Then, now andlooking forward!
200 years of Paediatric
Ophthalmology
David Taylor
London
MANCHESTER INSTITUTION
FOR CURING DISEASES OF
THE EYE
1814
William James Wilson
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Then And Now
2
1814
History up to then
Hot news in ophthalmology
What’s happened after then
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Then And Now
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Then And Now
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Then And Now
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The Increasing velocity of Ophthalmological Advances
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The Hollow Optic Nerve and flow of Pneuma
Rx based on flux, humours and vapours
Nerve Fibres
Galvanism
 Rx
Ophthalmoscope
26/06/2014
Then And Now
12
The Anatomists
330-250 BC
Herophilus & Erasistratus
Galen 130-200AD
Hunain ibn Ishaq (809-873)
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Then And Now
14
Al Farisi AD 1316
Topkapi
Alhazen AD 965-1039
Fatih
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Then And Now
15
William of Conches
1090-1154
Heart→ “Spiritual Virtue”
↓
Rete Mirabile + Brain
↓
“Psychic Humour”
↓
Hollow Optic Nerve
↓
Object of regard
↓
Soul
Alhazen 1572
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Then And Now
16
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Then And Now
17
A man blighted
by a glance from
a person with the
evil eye
from Georg Bartisch
Ophthalmodouleia
Das ist Augendeinst
(“Eye service. That is
eye-work”) 1583
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Then And Now
18
The Renaissance
The hollow nerve doubted
Vesalius couldn’t find it:dog
cattle
man (beheaded)
- But didn’t deny it!
Fallopia (1523-1563)
Coiter (1534-1600)
-Also doubted fibres
Jean Riolan the elder
- “Nature changes things”
Andreas Vesalius 1515-1564
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Then And Now
19
Antoni
van Leeuwenhoek
Holland
1632-1723
Bovine optic nerve
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Then And Now
22
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Antoni
van Leeuwenhoek
Holland
Then 1632-1723
And Now
23
Isaac Newton
Opticks
1704
Isaac Newton
Opticks
1704
Emission theory of light
Colour
Diffraction
Gravity
26/06/2014
Then And Now
24
John Hunter (1728-1793)
Described Ocular pigments
&
Ophthalmia
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Then And Now
25
Benjamin Franklin
1706-1790
Bifocals1784
“If you would not be forgotten, as
soon as you are dead and rotten,
either write things worth reading or
do things worth the writing”.
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Then And Now
26
John “Chevalier”
Taylor(1703-1772)
“Opthalmiator Pontifical,
Imperial, and Royal"
to George II
Quack
Charlatan
Brilliant physiologist?
Cataract
Chiasm
Strabismus
Ophthalmia
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Then And Now
27
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Then And Now
28
Erasmus Darwin (1731-1802)
Litchfield
Recommended
trephination to
“some ingenious
oculist”
Patching?
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Then And Now
32
William Withering
1741-1799
Samuel Galton
1753-1832
Joseph Priestley
1733-1804
Josiah Wedgwood
1730-1795
The “Lunar Men”
Matthew Boulton
26/06/2014
1728-1809
James Keir
1735-1820
Then And Now
James Watt
1736-181933
Adam Smith
(1723-1790)
“..nation of
shopkeepers..”
Edmund Burke
(1729-1797)
Thomas Paine
(1737-1809)
“Superstition is
the religion of
feeble minds”
“(Burke) rose like
a rocket, he fell
like the stick”
Jeremy Bentham (1748-1832)
“The greatest happiness of the greatest
number is the foundation of morals
and legislation”
“All punishment is mischief..”
David Hume(1711-1776)
26/06/2014
Then
And Now
“Avarice, the spur
of industry”
34
The philosophers
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Then And Now
35
Lord Byron
(1788-1824)
A lady of a ‘certain age’,
which means‘certainly aged’.
William Wordsworth
(1770-1850)
There is
one great society alone on earth
the noble living and the noble dead
The Poets
Percy Bysshe Shelley
John Keats
1792-1822
(1795-1821)
Are we not formed, as notes
“I would sooner fail
of music are, for one another,
than not be among
though
dissimilar
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Then And Now
the greatest”
36
Thomas Young
(1773-1829)
1792- Medical School
1793- Accommodation
1801- Astigmatism
1801-Colour vision-retina
1803 – MB (Cambridge)
1801-3 Wave theory of light
1803 –Interference
1804 –Diffraction
1804(?14) --- Deciphers Rosetta
Stone
1804 –Capillarity
? 1804–Modulus of Elasticity
1808 MD
Wellcome 0008178
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Then And Now
42
William Falconer
James Ware
Walter Farquhar
Richard Pearson
Maxwell Garthshore
George Pearson
Thomas Beddoes
George Smith Gibbes
V0006726
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Then And Now
45
1805
The London Dispensary for
curing Diseases of the Eyes
and Ears
Later
Royal London
Ophthalmic Hospital
John Cunningham Saunders
26/06/2014 (1773---1810)
Then And Now
47
John Cunningham
Saunders1811
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Then And Now
49
James
Wardrop
15 yo blind boy
in a hinged
wooden
box,1820
He did not do
well!
