THE INTRODUCTION OF INHALATION ANÆSTHESIA AND OPHTHALMIC SURGERY
Ether was first employed as an anæsthetic for surgical operations
in England on December 19th, 1846, when Robert Liston performed an
amputation of the thigh, and the removal of a great toe-nail, on
patients under its influence, at University College Hospital, Gower
Street. In Edinburgh, Sir James Simpson first gave a description of his
use of chloroform, at the Medico-Chirurgical Society in that city, in
November, 1847.
The adoption of anæsthetics for general surgical procedures rapidly
followed, but, due to the sickness by which they were often followed,
their employment in ophthalmic surgery was for some time delayed. Thus,
Mackenzie of Glasgow, writing in 1854, says:
“Needle operations may be performed on timid adults under the
influence of chloroform. In extraction I have not ventured to use it,
being afraid lest the vomiting which is apt to follow might cause
rupture of the internal structures of the eye.”
In a review of Haynes Walton’s textbook on eye diseases in 1853, an
anonymous writer says:
“We agree with Mr. Walton that it is not advisable to use chloroform
in the extraction of cataract, and we would remark that a surgeon
with a sharp eye, a cool head, and a steady hand will usually prefer
to have the command of his patient’s voluntary motions, and to avoid
the danger which may arise from his restlessness on awaking from his
drunken sleep.”
Hulke, writing of his reminiscences of Sir William Bowman’s work, said:
“In London, so far as my knowledge extends, Sir William Bowman was
the first surgeon who employed chloroform in ‘extraction.’ In his
first case the administration of chloroform was followed by vomiting
after the completion of the operation—which could not have been more
perfectly performed—and the violent straining induced choroidal
hæmorrhage with extrusion of the vitreous humour and the retina
through the corneal incision—the eye was lost. So serious a disaster
would have deterred many men from the further trial of chloroform,
but its advantages in respect of the performance of the operation
were so manifest that Sir William Bowman persevered in its use, and
in order to inspire confidence in his patients he experimentally
inhaled it to complete anæsthesia himself. His conviction of its
extreme usefulness in extraction was soon shared by others, and its
employment quickly became general.”
The practice as regards the use of chloroform at Moorfields Hospital
during the first decade after its introduction is summed up in the
following extract on the subject from the second edition of James
Dixon’s _Guide to the Practical Study of the Diseases of the Eye_:
“We may regard it under two aspects: as saving the patient from
pain, and as facilitating the manipulations of the surgeon. Now, it
is notorious that operations performed on the globe itself cause
very little pain, and last but a very short time. Those on the
lids, involving as they do the wounding of the skin, are of course
more painful; but, in respect of the suffering they cause, none of
these are comparable to the larger operations in General Surgery,
and there are few adults who, if thoroughly informed as to the real
nature of such operations as those for cataract, artificial pupil and
strabismus or even entropion and ectropion in their slighter forms,
will not readily undergo them without the aid of anæsthetics.
“A perfect passive condition of the eye is so desirable in the
delicate operations of cataract and artificial pupil, that one
would naturally expect to find chloroform universally applicable
in such cases; and specially indicated in the most delicate of
all—extraction. But this forms a peculiar and exceptional case, and
for the following reasons: We have seen that—provided the operation
has been properly performed—the successful result of an extraction
chiefly depends upon the rapidity with which the union of the corneal
wound can be effected. Now, with every precaution it will sometimes
happen that chloroform induces vomiting, and the violent efforts
which attend this might disturb the lips of the wound, and cause the
vitreous body to escape between them, thus inducing a prolapse of
the iris, with all its accompanying irritation and retarded union.
But, without taking such an extreme case as this, we shall find a
very serious objection to the use of chloroform in the fact, that the
squeamishness and disrelish for food which it induces may interfere
with the reparative process, by impairing the nutrition of the cornea
during the critical twenty-four hours immediately following the
operation.
“In adults who are extremely fearful and unsteady, chloroform may be
required in the operations for artificial pupil and strabismus; it
will always be indicated in cases of extirpation of the globe, and it
may greatly facilitate the examination of eyes rendered irritable by
disease or by the presence of foreign bodies.
