CHAPTER V. The Royal London Ophthalmic Hospital

THE ROYAL LONDON OPHTHALMIC HOSPITAL

His Royal Highness the Duke of York, the Infirmary’s first Patron, died in 1827.

At the three days’ sale at the Mansion House in 1828 the Duchess of Kent was one of the Lady Patronesses. In 1836 the Rev. Dr. Blomberg, a member of the General Committee of the Infirmary, stated that he had reasons to hope that an application to their Royal Highnesses the Duchess of Kent and the Princess Victoria to become Patronesses of the Institution would be likely to meet with success. A letter was then drawn up, addressed to the Rev. Dr. Blomberg, and signed by the President, with a statement of the following claims by the Institution to so high a distinction: That the grand total of patients admitted since its establishment to the end of 1835 (a period of about thirty years) was 116,890, during which time 1,070 cases of cataract or closed pupil (including 136 born blind) had had their sight restored. That the annual number of patients admitted of late years had varied from 5,000 to 5,500. That 74 capital operations were performed in 1834, 69 of which were successful, and of 78 performed in 1835 four only failed to produce the desired effect. That no less than 1,320 physicians and surgeons had been pupils at the Infirmary, and were now dispensing its benefits in various parts of the globe. That it was the parent institution of the numerous hospitals since established throughout the kingdom for the same benevolent purpose.

It was requested that the Rev. Dr. Blomberg would bring these facts before the notice of the Duchess of Kent and her illustrious daughter, the Heiress-Presumptive to the Throne, requesting their gracious permission to place the Institution under their august patronage.

In response to this petition the following letters were received:

“KENSINGTON PALACE,

“12th March, 1836.

“My dear Sir,

“By the accompanying letter which you will be so good as to forward you will see that the Duchess of Kent has lent her aid and that of the Princess Victoria to the excellent charity whose cause was so ably advocated in Mr. Mellish’s letter.

“Her Royal Highness is very happy to find an occasion to meet a wish of yours.

“Believe me always, my dear Sir,

“Yours very faithfully,

“JOHN CONROY.

“THE REV. DR. BLOMBERG.”

“KENSINGTON PALACE,

“12th March, 1836.

“Sir,

“I have the honour to lay before the Duchess of Kent your letter of yesterday’s date, and Her Royal Highness begs you will assure the Committee of the London Ophthalmic Infirmary, Moorfields, that it will be very gratifying to her to allow her name and that of Her Royal Highness the Princess Victoria to be placed as Patronesses of so benevolent an Institution.

“I have the honour to be, Sir,

“Your most obedient servant,

“JOHN CONROY.

“WM. MELLISH, ESQ.,

“112, Bishopsgate Street Without.”

As the outcome of the Royal Patronage, it was agreed at a General Meeting of Governors, on April 20th, 1836, that the name of the Institution should be changed to “The Royal London Ophthalmic Hospital, Moorfields.”

In 1837, on Queen Victoria’s accession to the Throne, the Chairman of the Committee of the Hospital applied to Lord John Russell, the Secretary of State for the Home Department, to ascertain Her Majesty’s pleasure as to continuing Patroness of the Hospital, and received from him the following reply:

“WHITEHALL,

“August 29th, 1837.

Sir,

“I have the honour to lay before the Queen the petition of the Committee of Management of the Royal Ophthalmic Hospital.

“And I have the satisfaction to inform you that Her Majesty has been graciously pleased to be the Patroness of that Hospital.

“I have the honour to be, Sir,

“Your obedient servant,

“J. RUSSELL.

THE REV. J. RUSSELL, D.D., etc.,

“Rectory House,

“Devonshire Square.”

The Patronage of the Queen, thus commenced, continued throughout the whole of her long reign.

