THE WORK OF JOHN CUNNINGHAM SAUNDERS
That the Institution which Saunders had founded provided a much felt
want is evident from the following statement of the number of patients
with eye diseases dealt with, and the numbers stated to be “cured,”
during the first four years of its existence.
1st year, 1805, admitted 600, cured 500. 2nd year, 1806, admitted
1,526, cured 1,036. 3rd year, 1807, admitted 2,126, cured 1,796. 4th
year, 1808, admitted 2,357, cured 1,970.
It must be admitted that it is somewhat doubtful what the term cured
actually implied, for in a list of the diseases which those “cured”
suffered from are included some, such as total opacity of the cornea,
for which even to-day no absolute cure is known.
Successful as the Institution proved to be in dealing with eye disease,
it was far less so in connection with ear disease.
Saunders’ first publication was a book entitled _The Anatomy of the
Ear: A Treatise on the Diseases of that Organ. The Causes of Deafness
and their Treatment_. It must evidently have met with much demand, for
a third edition was published after his death, in 1829. Although he had
devoted so much study to the treatment of diseases of this organ, he
seems soon to have realised that the interests of his Institution would
be best served by restricting its aims to the treatment of diseases of
the eye only. His reasons for doing so are set out in the following
letter which he sent to the Committee in December, 1807:
“Gentlemen,
“Antecedent to the establishment of this Dispensary the diseases
of the Eye and Ear had never been made the object of a specific
institution, although their great variety and complexity seem to
require the most minute and attentive investigation. Those who have
practised on the eye have always partially cultivated the ear, and
when I chose the former for professed pursuit, the latter also
became the subject of my serious enquiry. I had ascertained by
observation that certain cases of disease are alleviable. Still I
was aware how little would be the success, as the most complicated
structure of the organ, which occupies an inaccessible part of our
frame, is most frequently the seat of disease. Regardless of this
conviction and solely influenced by a knowledge of the positive
good which the deaf occasionally receive, I did combine in my
proposal for the institution of this charity, the ear with the eye,
solicitous of gaining public esteem by doing for the public all
the good in my power. But the experience which this institution
affords demonstrated the proportion of curable and incurable cases,
a proportion much smaller than was expected, at most exceeding
(obstruction from inspissated wax excepted) one in a hundred. It
grieves me now to state, this branch of our institution exhausts
the funds without an adequate advantage, and consumes a portion of
my time on an impracticable point, that must ultimately tend to
diminish my reputation. The performance of this part of my duty is,
therefore, irksome to me, not because it is laborious, but because
it neither leads to distinction nor obtains even the common reward
of benevolent institutions. To be thankful for intended benefits
demands a refinement of reason which none but liberal minds possess.
Of those who are dismissed incurable more are made vindictive by
disappointment than are grateful for the care bestowed upon them, and
the former almost universally represent him who has ineffectually
attempted their relief as the author of their misfortunes.
“My attention to the vast number of irremediably deaf which are
accumulated at the Charity is not merely disagreeable to my
feelings, but absolutely injurious to my interest by causing me
to be considered as an Aurist when I am in fact an Oculist. The
branch of the profession has always been in my private practice a
secondary object. In this light I should wish it to be placed in
the Dispensary. The Ear may consistently with the preservation of
those privileges which the Governors have acquired be withdrawn from
public notice. Then, whilst I render the same service to those for
whom they may individually be interested, it will cease to operate to
my prejudice. The mode to be adopted for the accomplishment of this
object is implicitly submitted to your judgment.
“I am, gentlemen,
“Your obedient servant,
“J. C. SAUNDERS.”
After consideration of this letter by the Governors it was resolved, at
a General Meeting in the following January:
“That diseases of the Eye shall in future be the sole object of the
Charity, and that its name be changed to that of The London Infirmary
for Curing Diseases of the Eye.”
In June, 1806, Saunders published an Essay “On Inflammation of the
Iris, and the Influence of the Extract of Belladonna to prevent the
Consequent Obliteration of the Pupil.” In it he gives an accurate
description of the clinical characteristics of the affection, and
records several cases treated at the Dispensary in which he had
prevented loss of sight from closure of the pupils by keeping them
dilated with the extract of belladonna, applied to the conjunctiva
whilst the inflammation lasted.