“In children all these manipulations will be greatly facilitated
by the use of chloroform, and some can hardly be performed at all
without its aid.”
White Cooper, who was a great friend and follower of Dalrymple, wrote
in 1853 as follows:
“In common with many others, I for some time hesitated before using
chloroform in extraction of cataract, from a fear that the object of
the operation might be defeated by the eye receiving injury during
the return of consciousness, or by vomiting afterwards. It appeared
to me, however, so deserving of a trial that nearly two years ago I
first employed it, and since that time have availed myself of it very
frequently in operations on the eye, including 16 cases of extraction
of cataract, 9 of artificial pupil, 4 of foreign body in the eyeball,
and 2 of tumours of the globe, besides numerous needle cases.
“The advantage obtained by the use of chloroform in operations on
the eye are a perfectly quiescent condition of the globe or the
lids, absence of congestion of the eye, and mental tranquillity for
the patient. To the operator the perfect repose of the eye affords
a manifest advantage, the various steps of the operation being
performed with as much facility as in a demonstration on the dead
subject; the risk of prolapse of the iris (which is usually caused by
muscular action) is greatly diminished, and the corneal flap can be
accurately adjusted.”
By improved methods of preparation of patients before the
administration of chloroform the risks of vomiting became reduced. By
a modification of the operation of extraction so that a piece of the
iris was removed, either at the time of the extraction of the cataract
or as a preliminary procedure, the risk of its protrusion into the
wound was avoided; and by the modification of the opening made in the
eye, so that it formed a straight linear incision instead of a flap,
the risk of its gaping open subsequently was diminished. Ultimately, up
to the time of the introduction of cocaine in 1884, the employment of
chloroform for extraction of cataract became the general custom, and
the performance of the operation without its aid the exception.
The following return of the number of cases to which chloroform was
administered during the first six months in 1868 shows how general
its use in operative procedures on the eye had then become: Cataract,
74; removal of eye, 67; iridectomy, 99; iriddesis, 11; syringe, 15;
entropion and ectropion, 36; abscission, 5; strabismus, 166; tumours of
lid and orbit, 8. Total, 481.
After the introduction of anæsthetics many new operative procedures
on the eye were invented, and those formerly in use, like that of
extraction of cataract, became modified and improved. In all these
changes and advances Critchett and Bowman, at Moorfields Hospital,
played a conspicuous part.
Excision of the eyeball was at one time a most formidable procedure,
and was only resorted to in cases of malignant growths. Hulke has
recorded the following graphic description of his recollections of it
at the time of his pupillage:
“The first excision of the eyeball that I saw was to me, a novice,
so horrible and distressing a scene that the impression it made
still lingers in my recollection. No anæsthesia. The surgeon first
passed through the eyeball a stout needle armed with stout silk,
and knotting the ends, formed a loop. Next, with this he dragged
forwards the eyeball, and then scooped it out of its socket with
a double-edged scalpel curved on the flat of the blade. This done
an assistant, who stood ready with a large brass clyster-syringe,
checked the profuse bleeding by squirting into the orbit iced water.
How different this from enucleation as now done—methodical circular
division of the conjunctiva, severance of the muscles at their
insertions into the globe, careful section of the optic nerve with
scissors!”
The suggestion that the eyeball might thus neatly and safely be
dissected out of its encircling capsule originated with an anatomist,
O’Ferrall, in Dublin in 1841, and was first put into practice by
Bonnet in France in the following year. George Critchett independently
adopted it, and gave a description of the proceeding in 1851. After
that, excision of the eye became an increasingly frequent operation
for the relief of pain, when the sight was irretrievably destroyed, or
for the improvement of appearances where the eye had become unsightly
and disfiguring. The consequent increased demand for artificial eyes
resulted in their improvement in construction and appearance. Their
manufacture became a highly specialised art, and a Mr. Gray was
appointed purveyor of artificial eyes to the Hospital.
PLATE XI.
