodation, for the resident staff. The drainage, laid down without any general plan, and in piecemeal fashion, was constantly being attended to and tinkered with.

In 1887 the Medical Council complained of the defective sanitation of the Hospital, and requested that a sanitary expert might be asked to examine the drainage and advise in the matter. At the same time it submitted to the Committee a report entitled, Some Defects in the Royal London Ophthalmic Hospital, in which the above mentioned deficiencies and others were set out in detail. From the consideration of this report, and that received from the sanitary expert, it became obvious that nothing but a new building would meet all the requirements.

The building land in the rear of the Hospital facing Eldon Street still remained temptingly vacant, and, in 1887, a suggestion was received, emanating from the City architect, that an exchange might possibly be effected—i.e., the taking of the existing site of the Hospital for the vacant site in Eldon Street together with a sum of £15,000.

Though this suggestion did not come to anything, it served to awaken the Committee of Management to the valuable assets the Hospital possessed in the greatly enhanced value of its freehold and leasehold properties, due to the changes which had taken place in its environment since it was first built—unearned increment, which was eventually put to the best possible use by an extension of the means for the relief of suffering in the community.

Mr. Lander, the Hospital’s surveyor, was then requested to obtain valuations of the Hospital’s site and of that of the vacant land adjoining it. No very precise figures were obtained, the site of the Hospital being valued at anything between £50,000 and £100,000. The Committee still, however, hesitated to make any tender for the vacant land.

In July, 1888, after a consultation of representatives of the Medical Council with Sir John Lubbock, the President of the Hospital, he agreed to introduce a deputation to the Lord Mayor to request him to use his influence in obtaining for the Hospital a gift of the vacant land adjoining it from the Corporation. The Lord Mayor pointed out that it was trust property held by the Bridge House Estates, which had no power to comply with the appeal of the deputation “so earnestly and reasonably made.” The deputation next waited on the Bridge House Estates Committee, who replied that it was unable to pledge itself not to accept any tender, but the matter would receive its most favourable consideration.

Matters were still further advanced in that year: firstly, by the receipt of an unsolicited donation of fifty guineas from the trustees of St. Stephen’s, Coleman Street, towards a Building Fund, which led to the opening of such a fund for subscriptions, to which the surgeons of the Hospital in the following year promised a gift of £1,000; secondly, by the desire of the City to effect a street improvement, so as to widen the junction of Blomfield Street and Eldon Street, which would necessitate a surrender of a slice of the Hospital’s ground.

A complication arose, due to the Hospital’s land not directly adjoining that vacant in Eldon Street—a Welsh chapel, with a lease of four years yet to run, intervening between them.

Ultimately, the Bridge House Estates Committee offered the Hospital the vacant area, including that of the Welsh chapel, comprising in all 7,180 feet, on lease for ninety-nine years at a peppercorn rent of £311 per annum until the chapel’s lease expired, and then at £388 per annum, with, however, the provision that the Committee of the Hospital or its trustees were made personally responsible for the payment of the rent and the observance of the conditions of the lease. This provision neither the members of the Committee nor the trustees of the Hospital were prepared to accept, and the whole of the year 1889 was spent in endeavouring to come to terms with the Law Guarantee and Trust Society to take on these responsibilities. These negotiations not proving satisfactory, it was decided, in 1890, that application should be made to the Privy Council for a Charter of Incorporation. A Petition for Incorporating the Hospital by Royal Charter was prepared and presented to Her Majesty the Queen in Council, together with a draft form of the Charter which would empower the Hospital to hold land in mortmain, and thereby enable it to proceed with negotiations for the lease. The Charter of Incorporation under the Great Seal was passed in December, 1890, to which a common seal, that had been designed for the Hospital, was appended.

In the lease obtained for the ground in Eldon Street it was laid down that building was to commence before January, 1893, and it became necessary at once to appoint a suitable architect to draw up plans. Messrs. Lander and Bedell were at that time acting as surveyors to the Hospital, but hospital construction had developed into a very specialised branch of architecture, and it was thought desirable to employ for the new building one who had a large experience of that kind of work. In August, 1891, Mr. Keith Young, who had already designed several hospitals, was appointed, to be assisted by Mr. Lander, and after his death in 1892 by Mr. Bedell.