In January, 1809, he advertised in the medical journals his intention
of publishing a treatise on some practical points relating to the
diseases of the eye, and particularly on the nature and cure of
cataract in persons born blind.
Up to the beginning of the nineteenth century only two forms of
operation for cataract were in vogue: that of displacing the opaque
lens downwards with a needle out of the axis of vision, the operation
of “couching,” which may be regarded as one of the most ancient of
surgical procedures; and that of removal of the opaque lens out of
the eye, the operation of “extraction,” first performed by the French
surgeon Daviel in 1745.
It was observed by several operators who couched cataracts that if they
failed in displacing the lens down it was sometimes possible to break
it up with the needle, and that the fragments so formed tended in time
to disappear. Percival Pott, a surgeon at St. Bartholomew’s Hospital,
in 1775, first pointed out that this disappearance of the fragments of
lens substance was due to them becoming dissolved in the fluids of the
eye, and he advocated a procedure to facilitate their solution.
To Conradi, a surgeon at Nordheim in Hanover, seems to be due the merit
of first proposing a distinct method of operating for cataract by its
division with a needle through the cornea, and he published an account
of his method in 1797.
Neither the operation of couching nor that of extraction were found
suitable for small children afflicted with cataract, and it was
customary in cases of congenital cataract to advise postponement of
operation until the patient had arrived at the more manageable age of
twelve to fourteen. As has been already mentioned, James Ware, in 1801,
contributed a paper to the Royal Society, describing how he had removed
a cataract from a boy, aged seven, by breaking it up with a couching
needle.
In the medical report of the Dispensary at the end of its second year
it is recorded that three children born blind with cataract had been
cured at the respective ages of seven, five, and four years. On its
receipt by the Governors the following resolution was passed:
“That the thanks of this General Meeting be given to Mr. Saunders
for the ability and care by which he has cured so great a number
of patients, many of them labouring under the most complicated
diseases of the eye, and more especially for having been the first
to establish by repeated success the propriety of performing the
operation for the cataract at the earliest ages in children born
blind of that disease.”
So pleased were the Governors with this proof of the value of their
charitable institution that they directed that these three small
children whose sight had been restored should be introduced at the
anniversary dinner. These anniversary dinners were held each year for
the purpose of increasing the number of subscribers to the Charity. The
dinner at which these children were exhibited was held at the London
Tavern, Bishopsgate Street, in May, 1807, at 5 p.m. It is recorded
that the price of the dinner was 7s. per head, including beer, bread,
cheese, and radishes. The dessert was 1s. 6d. extra, and the wines,
port and sherry. The President, Sir Charles Price, Bart., M.P., was
in the chair, and about one hundred gentlemen were present; sixty new
subscribers were obtained.
At a similar dinner held in the following year the number of Governors
and their friends who attended was 277, and new subscriptions to the
amount of £708 15s. were received.
In a letter to the Committee, dated March, 1808, Saunders wrote as
follows with reference to his work in connection with congenital
cataract:
“By the adaptation of an operation on the cataract to the condition
of childhood I have successively cured without a failure fourteen
persons born blind, some of them even in infancy, and it has just
been performed on an infant only two months old who is in a state of
convalescence. As I reserve for another occasion the communication
of the method which I pursue for the cure of very young children, I
shall no further compare it with extraction, than by observing that
extraction is wholly inapplicable to children, or only fortuitously
successful. Those who on all occasions adhere to this operation, and
have never turned their thoughts towards the application of means
more suitable to this tender age, have been obliged to wait until the
patient has acquired sufficient reason to be tractable; otherwise
when they have deviated from this conduct, the event has afforded
little cause of self-congratulation.
“How great the advantage of an early cure is a question of no
difficult solution. Eyes originally affected with cataracts contract
an unsteady and rolling motion, which remains after their removal,
and retards, even when it does not ultimately prevent, the full
benefit of the operation. A person cured at a late period cannot
overcome this awkward habit by the utmost exertion of reason or
efforts of the will. But the actions of infants are instinctive.
Surrounding objects attract attention, and the eye naturally follows
them. The management of the eye is therefore readily acquired, his
vision rapidly improves, and he will most probably be susceptible of
education about the usual period.”
During 1809 Saunders, in preparation for the publication of his
advertised treatise, wrote essays “On the Inflammation of the
Conjunctiva in Infants” and “On the Cure of the Inversion of the
Eyelids by Excision of the Tarsus.” He also commenced to put together
his notes on congenital cataracts and of his methods of operating
on them. His work, however, in these matters became much impeded by
recurrent, violent, acute attacks of headache due to brain disease,
which in February of the following year proved fatal.
