This article is more than 5 years old. Information may no longer be current.
Eye Capitals: London features prominently in history of ophthalmology
Physicians run the gamut from 'quacks' such as 'Chevalier' John Taylor to pioneers such as Sir Harold Ridley.
Click Here to Manage Email Alerts
London has had a long association with the eye throughout history, and there are indications from Roman seals that eye drops, or collyria, were made during the occupation of Britain.
Little was known about the anatomy of the eye until well into the 16th century, but couching of the cataractous lens, which had been described by Sushruta more than a millennium before, was widely practiced in the Middle Ages, often by monks. John of Arderne and John de Peckham tried to understand more about eye diseases and the properties of lenses, and the former was considered to be the father of English surgery.
Plagiarism characterized much of the ophthalmic writing in the 17th century. Richard Banister’s Treatise of One Hundred and Thirteen Diseases of the Eyes and Eyelids was copied almost entirely from a French textbook. Banister wrote disparagingly about non-medically qualified women who treated eye conditions and yet “can take hennes, chickens, and such reasonable rewards for their unreasonable wrongs.” However, he admired a contemporary who lived in London, one Luke of Erithe, “a man that lived in greate fame and credite had the greatest practise and sumes of money for he hathe had from XX to LX £ (£20-60) for Cataracke couching.” That is between £5,000 and £15,000 in today’s money.
Science started to appear in optics and anatomy when Sir Isaac Newton used a prism to demonstrate the nature of the spectrum in white light. Further, he described the anatomy of the optic chiasm with half the nerve fibers crossing over.
In the 18th century, Jacques Daviel introduced cataract extraction in France. However, in London, eye quackery was rife. The most infamous of all these quacks was “Chevalier” John Taylor, who practiced cataract couching. His surgery was described by a contemporary thus: “If his operation succeeded, so much the better; if not the patients could but be blind, or in danger of being so, as they were before.” He reportedly blinded Handel and helped to kill Bach through his surgery. Yet, not all were quacks. Samuel Sharp, a surgeon at Guy’s Hospital, described the single incision by puncture and counter-puncture for Daviel’s cataract extraction. For most surgeons, there was little enthusiasm to adopt the new French technique. Percivall Pott, a surgeon at St Bartholomew’s Hospital, declared that cataract extraction was only a “kind of fashion.” A continental contemporary said: “Some of the English ophthalmologists rejected the extraction method in order to please Mr Pott, others in order to stand out among the crowd. A third group did it out of national pride and out of hate of all French. And a fourth group did it because they had bad results due to prejudice or clumsiness.”
Thomas Young, a physician at St George’s Hospital, was the founder of physiological optics. In 1793, he explained how the eye accommodates by changing the curvature of the crystalline lens. In 1801, he was the first to describe astigmatism and hypothesized, before von Helmholtz, that color vision needed three types of nerve fibers.
This was a good omen for the start of a new century after all the non-science that had preceded it. What was soon to happen in London was much aided by Napoleon Bonaparte. In 1798, he invaded Egypt, and the British army went there to fight him. Both armies were plagued by a new infectious eye disease then called “Egyptian ophthalmia.” John Cunningham Saunders founded the London Eye Infirmary in 1805 “out of compassion for the pitiful state of many soldiers.” This became known as Moorfields Eye Hospital. Over the next 50 years, four other dedicated London eye hospitals opened, and general hospitals began to have eye departments.
The latter half of the 19th century proved to be a golden era for London ophthalmology. This was helped by the invention of the ophthalmoscope by von Helmholtz and the first International Ophthalmic Exhibition held in London in 1851. Many of the terms still in common use to describe ophthalmological conditions and anatomy were first described by London ophthalmologists during this period: Bowman, Hutchinson, Gunn, Tay, Coats, Nettleship and Treacher Collins.
Sir John Parsons, a consultant at Moorfields, was an important part of London ophthalmology in the early 20th century. He wrote prolifically, with 140 articles and books on eye diseases, ophthalmic pathology, color vision and the theory of perception. He was chief editor of the British Journal of Ophthalmology for 22 years and helped to restart the International Council of Ophthalmology in 1927.
Strabismus was becoming more important in London with the likes of Claud Worth and Ernest Maddox. The latter’s daughter Mary became the world’s first orthoptist and started the first school of orthoptics.
In 1928, Stewart Duke-Elder, a giant of 20th century ophthalmology, was appointed to St George’s and Moorfields hospitals. Apart from his extraordinary achievement in writing the seven-volume Textbook of Ophthalmology and then, 15 years later, the 15-volume System of Ophthalmology, he set up the faculty of ophthalmology at the Royal College of Surgeons in 1945 and the Institute of Ophthalmology in 1947. Norman Ashton, the first director of pathology, discovered that excessive oxygen given to premature babies causes retinopathy of prematurity. At St Bartholomew’s Hospital, pioneering work was done on ocular tumors by Hyla Stallard, who introduced radioactive cobalt plaques to treat retinoblastoma and choroidal melanoma.
But something else was happening in London ophthalmology that would have far more important consequences. In 1949, Sir Harold Ridley performed the world’s first lens implant at St Thomas’s Hospital in London. His experience with eyes damaged by aircraft canopy fragments during World War II led to the lens material PMMA. His invention was controversial when he went public at the Oxford Ophthalmological Congress in 1951. But other developments were taking place in cataract surgery, and after a chance meeting with Charles Kelman in 1969, Eric Arnott took a course in phacoemulsification in 1971 and introduced this technique to Europe. I joined Eric as his senior registrar at Charing Cross Hospital in December 1978 and did my first phaco in January 1979. Together we recognized the need for a lens material that could be folded to go through the phaco incision. We published a paper in 1981 outlining the potential use of poly-HEMA with a rabbit study. Sadly, we did not patent this.
In the past 20 years, Prof. John Marshall, who has worked at the Institute of Ophthalmology and also St Thomas’ Hospital, has made major contributions to London ophthalmology. He discovered the effects of blue light on retinal cells. His involvement with lasers has included the creation of the first diode laser for retinal and glaucoma treatment, and he helped to patent the excimer laser. More recently, the earliest stem cell trials in patients with Stargardt’s disease and other retinal diseases have taken place in London. There is now a dedicated research department at University College looking at the use of stem cells and gene therapy in sight loss from macular degeneration, inherited diseases, diabetic eye disease, uveitis and corneal disease.
- For more information:
- Richard B. Packard, MD, FRCS, FRCOphth, OSN Europe Chairperson of the Editorial Board, can be reached at Arnott Eye Associates, 22a Harley St., London W1G 9BP, England; +44-20-7580-1074; email: eyequack@vossnet.co.uk.
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.