After due and deliberate consideration, the architects arrived at the opinion that the site, even including that of the Welsh chapel, would not allow of sufficient space to meet all the requirements of the new Hospital. They suggested that a larger one might be acquired in a less valuable locality. Investigations were made, and a site which seemed to offer many advantages was discovered in the City Road. Many of those associated with the Hospital felt very loath to move the Institution from the neighbourhood of Moorfields, with which it had become so intimately associated. The matter was discussed at length at a joint meeting of the Committee of Management and the medical staff, and in July, 1892, the latter passed the following resolution:

“That considering the alleged great value of the present site and the difficulty of constructing a suitable building upon it, the Medical Council is of opinion that the present site should be sold and that, so far as the information at present at its disposal goes, the City Road site is best adapted for a new Hospital provided that the whole of that site can be acquired.”

With the sanction of the Bridge House Estates Committee, the lease of the Eldon Street site with all its obligation was transferred to a substantial tenant, who was willing to pay the Hospital a premium of £1,000.

The lease was then obtained for 999 years from March, 1894, of what was termed the City Road and Peerless Street site of some 35,000 feet, in the parish of St. Luke’s, Old Street, in the county of Middlesex, at a rent of £1,210 per annum, from the Ecclesiastical Commissioners.

It is rather a remarkable coincidence that another hospital, which was originally situated at Moorfields, should have previously removed to the neighbourhood of the City Road, and not very far from the Peerless Street site. St. Luke’s Hospital, which, though independent of Bethlehem Hospital, dealt with the same class of ailments, was originally established in 1750 on the north side of Moorfields. In 1782 a new building was erected near the junction of Old Street and the City Road, it being recorded that at that time green fields could be seen in every direction. The building continued as a hospital for the mentally defective until the time of the Great War, when it was taken over by the Bank of England, of which it continues to be a branch.

Peerless Street runs between the City Road and Bath Street. It is lined by a row of small, mean houses, which, but for the Rent Restriction Act, would have been swept away ere this by the ground landlord, St. Bartholomew’s Hospital. Anyone unacquainted with the history of the neighbourhood may well wonder how such a poverty-stricken street could have acquired such a high-sounding name. It is the last remaining sign of the delectable attractions which formerly existed in its neighbourhood.

In ancient times some springs overflowed and formed a pond between what is now Peerless Street and St. Luke’s Hospital; from it water was conducted through pipes to Lothbury for the benefit of the inhabitants of that district. Stowe describes it in 1603 as “cleare water called the Perilous Pond because divers youths by swimming therein have been drowned.” In consequence of such accidents (the inhabitants of Lothbury having obtained water from elsewhere), the Perilous Pond was entirely filled in. In 1743 Mr. William Kemp, an eminent jeweller and citizen of London, having derived relief from violent pains in the head from which he had suffered for several years by bathing in the water from the spring, converted it into what William Maitland, in his History of London, 1775, describes as “the completest swimming bath in the whole world.” “He spared,” Maitland says, “no expense nor contrivances to render it quite private and retired from public inspection, decent in its regulations and as genteel in its furniture as such a place could be made.” At the same time he changed its name from the disagreeable one of the “Perilous Pond,” which it no longer was, to the pleasing one of the “Peerless Pool,” which, owing to its size and surroundings, it had undoubtedly become. The swimming bath measured 170 feet in length and 100 feet in width, and varied from 5 to 3 feet in depth. The entrance to it was through a marble pavilion 30 feet in length and across a bowling green; it was surrounded by dressing compartments, outside which were lofty banks covered with shrubs and a terraced walk planted with lime trees. Four pairs of marble steps descended to the bath, which had a fine gravel bottom. Besides this open swimming bath, there was a covered cold bath, supplied with water from a specially cold spring, faced with marble and paved with stone. The most remarkable feature, however, of the Peerless Pool was “a noble fish pond constructed by Kemp due east and west. It was 320 feet long, 93 feet broad, and 11 feet deep, stocked with carp, tench, and a great variety of the finney tribe, wherein subscribers and frequenters of either the pleasure or the cold bath were privileged to angle.” William Hone, in his Every-day Book, published in 1831, gives engravings of the fish pond (showing the lime walk and Kemp’s house in the distance) and of the swimming bath, made by Mr. John Cleghorn, an architectural draftsman and engraver, who for many years resided near the Pool.

