William Lawrence and the English Ophthalmology Textbooks of the 1830S and 1840S

SPECIAL ARTICLE William Lawrence and the English Ophthalmology Textbooks of the 1830s and 1840s

H. Stanley Thompson, MD; Patricia G. Duffel, RPh, MLIS

illiam Lawrence was a leading English ophthalmic surgeon in the middle of the 19th century. This article briefly discusses his life, career, and well-known textbook (Treatise on Diseases of the Eye). His book and 3 others were the best- known English texts on diseases of the eye of the 1830s and 1840s. The 3 others wereW William Mackenzie’s Practical Treatise on Diseases of the Eye, Richard Middlemore’s Treatise on the Diseases of the Eye and Its Appendages, and Thomas Wharton Jones’ Manual of the Principles and Practice of Ophthalmic Medicine and Surgery. Arch Ophthalmol. 2012;130(5):639-644

William Lawrence (1783-1867) anatomy by Johann Friedrich Blumen- (Figure 1) was a general surgeon who bach,1 a famous professor of physiology took a special interest in diseases of the eye and physical anthropology from Go¨ttin- and became famous in London, England, gen, Germany. Also, during these years, as an ophthalmic surgeon in the middle Lawrence wrote a much admired book on of the 19th century. His father, a success- the treatment of hernias that was re- ful surgeon in Cirencester, England, sent printed 5 times.2 The fourth edition of A him, at 9 years of age, to Elmore Court, a Treatise on Ruptures (1838) was a substan- grammar school near Gloucester, En- tial work of 636 pages. gland, for a solid classical primary educa- By the time he was 30 years old (1813), tion. In 1799, at the age of 16, he began Lawrence had been elected an adjunct sur- his medical career as an apprentice to John geon at Barts and became a fellow of the Abernethy (1764-1831) (Figure 2), who Royal Society (Figure 3), and at 42 years was a well-known surgeon and a founder of age, after 26 years at Barts, he was named of the medical school at London’s very old a surgeon. This promotion was considered St Bartholomew’s Hospital (Barts). to be a speedy climb up the rungs of aca- Lawrence lived for 3 years in Aber- demic surgery at the time. When his for- nethy’s establishment with several other mer mentor Abernethy eventually re- apprentices. Then, Abernethy found him signed his leadership position in 1827, a paying job as a lecturer in anatomy at Lawrence applied for and gained Aber- Barts so that, at 19 years old (1802), he nethy’s administrative job as the principal could support himself while finishing his surgeon of Barts. The students’ nickname medical training. He apparently became a for this position was dictator of Barts3 be- good teacher and demonstrator of cause no one on the premises outranked the anatomy, even though he was, at first, principal surgeon. Lawrence held this po- younger than some of his students. sition until well after the usual retirement In 1805, at 22 years of age, he took his age and continued to teach and treat pa- medical examinations and became a mem- tients. It is notable that, when he was 75 ber of the Royal College of Surgeons (RCS) years old, the official mandatory retire- and then an assistant surgeon. At the age ment age at Barts was, rather pointedly, set of 24 years (1807), he translated, from Ger- at 65 years, and Lawrence voted for this rule. man into English, a book on comparative When asked why, in that case, he had not yet retired, he said, with a smile, that he had Author Affiliations: Department of Ophthalmology and Visual Sciences, University decided that the rule did not apply to him of Iowa, Iowa City. but only to future principal surgeons.3

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©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 1817), which were quickly published. His lectures were influenced by his reading of the histol- ogy of Xavier Bichat and the comparative anatomy of Georges Cuvier and J. F. Blumenbach. When these 2 lectures at the RCS appeared in print, they caused quite a fuss. Abernethy, whose conserva- tive position went down well with most of the English medical com- munity and with the Church of En- gland, was outraged at Lawrence’s scandalous ideas and arranged to publish his own RCS lectures.4 Unlike Abernethy, Lawrence found that he rather favored the Figure 3. William Lawrence, fellow of the Royal French idea that physics and chem- Society. istry should be applied to understanding the human body and its func- Figure 1. William Lawrence at 