[Illustration: GEORGE CRITCHETT]
In 1844 Lawrence wrote:
“The influence of one eye upon the other is not confined to cases
of disease. When an eye has been lost by accident, the other
often becomes diseased sooner or later, without any imprudence
or any external influence that would be injurious under ordinary
circumstances. This kind of occurrence is so common, that it is
necessary to warn those who have lost an eye of this danger, and the
necessary precautions for avoiding it.”
The prophylactic treatment of removal of eyes injured in such a way
as to provoke this sympathetic disease does not, however, seem to
have been put into practice until 1854, when it was first adopted by
Prichard of Bristol. So effectual did this prophylactic measure prove
that it soon became generally adopted, and excision of the eyeball at
Moorfields Hospital, from being a rarely performed operation, as it was
in the pre-anæsthetic days, became one of the commonest operations.
The operation for squint, before the introduction of anæsthetics, was
a very crude procedure, and was performed often in what seems to-day a
very indiscriminate manner.
The patient was seated in an armchair with a high back, against which
the head was fixed by an assistant who stood behind it. The same, or
another assistant, held the eyelids apart. The operator, standing in
front, exposed the muscle to be dealt with by making a long incision
in the membrane overlying it. He then passed a curved grooved director
beneath it, and divided the muscle by running a sharp-pointed bistoury,
or knife, along the groove in the director, no special attention being
paid as to whether the tendon or the muscle itself was cut across. Loss
of mobility with an unsightly prominence of the eye not infrequently
resulted; whilst the large, open wound which was left often developed a
mass of granulation tissue which considerably delayed healing.
Through the ingenuity of George Critchett, a much neater and simpler
procedure was devised, by which many of the disadvantages of the older
method were obviated. Only a small opening was made in the conjunctiva,
the whole proceeding for division of the tendon being carried on
beneath it, a hook was inserted under the muscle in place of the
director, and scissors were used to cut through the tendon close to its
insertion into the eyeball.
Disorders arising in connection with the drainage apparatus for the
passage of the tears from the eye to the nose have attracted the
attention of those engaged in the healing art since very ancient times.
In 1833 Sir William Lawrence wrote that to give a description of all
the proceedings which have been proposed for removing obstruction to
the tear duct would fill a moderate volume, but that the greater part
were obsolete. The collection of all those which have been proposed
since that date would fill a second volume. Amongst all these different
methods of treatment, that devised by Bowman in 1851 of slitting up
the openings into the tear sac at the inner angle of the eyelids, the
lacrymal puncta and canaliculi, represented a considerable advance on
those which had been previously employed. He first practised it in
cases of overflow of tears caused by closure or displacement of the
lacrymal puncta; afterwards, in the treatment of obstruction of the
nasal duct, he passed probes through the slit canaliculus to dilate the
stricture in the duct, and introduced through it styles to be worn for
a time in order to maintain the dilatation. The introduction of styles
worn in this way avoided the disfigurement entailed when, as formerly,
they were introduced through the skin of the nose overlying the tear
sac.
Gibson of Manchester (as mentioned in Chapter II.), independently of
Saunders, introduced in 1811 a method of operating on cataracts in
infants. He first broke up the lens, and reduced it to a pulp, with a
couching needle; then, two or three weeks later, evacuated it through a
small incision in the cornea by the introduction of a curette.
This operation, though practised for some time in Manchester, fell into
disuse. At Moorfields, the Saunderian tradition was still adhered to,
allowing the lens matter slowly to become dissolved in the fluids of
the eye. In 1851 Bowman revived and improved upon Gibson’s operation,
and in 1864, in the Ophthalmic Hospital Reports, T. Pridgin Teale,
junr., described how, in order to aid the removal of softened lens
matter, he had employed a suction curette. The curette was converted
into a tube by having its groove roofed over to within a line of
its extremity; it was connected with an indiarubber tube, and the
suction was made by the mouth of the operator. The idea of extraction
by suction can, he said, “boast of considerable antiquity, as the
following quotation, kindly sent me by Mr. Bowman, will show
“According to Avicenna a similar proceeding (viz., excision of
cataract, by opening in the cornea and drawing out the cataract by
a needle) was practised by the Persians in the fourth century, and
Albucasis reports that the procedure was gradually displaced by the
‘suctions-method,’ in which the cataract was sucked out through a
hollow needle.”