PLATE XXIV

*TERMS OF SUBSCRIPTION*

PLEASURE BATH £. s. d. Month 0 9 0 Two Months 0 10 0 Year 1 1 0

Single Bathe} with Towels } 0 1 0 and Box } Ditto without 0 0 6

COLD BATH £. s. d. Month 0 10 0 Two Months 0 17 0 Year 1 10 0

Single Bathe 0 1 0

1 Bath Buildings; Entrance—2. Baldwyn Street Entrance—3. Cold Bath—4. Pleasure Bath—5. Dressing Boxes—6. Shrubberies

*THE PLEASURE BATH OF PEERLESS POOL,*

The largest in England, is situated in the immediate neighbourhood of the heart of the City, within Ten minutes direct walk of the bank and Exchange, (vide plan.) Surrounded by trees and shrubberies, open to the air, although entirely screened from observation, and most ample in its dimensions—*170* feet in length, by *108* in breadth—it offers to the Bather the very advantages he would least expect to find at so short a distance from the centre of the metropolis. Its depth, which increases gradually from 3 feet 6 inches to 4 feet 8 inches, is such as to afford free scope to the Swimmer, while it precludes all fear of accident to any and the temperature of the water rises to a height sufficient to ensure all the comfort and luxury of Bathing, without the risk of injury to health, from a too violent contrast with the external air.

*THE COLD BATH,*

Thirty-Six feet by Eighteen, is the largest of its kind in London, and both Baths are entirely supplied by Springs, which are constantly overflowing.

The City Road is the line from all parts of the West End to the City. Omnibuses pass both ways nearly every minute throughout the day.

BILL OF PEERLESS POOL. Circ. 1846.

In the Daily Advertiser of August, 1748, are some doggerel verses extolling the attractions of the Peerless Pool, and also a statement that—

“any gentleman, who subscribes only one guinea per annum, is entitled to the pleasure and cold bath, and to the diversion of angling and skating at proper seasons; and that if any occasional visitor, who must pay 2s. each time he bathes, thinks proper to become a subscriber in the fourteen days from his first visit, he shall be allowed that he has paid it as part of his subscription.”

After Kemp’s death the Pool seems to have changed hands several times. On the expiration of the lease in 1805, a new one was obtained from St. Bartholomew’s Hospital by Mr. Joseph Watt, at an annual rental of £600. To remunerate himself Mr. Watt drained the fish pond, felled the trees around it, and built Baldwin Street, which lies just south of Peerless Street, on its former site. He also erected Bath Buildings on the ground occupied by Kemp’s orchard, but left the pleasure bath intact. In 1831 William Hone wrote:

“The pleasure bath is still a pleasant spot, and both that and the cold bath retain their ancient capabilities. Indeed, the attractions of the pleasure bath are undiminished. Its size is the same as in Kemp’s time, and trees enough remain to shade the visitor from the heat of the sun while on the brink, irresolute whether to plunge gloriously in, or ignobly walk down the steps.... Every fine Thursday and Saturday afternoon in the summer, columns of blue-coat boys, more than three score in each, headed by their respective beadles, arrive, and some half strip themselves ere they reach their destination; the rapid plunge they make into the pool, and their hilarity in the bath, testify their enjoyment of the tepid fluid.”

The Peerless Pool continued in existence as a public bath until 1850, the site occupied by it being built over between that date and 1860.

Out of the City Road, on the opposite side to Peerless Street, leads Shepherdess Walk, which marks the site of the Shepherd and Shepherdess ale-house and tea-garden, built some time before 1745. The gardens were frequented by visitors who regaled themselves with cream, cakes and fromity. Invalids sometimes stayed at the inn to benefit by the pure air of the neighbourhood.

“To the Shepherd and Shepherdess then they go To tea with their wives, for a constant rule; And next cross the road to the Fountain also, And there they all sit, so pleasant and cool, And see, in and out, The folk walk about, And the gentlemen angling in Peerless Pool.”