37 years of age. he thought of anyone with an op- tions. He pointed out that if the brain posing opinion, but his published itself were malformed or injured, it opinions tended to be smooth, po- usually did not work very well, and lite, and reasonable. His mentor the patient might have little or no Abernethy was the opposite; he was mental activity; thus, the mind (call inclined to give anyone with an op- it the soul if you must) is a product posing view a vigorous, condemna- of the brain, and it must therefore be tory tongue-lashing. part of the body. The British, having In 1814, at the age of 50, Aber- been recently at war with France nethy accepted an added position as (1793-1814), considered these ideas professor of anatomy and surgery at altogether too French and objected to the RCS. It was customary for a new them because they seemed to leave no RCS professor to give 1 or 2 intro- place for the immortal soul, so cries ductory lectures to the college. The of “materialist!” and “atheist!” were publication of these lectures was heard. However, the objections of- considered optional. Abernethy gave fered by Abernethy and many others 2 such lectures in 1814 and 1815.4 on this subject just stimulated the They were in praise of the concepts strong-willed Lawrence to wade fur- of “vitalism” that he had been taught ther into the argument. He set about by John Hunter. Vitalism had been summarizing and defending his po- popular in England in the late 18th sition and came out with a book called century, but Lawrence considered it Lectures on Physiology, Zoology, and to be hopelessly old-fashioned. It was the Natural History of Man, and, of Figure 2. John Abernethy. a worldview in which life, body, and course, he did it in his usual forth- mind (read soul) were 3 entirely right way, letting the chips fall where An elderly and then famous Law- separate God-given entities; to Ab- they may.6,7 rence attended to Queen Victoria’s ernethy, the immortal soul was not Eighteenth-century scientists eye problems, and the queen made something that grew in the body, it knew there were animal bones in him one of her serjeant surgeons. was a divine gift, added to the body.5 some geologic strata that suggested Then, just before his death in 1867 The Oxford English Dictionary of- there had been animals on the earth at the age of 84, she gave him a bar- fers the following clarifying state- much longer ago than anyone had onetcy—a title that he could pass on ment: “The mind was thought of as imagined. Lawrence blithely stated in to his oldest son, Trevor. When Sir the system of cognitive and emo- his new book that the biblical story William died, he had a right hemi- tional phenomena and powers that of creation found in Genesis seemed paresis from a recent stroke but was constituted the subjective being in simply to be derived from ancient He- still clinging to his position as boss a person. This was the spiritual part brew traditions, and therefore the of Barts. of a person, and thus the ‘soul’ as dis- whole matter of the origins of man- During much of his life, Wil- tinguished from the body.” kind was clearly open for discus- liam Lawrence seemed to have cul- In 1815, Lawrence, at the age of sion. Naturally, there were many who tivated a sharp, sarcastic wit. He was 32, was also offered an RCS profes- disagreed. quick to express his opinion and was sorship, and he too gave some in- Bringing religious belief into this quite ready to say (very clearly) what troductory lectures (in 1816 and discussion was perhaps a tactical er-

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©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 ror. The matter was soon brought before the old-fashioned Chancery Court (Figure 4). Apparently, many in the court suggested that Law- rence, by saying that the Genesis story was wrong, was “contradicting the word of God.” Therefore, he was surely guilty of blasphemy and, given the close connection between the Crown and the Church of England, perhaps also of sedition. The lord chancellor, using his court in its most ancient role as a court of con- science, agreed. It soon became obvious to Law- rence that this rumpus was going to affect his career as a surgeon. After all, who would want an established blas- phemer to remove his cataract—a procedure that, in those days, re- quired 4 assistants to hold the patient down and keep the head immo- bile? Would God still guide and Figure 4. The Court of Chancery (in approximately 