Hospitals by Denise Amos

The Nottingham Eye Hospital

The treatment and study of eye diseases, ophthalmology, was until the beginning of the nineteenth century mainly practised by quacks and charlatans. During the Napoleonic Wars (1792-1815) soldiers returning from Egypt and the Mediterranean many were suffering from ‘Egyptian Ophthalmia, a serious threat to the eyesight then and even now in third world countries. The disease spread by the trachoma virus was thought to be brought back home and spread to the civilian population.  It is the world's leading cause of preventable blindness and occurs where people live in overcrowded conditions with limited access to water and health care, all present in nineteenth century England and Nottingham. As a result a large ophthalmic depot was established near Selsey (nr to Chichester where returning troops would have landed) and three more founded in London. Bristol and Manchester both established eye hospitals in the second decade of the nineteenth century.

The spread of ‘Egyptian Ophthalmia’ seemed to ignite an interest in eye care amongst surgeons and physicians and it was recommended at the first International Congress of Ophthalmology in 1857 that special eye hospitals should be set up. Nottingham’s first eye dispensary was opened in July 1859 on Park Row, not far from the General Hospital. It was to be run by a committee chaired by the Duke of Newcastle. There already had been established since 1843 a Midland Institute for the Blind on Chaucer Street, Nottingham. However, it was felt that more had to be done to tackle the causes of chronic infections of the eye rather than helping people when they had gone blind.

One of the leading men in Nottingham was the surgeon Charles Bell Taylor who became well known throughout the Midlands and published an article on cataract surgery in the Lancet in 1871 and is believed to have carried on operating until the age of 80 years!

The Eye Infirmary (as it was now called) was moved to 56 St James’ Street to a better and larger premises in 1866 but was still rented. It was till run by a committee but when the Duke of Newcastle died 1879 the post was offered to the Duke of Rutland who was pleased to accept the post. However, in 1890 the post was offered to the Duke of Portland who had been making regular donations to the charity – as he was to many other such charities. The premises were purchased eventually for the sum of £4000. The charity was nonetheless fortunate in that considerable sums of money in the form of donations and legacies were being given to the hospital. The demands on the services were growing and many had to queue out in the cold until the 1880s when a covered waiting area was built.

In the early years the unit was staffed by visiting honorary doctors and surgeons. In order to be appointed they had to have worked in Nottingham for six months and be suitably qualified. The committee ran the every day work and the doctors did the doctoring. One such doctor was Thomas Appleby Stephenson who was reprimanded for leaving his post at the hospital to return to his own practice in London.

After some considerable consultation in April 1911 the foundation stone for the new purpose built hospital on The Ropewalk was laid. The architect was Arthur Marshall and the builder was Thomas Barlow. The Duchess of Portland officially opened the hospital on 13 March 1913. The new building was described as ‘the most complete and up-to-date institution of its class in the country.’ Even with this new hospital dealing with problems of the eyes was still a delicate procedure; no steroids, antibiotics were available at this time.  Those unfortunate to have serious diseases of the eye often had to have an eye removed and replaced with a glass eye. Nevertheless, operations on cataracts, although still far from that of today, was helping many people see again; Glaucoma which was a serious cause of blindness was treated by serine droplets as well as surgery on acute form of glaucoma. The link between the eye and other diseases of the body was also beginning to be understood. Improvements in both medical and working conditions as well as health and safety have over the years altered the type of injury or disease seen in patients’ eyes.

During the First World War, one of the honorary eye surgeons, Dr Thomson Henderson, who had presented papers to the Ophthalmological Society and was very interested in the histology of glaucoma and the use of the gonioscope (an optical instrument for examining the angle of the anterior chamber of the eye and for demonstrating ocular motility and rotation), volunteered for medical service along with Dr Herbert. Dr A Christie Reid was appointed in their place. He was paid £80 a year for three afternoons a week. He had a special interest in problems that miners suffered due to working in poor lighting conditions. In 1919 he took over as honorary eye surgeon to Mansfield and Worksop hospitals as well as to the Nottingham Eye Hospital. He continued to work until 1947 and died in 1950. During this time 34 cases of tuberculosis were admitted between 1912 and 1914 and 148 cases of Ophthalmia neonatorum, a serious infection of newborn children’s eyes were admitted during 1915. At the 57th Annual General Meeting of the hospital in March 1917 it was reported that 9355 recommendations were issued to subscribers and up to 23,000 outpatients had been seen, an increase of nearly 2000 on the previous year. Patients admitted were 750 and in addition 1379 operations had been performed and in 200 anaesthetics had been used. The increased numbers were due to the use of the infirmary for war work. Not only was it an Auxiliary Military Hospital and used for treatment of eye cases from the front line – for some months after the battle of the Somme (1916) the infirmary was almost more a military than a civil hospital – but since March 1916 it had been made an ophthalmic centre, under the Northern Command, for the examination and treatment of cases of defective vision among soldiers and recruits.

Between the two wars the eye hospital continued steadily to help people with over 2000 out patients seen each year. One of the surgeons at the hospital was Dr G Napier who strove to improve and expand the eye hospital. During the period of the Second World War the hospital continued its work and the numbers of patients treated increased to over 30000. One ward was set aside for the treatment of members of the armed forces. After the 1939-45 war the there was a very active Ophthalmic nursing school in Nottingham.

Before the beginning of the National Health Service, the hospital was financed through subscriptions from a wide range of groups. In 1943 for every pound donated, four outpatients recommendations could be given. If the outpatient required medicine he had to pay three pence a week and in patients paid 1/6d a day towards the cost of board. A private bed cost £1.0.0 a day. In 1944 before the NHS was implemented it was suggested that the Eye Hospital should be merged with the General Hospital which was nearby. However this was not accepted but in 1948 both hospitals were taken over by the Ministry of Health, under Sheffield Regional Hospital Board. All documents relating to the securities of the eye hospital were transferred to the government and in a stroke all local wealth disappeared.

After the war the hospital was well set up for treating patients with eye problems; there were six private beds on the top floor, a female ward and a children’s ward, and operating theatre and outpatient’s department. All meals were prepared and cooked on the premises and milk was delivered in a churn right up until 1967. During the 1950s Dr Thomson Henderson retired and his position was taken by George Robinson. The hospital still received donations and thanks to the generosity of Elizabeth May King a large extension was added to the building to cope with the increasing workload. In the 1960s there were six consultants and in 1967 George Napier retired. There had been great advances in eye treatment in the period up to the 1970s. Cataract surgery was 90% successful and patients no longer had to wear thick glasses afterwards. Corneal grafting had become routine and anti-biotics were the norm. Apart from the staff side, improvements in instruments had made operations and methods for examining the eye far more successful.

The introduction of a new Medical School in Nottingham (see Queen’s Medical Centre) benefitted the eye department, not only would there be an increase in space for the numbers of patients but also being situated alongside a Medical School would have its benefits. Initially the outpatients moved to the QMC first and then the wards and casualty. The department is now the Eye, Ear, Nose and Throat Department which was opened in 2000. Even before the eye department moved over to the QMC, it was proposed that an academic department of Ophthalmology was needed in Nottingham. In 1986 Stephen Vernon was appointed as senior lecturer and foundation member of the department. The eye department is known internationally and although the pattern of eye disease has changed since the service originated in 1859, with problems in younger people being less of a problem and older people with diseases associated with ageing has become the greatest challenge.