In Baldwin Street there is still a public-house called “The Fountain,” which is probably the survival of the one referred to in this old rhyme, and of one which Franklin wrote of, “a very genteel public house at the east end of Kemp’s garden.”

The City Road, which was opened in 1761, cut through the meadow grounds which surrounded the Shepherd and Shepherdess, so that the place lost its rural isolation. The inn was pulled down in 1825, and the Eagle Tavern, which formed the nucleus of the famous Eagle establishment, with its Grecian saloon and theatre, and its garden and dancing pavilion, was erected near its site. It was this establishment which was celebrated in the refrain of the popular song;

“Up and down the City Road, In and out the Eagle, That’s the way the money goes, Pop goes the weasel.”

It has been suggested that this refrain might be paraphrased by those employed at the Moorfields Hospital as follows:

“Up and down the City Road, In and out Moorfields, That’s the way we spend our lives, Oh! the joy it yields.”

Whilst the above discussions and negotiations with regard to the erection of a new Hospital were in progress several changes took place in the personnel of the staff.

In 1890 John Whitaker Hulke, having reached the age of sixty, retired. He died five years later whilst holding the highest position in his profession, that of President of the Royal College of Surgeons in England. John Browning Lawford, who had already held the posts of house surgeon and of curator of the Museum, was elected in his place.

In 1891 George Lawson also had to retire under the age limit rule. In 1869 he had published a Manual on Diseases and Injuries of the Eye, which, owing to its practical character, became exceedingly popular amongst medical students, and rapidly ran through five editions. Lawson endeared himself to his patients by the personal interest he manifested in their welfare. His treatment went far beyond the mere prescription of drugs or the performance of operations. He would instruct a mother how to feed, clothe, and train her child. He would tell a patient, for whom nothing could be done to restore the lost sight, what his future might be and how to get to work to earn a livelihood. Many of those engaged in seeing out-patients often wish they could prescribe food for them instead of medicine. Lawson actually did this, having an arrangement with a neighbouring butcher by which he could at his own expense order patients so many pounds of meat. Nor did his generosity to Hospital patients end with supplying sound advice and meat; many to whom some unusually disastrous circumstance had occurred would be led quietly aside and return with a smiling face and a closed palm.

In 1886 Lawson was appointed surgeon oculist to Her Majesty Queen Victoria, which appointment he held until her death. He himself died in 1903 at the age of seventy-two, having had the satisfaction of seeing his son Arnold (now Sir Arnold Lawson) appointed on the staff at Moorfields, where he himself had worked for so long.

The vacancy caused by Lawson’s retirement was filled by the election of A. Stanford Morton, who was educated at Edinburgh University. He had served the Hospital first as house surgeon and later as clinical assistant for a period of sixteen years. He did not take the necessary qualification of the Fellowship of the Royal College of Surgeons of England, which would qualify him as a candidate for the staff, until 1888, and was forty-eight years of age at the time of his election. His name has become widely known throughout the ophthalmic world in connection with the very serviceable and popular pattern of ophthalmoscope which he had constructed for him by Messrs. Curry and Paxton. It happily combined all the best features and adaptations which had previously been suggested.

For dexterity and neatness as an operator on the eye Morton was unsurpassed in his time. He enthusiastically instructed others in the art, holding classes of operative ophthalmic surgery in which he employed pigs’ eyes fixed in a frame to enable students to obtain the necessary manipulative dexterity. Whilst he was working as a clinical assistant, the practice of retinoscopy for the correction of errors of refraction came into use, and he wrote a small book on Refraction of the Eye, describing it in such an easily assimilated manner that the book had a large sale, several editions being called for.

Being a good draftsman, and having an excellent eye for colour, Morton made many beautiful coloured drawings of ophthalmoscopic changes, the originals of which he presented to the Hospital on his retirement. The extreme care which he took in their production often necessitated several sittings on the part of the patient. In one interesting and complicated case, the drawing of which took a very long time, Morton found it necessary to remunerate the patient liberally after each sitting to ensure his subsequent attendance. When the drawing was finished the man found that Morton’s interest in his case had evaporated, and, being hard up, appeared at the Hospital one morning offering to sell him one of his eyes if he would like to take it out—an offer which it is perhaps needless to say was not accepted. The man afterwards went about to various ophthalmic clinics calling himself the celebrated Moorfields case, and he informed those who examined him “that gentlemen generally gave him something after looking at the backs of his eyes,”