Saunders had realised that congenital cataracts varied considerably
in character and consistency, and also that they might be dealt with
either by passing the needle, as in couching, through the sclerotic
and behind the iris in its approach to the pupillary area, or through
the cornea, the so-called anterior operation. He was wisely waiting
to gain experience as to which form of procedure was better suited
for the different forms of cataract before rushing into print on the
matter. He had two pupils working with him at the Dispensary, both
of whom subsequently became ophthalmic surgeons, and both of whom in
later years wrote in glowing appreciation of all they learnt from him.
The one was William (afterwards Sir William) Adams, and the other John
Stevenson. Two letters addressed to the latter in April and August,
1808, are the only authentic documents in Saunders’ writing descriptive
of his operation for cataract; with the first he enclosed two of his
improved needles for Stevenson’s own use. Needles of a similar pattern
are still employed, and known by Saunders’ name, at the present time.
“My dear Friend,
“I confide the method of operating which I pursue for cataract to
your honour, and I am very certain that it is safely deposited. I
shall not have time to point out all the advantages which result from
this deviation from the old method of couching; but simple as they
appear, they are very important, as you will perceive when I detail
all the circumstances, which I shall sometime do, in a treatise on
the cataract.
“I always use the solution of Belladonna, and never begin the
operation until the pupil is as much dilated as it will admit of,
keeping the eye, by means of Pellier’s elevator, or else my own
fingers, as steady as possible. The object of my introducing the
instrument into the eye is, to cut the capsule in the anterior part
of the crystalline; and therefore, as the lens is generally more
dense towards the centre, I take care that it shall pass through the
crystalline as near to the capsule as possible. That the instrument
may traverse the lens freely, you will observe that it is made of the
greatest tenuity, and flat, and that it cuts towards the point on
each side. I find by experience that it can be conducted, with care,
through the hardest lens; whereas the needles, such as Scarpa’s and
Hey’s, only push the whole lens before them, and without being able
to carry the instrument to the capsule, the lens is made to press on
and protrude the iris; whence results the consequent inflammation. As
for the crystalline itself, you may or may not meddle with that; it
may be well to loosen its texture in some instances, but you ought
never to depress it....
“The instrument should enter the sclerotica about a line behind the
ciliary ligament, and should be conducted through the anterior part
of the crystalline which is softest. You may loosen the texture of
the cataract before you divide the capsule, or after, as in the
operation seems most convenient, but the _capsule must be divided
at all events_. I do not much care what becomes of the substance of
the crystalline. I sometimes let it go in considerable quantity into
the anterior chamber, if it seems tending that way, but I never push
it, because that must press the iris. N. B.—Follow Hey’s rule, to be
careful not to do too much. After the operation the plan with me is
purely antiphlogistic, and I believe you well know what that is. If
your operation should not succeed at the first attempt, describe to
me the appearances, and I will gladly give you my sentiments as to
repeating it.
“With respect to congenital cataracts, from the repeated
conversations we have had on the subject, it seems scarcely necessary
for me to remind you, that they are generally capsular, the whole or
greater part of the lens having probably been, at some antecedent
period during the foetal state, spontaneously absorbed. I shall only
add to what I have already stated, that the steps to be pursued in
the operation are nearly similar to those adopted for lenticular
cataract; the great object being either to make a sufficiently large
central aperture for the rays of light to pass freely through it to
the retina, or also to endeavour to tear the condensed capsule into
as small fragments as possible, and be gradually absorbed; for which
purpose, you may use the needle with much more freedom than in the
former case.
“With our united regards,
“I am yours faithfully,
“J. C. SAUNDERS.”
It is interesting to note how in these pre-anæsthetic days the
small children were kept sufficiently still to allow of operations
for cataract to be performed on their eyes. The following is the
description of the method employed given by Dr. Farre:
“Four assistants, and in stouter children five, are required to
confine the patient. The first fixes the head with reversed hands,
the second not only depresses the lower lid with his forefinger, but
also receives the chin of the child between his thumb and forefinger,
as in a crutch. By this means the play of the head on the breast is
prevented, a motion which the child incessantly attempts, and which
will very much embarrass the surgeon. The third assistant confines
the upper extremities and body; the fourth the lower extremities. The
surgeon, seated on a high chair behind the patient, takes Pellier’s
elevator in his left hand, and the needle in his right, if he is
about to operate on the right eye, or the speculum in his right hand
and the needle in his left, if the operation is to be performed on
the left eye.”