In 1838 William Mellish, who had been President of the Hospital for twenty years, died, and the Committee placed on record their gratitude and respect for the uninterrupted paternal care and attention he had shown to the interests of the Institution during his time of office. He was what may be described as a real live President, having been always ready to take the Chair at the annual meetings of Governors and at the anniversary dinners. He was succeeded in the office of President by Earl Fitzwilliam, who resided mainly in the country, and but seldom visited the Hospital, so that the control of its affairs fell largely into the hands of the Chairman of the General Committee, who was at that time the Rev. J. Russell, D.D.

It was obvious at the foundation of a special institution devoted to eye diseases that the treatment would be mainly surgical, but the importance of the medical side of ophthalmology was recognised by the appointment of a physician. With the expansion of the work of the Institution during the first thirty years of its existence the number of surgeons on the staff had to be increased from one to four. During all that time Dr. J. R. Farre acted alone as consulting physician, having referred to him for his advice and aid cases requiring medical treatment. In 1836, when he had reached the age of sixty-one, a special Committee, of which he was not a member, decided that it was desirable to appoint an assistant-physician; the post was advertised in the daily journals, and Dr. Frederick John Farre, assistant-physician at St. Bartholomew’s Hospital, son of Dr. J. R. Farre, was appointed, he being the only candidate. It was then arranged that the Hospital should be opened for out-patients, to be seen by the assistant-physician, on Wednesday mornings at eight o’clock, and that notices to that effect should be advertised.

In turning over the leaves of the minute books recording the doings of the various Committees, it is remarkable to find how much time and attention Dr. J. R. Farre devoted to the management and administration of the Infirmary during its first thirty years. Travers aptly described him as “the foster-father of the London Ophthalmic Infirmary.” He has also aptly been described as “the father of Ophthalmic Medicine.” He was most regular in his attendance, and when a petition, a report, or any letter of importance had to be composed, his assistance was always sought for. Though his style now seems florid and verbose, it met the requirements of the time, and generally effected the purpose for which it was intended.

With remarkable foresight he endeavoured to establish, with varying degrees of success, many of the developments which have in later years become some of the most prominent features of the Hospital’s work. Thus the Saunderian Institute, one of the purposes of which was the investigation of the minute anatomy of the eye, foreshadowed the Pathological Laboratory and Museum which were established later.

In 1828 Dr. Farre started the publication of a Journal, of which, however, only one number appeared, but in a way it may be considered the precursor of the Royal London Ophthalmic Hospital Reports, which commenced in 1857. Farre’s Journal contained a most remarkable mixture of subjects, and serves to show him as a man of wide and varied interests.

It was entitled, Journal of Morbid Anatomy, Ophthalmic Medicine and Pharmaceutical Analysis, with Medico-Botanical Transactions communicated by the Medico-Botanical Society.

It contained reports from the Calcutta and Madras Eye Infirmaries; notes on cases and pathological examinations of rupture of the heart, angina pectoris, aneurysm, etc., by various observers; a paper by Richard Battley on experiments on Chinchona; the Transactions of the Medico-Botanical Society; observations on the climate of the Azores, of Hastings, and Penzance; a paper by John Dalrymple, ‘On the Muscularity of the Iris,” which, Dr. Farre said, in some introductory remarks, met the principal object for which his Academy was instituted—

“the inquiry having been physiologically conducted and pathologically directed, assumed the very spirit which he most desired to encourage amongst the many British candidates for anatomical character.”

It was announced that:

“Parts of the Journal will be published at fixed periods of Midsummer and Christmas, and also intervening parts, as opportunity may admit, for the completion of each volume, if the Editor’s health should, by God’s permission, enable him to separate from the hours of his repose a portion of time adequate to the service announced in this notice to contributors.”

These good intentions were, however, not realised, no further number of the Journal being issued.

The Library, for which a special room had been set apart in the new building, was started by Dr. J. R. Farre’s presentation of eighteen volumes of the Philosophical Transactions and various works on optics. These formed a nucleus around which has been built up one of the most extensive and valuable collections of books dealing with ophthalmology, a collection which has proved of inestimable service for purposes of reference and research to several successive generations of workers at the Hospital.