Though it had been the custom for a long time to print on the letters given to patients, and to have posted up in the out-patient department, a notice to the effect that the Hospital was only open for the reception of really indigent patients, it was a rule which the medical staff found very difficult to enforce, and which was obviously very frequently infringed. In 1893 on the advice of the Medical Council, the Committee of Management adopted the plan in use at several of the other London hospitals of appointing an “inquiry officer” to attend daily and make necessary inquiries, so that “no person should be admitted in the first instance to Hospital relief who can afford to pay a fee of one guinea for a consultation (except in cases of accident)” The officer appointed for this Purpose was one selected by the Charity Organisation Society, who had been trained under its superintendance. As the result of his investigations, from about 500 applicants were refused yearly, it being found that they were able to pay a surgeon’s fee, many of them stating that they were unaware that the Hospital was open for the poor only.

John Couper’s time for retirement from the staff came in 1895. He continued in active practice for several years afterwards, and died in 1918, in his eighty-third year. He had always been a firm supporter of the movement for the admission of women to the medical profession, and welcomed Miss Elizabeth Garrett (afterwards Mrs. Garrett Anderson) as an onlooker at his clinic at Moorfields. It was not, however, until after he had left the staff, in 1898, that the eligibility of women to become pupils and clinical assistants at the Hospital became officially recognised.

E. Treacher Collins, who, like Lawford, had been both house surgeon and curator of the Museum at the Hospital was appointed as Couper’s successor.

The premature and unexpected resignation from the staff of Edward Nettleship took place in 1898; his keen interest in the scientific side of ophthalmology, however, did not slacken. He gave the Hospital a donation of £250, to be expended on scientific apparatus and appliances for the laboratory in the new building. With more time at his disposal for research work, his valuable scientific contributions increased in number. With indefatigable ardour and strenuous accuracy he worked out pedigrees of hereditary diseases, the value of which work was recognised in 1912 by his election as a Fellow of the Royal Society. On his retirement from practice in 1901, his friends and pupils inaugurated a fund to found the “Edward Nettleship Prize” for the encouragement of scientific ophthalmic work. It took the form of a Gold Medal to be awarded at intervals, at the discretion of the Council of the Ophthalmological Society, British subjects alone being eligible. He died in October, 1913, being actively employed up to the time of his death, in conjunction with Karl Pearson and C. H. Usher, on a large monograph upon “Albinism in Man.”

To fill the surprise vacancy caused by Nettleship’s retirement, W. T. Holmes Spicer was appointed.

Three matrons at the Hospital resigned from ill-health in the course of a few years, and, in 1895, Miss Ada Robertson, a former sister at the London Hospital, was appointed to the post. She not only carried through the difficult task of transferring the work of the Hospital from the old to the new building, but also, with skill and tact, raised the nursing to a higher standard of efficiency than it had reached before.

In 1897 Mr. Charles Gordon, who had acted as Chairman of the Committee of Management for eighteen years, and who had taken an active part in all the negotiations for the removal of the Hospital to a new site, on the eve of the laying of the foundation stone, found it incumbent upon him to resign owing to his advanced years; he died two years later. Thus, like Moses, having led his colleagues to within sight of the promised land, he left it for them to enter into its occupation.

Mr. H. P. Sturgis, a director of the London and Westminster Bank, was elected Chairman in his place.

About the same time, Mr. Robert J. Newstead, after twenty-five years’ service as secretary, had to resign from ill-health, and died at the end of the year. Mr. Robert J. Bland was appointed as his successor.

On the 28th of May, 1897, the work of clearing and preparing the foundations being sufficiently advanced His Royal Highness the Prince of Wales (afterwards King Edward VII.), on behalf of Her Majesty Queen Victoria, laid the foundation stone of the new Hospital. His Royal Highness was accompanied by their Royal Highnesses the Princess of Wales (afterwards Queen Alexandra) and Princess Victoria, the former graciously consenting to receive purses containing donations in aid of the Hospital. The silver trowel used on the occasion, which was provided by Mr. E. Hogg, one of the members of the Committee of Management, was presented to His Royal Highness, who stated “it is Her Majesty’s great and earnest wish that this Hospital may be prosperous and successful in every way.” Her Majesty further manifested her continual interest in the Charity by giving a donation of £100 to the Budding Fund. The Prince of Wales on his departure signified his intention to become a Patron of the Hospital.