Bowman himself, later on, had constructed a suction apparatus for soft
cataracts, which could be manipulated with one hand, the suction being
made by the movement upwards of a piston with the thumb.
After the introduction of anæsthetics, which allowed of patients being
kept perfectly quiet during the performance of operations on the eye,
procedures requiring great precision and skill were introduced by both
Bowman and Critchett for the formation of artificial pupils.
Bowman, in order to produce an enlargement of the pupil of a limited
extent, in a suitable direction, whilst still keeping it as central
as possible, made use of canula-scissors. These were scissors with
delicate blades expanding from a stem which moved up and down in a
canula, the size of a cataract needle, by means of a spring in the
handle. When the spring was pressed the scissors were closed by being
drawn partly into the canula, and when it was relaxed they opened,
being protruded by the spiral wire. One blade of the scissors, which
protruded beyond the other, was pointed with a sharp cutting edge
capable of penetrating the cornea and allowing the whole of the closed
scissors being introduced into the anterior chamber of the eye. The
other shorter blade of the scissors was blunt-pointed. When within
the eye, the blades of the scissors were opened and made to cut the
pupillary border of the iris, the blunt-pointed blade being passed
behind and the sharp-pointed one in front. The calibre of the canula
was so graduated as to plug the wound through which it was introduced,
and prevent the escape of the aqueous humour.
For use in other cases he had constructed a modified form of Tyrrell’s
hook. It was of the same size, but sharp and flattened at the point.
Its stem was cylindrical so as exactly to occupy the corneal wound and
prevent the escape of the aqueous humour. With this “needle hook,” as
he termed it, the necessity of making a preliminary incision with the
loss of the aqueous humour, before the introduction of the hook, was
avoided; the needle hook introduced itself into the eye, the retention
of the aqueous humour facilitating the precision with which the hook
could be passed round the pupillary border.
Critchett invented an operation which he called “iriddesis,” or the
formation of artificial pupil by tying the iris. The purpose of the
procedure he described as follows:
“The formation of what is commonly called an artificial pupil is
required under various morbid or abnormal conditions of the eye,
and demands a corresponding variety in the modes by which it is
accomplished. In some cases, a restoration of the original pupil as
regards size and situation is all that is wanted; in others, a change
in the size, shape, and situation of the natural pupil is required;
or, again, it may be necessary to form a new pupil in an abnormal
situation and in the very substance or tissue of the iris. In each
of these different cases the object is the same—viz., to establish a
clear pupil or aperture in the iris opposite to a transparent part of
the cornea.
“It is very desirable that, in the formation of an artificial pupil,
the conditions upon which the perfection of the natural pupil
depends should be as nearly as possible preserved and imitated, both
as regards its position and defined border, its size, mobility,
and sensitiveness to light. In the methods usually employed these
conditions are frequently unattainable, and the circular fibres of
the natural pupil are either cut or torn through, and an opening is
formed which is very probably large and irregular in shape, fixed and
insensible to light, ill-defined and extending to the margin of the
cornea—thus admitting rays of light that are too much refracted by
the margin of the lens, and having the effect altogether of confusion
of vision.”
His operation, designed to overcome the disadvantages above mentioned,
consisted in drawing into a wound at the margin of the cornea, with
canula-forceps, a small piece of the periphery of the iris and fixing
it there by tying a loop of silk around it. In this way an alteration
of the position of the pupil was effected without its margin being cut
or the sphincter muscle interfered with.
The operation was for some time extensively practised at Moorfields,
not only by Critchett, but also by Bowman and Poland. In cases of
conical cornea, Bowman, by performing this operation at the outer and
inner margin of the cornea, produced a laterally elongated slit-like
opening; in order to create the same beneficial visual effect, in such
cases, as is sometimes derived by holding a slit-shaped opening in a
metal disc in close proximity to the eye.
Later on, it was found that this ingenious operation of iriddesis was
liable to be followed by inflammation in the eye of a type which might
spread to the fellow eye: it became, therefore, entirely abandoned.