In 1837 Dr. J. R. Farre advised the Committee that it was desirable that a Pharmacopœia should be constructed for the use of the Hospital; in its compilation Dr. Frederick Farre, who was lecturer on Botany at St. Bartholomew’s Hospital, and later lecturer there on Materia Medica, rendered valuable assistance.

Dr. Farre, senior, seems to have been a man who inspired the warmest regard and affection in all who became associated with him; in 1838 a full-length portrait of him was presented to the Hospital by some of his friends with the accompanying letter:

“LONDON, 18th August, 1838.

“34, Montagu Square.

“Gentlemen,

“I have the honour on behalf of my brothers and myself to present to the Royal London Ophthalmic Hospital, of which he has so long been a liberal patron and zealous benefactor, a portrait of our esteemed friend Dr. John Richard Farre, painted by T. Phillips, R.A.

“To those who appreciate the character and services of the worthy original we feel assured that we need only offer in order to obtain for it a welcome reception.

“I am, Gentlemen,

“Your most obedient servant,

“J. ROACH BOVELL.

“THE PRESIDENT, VICE-PRESIDENTS, TREASURER AND COMMITTEE OF THE R.L.O.H.”

On receiving it the Committee passed the following resolution:

“That recognising in Dr. Farre not only one of the Founders of the Institution but a munificent contributor to its funds, and the able physician by whom the science communicated and dispensed within its walls has been effectively upheld and enlarged, the Committee accepts the testimonial of private esteem and affection with peculiar pleasure as the means of publicly manifesting, and of transmitting to posterity, the high claims of public respect and gratitude for that highly distinguished public benefactor.”

PLATE IX.

From an engraving by Frank Bromley, after a picture by Thomas Phillips, R.A.]

Thomas Phillips, R.A., painted the portraits of most of the celebrated literary and scientific men of his time; that of Dr. Farre must certainly have been one of his largest works of this description. It now occupies a dominating position in the Board Room of the Hospital, and shows Dr. Farre clothed in stockings and knee-breeches, with a buff-coloured waistcoat, stock, and blue coat with brass buttons. He is represented seated at a table with the drawing of a malformed heart in one hand, and a portfolio beside him, evidently containing his valuable collection of drawings of pathological specimens, which was afterwards presented to St. Bartholomew’s Hospital Museum.

Dr. Farre was a religiously devout man, and most appropriately there is conspicuously shown amongst the books on his table a copy of the Holy Bible. He continued to serve the Hospital in the capacity of consulting physician until 1843, but lived on until 1862, when he died in his eighty-eighth year, having outlived all those who had been associated with him in the Hospital’s foundation.

His son, Dr. Frederick J. Farre, was educated at Charterhouse School, and was the captain of it during Thackeray’s first year there. Thackeray afterwards introduced him in The Adventures of Philip as Sampson Major, the cock of the whole school.

Mackmurdo and Dalrymple’s duties as assistant-surgeons consisted mainly in the treatment of the out-patients. After having been so employed for several years, they not unnaturally aspired to gaining skill and experience in the performance of the major operations of ophthalmic surgery on the in-patients. With such aspirations several members of the Committee of Management were in sympathy, and much discussion took place as to some alteration in the rules which would permit of them acting as full surgeons. Tyrrell and Scott, however, were opposed to any proposal which was likely to lead to a curtailment of their privileges as senior officers.

The following return was drawn up and laid before the Committee to show how the work of the Institution was distributed amongst the different members of the medical staff in the year 1842.

