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1. The First Fifty Years Miss Barbara M. Lee, M.B.E., D.B.O.(T) Principal, School of Orthoptics, Moorfields Eye Hospital. Secretary-General, International Orthoptic Association. PREAMBLE I will discuss the origins of orthoptics in the United Kingdom and its development as a Profession Supplementary to Medicine with reference to the British Orthoptic Council, the British Orthoptic'b Society and the part played in the formation of the International Orthoptic Association. I will speak about Education, continuing Education, conditions of service and the development of practices 1929-1981. I wiil conclude with ideas we foresee in the future. I It was with the greatest pleasure that I received the most kind and generous invita- tion of the Japanese Orthoptic Society, and a great honour to be asked to speak about developments in Orthoptics in the United Kingdom. 1934 BRITISHORTHOPTIC COUNCIL (B.O.C.) of which we are aware of orthoptists working 1937 BRITISHORTHOPTIC SOCIETY (B.O.S.) alongside ophthalmologists before then. 1967 INTERNATIONALORTHOPTIC ASSOCIATION (I.O.A.) It is therefore fitting to look back to those early beginnings when in 1929 Mary Maddox It is fortuitous that this invitation coincides began her work at the Royal Westminster in the same year as a celebration at the High Ophthalmic Hospital in London. That Holborn branch of Moorfields Eye Hospital hospital is now the Holborn branch of to mark the 50th Anniversary of the opening Moorfields Eye Hospital where it is my of the first orthoptic clinic in the United privilege to work. Kingdom, which was possibly the first in the The History of the Royal Westminster world there being no other recorded evidence Ophthalmic Hospital is in itself an interesting 70 describe this part of London) within which was the leper hospital-supposedly on the site of the present hospital. Records tell us that in about AD 1225 a small blacksmith shop stood at the North West end of Drury Lane and that this existed until AD 1595. This no doubt was on the hospital's site. The Manor of St. Giles has prospered and declined throughout the ages. It received special favours from Pope Alexander IV which increased its prestige and naturally brought other endowments. The first decli- ne occurred during the reign of Henry VIII with his policy of the dissolution of the monastries coupled with the hospitals contro- lled by the power of the church. A different prosperity followed as the area now rich in game-particularly hare, fox and boar became the hunting ground of the the Holborn branch of Moorfields Eye Hospital nobility. This led to their building hunting lodges and houses in which to entertain guests; and cottages to house their servants and gamekeepers. Queen Elizabeth I, however decreed that this re-strained agriculture and engendered pestilence and as such must stop! There followed periods during which only the poorest inhabited the area-was the place where the great plague first occurred-and by the middle of the 19th Century had become and long one. To set the scene I make the place of shelter for thieves, cut-throats reference to this. and beggars living in indescribable squalor. Before AD 1066 at the time of the Norman Fortunes changed yet again with the build- Invasion this part of London was marshland ing of a new road to connect the old city to with few inhabitants and one small church. the East with the West (New Oxford Street) It was a wet and unhealthy place causing a so that slums were pulled down and it again great deal of sickness particularly leprosy. became fashionable for the upper middle In AD 1117 Queen Matilda, the consort of class to reside in the district and especially King Henry I much concerned by the pestilen- neighbouring Bloomsbury that attracted ce and suffering founded a hospital for 40 poets, painters and men of letters. lepers and their attendants. Thus began the The devastation caused by bombs damage Manor of St. Giles (a name still used to during the Second World War and the post 71 -war building programmes has removed yet A newspaper cutting from •gThe Morning more slum areas so that today the district Chronicle•h of December 7th 1816 bears may have a smaller residential population witness to this and can be seen in the than for hundreds of years but a great incre- Hospital Secretary's office at Hollborn, ase in business premises has brought increas- naming His Royal Highness the Duke of ed numbers to the district for their work and York KG as Patron, His Grace the Duke of increasing prosperity of a different kind. Wellington, KG, as President and other nobles and gentlemen including Guthrie as II the only