Another discovery which largely extended the range of operative
ophthalmic surgery was that glaucoma could be relieved by the removal
of a piece of the iris.
A. von Graefe first performed an operation of this description for
glaucoma in Berlin in June, 1856. His study of the natural history
of the disease, and of its ophthalmoscopical appearances, had led
him to the conclusion that increased hardness, or tension, of the
eyeball was the leading factor in its causation, and that, if some
means could be devised of permanently lowering the tension, its cure
might be effected. Experience had shown him that after the removal
of a piece of the iris to form an artificial pupil, in eyes where the
tension was increased, normal tension became restored. After having
performed experimental iridectomies on animals’ eyes, he felt justified
in trying the effect of the operation on patients suffering from
glaucoma, and with the most gratifying results. Up to that time the
disease inevitably resulted in blindness, and in some of its forms was
accompanied by the most agonising pain and distress. The discovery of
a means whereby not only could the pain be relieved, but the loss of
sight also prevented, must always be regarded as one of the greatest
triumphs of ophthalmic surgery.
The successful performance of iridectomy for glaucoma requires a
steadier hand and more skill than any other operation on the eye. It is
also necessary to have the patient absolutely quiet. The acute pain to
which the affection gives rise renders the eye exceedingly sensitive,
and even to-day most surgeons prefer to perform it on patients under
the influence of a general anæsthetic. Indeed, the introduction of
inhalation anæsthesia may be said to have paved the way for the
operative treatment of glaucoma.
1851 was the year of the first Great Exhibition in London, held in
the Crystal Palace in Hyde Park. Visitors from all parts of the world
flocked to see it, and amongst them came Albrecht von Graefe, then
twenty-three years of age, full of enthusiastic ardour and fresh
from his studies in the clinics of Germany, Vienna, and Paris; also
Frans Cornelius Donders, thirty-three years of age, whom his friend
Moleschott described with fervid admiration as “a swelling rose-bud,
whose calix leaves signified nothing but pure science; the flower
leaves hidden glory. In one word, he was a man complete—perfect for
his time of life.” He was at that time Professor Extraordinary at the
University of Utrecht, and lectured on no less than four subjects—viz.,
Forensic Medicine, Anthropology, General Biology, and Ophthalmology.
These two men and Sir William Bowman, destined to revolutionise the
practice of ophthalmology, met for the first time in London in that
eventful year, and remained on terms of the most intimate friendship
for the rest of their lives. Donders and Bowman have left on record the
following interesting descriptions of their first meeting; the first
wrote:
“In August, 1851, at the International Exhibition, chance threw von
Graefe and myself together in London. I had already enjoyed the
companionship of Friedrich von Jaeger, when one morning a young man
in Alpine costume rushed into Guthrie’s eye hospital—he had reached
London but two hours before—and threw himself into Jaeger’s arms.
With the words, ‘You are made for each other,’ the latter literally
threw him into mine. And he was not mistaken. From early morning,
when, on our way to Moorfields Hospital, we took our modest breakfast
in Oxford Street amongst the workmen going to their work, till late
evening, when we gratefully quitted the hospitable home of our friend
William Bowman, we remained inseparably united in common objects of
pursuit. Von Graefe was my guide in practical work, of which I had as
yet but little experience, and I again could impart to him much from
the physiological side. This mutual instruction constituted for us a
great attraction. These days in which von Graefe unfolded the whole
charm of his nature belong to the happiest recollections of my life.”
Bowman, in describing Donders’ visit to London that year, says:
“It was his first travel, and it brought him, at least, one thing for
which he had great reason to be thankful—the personal friendship of
Albrecht von Graefe, an association soon to be fraught with splendid
results for the expanding science of ophthalmology; for these two
men, both of the first capacity, laboured ever afterwards to advance
it as brothers in council, and alike fruitfully; freely communicating
their ideas to each other, always in perfect harmony of aim. While
von Graefe, a stranger in London, was able to tell Donders of the
European hospitals he had been visiting, and of the new clinical
ideas he was maturing, as well as of the construction in that year,
by Helmholtz at Konigsberg, of a dioptric apparatus for rendering
visible the fundus of the eye, Donders, a stranger there too, could
on his side explain many discoveries of his own in the physiological
field, and, amongst other things, declare the true nature of the act
of accommodation, quite recently disclosed with certainty by his
countryman Cramer, under, it may be added, his own inspiration and in
his own laboratory.”
