History of Dermatology

History of Dermatology Br. J. Derm. (1970) 83, 690. Department of Dermatology, Royal Victoria Hospital, Belfast HISTORY OF DERMATOLOGY IN NORTHERN IRELAND REGINALD HALL

In “The Book of Belfast” compiled by Dr Robert Marshall for the 105th Annual Meeting of the British Medical Association in 1937 the following reference is made to early medical care in the city: "Mention of the healing art is first found in the annals of Belfast of the seventeenth century. In 1651 a permit was issued to Cromwell's Commissioners to engage a doctor and an apothecary should there be want of such ‘only limiting you in this, that you exceed not £100 yearly to the doctor nor £60 yearly to your apothecary’. We read that in 1689 those stricken with 'the mortality' in the English camp before Drogheda were sent to the Great Hospital in Belfast, where over three thousand died; this was, however, a military base hospital, established by Schomberg, and not a permanent institution.

“The first organized medical relief in Belfast was given by the Belfast Charitable Society in 1774 to persons attending at the Old Poorhouse. This Society is still in existence and maintains an admirable home for the aged and infirm'.

Dermatology in Belfast has reason to be grateful to this Society for a grant of land on 2 occasions for the building of skin hospitals.

It was not until 1792 that the movement began which soon led to the establishment of the first general hospital in Belfast. Today this has become the vast hospital complex known as the Royal Victoria Hospital. Three other general hospitals were established later; the Belfast City Hospital in 1840, the Ulster Hospital in 1872, and the Mater Infirmorum Hospital in 1883.

The Medical School began in 1818 as a special Department of Medicine in the educational foundation known as the Royal Belfast Academical Institution, and the associated clinical instruction was given in the General Hospital. It will interest dermatologists to know that the first Professor of Medicine was Dr Henry MacCormack, a man of great erudition who was conversant with 20 languages, and whose son, William, went to London, where he became Sir William MacCormack, Bart., President of the Royal College of Surgeons. Henry MacCormack, formerly dermatologist to the Middlesex Hospital, was Sir William's nephew.

In 1849 the Department of Medicine became the Faculty of Medicine, when it was transferred to the newly-established Queen's College (later the Queen's University), Belfast. Until these arrangements for medical education were made in Belfast about 300 medical students went from Ulster annually to other colleges, chiefly in Dublin and Edinburgh; and it was hoped that many of these would take advantage of the opportunity for home education, because, as an Irish student in Edinburgh wrote: " To be a student of medicine here is a term of contempt; but to be an Irish student of medicine is the very highest complication of disgrace". Nevertheless many medical students continued to obtain their education outside Ulster.

There is no record of any special provision for the treatment of skin diseases in Belfast prior to 1865, although at this time a skin clinic was conducted in the Adelaide Hospital in Dublin by Dr Walter G. Smith.

Henry Samuel Purdon (1843-1906)

H. S. Purdon was the pioneer of dermatology in Northern Ireland. He was the eldest of the 17 children of Dr Samuel Delacherois Purdon. His grandfather, Dr Henry Purdon (1770-1840), held the impressive title of Staff Surgeon of Ulster and was the first of many medical Purdons. Like the other medical members of his family, including his father, H. S. Purdon, born on December 21st, 1843, received his medical education in Scotland, where he graduated M.D. (Glasgow) and L.R.C.P. (Edinburgh). To these qualifications he added the L R C S and L.M. (Dublin).

During his medical training in Glasgow, Purdon had clearly been much influenced and impressed by the dermatological teaching of McCall Anderson so that, when he returned to Belfast, he quickly realized the need for a dermatological service and decided to specialize in skin diseases.

On June 13th, 1865, when still only 20 years of age, Purdon arranged a public meeting at 12 Wellington Place, Belfast, with the object of gathering support "to establish a dispensary for the gratuitous treatment of the poor suffering from the various kinds of diseases of the skin ". The meeting gave general approval to the idea; a committee under the chairmanship of Elias H. Thompson was set up, and suitable premises were sought. Eventually a building in Academy Street, Belfast, was rented, and it was decided to call the new institution "The Belfast Dispensary for Diseases of the Skin ". Purdon was appointed physician- in-charge, with his uncle, Dr Thomas Henry Purdon, as consulting physician. Clinical work began in the autumn of 1865 and soon the service was being very fully used. Understandably the project had some early financial difficulties, and the records show that Purdon encouraged his many sisters to give some of their pocket money to help with the expenses. He also used their artistic talents in the construction of wax models of some skin diseases, and particularly of the very prevalent lupus vulgaris.