1810). steady the hand of such a sinful surgeon? to his audience. By 1822, the con- any notes, so they were able to give So, Lawrence bowed to the Chan- troversy that had been engendered the speaker their full attention. The cery Court and withdrew his book, by his 1818 book on The Natural His- hall was always packed, and Law- and he simply stopped talking about tory of Man was calming down, and rence had clearly worked hard to put it. The publisher was fined by the at the age of 39, Lawrence was asked together his personal notes on vari- court for copyrighting such blasphe- to prepare a series of lectures on the ous patients he had seen. Law- mous rubbish, and Lawrence was eye and its diseases. These lectures rence’s lectures eventually ap- obliged by the court to buy and de- were given in 1824 and 1825 at the peared in The Lancet, one lecture at stroy all the remaining copies. London Infirmary for Diseases of the a time, in volume 9 (1825) and vol- As can well be imagined, the book Eye at Moorfields. He gave 3 lec- ume 10 (1826). became notorious, and in the ab- tures a week in this series (starting An enterprising French physi- sence of a copyright, the book was at 7 PM, after dinner, every Tues- cian named Charles Billard trans- reprinted several times and widely day, Thursday, and Saturday). Sir lated these published lectures into circulated by others. There is evi- James Paget attended Lawrence’s lec- French, and they were republished dence that both Charles Darwin and tures and described Lawrence’s style: in Paris, France, by J.B. Ballière in 1830.9 In Billard’s book there is a Alfred Russell Wallace had copies of He used to come to the hospital in the 7 Lawrence’s book. omnibus, and, after a few minutes in the translation of Lawrence’s 1827 let- With this skirmish, Lawrence had Museum, would, as the clock struck, en- ter that gave his express permis- made a small mark in the early be- ter the theater, then always full. He came sion to Billard to publish this French ginnings of the idea of human evo- with a strange vague outlook as if with version of his lectures. Lawrence fin- lution; he argued that diversity in uncertain sight; the expression of his eyes ished his other project, on syphilis 10 any breed could easily result from was always inferior to that of his other and the eye, and then went back inheritance (just look at the varia- features. These were impressive, beau- to work on his big textbook on eye tions that occur in a single litter of tiful, grand – and significant of vast men- diseases. He reorganized some of the tal power, well trained and well sus- dogs or cats) and that Jean-Baptiste lecture material and added approxi- tained. He came in quietly, and after mately 300 pages of text, and his Lamarck (1744-1829) had been sitting for about half a minute, as if gath- wrong in suggesting that acquired book was published in London in ering his thoughts, began, in a clear, 11 characteristics could be passed along rather high note, speaking quite delib- 1833. to the next generation. It seems likely erately in faultless words as if telling ju- that the fuss generated by this small diciously that which he was just now THE ENGLISH English controversy might have con- thinking. There was no hurry, no de- OPHTHALMOLOGY BOOKS tributed to the delay of publication lay, no repetition, no revision: every OF THE DAY of Darwin’s Origin of Species. word had been learned by heart, and yet Lawrence was sometimes a diffi- there was not the least sign that one word Lawrence’s 1833 text was one of a was being remembered.8 cult and cantankerous man, but he handful of books available to Eng- was also a brilliant lecturer who cul- Because the audience knew that lish students of ophthalmology from tivated his speaking skills and was the lectures would appear in The the 1830s and 1840s. The text- proud of his ability to deliver ideas Lancet, they did not have to scribble books of the day were substantial