Sir William Bowman at the time of this memorable meeting was older than
his two friends, being thirty-five years of age. His biographer wrote
of him:
“At a period of life when most men are only beginning to apply
their powers of observation and reflection, he, exercising both
in a high degree, had already done work quite unexampled for its
novelty, interest, variety, and above all for its accuracy. Before
attaining the age of twenty-six, he had won for himself a leading
position amongst the most eminent anatomists of his time as a
microscopist of first-rate ability, and the discoveries he had made,
with the conclusions he drew from them, have ever since exercised
an important influence in practical medicine, and have served as
models for all subsequent and similar investigations. Later in life
he became distinguished as an original investigator in physiology,
and as a teacher in that subject, and, at a still later period,
devoting himself to a special branch of his profession, he stepped
naturally and easily into the position of leader and representative
of ophthalmic medicine and surgery, holding the same position in this
country, though for a far longer period, that was occupied in Germany
by his friend von Graefe, and in Holland by his still more intimate
associate Donders.”
PLATE XII.
[Illustration: SIR WILLIAM BOWMAN, BART., F.R.S.]
As the immediate result of his histological work on muscle, Bowman was
in 1841, at the unusually early age of twenty-five, elected a Fellow
of the Royal Society. At the Oxford meeting of the British Medical
Association, in 1847, he read a paper entitled, “On some Points in the
Anatomy of the Eye, chiefly in Reference to the Power of Adjustment,”
in which he demonstrated, simultaneously with and independently of
Bruecke, the structure and function of the ciliary muscle.
In the same year, he delivered to the students at Moorfields Hospital a
series of six lectures dealing with the parts concerned in operations
on the eye and on the structure of the retina. They contained an
account of his investigations into the microscopical anatomy of the
eye, and were published in book form two years later, a book which ever
since has been regarded as one of the classics of ophthalmology; a
French translation of it by M. Testelin was published in the _Annales
d’Oculistiques_ in 1855.
Bowman’s discovery of the ciliary muscle, bearing as it did on Donders’
investigations on the accommodation of the eye, formed from the first a
bond of intellectual union between the two men, which, with the growth
of years, ripened into the warmest esteem and friendship. Donders wrote
on the front leaf of his great work, _On the Anomalies of Accommodation
and Refraction of the Eye_:
“To William Bowman, F.R.S., whose merits in the advancement of
Physiology and Ophthalmology are equally recognised and honoured
in every country, this work on the anomalies of refraction and
accommodation is, in testimony of the warmest friendship and of the
highest esteem, inscribed by the Author.”
Though Graefe first performed the operation of iridectomy for glaucoma
in June, 1856, it was not until the following year that he published an
account of his great discovery. He wisely waited until he had tested it
in the different varieties and stages of the disease until he gave an
account of it to the world at large.
Dr. Bader, the curator and registrar at Moorfields, wrote in 1859:
“The first instance of glaucoma treated by excision of a portion
of iris by von Graefe’s method was in a case of chronic glaucoma,
operated upon May 1st, 1857; a second case was treated in the same
manner in October in the same year. Both were cases of chronic
glaucoma in an advanced stage, and the immediate result for vision
was not such as would recommend the operation. Then came several
cases of acute and subacute glaucoma, in which a striking improvement
followed shortly after the operation. Since then iridectomy has been
tried extensively at Moorfields, and with good and lasting results in
many cases.”
In the second number of the _Ophthalmic Hospital Reports_, published in
January, 1858, Critchett recorded some cases of acute glaucoma which he
had treated successfully by iridectomy, though not quite in accordance
with Graefe’s method.