In the removal of the Hospital from a prominent situation which had developed into a great business centre to a less known district easily accessible to those to whose needs it ministered the Committee of Management hoped to defray the cost of the building by the proceeds of the sale of the old site, and in doing so it was not far out in its reckoning. The old Hospital was sold for £78,500, and the new Hospital cost about £80,000. To provide the funds for the new building, whilst the work was being carried on in the old one, large loans had to be negotiated on the security of its freehold and leasehold property. In addition to the cost of the building the Committee had to provide funds for furnishing the new building, and equipping it with appliances and apparatus in keeping with its position as the leading ophthalmic institution in the British Empire. For this purpose it made a special appeal which was liberally responded to by the Corporation of the City of London and the following City Companies: The Worshipful Company of Carpenters, of Clothworkers, of Drapers, of Dyers, of Fishmongers, of Goldsmiths, of Grocers, of Leather Sellers, of Mercers, of Merchant Taylors, of Sadlers, of Salters, and of Skinners.

The fund was further augmented by a festival dinner held at the Grand Hotel, Charing Cross, on the 6th of May, 1898, over which His Royal Highness the Duke of Cambridge graciously presided, he himself making a liberal contribution to the cause for which he pleaded. In the following year a large and influential number of ladies promoted a ball in the Empress Rooms at the Royal Palace Hotel, Kensington, on the Hospital’s behalf, and Sir Squire Bancroft generously gave to it the proceeds of one of his inimitable readings.

When the clearance of the site for the new Hospital in the City Road was commenced, a Building Committee was appointed, consisting of certain members of the Committee of Management, with Mr. H. Davidson as chairman, and three representatives of the Medical Council, Tweedy, Gunn, and its honorary secretary, at first Morton, and later Treacher Collins.

One of the first questions this Committee had to consider was the dual one of the ventilation and warming of the new building. Was the system of ventilation to be “natural” or “artificial”? If artificial, was it to take the form of propulsion or extraction, or a combination of both? It has been well said “that theories in ventilation and warming are as numerous as trees in a forest,” and so the Building Committee discovered when they commenced to consider the problem. Several hospitals in which artificial ventilation was in use were inspected; ultimately it was decided that artificial ventilation on the planum system should be adopted for the out-patient department, and that natural ventilation should be relied upon for the wards.

The air forced into the out-patient department is first filtered, and then warmed or cooled as required. A shaft is provided which allows the foul air to escape. The force employed is a large rotating fan-wheel which propels the air along underground passages, and through gratings which open into the various compartments. It is filtered by passing through a coke-screen, which is cleaned with a stream of water flowing over it automatically at periodic intervals. It is warmed by passing over hot-water radiators situated close to the gratings opening into the compartments. It can be cooled by substituting blocks of ice placed on the radiators for the hot water contained in them.

In the wards the position of the windows is arranged to allow of cross ventilation, and the main sources of heat are open fires. Additional sources for warmth and ventilation are provided by hot water radiators, past which fresh air is allowed to enter through gratings near the floor. A separate sanitary block running through the centre of the building is cut off from it by cross-ventilation lobbies.

Only those who worked in the old Hospital in Blomfield Street can fully appreciate the amenities afforded by the new one in the City Road. Daily at noon the whole in-patient department in the old building became permeated with the odour of cooked meat. In the new Hospital all such disagreeable smells have been avoided by having the kitchen placed on the top floor. Most of the cooking is carried on by steam, supplied from boilers in the basement. A special service lift conveys goods to the kitchen, and also permits of the distribution of food and fuel to various parts of the building. Both this lift and the passenger lift are worked by hydraulic power; the latter allows of the conveyance of a patient on a wheeled trolley, in the recumbent position, to his bed from the operating table.