In 1866, with the attendances steadily increasing, the name was changed to "The Belfast Hospital for Diseases of the Skin ". By 1868 the number of patients had outgrown the accommodation available, and the committee considered moving to a large building in Great Patrick Street. Purdon was authorized to complete the negotiations; but, because he was not wholly satisfied with the suitability of the premises, the project was abandoned. The committee, still faced with growing numbers of patients and with no suitable building to move to, decided to apply to the Belfast Charitable Society for a plot of ground in the Clifton Street area, on which a new hospital could be built. The Society granted land in adjacent Regent Street, and it is interesting to note from the plans that what is now a densely built-up area was then an open field. The new hospital was opened by the President, Elias H. Thompson, on October 28th, 1869, 4 years after the founding of the original hospital.

The new building provided mainly out-patient facilities but also had 8 beds. The out-patient department and operating theatre were at that time considered adequate, commodious and up-to-date. Before leaving Academy Street about 1000 patients a year were being treated, and this number steadily increased with the opening of the new hospital. As its reputation spread, patients came not only from Belfast but also from the surrounding counties. This success was clearly due to the energy and enthusiasm of Purdon, who, besides his clinical work in the hospital, also carried out 2 weekly sessions of undergraduate teaching as the following notice shows:—

At the same time as he was trying to obtain a proper place for the care of his patients, Purdon was avidly consuming the literature, and by his writings and contacts became widely known in developing dermatological circles in the United Kingdom, in Europe and in the United States; and he was a corresponding member of the New York Dermatological Society.

In 1866 the Journal of Cutaneous Medicine, was established under the editorship of Sir Erasmus Wilson, F.R.S., who became Professor of Dermatology at the Royal College of Surgeons of England. In 1870, when pressure of work caused Wilson to relinquish his post as editor, the position was offered to Purdon. It is clear from Purdon's preface to the fourth volume (June 1870) that he was much pleased to be asked, at 26 years of age, to follow such an illustrious predecessor; and he did his best to encourage contributors. He succeeded at first in getting articles from the United States, and from European and United Kingdom centres; but by 1871 the support became inadequate and the journal ceased publication! It was not until 1888 that the British Journal of Dermatology took its place.

Meanwhile Purdon and his hospital committee were very disturbed to find that within a relatively short time of the opening of the new hospital in Recent Street, where the beds had been increased to 14, the out-patient and in-patient needs had become too great for the available space. The hospital's limitations became widely known; and, in 1873, a public benefactor, Edward H. Benn, informed Purdon that he was prepared to finance the erection of a thoroughly up-to-date skin hospital to meet the needs of the community at a cost of around £3 000. This generous offer was quickly accepted by the hospital committee and an approach was again made to the Belfast Charitable Society for a site for the new hospital. This was forthcoming a few hundred yards away in nearby Glenravel Street; and in 1875, the new building was completed. Mr. Benn, who also financed the building of an Eye, Ear Nose and Throat Hospital, and the Samaritan Hospital for Diseases of Women, unfortunately died shortly before the new hospital was opened.

The Benn Skin Hospital cost £3,300. It was a substantial and commodious 3-storey building (Fig. 2). On the ground floor were the administrative departments, consisting of board-room, drug room, pathological laboratory, operating room, electric room, and kitchens; and at the rear were the wash-house and laundry. On the first floor there were bathrooms, male public wards, and 2 male private wards. On the second floor were the corresponding wards for women and children.

The hospital was then regarded as the most complete of its kind m the United Kingdom, furnished with the best appliances and having in all 30 beds and “a suite of baths of every description”.

Professor J. F Hodges, MD., F.R:C.S, Professor of Medical Jurisprudence, was elected president of the new hospital and served in this capacity for over 20 years. On his retirement he was succeeded by Purdon, who retained the office until his death m 1906 at the age of 62. The hospital was fortunate in having an energetic committee which kept it up-to-date. Some of these members gave long service to the successive hospitals, notably Elias H. Thompson, the first president, and John Bell, the secretary for 21 years. It is likely that it was in appreciation of these 2 friends, Purdon’s son, born on June 6th, 1870, was named Elias Bell Purdon.

In 1893 Purdon was joined on the hospital staff by Samuel W. Allworthy and by his own son, Elias Bell Purdon. Both continued the work begun by the founder until the hospital was severely damaged in an enemy air-raid in 1941, when it had to close down. In this air- attack on the hospital Dr Allworthy narrowly escaped being killed.

Samuel William Allworthy (1866-1952)

S. W. Allworthy entered Trinity College, Dublin, at the age of 15 years and had a distinguished undergraduate career. Among other awards he obtained the Ekenhead Scholarship in Experimental Science and graduated B.A. (1886), M.B., B.Ch. (1888) and M.D. (1890). Following a period of general practice m Darlington he returned to his native Belfast and combined his general practice with specialist work in dermatology. He was also consulting physician to the Royal Victoria Hospital and to the Belfast Charitable Institute. He published numerous papers in the British Journal of Dermatology, and in the British Medical Journal. He worked for a time in the Finsen Institute in Copenhagen and was a pioneer in radiotherapy in Belfast. Like many early radiologists who omitted to avoid over-exposure, his hands in later years were disfigured with X-ray burns, and 3 fingers had to be amputated. He served in the First World War as a skin specialist.