The following is the commencement of an unfinished medical report
which Saunders had in preparation to present to the Committee of the
Infirmary at the time of his death.
“Gentlemen,
“Five years have now passed since my proposal for establishing
this Infirmary was submitted to your notice, during which I have
incessantly and anxiously laboured to redeem the pledge then given
to make it a beneficial Institution to Society. My anxiety has been
relieved, and my labour consoled in the progress of this Institution,
by repeated instances of your respect; and the recollection of them
at present only heightens the satisfaction I feel, on finding myself
confirmed as the conductor of an establishment supported by liberal
and zealous advocates, and possessed of the means of performing an
important part in Society, and esteemed by Society for it.
“In prosecuting the object of attracting public attention towards
this Institution, I trust I have kept free from the practice of any
disingenuous art. Popularity has not been snatched; but studiously
and unremittingly sought: it was expected only as a reward of
service; and the share of it which has been gained, is ascribable
to the estimation in which the Governors have been pleased to hold
this service. I have confided the character of the Institution to the
quantum of professional good—excepting you may be pleased to add,
that mindful of being an agent for liberal and philanthropic men, I
have always administered with humanity and attention to the feelings
of the poor that relief which their bounty has supplied.”
Owing to the early death of Saunders, before the publication of his
promised book on diseases of the eye, and of any description of his
operation for cataract, there was much heated controversy for many
years afterwards, in which the Committee of Management of the Infirmary
became involved.
The chief matters around which dispute arose were: the publication
of Saunders’ unfinished manuscripts; his claim to having introduced
a new form of treatment for cataract; the advertisement of his
successful results prior to making known to the profession his method
of procedure; and the priority of his invention of an operation for
the restoration of sight in those in whom it had become impaired from
Egyptian ophthalmia.
Saunders died intestate, and there was nothing left for his widow but
what might result from the publication of his unfinished manuscripts.
The Governors of the Institution decided, in the first instance, that
the book should be published at its expense, and that the proceeds
of the work (without any deduction) should be appropriated to the
sole use and benefit of Mrs. Saunders. It was afterwards found that
Mr. Saunders’ brother and sister could claim legal rights to the
proceeds. It was, therefore, decided in lieu to present £50 to Mrs.
Saunders and an annuity of £40. Dr. Farre, at the request of the widow
and of Mr. Saunders’ brother, consented to edit the book and make
good its deficiencies, and it was published by Messrs. Longman and
Company in 1811, delay being caused in connection with the question
of copyright. Eighteen months after Saunders’ death his widow married
again, under which circumstances the Committee considered they had
reserved to themselves the right of reconsidering her annuity, and it
was discontinued. It was agreed, however, that she should retain the
copyright of her late husband’s book and receive any further proceeds
that might arise from its sale; these rights she later parted with to
Messrs. Longman and Company for the sum of £50. When a second edition
of the book was called for, Longmans offered the copyright to Dr.
Farre; he refused it for himself, but accepted it on behalf of the
Infirmary. The discontinuance of the annuity to Saunders’ widow after
her second marriage was the subject of an attack by those at enmity
with Farre and Battley up to the time of her death in 1817.
The book, entitled _A Treatise on some Practical Points relating to
the Diseases of the Eye_, opens with a short account of Saunders’
life, a rather detailed account of his last illness, and a statement
of the morbid appearances found by Astley Cooper on the examination of
his body. The account of his illness suggests that he suffered from
a tumour of the brain, which had affected one of his optic nerves and
caused impairment of the sight of his right eye. At the post-mortem
examination, however, no tumour was found, the immediate cause of death
being cerebral haemorrhage.
The first two chapters of the book consist of the three previously
published essays already referred to; the other three of unfinished
notes which were arranged and added to by Dr. Farre, and which deal
with “Cases illustrating Changes of Structure in the Eye,” and with
“Congenital Cataract.”