The lighting arrangements in the out-patient department, for the examination of the patients and the testing of their eyesight, and in the operating theatre to meet its varied requirements, engaged the architect’s and the Committee’s prolonged consideration. For the examination of patients in the first instance, and for many operations, uninterrupted direct skylight from a northern aspect was regarded as essential, and the new building was so planned as to allow of this in the large consulting room and in the operating theatre. As the work of the Hospital has to be carried out on dark days as well as bright ones, adequate means for the examination of patients by artificial light, in the absence of daylight, had to be provided. In the old Hospital, where gas was the main source of artificial illumination, there were various contrivances rendering it more or less efficient by the use of reflectors. In the operating theatre, a device used by the Nottingham lace workers had been employed. It consisted of a large hollow glass globe filled with water and suspended from the ceiling, which concentrated light from a lamp placed behind it on to the face of a patient lying on the operating table. The introduction of electricity for illuminating purposes throughout the new building simplified matters considerably. In the consulting room, movable flexes and adjustments permit light being easily brought into the most suitable position in which to conduct an examination. The employment of electric light globes for ophthalmoscopic examinations in the dark room, in place of argand gas burners, renders the atmosphere in it far more healthy and pleasant to work in, but it is doubtful if any form of electric bulb supplies quite such a uniform and satisfactory area of illumination for these examinations as the old argand gas burner.

The electric current supplied to the Hospital for lighting purposes is an alternating one; fortunately a constant current was also available in the district, being used in neighbouring factories. One of the chief purposes for which it is required is for working electro-magnets for the extraction of chips of iron or steel implanted in the interior of the eyeball.

It has been already mentioned how in 1858 Dixon tried unsuccessfully to remove a chip off the edge of a chisel, seen floating in the vitreous chamber, by a permanent magnet. In a similar case, McKeown of Belfast, in 1874, succeeded in the removal of the foreign body by the introduction of the tip of a permanent magnet into the interior of the eye.

In 1878 Malcolm McHardy, who was later ophthalmic surgeon to King’s College Hospital, employed for the first time an electro-magnet, and with it successfully removed a chip of steel which had become embedded in the crystalline lens. A few years later, Snell of Sheffield, Hirschberg of Berlin, and Bradford of Boston, U.S.A., had constructed electro-magnets which could be held in the hand, and have suitable terminals attached to them for introduction into the interior of the eye. Considerable success attended the use of such instruments when fragments of iron were situated in the front parts of the eye, but only on rare occasions when they had become deeply placed in the vitreous humour. In these latter cases, the foreign body was often hid from view, due to opacity of the lens caused by the injury, so that its exact position was unknown, and there was some doubt as to whether it had lodged in the eyeball or not. It was only when the nozzle of the hand magnet came close to the foreign body that it possessed sufficient traction power to draw it out, and in searching for it much damage was liable to be inflicted on the structures in the interior of the eyeball.

On the discovery of the X-rays by Professor Röntgen in 1895 it occurred to many ophthalmic surgeons that they might be utilised for the detection of foreign bodies in the eye. Two practical difficulties at first presented themselves, both of which were ultimately overcome. One was the density of the bony structures around the eyeball, and the other that of locating accurately the position of a foreign body when detected. It was found that excellent skiagrams, showing exceedingly minute pieces of metallic substances in the orbit, could be obtained if the sensitive plate was placed against the temple on the side of the injured eye, and the Crookes tube 10 to 15 mm. distant from the opposite temple. The most accurate localisation of foreign bodies implanted in the body was effected by an ingenious device of Mackenzie Davidson’s in which, after superimposing two skiagrams taken at slightly different positions, he followed the tract taken by the rays from the Crookes tube to the foreign body by means of threads, noting where they crossed in relation to the position of other known points.

Mackenzie Davidson (afterwards Sir James Mackenzie Davidson) worked at Moorfields as clinical assistant, and subsequently practised as an ophthalmic surgeon in Aberdeen. Soon after the discovery of X-rays, he removed to London and devoted himself specially to their application to surgery and medicine. His combined interest in ophthalmology and X-rays made him desirous of testing his method of localising foreign bodies in connection with eye injuries. Several members of the staff at Moorfields sent cases to him to report on, and such accurate and helpful information did he supply, not only as to the presence or absence of a foreign body in the eye, but also as to the exact position in which, when present, it could be found, that a desire arose to establish a special X-ray department and to secure his services in connection therewith. On the recommendation of the Medical Council, this was agreed to by the Committee of Management in November, 1898, £80 being voted for the cost of apparatus and an annual expenditure of £20 for the working expenses of the department. Mackenzie Davidson consented to accept the appointment of honorary medical officer in charge of the X-ray department, and a special room was fitted up in the new Hospital with the necessary conveniences for carrying on the work.