Some years later Bowman wrote the following description of the
introduction of the operation into this country:
“Since the winter of 1856–7, the splendid researches of von Graefe
on the nature and treatment of glaucoma have prominently attracted
attention. On the Continent, his proposal to arrest the disease by
the excision of a portion of the circle of the iris has been adopted
and practised by the ablest men, including especially Professors
Donders of Utrecht, Arlt of Vienna, and Desmarres of Paris. In May,
1857, I first performed it in England. At the Ophthalmological
Congress at Brussels, in September following, von Graefe gave an
account of his researches, and distributed amongst his friends an
essay on the subject, then just presented to the French Institute.
In the ensuing autumn, iridectomy as a remedy for glaucoma was, in
my opinion, and in that of my friend and colleague, Mr. Critchett,
established by the facts we had ourselves observed, as a proceeding
competent to cope with the disease, by reducing that tension of the
eyeball, and compression of the retina and its vessels, which is the
cause of the loss of sight.
“It was our earnest wish that the value of von Graefe’s discovery
should be early and extensively acknowledged by medical men, so
that those suffering from so serious a malady might no longer be
drifting, as before, into hopeless blindness. Since then we have
with no faltering voice continued to advocate the practice, and have
performed the operation on all suitable occasions, both in private
and in public. At Moorfields, iridectomy has been exhibited and
tested on a very large scale, scarcely a week having passed since
1858 without one or more instances of it; and a host of competent
observers, both students and practitioners, have witnessed the method
of performing it, and its results, in the hands of several of my
colleagues and myself.”
Both Critchett and Bowman began as general surgeons as well as
ophthalmic surgeons. Critchett was appointed assistant-surgeon at the
London Hospital in 1846, and became full surgeon in 1861. Bowman was
appointed assistant-surgeon at King’s College Hospital in 1840, and
became full surgeon in 1856.
So extensive and absorbing became their work in ophthalmology that both
of them ultimately found it necessary to resign their general surgical
appointments and devote themselves exclusively to the treatment of eye
diseases.
Their reputation as masters in their speciality was not confined to
their own country, but became world-wide. George Critchett, who was
an admirable French scholar frequently attended the meetings of the
International Ophthalmological Congress, and his son, Sir Anderson, was
fond of relating how, at one of its meetings held in Paris in 1867, he
performed the operation of extraction of cataract before the assembled
Congress, on the two eyes of a patient, using his right hand for the
one eye and his left hand for the other. So great was his dexterity
that at the conclusion of the operation, Graefe, who was presiding
at the Congress threw his arms round his neck and kissed him on both
cheeks.
Both Critchett and Bowman were men with strong and attractive
personalities, and collected around them at Moorfields not only a large
body of students, but also practitioners who were devoting themselves
to ophthalmology from all parts of the world. In 1859 they commenced to
supplement their clinical teaching by giving a systematic three months
course of lectures on Ophthalmic Surgery, attendance at which course
enabled students to comply with the rules of the Royal College of
Surgeons for obtaining a certificate.
Most foreign missionaries from this country have endeavoured to
promote the spread of Christianity by practising gratuitously the
healing art. David Livingstone was a qualified medical man, and
administered medical relief to large numbers of the African natives
amongst whom he lived. From some remarks of Sir J. Risdon Bennett,
with reference to Livingstone’s medical studies in London in 1839, it
seems probable that he was then in attendance at Moorfields Hospital.
Many missionaries have not sufficient medical training to entitle them
to practise in this country, but, when abroad, feel themselves called
upon to administer such European drugs as they possess, having greater
knowledge of their uses than the inhabitants of the district in which
they are situated. It was to aid such persons to alleviate affections
of the eye that the Committee of Management of the Hospital obtained
the consent of the medical staff, in 1854—
“To admit gratuitously to the practice of the Hospital gentlemen
qualified to derive advantage from it, by the possession of some
amount of preliminary medical knowledge; provided they be duly
authenticated to them by a Missionary Society or otherwise, as being
about to proceed on missionary labours abroad.”
A letter was then drawn up and printed, embodying this resolution, for
circulation amongst those whom it might interest. Large numbers of
missionaries, both men and women, have since availed themselves of the
opportunities thus afforded them before taking up their duties abroad,
and in this way the teaching and benefits of Moorfields have been
spread to remote regions and to many uncivilised people.