Out-patients: Dr. F. Farre 607 (one day a week) Mr. Tyrrell 1,090 Mr. Scott 1,037 (two days a week) Mr. Mackmurdo 1,274 Mr. Dalrymple 1,714

Operations performed: Extraction of Needling of Artificial Cataract. Cataract. Pupil. Mr. Tyrrell 42 20 7 Mr. Scott 29 9 7 Mr. Mackmurdo 0 4 0 Mr. Dalrymple 0 5 0

The matter was brought to a head by the death of Tyrrell in June, 1843. By that time Mackmurdo had served the Hospital as assistant-surgeon for a period of thirteen years, and Dalrymple for eleven years.

After due notice had been given it was then agreed, at a special General Meeting of the Governors, that the laws regarding the appointment of the medical officers should be suspended, and that Mr. Mackmurdo and Mr. Dalrymple should forthwith be appointed surgeons to the Hospital; also that two new assistant-surgeons should be elected. Mr. John Scott strongly protested against such an increase in the surgical staff, pointing out, quite correctly, that such an increase was out of proportion to the increase in the number of patients.

Shortly afterwards Dr. Frederick J. Farre was likewise promoted from assistant-physician to physician to the Hospital, his father, Dr. J. R. Farre, being described as consulting physician, the capacity in which he claimed to have always served as a member of the staff.

The candidates for the two posts of assistant-surgeon were:

Mr. James Dixon, who had been articled as apprentice to Tyrrell, and who was demonstrator of anatomy at St. Thomas’s Hospital.

Mr. George Critchett, who had been articled to Scott, and who was demonstrator of anatomy at the London Hospital.

Mr. William Bowman, who had served his apprenticeship at the Birmingham Hospital, and who was demonstrator of anatomy at King’s College Hospital.

The latter withdrew his candidature in favour of the two former when he found that they had been already working at the Hospital, but at the same time intimated his intention of applying again when a further vacancy arose. This occurred in 1846, due to Scott’s retirement from ill-health, and Bowman was then elected assistant-surgeon unopposed.

Dr. J. R. Farre was, as already shown, a man of ideas as well as of affairs; the time, however, occupied by the latter precluded his putting many of the former into practice. He was, therefore, exceedingly fortunate in finding in John Dalrymple a most energetic and capable disciple.

John Dalrymple, who was related to the Stair family, was born in 1803. His father, William Dalrymple, who had studied under Astley Cooper, was surgeon to the Norfolk and Norwich Hospital. He was a liberal-minded man as well as a skilful surgeon, and attracted considerable attention in 1813 by repeating successfully Travers’ operation of tying the common carotid artery in a case of “aneurism by anastomosis” of the orbit. He had also devoted some attention to ocular pathology, and had made a valuable collection of anatomical and pathological preparations, which he presented to the Norfolk and Norwich Hospital.

John seems to have served his apprenticeship under his father, and to have acquired from him a liking for both pathology and ophthalmology. He studied for a time at Edinburgh University, and came to London, where he qualified as M.R.C.S. in 1827.

His association with Dr. Farre and with the Moorfields Hospital then commenced, with his appointment already mentioned, as demonstrator and secretary to the newly opened Saunderian Institution, where he carried out anatomical and pathological investigations. In 1834, as the outcome of his work at the Institute, he published a treatise on the Anatomy of the Human Eye, which he dedicated to Dr. J. R. Farre, Frederick Tyrrell, and John Scott, his colleagues at the Infirmary, to which he had been appointed assistant-surgeon the previous year. This book, besides containing a description of his own dissections, gives an excellent review of the work of previous investigators, and is illustrated by five engraved plates from his own anatomical drawings. Dalrymple’s investigations were not restricted to ophthalmology; between the years 1840 and 1849 he contributed several papers to the Medico-Chirurgical Society’s Transactions relating to general pathology, and also wrote articles dealing with Natural History.