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©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 Figure 5. William Mackenzie. Figure 6. William Lawrence at the age of 48 Figure 7. Richard Middlemore. years. works, often based on a series of lec- sachusetts Medical Society’s publica- tures that had been delivered with- learning ophthalmology from tion of Mackenzie’s text. He founded out the help of any models or dem- Mackenzie and others. a serial publication that he adver- onstrations. When the lectures were In 1830, Mackenzie’s lectures were tised as “a medical newspaper” and published as a book, the pages were published in London as a textbook named it The Register & Library of filled with small type and without called A Practical Treatise on Dis- Medical and Chirurgical Science. Gran- any illustrations of any kind. Law- eases of the Eye.12 Then, in 1833, just ville Sharp Pattison, a professor of rence’s text was one of only 4 ma- as Lawrence’s book was about to ap- anatomy at Jefferson Medical Col- jor English ophthalmology texts of pear in London, Mackenzie’s excel- lege, Philadelphia, Pennsylvania, was this period. These 4, in the order of lent text was reprinted in Boston by named as the editor. Thus, Law- their publication, were by William the Massachusetts Medical Society rence’s 1833 text became available to Mackenzie, William Lawrence, “strictly for the use of its fellows.”13 Americans in 1834 as a journal ar- Richard Middlemore, and Thomas It appeared in their journal (The Li- ticle of 582 pages, half in the May is- Wharton Jones. brary of Practical Medicine) as a sub- sue and the rest in the June issue of William Mackenzie (1791- stantial hardcover item of 719 pages. Green’s new medical newspaper.14 1868) (Figure 5) was born and The second edition of Mackenzie’s The stereotyped text is clear and leg- grew up in Glasgow, Scotland, and textbook appeared in London in ible, but it leaps from the May issue went on to study in Europe. He 1835. In both the third (1840) and to the June issue in midsentence. learned his ophthalmology from fourth (1854) editions, Mackenzie Green was no bookbinder; he seems Georg Joseph Beer in Vienna, Aus- was assisted by Wharton Jones. to have expected the new owner to ar- tria. This might have seemed odd to Lawrence’s lectures of 1823- range to have the 2 issues bound care- an Englishman at the time, but Beer 1824 were published in The Lancet in fully into a single volume at the own- had already published more new in- 1825-1826 (Figure 6). The French er’s expense. In their published state, formation on the eye and its dis- translation of the lectures was pub- both volumes are sewn with a tight eases than anyone in England. Fur- lished in 1830. Lawrence finished his gutter, and their disposable, blue pa- thermore, in Vienna, a Scotsman book on ocular syphilis in 183010 and per covers are printed and pasted in would just be another foreigner try- then undertook the big job of expand- place without care or grace. Later, in ing to learn some German, whereas ing his Lancet-published lectures into 1843, an American edition of Law- in London his Scots version of spo- a major text. This textbook of 800 rence’s text15 was published by Lea ken English would be constantly pages called A Treatise on the Dis- and Blanchard of Philadelphia. This ridiculed. In 1819, Mackenzie re- eases of the Eye did not appear until time, the text had been carefully and turned to Glasgow as an ophthal- 1833.11 As was common at the time, thoughtfully edited by Isaac Hays, a mic surgeon. In 1824, he and George there was not a single illustration of respected ophthalmologist at Wills Cunningham Monteath (also Vi- any kind in the entire work. Eye Hospital in Philadelphia. Hays enna trained) founded the Glasgow An edition of Lawrence’s text for added helpful parenthetical com- Eye Infirmary, and in 1828-1829, American readers was undertaken by ments and updates, and he gener- Mackenzie gave a popular series of Duff Green, a printer with a shop in ated 67 much-needed illustrations. lectures in Glasgow on the eye and Washington who usually printed fli- Hays was good at this sort of thing; its diseases, just as Lawrence had ers and pamphlets. In those days, it he was the editor of the American Jour- done in London 4 years earlier. The must have been complicated and nal of Medical Sciences for 52 years. young Wharton Jones had moved time-consuming to arrange transat- Richard Middlemore (Figure 7), from Edinburgh to Glasgow in 1829 lantic copyright agreements, so Green from Birmingham, England, also stud- and apparently took an interest in followed the path laid out by the Mas- ied medicine at Barts under Abernethy