The introduction of the constant electric current into the operating theatre allowed of the employment of far more powerful magnets for the extraction of fragments of iron from the eyeball than had previously been used in this country. These powerful magnets have appropriately been described as “giant magnets”: they were originally introduced into ophthalmic practice by Professor Haab of Zurich. Their traction force is so great that a chip of iron hidden in the back part of the eyeball can be drawn forward into view in the front part.

In the Hospital Reports, H. V. McKenzie, the house surgeon in 1895, collected notes of all the cases in which a foreign body had been removed from the eye by the small hand magnet—i.e., prior to the introduction of X-ray localisation, and found that in 26 per cent, of those in which it was lodged in the vitreous the eye was saved. In 1902 the house surgeon, A. F. MacCallan, tabulated the results obtained by the use of Haab’s Giant Magnet, and found that in a similar class of cases by its use 58 per cent. of the eyes were saved, and that in half of these good vision was obtained. If accurate localisation of the foreign body by X-rays was carried out previous to the use of the magnet, a still larger percentage of success resulted.

The operating theatre in the new Hospital has been designed to make possible the practice of aseptic surgery. Antiseptic surgery, as first introduced, relied on the destruction of micro-organisms by chemical agents, and it was thought essential, whilst an operation was in progress, to have a spray of carbolic acid playing to prevent aerial infection of the wound. Later, as the result of experience gained in bacteriological laboratories, it became realised that such a precaution was unnecessary; micro-organisms being like dust particles subject to the law of gravitation, all that was required was to prevent any accumulation of dust and to avoid currents of air.

To avoid any accumulation of dust in the new operating theatre, its walls, ceilings, and floor are so constructed that at any time they can be washed over with a hose. The wall and ceiling are lined with glass tiles, technically known as “opalite,” the floor is paved with terazzo, and all the corners are rounded. All the pipes are of copper, and the radiators of the same metal. The latter are constructed so that they can be swung out on a pivot, and no dirt be allowed to accumulate behind them; they are in three divisions, which allow of variations in the amount of warmth given out as may be required.

To permit as many onlookers as possible being able to watch the operator’s procedures, without inconveniencing him or his assistants, fixed stands are erected on each side of the operating table, each stand being composed of three tiers, and each tier accommodating four persons.

The colour of the tiles on the walls and ceiling is a creamy-white with a dado of pale green. As some operations have to be conducted in a darkened room by artificial light concentrated on the eye, a dark blind is provided which can be drawn up from below, being enclosed when not in use in a brass box.

The case in which the instruments are stored is constructed entirely of brass and glass, and apparatus is provided to allow of the instruments being sterilised by boiling them before use. A special steriliser for dressings is also provided, with an outer jacket for steam, which permits of them being delivered dry when required for use.

In the wards, passages, and other parts of the building, all possible precautions are taken to avoid any lodgments for the accumulation of dust, the floors of all the wards being constructed of polished teak, and wherever possible the corners are rounded. All cupboards have sloping tops, and are fixed to the walls at such a height that the highest part of them is easily within reach. Arrangements are made for the storage of the patients’ clothes, when in bed, in special cupboards outside the wards, and the small marble-topped lockers placed beside their beds were specially designed just to contain a few of their possessions.

A special eye hospital differs from a general hospital in the large proportion of its patients who are able to be up out of bed during the daytime. It is, therefore, desirable to have special day rooms in which they can congregate away from the wards, and have their meals. In the new Hospital, on each floor, such day room accommodation is provided.

Notwithstanding the enormous amount of work involved in the removal to the new building, it was effected with scarcely any interruption in the routine work of the Institution. The new building was opened for the reception of patients on September 4th, 1899, the work in the old Hospital being carried on for in-patients up to August 19th, and for out-patients up to August 26th.