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
105 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.
th
“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 physicianin-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 BrookePurdon, 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.