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Then And Now
50
Benjami
n
Gibson
(1811
Manchester)
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Then And Now
51
Benjamin Gibson 17841812
• Born Newcastle-on-Tyne
• Apprenticed to Ingham, Newcastle
• 1796. Student of Baillie, London.
• +/- 1798. Dissector in Edinburgh
• 1799. With Charles White,
Manchester
• 1804-12. Manchester Infirmary
• Died of consumption 6th March 1812
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Then And Now
52
GJ Guthrie on Gibson’s
technique & character
P188. “I have transcribed this
statement because it is highly
honorable to his character as a
surgeon and a man; neither
encreasing or diminishing the
difficulties of the operation….he
endeavours to forewarn the
student….”
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Then And Now
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O Gibson, ere those orbs of thine
Received the sun's resplendent
light,
In far-off regions these of mine
With many a pang were closed in
night……
Edward Rushton, Poet & Political
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Then And Now
writer
54
From men of skill on Mersey's strand,
Whose far-famed science nought
avail'd,
To men of skill throughout the land,
I pass'd, but every effort fail'd.
When lo ! by rigorous duty sway'd.
To thee. Oh Gibson, I applied,
And soon by thy transcendent aid
The new form'd opening light supplied.
http://www.geni.com/people/Benjamin-Gibson/6000000007867476412
Gibson 2011 pp76-82
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Then And Now
55
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Then And Now
56
Warren Tay
1843-1927
RLOH 1877-1904
London Hospital
Friend of
Jonathan Hutchison
Unilateral glaucoma
Tricyclist
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Then And Now
65
Marcus
Gunn
1850-1909
MEH 1883-1909
St Andrews
Edinburgh
UCL
Perth
Vienna
MEH
Australia
MEH / QS
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Then And Now
66
Edward Treacher Collins
1862-1932
RLOH1895 -1922
Pathology
Bacteriology
Evolution
Persia
History of MEH
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Then And Now
67
Other
“Paediatric
Ophthalmologists”
• Jonathan Hutchison 1828-1913
• Hughlings Jackson 1835-1911
• PG Doyne
• William J. Adie 1886-1935
• Edward Nettleship
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Then And Now
68
William Mackenzie
1791-1868
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Then And Now
69
William Mackenzie
1791-1868
1st ed 1830
“In cases of congenital cataract, ought the
operation be delayed…..or ought it to be
practised during infancy?”
“The answer decidedly is to operate in
infancy”
(“if possible before teething commences4th ed1854)
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Then And Now
70
1910
1927
Claud
Worth
Three
Life Works
-Three
Classics
1903
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Then And Now
75
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Then And Now
76
Claud Worth’s Era
“I use the black silk
made for sewing
boots by
W.H.Staynes,
Leicester”
The suture is coated
with…“a very hot
mixture of white
beeswax...and white
Vaseline”
26/06/2014
“The eye to be
operated is
irrigated with….
a drop of suprarenal extract”
Then And Now
77
Claud
Worth’s
Era
The sutures are removed
before the child leaves
the hospital (1 week)
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“A young child is
kept in bed with
both eyes
bandaged for the
first four days”
Then And Now
78
Worth’s
Dots
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Then And Now
79
Worth’s Balls
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Then And Now
80
Worth’s Amblyoscope
“Before I had electric light I
used two paraffin lamps on a
table, varying the distance of
each lamp and the height of
the flame as required.”
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Then And Now
81
Instillation of Atropine
into the Fixing Eye only
….and:- “When glasses are ordered, it is a good plan ..to
continue the atropine which has been used for
retinoscopy until the glasses arrive…..the infant
soon discovers that he sees better with the glasses
than without them…..”
DVD
26/06/2014
“I have seen a few well-marked
cases of so-called double hyperphoria
..either eye turned up when screened…”
Then And Now
82
Claud Worth and
adjustable sutures
“For older patients…I
use a 10% solution
of Cocaine……so
that one can gauge
exactly the extent
that the muscle
has to be
advanced”
“ The immediate effect
is the permanent
result….in
operating under
general
anaesthesia, one
has to bear in
mind……”
P 206
P 210
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Then And Now
83
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Then And Now
The Claud Worth Room
Little Ships Club, London
84
Mother’s reply:“How can you say so?
He was quite a common
-looking man”
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Then And Now
85
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Ida Caroline Mann
(1893-1983)
Appointed
MEH 1927
Then And Now
86
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Then And Now
87
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Then And Now
88
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Then And Now
89
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Then And Now
90
1947
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Then And Now
91
Kenneth Cullen Wybar
MEH 1956-1983
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Then And Now
92
The future…uncertain?
• Phenotyping
• Molecular Genetics
• Stem Cells
• Super-Specialist surgery
–Ant Segment
–Retina
–Lacrimal / plastics / orbits
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Then And Now
93
The Future……Certain!
• Human qualities
–Kindness, understanding and
thoughtfulness.
• Training.
• Paramountcy of History &
Clinical examination.
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Then And Now
95