History of Dermatology

Br.J. Derm. (1970)83. 690.

Department of Dermatology, Royal Victoria Hospital, Belfast

HISTORY OF DERMATOLOGY TN NORTHERN IRELAND

REGINALD HALL

IN *' Tbe Book of Belfast " compiled by Dr Robert Marshall for tbe 105tbAnnual Meeting of tbe Bi-itiHb Medieal Association in 19:t7 tbe following referenceis inude to early medi(-al care in tbe city:—

" Mention of tbe boaliug art is first found in tbe annals of Belfast of tbe seven-teentb century. In U)51 a permit was issued to ('romweH's Commissioners toengage a doctor and au ajrotbeoary should there be want of sueh ' only liuiitingyou in this, that you exceed not £100 yearly to tbe doctor nor £'60 yearly to yourapothecary.' We read that in 1689 those stricken with 'the mortality * in tbeEnglish cam}) before Drogheda were sent to tbe (ireat Hospital in Belfast, wbcreover tbrec tbousand died; tbis was. however, a military tiase lios|)it;il. establishedby Scbombcrg. and not a permanent institution.

'• Tbe first organized medical relief in Belfast was given by tbe Belfast CliaritableSociety in 1774 to persons attcn<liTig at the Old Pnorhouse. This Soeiety is stillin existence and maintains an admirable bome for tho aged and infirm. '

Dermatology in Belfast has reason to he grateful to this Society for a grant ofland on 2 occasioiis for the building of skin bospitals.

It was not until 1792 that tbe movement began wlucb soon led to tbe establisb-ment of tbe first general bospital in Belfast. Today tbis bas become tbe vast-hospital eom])Iex known as tbe Royal Victoria Hosi)ital. Three otber generalhospitals were established later; the Belfast City Hosjiital in 1S40. tho ITlsterHos])ital in IS72. and the Mater Infirmoruin Hospital in lS.S:i.

The Medical School Iiegan in 1S|S as a s])eeial Dc))aitnient of Medicine in theeducational foundation known a« the Royal Belfast Ac-adcmical Institution, andtbe associated eiinical instruction was given in tbe General Hospital. It willinterest dermatologists to know tbat tbe first Professor of Medi<'ine was Dr HenryMac(\)rnm(-k. a man of great erudition wbo was conversant witb 20 languages,and \\bose son. William, went to London, whej-e he became Sir William Mac-Corniiick, Bart.. President of tbe Ko\al College of Sui-geons. Henry MaeCormack,formerly dermatologist to tbe Middlesex Hospital, was Sir William's nephew.

In 1849 tbe Departuient of Medicine beeame tbe Faculty of Medicine, when itwas transferred to tbo newly-established Queen's College (later tbe Queen'sUniversity). Belfast.

Until tbese arrangements for medical education were made in Belfast about300 medical students went from Ulster annually to otber colleges, cbiefiy inDublin and Edinburgb ; and it was boped tbat many of tbese would take advantageof tbe opportunity ftir home education, because, as an Irisb student in Edinburgb

Accepted for publication August 20th, 1970.

HISTORY OF DERMATOLOGY IN NORTHERN IRELAND 691

wrote: " To be a student of medicine here is a term of contempt; but to be anIrisb student of medicine is tbe very highest eomplieation of disgraee ". Never-theless many medical students continued to obtain their education outside Ulster.

Tbere is no record of any special provision for tbe treatment of skin diseases inBelfast prior to 1865, although at this time a skin elinic was eondueted ia tbeAdelaide Hospital in Dublin by Dr Walter G. Smitli.

Henry Samuel Purdon (1843-1906)

H. S. Purdon was tbe jiioneer of dermatology in Nortbcrn Ireland. He was tbeeldest of tbe 17 cbildren of Dr Samuel Delacherois Purdon. His grandfatlier. DrHenry Purdon (1770-1840), held the impressive title of Staff Surgeon of Ulsterand was tbe first of many medical Piirdous. Like the other medical members ofbis family, including his fatber, H. S. Purdon, born on December 21st, 1843,received bis medical education in Scotland, where he graduated M.D. (Glasgow)and L.R.C.P. (Edinburgb). To tliese qualifieations be added tbe L.R.C.S. andL.M. (Dublin).

