The Eye Department of Addenbrooke's Hospital Cambridge Early days
To appreciate just how much has changed in eye care during the past few decades it is interesting to review what has occurred within the eye department since its inception. These changes have been a response to the rapid advances in technology and the understanding of the underlying pathology of eye disease so that many diseases which were blinding fifty years ago are now either preventable or treatable. As a consequence even though there has been a large increase in staffing and the development of specialisation within ophthalomology the problem remains that there have always been, and still are, more patients with eye problems than there are qualified people to look after them.
Eye disease was part of the everyday business of all physicians until well into the eighteenth century. `There were few effective remedies, the eye drops and salves (ointments) were derived from plants and minerals. Many of these had remained unchanged since the Middle Ages. As late as 1959 the Moorfields Pharmacopoeia was a 5x3 inch booklet of only 20 pages. Only 10 of the preparations, listed with instructions for their manufacture in their various guises, are still in even occasional use today.
Surgically the situation was not much better. Cataract is still the major cause of blindness world-wide. From ancient times this was treated by pushing the swollen lens of the eye backwards into the vitreous cavity; a procedure known as couching. In Norfolk and Cambridgeshire one such 'coucher' was Chevalier Taylor who, from about 1734, periodically left his home in Norwich with a flamboyant entourage and progressed round the kingdom doing operations for cataract. However, he planned his tours carefully to be sure that he was well away from the district before the complications occurred!
From the middle ages onwards general surgeons would expect to include eye surgery in their armamentarium. This changed after the Napoleonic wars because specialist eye hospitals had to be established throughout Europe to manage the pandemic of trachoma which resulted from the return of soldiers who had contracted the "Egyptian Ophthalmia"; a combination of trachoma and gonorrhea.
No specialist eye unit was established in Cambridge during this period but the number of patients needing to be seen led to the appointment of Mr Wherry in 1879. Even so it was not until 1884 that an "eye room" was constructed (Installing electricity cost £19,1s extra). He continued with his general surgery as well and, during the First World War, became a surgeon at the Eastern General Hospital, which was established to treat the wounded in the site now occupied by the University Library.
By1911 he had been joined by Drs Graham and Davies. They were both general practitioners and were well remembered in the city until the 1960's. Mr. Graham lived in 22 Parkside and did his rounds in an immaculate carriage drawn by two horses with two footmen all of who wore green peacock feathers. (the coach house is still there) He was also reputed to have two of the most beautiful daughters in Cambridge!
In 1917 Mr Cooke was appointed when he left the army but it was not until 1932 that he managed to have an eye ward built. By doing so the infection rate was reduced from 9% to 2%, a very low figure at the time. This ward and operating theatre occupied the centre of the old Addenbrooke's house round which the hospital had been constructed.
Figure 1 The out patient department in Trumpington Street, in what is now Browns Restaurant
It was in use until the 1970's and could not be altered because any work on the walls would have meant the whole hospital would collapse inwards.
Figure 2 The eye ward 1965 This was situated in the original hospital Trumpington Street. No construction work was possible here as the whole hospital would have collapsed. The patient in the centre bed has both eyes covered; the head between sandbags. He had to remain like this until the eye had healed
The operating theatre measured only 14ft by 9ft and as there was no anaesthetic or recovery room, both activities were expected to take place in the adjacent ward or the corridor. Into the theatre had to be fitted an operating table, an anaesthetic machine, trolleys and numerous people. It was widely rumoured that if matron had to appoint a theatre nurse for the eye department she would have to be measured first to make sure she could be accommodated in the theatre! Added to this was the instruction that nursing staff could not wear nylon underwear because of the risk of explosion from anaesthetic gasses. It is a wonder anyone ever came near the Eye Department.
Mr Cooke died just after the ward opened (his commemorative wall plaque is still displayed in the department) He was succeeded by Mr Recordon and Mr Wright. During the Second World war Miss Perrers Taylor and Mr Glass-Watson held the fort. After Mr Recordon's death in 1957 Mr Wallace Foulds was appointed. He became Professor of Ophthalmology in Glasgow at the time when Mr Wright also became very ill. Their place was taken by Mr John Cairns and Mr Peter Watson shortly to be joined by Mr John Scott. These three enabled specialization to occur within the surgical team and with it came new techniques for the treatment of glaucoma and retinal detachment. This in turn needed new technology some of which was a problem. The precursor of the modern laser was the "light coagulator", a huge machine which used the same lamp as that found in lighthouses with a long snout which needed to have hole cut in the theatre door to allow it to be used. The first time it was turned on all the lights in Trumpington Street went out!
There was a temporary move to the current site of Addenbrooke's when the Queen opened phase1. After the ward had been refurbished and a new operating theatre commissioned the surgical ward returned to Trumpington St where it remained until the closure of the old hospital.
The changes in eye care since 1976 and the move to Hills Road have been immense in both what can be treated medically by treatments as out patients and in the success of surgical treatment. Before 1960 a cataract operation required 10 days in bed, not moving, with sandbags on both sides of the head to keep it still. Now the operation is a day case procedure with almost instantaneous recovery of excellent vision and a 98% success rate. Most glaucoma patients can be treated by medication or laser. If surgery is required the operation developed in Addenbrookes is the 1960's is still the most effective and still used world wide. Retinal detachment, which was again virtually untreatable at the end of the war, is now almost always successful with a good visual result. This change is, in no small way, due to advances made in this department. Blinding diseases such as macular degeneration, diabetic retinopathy, and uveitis and children's problems are now treatable. The list goes on and each of the now numerous teams within the department are all striving to eliminate the few remaining causes of blindness through their researches and improving equipment and care.