In the course of events it not infrequently happens that circumstances
lead up to an epoch when some new development becomes ripe for
discovery, and that then more than one mind independently “hits the
moment” at about the same time. Later on, when history steps in to
record the event, considerable discussion is liable to arise as to
whom the palm of priority is to be awarded. This is what occurred in
connection with the introduction of the operation of solution for the
removal of congenital cataracts.
The solubility of the substance of the crystalline lens in the aqueous
humour of the eye had been recognised long before Saunders began to
operate for cataract. But in introducing the method of solution for
the dispersion of cataracts in infancy he undoubtedly believed he had
discovered a new method of treatment. He appears to have been unaware
of Conradi’s method of needling cataracts in adults, published in
Germany. The real value of his contribution to ophthalmology in this
matter is well estimated in the following extract from a lecture
published in the Lancet by Mr. Green, a surgeon at St. Thomas’s
Hospital, in 1823:
“I do not mean to say that this operation is entirely new; if you
read Mr. Pott’s works, you will find that, in some instances, he
performed a very similar operation. He tells you, that in cases where
the cataract was too soft for depression, he sometimes lacerated
the anterior layers of the capsule, so as to admit the aqueous
humour, and procure the solution of the cataract. Hey, Scarpa, and
Ware have performed similar operations. We are not, however, to
consider those as inventors of any practice who have merely employed
it here and there, without stating any certain rules for its general
applicability. It is to Dr. Saunders that we are indebted for having
shown the principle on which he performed this particular operation,
its applicability to cataract in children, and to some cases of
cataract in adults. Dr. Saunders, therefore, may be justly considered
as the inventor of this operation, and entitled to our respect and
admiration of so material an improvement in this branch of surgery.”
It must, however, be admitted that it was an error of judgment on
Saunders’ part to have allowed the Committee of Management to advertise
in the public press, stating that operations were being performed at
the Infirmary on children born blind of cataract, before the nature
of the operation had been made known to the medical profession. Such
a practice, together with the exhibition of the children who had been
operated on at a public dinner, savoured rather of the methods of the
quack oculists, though Saunders himself derived no pecuniary benefit
and died a poor man.
Benjamin Gibson in Manchester, independently of Saunders, recognised
the possibility of operating successfully on congenital cataracts in
infancy, and in the October number, for 1811, of the _Edinburgh Medical
and Surgical Journal_, published a description of his methods in an
article entitled “On the Use of the Couching-needle in Infants of a Few
Months Old.” The description of his operation was, therefore, published
almost at the same time as Dr. Farre’s description of Saunders’ methods
of procedure.
Saunders’ two pupils, William Adams (afterwards Sir William) and
John Stevenson, followed the example of their teacher, both claiming
to having introduced new methods of operating on the eye, and both
founding institutions for the treatment of its diseases.
William Adams, as already mentioned, had, like Saunders, served his
apprenticeship with John Hill, of Barnstaple, and had completed his
medical education at St. Thomas’s and Guy’s Hospitals. He worked
under Saunders in the dissecting room and also at the Eye Infirmary,
assisting him for a year and a half in both his public and private
operations. After obtaining the diploma M.R.C.S. in 1807, he went to
reside in Exeter, where he founded the West of England Eye Infirmary
for curing diseases of the eye, on the same lines as the one in London;
this Institution continues its work to-day under the same name. To it
Saunders allowed his name to be attached as Consulting Surgeon, and
wrote advice on several occasions to Adams concerning his work there.
Saunders had pledged Adams not to reveal the nature of the operations
he had learnt from him before he had had time to publish a description
of them. Even before Saunders’ death Adams resented being bound to
observe this pledge, and after his death considered himself exonerated
from its further observance. Most operators in the course of their
practice introduce modifications in their procedures. Adams considered
that the modifications which he introduced in the operations he had
learnt from Saunders justified him in claiming them as his own. It was
on the strength of these claims, that on his return to London, after
Saunders’ death in 1810, he was appointed to operate on pensioners
dismissed from the Army as blind through Egyptian ophthalmia. The
operation he performed was a modification of that introduced by
Saunders of excision of the tarsus of the eyelid. He was also appointed
to operate for cataract on seamen at Greenwich, and later an Ophthalmic
Institution was founded for him in part of the York Hospital, Chelsea,
which was afterwards transferred to Regent’s Park.
He became oculist extraordinary to the Prince Regent and to the Dukes
of Kent and Sussex, and in 1814 was knighted. A Select Committee of
Parliament reported on his work at the Ophthalmic Institution and on
his claim to public money, and with Lord Palmerston’s support he was
voted the sum of £4,000.