surgeon. The first hospital in London specially The hospital was first in Piccadilly; but devoted to diseases of the eye, the forerunner because of cramped conidtions and increased to Moorfield was the London Infirmary for extension of work had three homes before curing diseases of the eye-opened in 1805. coming to Holborn where an 8 storey-100 In 1816 an Army surgeon, George James bedded-hospital was built at the cost of a Guthrie who had served with the Duke of mere •’150,000 and opened for use in 1928. Wellington in the Peninsular War in Portugal succeeded in influencing that great man of the need for an eye hospital in the Western section of the City of London. Until the hospital could be built Guthrie would see patients on three mornings a week at his private home in Berkeley Square. Of particular interest to this audience was the reference to a •gSquint Department where ocular exercises are undertaken for cases of squint both before and after operation.•h The interest to orthoptists that we have in Guthrie is mainly with his son who succeeded him. Guthrie Senior was born in London in 1785 of Scottish parents, his grandfather also being a doctor of repute. As was the custom in those days he was apprenticed to a surgeon from the age of 13 years, and three years later (aged 16) posted to a regiment in North America where he saw service as Inspector-General of Army Hospitals in France, Holland, Portugal and Spain returning home in 1814. Two years George James Guthrie later he had founded the Royal Westminster 72 Ophthalmic Hospital. made; but it was Guthrie- a fashionable A colleague at RWOH, Sir Charles Forbes, surgeon who performed a prodigious number also a military gentleman of repute had of tenotomies all without anaesthetic in 10 served in Egypt, the West Indies as well as months April 1880-February 1881 a total of many European countries thus proving bet- 567. ween them that it was just as easy to see the His paper presented to the Governors of world at your Government's expense in the RWOH states that •gIn no instance under my 19th Century as it is today. care has the sight of the eye operated on been These 2 surgeons had a dispute causing the lost or impaired•h (quote) resignation of Sir Charles. The trouble seems to us now to be childish that of one member of staff altering the treatment of the other during a colleague's absence. Unlike today a dual was fought. The principals being poor marksmen exchanged shots not once but three times without effect-where- 8 cases diverged post-operatively, of which upon the seconds left and would not permit 4 had •gthe opposing rectus divided with the dual to continue. Had shots continued success.•h Post-operative care consisted of a they would no doubt have been liable to a pad and bandage and bathing with cold criminal charge. water. Guthrie senior wrote a paper on cataract in Javal in France (1839-1907) would dispute 1834 and mentions that Von Graefe of Berlin, these successes referring as he did to the Germany, had been asked to demonstrate his tenotomy as •gmassacre of the internal new knife when invited to operate at RWOH. rectus.•h He spoke with feeling his own Guthrie remarked afterwards that •gI was sister being a victim of this form of treatme- satisfied that he knew as much as I did about nt. it, and I was infinitely more gratified to III perceive that he did not know more•h (quote). This therefore was the background to be Guthrie also wrote a book of lectures on •g faced by those studying orthoptics. Operative Surgery•h (1819). In this there is That of the routine of ordering glasses to no mention of operations for squint. However, the son Charles William Gardin- er Guthrie (1816-1859) who succeeded his father at RWOH in 1838 wrote a paper (1841) just 100 years ago entitled •gThe Cure of Squinting.•h Dieffenbach of Berlin, Germany seems to have been the first to perform a tenotomy for squint. An enthusiatic medical student (A Mr. Pyper) went to Berlin to study Diffenba- ch's methods and having assisted with several operations brought back an account of the method used and had a set of instruments Louis Emile Javal (1839-1907) 73 be worn and hoping for the best. The •g best•h if it occurred pin-pointed whatwe now know as Accommodative Squint of one sort or another. Cases in which this magical solution was not achieved had operation. After that the eyes were said to be generally straight and classed as •gcured•h. That there was defective vision was frequently ignored. And then.... a quiet, sensitive and dedicat- ed ophthalmologist practising in the South coast seaside resort of Bournemouth in the 1920s came to the fore.

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