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A B C D E F and Lawrence. When Middlemore Figure 9. The primary textbooks for English-speaking ophthalmologists from 1830 to 1850. A, First was fully qualified, he returned to Bir- American reprinting of Mackenzie’s text titled A Practical Treatise on the Diseases of the Eye.13 mingham and specialized in surgery B, Lawrence’s book titled Treatise on the Diseases of the Eye.20 C, First American reprinting of Lawrence’s of the eye. He was a quiet, shy, self- book in 1834.14 D, Later, in 1843, Isaac Hays edited this American edition of Lawrence’s text.15 E, Richard Middlemore’s 1835 2-volume textbook (total of 1644 pages). F, The 1855, second English edition of effacing man. He was, in his person- Wharton Jones’ text.21 ality, quite different from Lawrence, but he maintained a friendship with his teacher for many years. In 1831, had given an important series of lec- was directed into the eye with a mir- he won the Jacksonian prize for an es- tures on ophthalmology in 1828- ror, and the observer looked along say on diseases of the eye, which en- 1829. After 5 or 6 years in Glasgow the light beam into the patient’s eye couraged him to enlarge his essay into and 2 years in Ireland, Wharton by peering through a hole scratched a book. He put considerable time and Jones went to London to practice in the silvering on the back of the effort into the text. It was called Trea- ophthalmology. After some years he mirror. Wharton Jones told Bab- tise on the Diseases of the Eye and Its was adding to his income by giving bage that the device had no practi- Appendages,16 and it finally reached ophthalmology lectures to medical cal use, so Babbage cast it aside.19 1644 pages and appeared in 2 students, and in 1847, he turned his Wharton Jones did not realize that substantial volumes in 1835, again, lectures into a small textbook. Jones’ by holding up an appropriate lens he without a single figure or diagram. It manual18 was useful to the stu- might have brought the retina into was a daunting treatise, guaranteed to dents and went through several edi- sharp focus and become the inven- intimidate any reviewer. Julius tions. Wharton Jones had an unusu- tor of the ophthalmoscope. In 1855, Hirschberg said of Middlemore’s ally elevated notion of the formality Wharton Jones acknowledged his opus, “This is the most voluminous of the lecture setting, and he dressed mistake and came out with a sec- textbook of ophthalmology to ap- accordingly: he was a short man ond edition of his manual that in- pear in England during the first half with a tall silk hat and long, old- cluded a colored fundus drawing. of the 19th century. It deserves close fashioned dress coat that reached his This was the first fundus image to scrutiny.”17 ankles. He was not an inspiring appear in an English textbook. Thomas Wharton Jones (1808- speaker. He read his lectures, word 1891) (Figure 8) earned his medi- for word, in a heavy Scots accent CONCLUSION cal degree in Edinburgh, and he was without looking up at his audi- working in the late 1820s as an as- ence. The students called him Lawrence’s book, together with sistant to the anatomist Robert Knox mummy Jones, and they often stayed those of Mackenzie, Middlemore, at the time that they were receiving away so that they could read his text- and Wharton Jones, turned out to bodies for anatomical studies book without the distraction of the be the primary textbooks for a gen- through the murderous, body- Scots accent.19 In that same year eration of English-speaking oph- snatching efforts of Brendan Burke (1847), he famously missed an op- thalmologists in the last 2 decades and William Hare. This whole scan- portunity to discover the ophthal- of the first half of the 19th century dalous affair caused such a public moscope. Charles Babbage, the in- (1830-1850) (Figure 9). These sensation that, in 1829 after the trial, ventor of a mechanical computer books set the stage for the changes Wharton Jones moved to Glasgow that calculated logarithmic tables, coming at midcentury that would to get away from it all. showed Wharton Jones a rudimen- have even more profound effects Wharton Jones learned his oph- tary instrument of his own making on the practice of ophthalmology. thalmology in Glasgow, where he that produced a red glow in the pu- These changes were as follows. In was influenced by Mackenzie, who pil of any patient’s eye when a light 1848 and 1849, William Bowman