Sir William Adams’ claims to the invention of new operative procedures
was much resented by Farre and Battley, who regarded them as piracy
of their deceased friend’s work at the Eye Infirmary. In 1814 the
Committee of Management of that Institution requested its medical
directors to furnish them with a report on the matter, showing how Sir
William Adams’ claims had been anticipated. This report was sent to His
Royal Highness the Duke of York, the Commander-in-Chief of the Army,
and to His Majesty’s Ministers, with the request that deputations from
those connected with the Infirmary might be received. As an outcome
of the deputation to the Duke of York, His Royal Highness graciously
condescended to become a Patron of the Infirmary.
In 1817, when the question of a monetary grant to Sir William Adams was
raised in Parliament, further deputations waited on Lord Palmerston
and on the Chancellor of the Exchequer with the object of refuting his
claims, and of obtaining some pecuniary assistance for the Infirmary’s
building fund, but no success in the latter direction was met with.
In later life Adams became interested in Anglo-Mexican mines, but his
speculations do not appear to have been attended with success. Two
years before his death he changed his name to Rawson in compliance with
the will of his wife’s mother, the widow of Colonel Rawson.[A]
[A] It is due to this change of name that a writer of a life of Sir
William Adams, in Vol. II. of the _British Journal of Ophthalmology_,
failed to find a notice of him in the _Dictionary of National
Biography_. It is from the description there given of Sir William
Rawson that most of the above facts respecting him have been taken.
John Stevenson, like Adams, worked under Saunders in the dissecting
room at St. Thomas’s Hospital and at the Eye Infirmary. Having
obtained the diploma of M.R.C.S., he settled in or near Nottingham, but
on Saunders’ death returned to London to practise there as an oculist
and aurist. In 1813 he was appointed as such to the Prince of Wales and
to Leopold, the Duke of Saxe-Coburg.
He wrote several treatises on the structure and functions of the eye
and ear, and much on the subject of cataract and its treatment. Whilst
always acknowledging his obligations to Saunders and his admiration
for his genius and industry, he claimed credit for having introduced
a method of successfully removing cataracts in adults at an earlier
stage in their development than was then usual, and thereby obviating a
prolonged period of semi-blindness.
In 1830 he founded at 13, Little Portland Street, Cavendish Square, the
Royal Infirmary for Cataract and other Diseases of the Eye, under the
Patronage of His Majesty King William IV., to whom he was soon after
appointed oculist and aurist. This Infirmary, besides the patronage of
the King, had a long list of Royal Patronesses and of noble supporters.
The indigent poor suffering from all forms of diseases of the eye were
treated gratis as out-patients, but only cataract cases were admitted
as in-patients. In the _Dictionary of National Biography_ it is stated
that after 1844 all trace of Stevenson is lost.
It is noteworthy that both this Infirmary and Wathen’s Institution,
which were established under Royal Patronage in the West End of London,
existed for only a comparatively brief time, whilst that founded by
Saunders, with the approval and support of the medical and surgical
staffs of the Borough Hospitals, and under the patronage of the City
fathers, has continued to flourish and grow in the manner which the
following pages will relate.
Farre described Saunders as a man of middle size, well made and of an
engaging mien, with an active mind, generous in his private practice,
and perfectly unreserved in stating his opinion in cases submitted to
his judgment. That he had the capacity of forming firm friendships is
shown by the marked respect which Farre describes as having been paid
to him at his funeral, and the steps which were taken to perpetuate his
memory. At a General Meeting of the Governors of the Eye Infirmary it
was unanimously agreed that a portrait and bust of Mr. Saunders should
be obtained and placed in the Committee Room. In accordance with this
resolution a portrait was painted by Devis, and a bust was executed by
Henry Weekes. The former hangs to-day in the Board Room of the present
Hospital, and an engraving of it by Anthony Cardon was inserted as a
frontispiece to Saunders’ treatise, and is still used to adorn the
certificates which are presented to students who have completed a
course of instruction at the Hospital.
This portrait shows Saunders with a mass of brown curly hair coming low
down over his forehead, with mutton-chop whiskers, pronounced features
and a mouth shaped like a Cupid’s bow. He wears a high white stock
round his neck, has a frill to his shirt, and a blue coat.