Allworthy was a man of great energy and many interests. He pursued his family's interest in local government and became an alderman. His many and varied distinctions included: Fellow of the Jenner Institute; Fellow of the Chemical Society; Member of the Lister Institute of Preventive Medicine; Member of the Royal Irish Academy; President of the Belfast Natural History and Philosophical Society; President of the Ulster Photographic Society. Member of the Senate of Queen's University, Belfast, and of Trinity College, Dublin; Chairman of the Belfast Water Commissioners.

He was vice-president of the Section of Dermatology when, as has been mentioned earlier, the B.M.A. met in Belfast in 1937.

He died on September 18th, 1952, aged 86.

Elias Bell Purdon (1870-1947)

E. B. Purdon was the fourth generation of his family to practise medicine and the last Purdon to attend as physician to the Belfast Charitable Society. At the time of his death the family had given unbroken service to the Society for 143 years.

E. B. Purdon was educated at Methodist College, Belfast, Morrison’s Academy, Crieff, Queen’s University, Belfast, and at Edinburgh University. He graduated M.B., C.M. (Ed.) 1893, and L.R.C.P. & S. (Ed.) and L.F.P.S. (Glasgow).

On his return to Belfast he began the practice of dermatology with his father and with Allworthy.

Apart from dermatology his great interest was music. He was a member of the Philharmonic Society and was one of its cellists for many years. He was unmarried. His cousin, Major-General William Brooke- Purdon, was for a time Ulster Agent in London.

William Calwell (1859-1943)

Apart from the Benn Skin Hospital there was established, at the turn of the century, a clinic for skin diseases in the Royal Victoria Hospital in the charge of Dr William Calwell, an assistant physician to the hospital. The hospital records list him as "Attending Physician for the Dermatological Department".

Calwell was the first physician at the Royal Victoria Hospital to bear the title of dermatologist. He was born in Belfast and educated at the Royal Belfast Academical Institution, Queen's University, and in Dublin and London. He graduated M.A., M.D., M.Ch., Queen's University, and L.M. (R.G.P.I.). He was the first registrar in the Royal Victoria Hospital; he was appointed to this post in 1893. Two years later he became assistant physician; and shortly afterwards he established the clinic for skin diseases. The hospital records show that this clinic was held regularly until his retirement from the staff in 1924. He died in 1943 after a long and useful life.

Ivan Henry McCaw (1897-1961)

Ivan McCaw was the only son of Dr John McCaw, a pioneer in paediatrics in Belfast. He was educated at the Royal Belfast Academical Institution and was a medical student at Queen's University at the beginning of the First World War. He volunteered for service and was commissioned in the Royal Irish Rifles. He was severely wounded in the right shoulder at the battle of Messines in 1917. When he recovered and was invalided home, he resumed his medical course, graduating with honours in 1922. The war injury left him with a partial paralysis of the right arm and hand, making it impossible for him to follow the surgical career which he had planned. He soon began training as a dermatologist, and worked under H. W. Barber at Guy's Hospital, and later in Vienna. When he returned to Belfast he took charge of the Skin Clinic in the Royal Victoria Hospital Group, vacated by William Calwell, and steadily, and for many years single-handed, expanded the service considerably. His full clinical commitments left him little time for writing and research, but he amassed a vast clinical experience. He was a gifted teacher and an excellent speaker. He regularly attended the meetings of the British Association of Dermatology and, in 1948, was elected president. Despite his physical disability he was a keen golfer; and, with Dr Geoffrey Dowling, jointly presented the cup which bears their names and which is competed for at each annual meeting of the Association.

McCaw made a notable contribution to dermatology in Northern Ireland and, under his direction, the foundations of the present extensive service were securely laid.

Following the destruction of the Bem1 Skin Hospital in 1941, it was decided not to rebuild it but to use the funds for the improvement of the amenities in McCaw's department in the Royal Victoria Hospital. Purdon's name was perpetuated by naming the in-patient unit “The Purdon Skin Ward”. A memoria1 plaque is displayed at the entrance to the ward.

Jonathan Jefferson (1921-1968)

Jefferson was educated at Portora Royal School and Queen's University, where he graduated in 1943 and was later awarded the M.D. with commendation. After a period of training in dermatology in London he began to work with McCaw in 1947 and helped considerably in the expansion of the specialty in Northern Ireland. He made many useful contributions to various journals.

His main interest was in industrial dermatoses in which he had a very extensive practice. He was much interested in teaching; and, until his first illness in 1966, was a post-graduate clinical tutor. His early death at 47 years of age was a great loss to dermatology in this area.

Northern Ireland, with its population of 1½ million, now has a dermatological service in 20 hospitals staffed by 8 consultants, 2 senior registrars, and a number of more junior staff, who, between them, deal with approximately 40,000 cases per annum.