Tyrrell’s unexpected decease, and later Scott’s retirement, left Dalrymple in a leading position in ophthalmology, and his reputation and practice rapidly increased. In 1847 he found the state of his health to be such as to render it impossible for him to keep up his attendance at the Hospital during the winter months. As he was the only surgeon in attendance on Wednesdays and Saturdays, whereas on the other days of the week both a surgeon and an assistant-surgeon were on duty, the Governors agreed to appoint a third assistant-surgeon, and thereby relieve Dalrymple of his duties during the winter. Alfred Poland, who had served his apprenticeship under Aston Key at Guy’s Hospital, and who was a demonstrator of anatomy there, was elected to the post.

Dalrymple’s health did not tend to improve, and in 1849 he felt compelled to resign his appointment on the active staff, and was appointed consulting surgeon. On his retirement no fresh appointment was made to the staff, Critchett being promoted to the post of surgeon in his place. In 1850 Dalrymple was elected a Fellow of the Royal Society.

For a number of years John Scott and Dalrymple had been collecting water-coloured drawings of diseases of the eye, made from patients under their care at the Hospital by the best artists. Scott, at his death, bequeathed to Dalrymple the drawings he had collected, and these, added to Dalrymple’s own, amounted to several hundred. It was from a selection of them that in 1852 Dalrymple was able to produce his great Atlas of Pathology of the Eye. The publication of the volume was entrusted to Mr. Churchill, and every advantage that fine paper and artistic skill could afford was supplied. The Atlas consisted of thirty-six plates, some containing six figures, and others full-page illustrations, with explanatory letterpress. The original drawings were made by W. H. Kearney and Leonard, and the drawings on stone by W. Bragg. It can safely be asserted that no illustrations of eye diseases ever surpassed or even equalled those in this Atlas, both as regards artistic merits and faithfulness in the depiction of the characteristics of the conditions they represent. The cost of the production of the Atlas was nearly fifteen hundred pounds, and copies of it now are exceedingly scarce. Dalrymple only lived a few weeks after its completion, dying in the zenith of his fame and the full tide of prosperity. The whole collection of drawings, from which those reproduced in the Atlas were selected, was bequeathed by him in his will to the library of the Royal London Ophthalmic Hospital, where they are still preserved.

It is perhaps remarkable that, though Dalrymple did so much for ophthalmology by his anatomical investigations and the production of this Atlas, his name is best known by ophthalmic surgeons at the present day in connection with the symptom of retraction of the upper lids in “Graves’ disease” or “exophthalmic goitre,” which produces the peculiar staring look that forms one of its most characteristic features. This symptom is spoken of in textbooks as “Dalrymple’s sign,” but to his description of it Dalrymple himself apparently attached but little importance.

John Dalrymple was one of a family of nine; two of his brothers became medical men and practised in Norwich; another, named Robert Francis, was a solicitor in the firm of Bircham, Dalrymple, and Draise, and on the retirement of Francis Bircham, his partner, from the post of secretary to the Hospital in 1844, R. F. Dalrymple was appointed in his place. He discharged the duties of the office most efficiently for two years, and was then succeeded by Mr. F. A. Curling.

PLATE X.

Richard Battley married one of Dalrymple’s sisters. John Dalrymple died in May, 1852, and Battley in 1856. The latter’s widow, after the death of her husband, presented to the Hospital a bust of her brother, which now stands in the hall of the present building. In the same year, 1856, Robert Dalrymple was elected a member of the Committee of Management of the Hospital, and presented to it an engraving of his brother, which still hangs in the Board Room of the Hospital, mounted in what was described at the time as “an elegant gilt frame.” Another presentation to the Hospital that year was a copy of Dalrymple’s Atlas from John Churchill, the publisher, with the following inscription on the flyleaf:

“Presented to the Royal London Ophthalmic Hospital, in honour of that sight-saving Institution, and as a memorial of the highest respect and esteem for the memory of the author, whose lamented death took place soon after the completion of his immortal work, the subscriber having enjoyed the friendship of the author, as well as being his publisher.

“(Signed) JOHN CHURCHILL.

“6th October, 1856.”