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©2012 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/26/2021 published his lectures on the in 2011 at the Cogan Ophthalmic maladies des yeux, ou, lec¸ons donne´es à anatomy of the eye. This new History Society. L’infirmerie Opthalmique De Londres en 1825 et 1826. In: L’Anatomie, La Physiologie et la Pa- knowledge gradually allowed eye thologie Des Yeux. Paris, France: JB Baillière; 1830. surgeons to risk new procedures. REFERENCES 10. Lawrence W. A Treatise on Venereal Diseases of In the 1850s, Professor Hermann the Eye. London, England: John Wilson; 1830. Helmholtz’s new ophthalmoscope 11. Lawrence W. A Treatise on the Diseases of the Eye. gradually became a standard office 1. Blumenbach JF. Handbuch Der Vergleichenden London, England: John Churchill; 1833. Anatomie [translated from the German by W. Law- 12. Mackenzie W. A Practical Treatise on Diseases of tool that was used every day. In rence as a Short System of Comparative Anatomy: the Eye. London, England: Longman Rees Orme 1864, Franciscus Cornelis Donders With Additional Notes and an Introductory View Brown & Green; 1830. demonstrated his crystal clear of the Classification of Animals]. London, 13. Mackenzie W. A Practical Treatise on the Dis- understanding of the optics of England: Longman Hurst Rees & Orme; 1807. eases of the Eye [American edition]. Boston, MA: http://babel.hathitrust.org/cgi/pt?id=nyp refraction in his book titled On the Carter Hendee & Co; 1833. .33433010834541. 14. Lawrence W. A Treatise on the Diseases of the Eye. 2. Lawrence W. A Treatise on Hernia: Being the Es- Anomalies of Accommodation and Washington, DC: Stereotyped by Duff Green, for 22 say, Which Gained the Prize Offered by the Royal Refraction of the Eye. These major the Register and Library of Medical and Surgical College of Surgeons in the Year 1806. London, changes in the practice of ophthal- Science. 1834;1(xxiv):1-304 and 1834;1(2):305- England: J Churchill; 1806. 582. mology (together with a decrease 3. Stinson DT. The Role of Sir William Lawrence in 15. Lawrence W. A Treatise on the Diseases of the Eye: in the cost of printing images) 19th Century English Surgery (Zu¨rcher Medi- From the Last London Edition With Numerous Ad- quickly made this older generation zingeschichtliche Abhandlungen, 67) . Zurich, Swit- ditions, and Sixty-Seven Illustrations by Isaac Hays zerland: Juris Druck und Verlag; 1969. of squat, figure-free textbooks MD. Philadelphia, PA: Lea & Blanchard; 1843. 4. Abernethy J. An Enquiry Into the Probability and seem old-fashioned and badly out 16. Middlemore R. Treatise on the Diseases of the Eye Rationality of Mr. Hunter’s Theory of Life: Being and Its Appendages. London, England: Long- of date. the Subject of the First Two Anatomical Lectures Delivered Before the Royal College of Surgeons, man Rees Orme Brown Green & Drake; 1835. Submitted for Publication: June 29, of London . London, England: Longman Hurst Rees 17. Hirschberg J. The History of Ophthalmology [translated into English by Frederick C. Blodi]. Vol 8b. 2011; final revision received Au- Orme and Brown; 1814. 5. Vitalism. In: Oxford English Dictionary. Oxford, En- Bonn, Germany: Wayenborgh; 1988:52. gust 24, 2011; accepted August 25, gland: Oxford University Press; 1928. 18. Jones TW. A Manual of the Principles and Prac- 2011. 6. Lawrence W. Lectures on Physiology, Zoology and tice of Ophthalmic Medicine and Surgery. Lon- Correspondence: H. Stanley the Natural History of Man, Delivered at the Royal don, England: John Churchill; 1847. Thompson, MD, Department of College of Surgeons in the Years 1816, 1817, and 19. Godlee RJ. Thomas Wharton Jones. Br J Ophthalmol. 1921;5(3):97-117, 145-156. Ophthalmology and Visual Sci- 1818, by W. Lawrence, F.R.S. London, England: J Callow; 1819. http://babel.hathitrust.org/cgi/pt 20. Lawrence W. Treatise on the Diseases of the Eye. ences, University of Iowa, 200 ?id=mdp.39015022433133. 3rd ed. London, England: Henry G Bonn; 1844. Hawkins Dr, Iowa City, IA 52242- 7. Wells KD. Sir William Lawrence (1783-1867): a 21. Jones TW. The Principles and Practice of Oph- 1091 ([email protected]). study of pre-Darwinian ideas on heredity and thalmic Medicine and Surgery. 2nd ed. London, Financial Disclosure: None re- variation. J Hist Biol. 1971;4:319-361. England: John Churchill; 1855. 8. Chance, Burton Sir William Lawrence in relation 22. Donders FC. On the Anomalies of Accommoda- ported. to medical education. Ann Med Hist. 1926;8: tion and Refraction of the Eye: With a Prelimi- Previous Presentation: An earlier 273. nary Essay on Physiological Dioptrics. London, version of this work was presented 9. Lawrence W, Billard CM. Traite´ pratique sur les England: The New Sydenham Society; 1864.

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