At the Annual General Meeting of the Governors of the Hospital, after the death of Richard Battley, the following resolution was passed:

“That this Meeting most gratefully acknowledge the eminent services to this Hospital of the late Mr. Richard Battley; that to his energy and perseverance are attributed more especially the establishment of the Hospital; that in its origin, when checked by impediments and surrounded by difficulties, it was fostered by his influence and exertions and, in the arduous circumstances which ensued and continued during many years, was succoured and sustained by his active zeal; and that it is especially to be recorded that he upheld the Institution by an undeviating regard to the professional appointments by which the Hospital has been distinguished from its foundation.

“That this memorial be engraved and placed in the committee room of the Hospital with the portraits of his early friends, Saunders and Farre.”

Gilbert M. Mackmurdo was Dalrymple’s senior; he remained a member of the active staff of the Hospital until 1856, and died at an advanced age in 1869. In his obituary notice he is said to have had a fine appearance, a fair patrimony, and to have enjoyed great City and mercantile influence; it was largely due to the latter that he obtained his early appointment to the staff at Moorfields, and that of surgeon to St. Thomas’s Hospital and to Newgate Prison. The last appointment gave him for many years a handsome salary, with a commensurate retiring allowance.

Being well provided for with this world’s goods, he seems to have contented himself with the practice of the art of his profession without making contributions to its science. Early in life he was elected a Fellow of the Royal Society, but for what particular reason no record can be found. His only contribution to ophthalmic literature seems to be a short description of a case of recurrent haemorrhage from the inferior palpebral artery. He is said to have been thoroughly popular with his pupils and with his patients of all degrees, and never, never to have made an enemy in his life, either willingly or wilfully.

In 1849 Mrs. Dodson, who had held the post of matron at the Hospital for a number of years, died, and a Committee was appointed to report on the general arrangements and accommodation of the Institution. The following extract from it serves to show what these were, after the Hospital had been in existence for half a century:

“The establishment consists of a Resident Apothecary, a Matron, one Nurse, one Housemaid, and one Cook, all of whom reside upon the premises, and a Porter or Messenger who neither sleeps nor takes his meals in the building.

“There are 23 beds for patients in five separate wards, and during the winter only from one to five are occupied, whilst during the summer, or from May to October, when the season is propitious for the various operations, the whole of the beds are occupied.

“The Committee recommends that the new Matron to be appointed should be discreet and mild in her manner, whose standing and carriage is superior to a servant, of about 40 years of age and without encumbrances, and whose duties shall be to render assistance to and alleviate the sufferings of the patients by a regular oversight of them.

“Her salary to be 30 guineas a year, with an allowance of £5 for tea and sugar.”

As the fame of the Hospital extended there was a rapid increase in the patients who came to it seeking relief. The annual number of new out-patients became doubled in the course of ten years; in 1841 there were 5,643, and in 1851, 11,384.

This large increase made it necessary to provide for increased accommodation in the out-patient department. In a letter to the Committee, Dr. J. R. Farre drew attention to the early age at which the death of several of the members of the surgical staff had taken place. Saunders died at the age of thirty-six; Tyrrell at forty-nine; Scott at forty-eight; and Dalrymple at forty-nine. Farre suggested that this might to some extent be due to the tainted atmosphere of the receiving rooms for patients, and to the strain involved in having to attend to such large numbers.

A rearrangement of the rooms of the ground floor of the Hospital was then made to provide more space for those waiting to be attended to; an assistant was engaged to aid in the dispensing; and the staff was increased by the appointment of another assistant-surgeon.

The candidates for this post were Mr. H. H. Mackmurdo and Mr. T. N. Nunn; the former received 330 votes and the latter 160. The former probably, like his brother Gilbert, was able to bring considerable City and mercantile influence to assist him; he, however, only held the post for a year, and then resigned. Mr. J. C. Wordsworth, who was a descendant of a collateral branch of the poet’s family, and who was an assistant-surgeon at the London Hospital, was appointed in his place.