During bis medical training in tJlas-gow, Piu'don bad clearly been muchinfluenced and impressed by tbe derma-tological teaching of McCall Andersonso that, wben be retm-ned to Belfast,he quickly realized the need for adermatologieal service and de<;ided tospecialize in skin diseases.

On June 13th, 1865, when still only20 years of age, Purdon arranged apublic meeting at 12 Wellington Place,Belfast, with tbe object of gatberingsupport " to e,stablish a dispensary forthe gratuitous treatment of the poorsuffering from tbe various kinds ofdiseases of the skin ". Tbe meetinggave general approval to tbe idea; acommittee under tbo ebairmanshi]) ofElias H. Thompson was set up. audsuitable premises were sougbt. Even-tually a building in Academy Street,Belfast, was rented, and it was decidedto call tbe new institution '' Tbe BelfastDispensary for Diseases of the Skin

Fm. 1.—Henry Hanmol Purdon, 1S4S I'.

Purdon was appointed jjbysician-in-cbarge, witb bis uncle, Dr Thomas Henry Purdon, as consulting physician.Clinieal work began in the autumn of 186!) and soon tbe servit e was being veryfully used. Understandably tbe project had some early financial difficulties, andtbe records sbow tbat Purdon encouraged his many sisters to give some of theirpocket money to help with the expenses. He also used tbeir aitistic talents in tbeconstruction of wax models of some skin diseases, and particularly of tbe veryprevalent lupus vulgaris.

In 1866, with tbe attendances steadily increasing, the name was changed to

692 REGINALD HALL

" The Belfast Hospital for Diseases of tbe Skin ". By 1868 tbe number ofpatients bad outgrown tbe accommodation available, and tbe committee con-sidered nuning to a large building in (Jreat Patrick Street. Pm-don was autborizedto complete tbe negotiations; but, because he was not wboUy satisfied witb thesuitability of tbe premises, the projeet was abandoned. The eonmiittee, stillfaced witb growing numbers of patients and with no suitable building to move to,decided to apply to the lielfast Charitablo Society ior a i)lot of ground in theClifton Street area, on which anew hosijital could be built. The Society gi'ant<>dland in adjacent Regent Street, and it is interesting to note from tbe plans thatwhat is now a deiLsely btiilt-up area was tben an open field. The new bospitalwas opened by tbe President, Elias H. Tbompson, on October 28tb, 1869, 4 yearsafter the founding ofthe original liospital.

Tbe new building provided mainly out-patient faeilities but also bad 8 beds.The out-patient department and operating tbeatre were at tbat time consideredadequate, commodious and up-to-date. Before leaviiig Aeademy Street about1000 patients a year were being treated, and tbis number steadily increa-sed witbtbe opening of the new bospital. As its reputation spread, patients eame notonly from Belfast but also from tbe surroimding counties. This success was clearlydue to tbe energy and entbusiasm of Purdon, wbo, besides bis cilinical work in tbebospital, also carried out 2 weekly sessions of midergraduate teaching as tbefollowing notice sbows:—

' 1870 c-

TATOLOOy

Air

At tbe same time as he was trying to obtain a ]jroper place for tbe ciire of hispatients, Purdon was avidly consuming the literature, and by his writings andconta,cts became widely known in developing dermatological circles in tbe UnitedKingdom, in Europe and in the United States; and be was a corresponding memberof tbe New York Dermatological Society.

HISTORY OF DERMATOLOGY IN NORTHERN IRELAND 693

In 1866 the Jmtmal of Cutaneous Medicine \ 'as establislied under the editorshipof Sir Erasmus Wilson, F.R.S., who became Professor of Dermatology at theRoyal (.'ollege of Sm-geoiis of England. In 1870, when pressure of work causedWilson to relinquish his i)ost aa editor, the position was offered to Purdon. It isclear from Purdon's preface to the fourth volume (June 1870) that he was muchpleased to be asked, at 2G years of age, to follow such an illustrious predecessor;and he did his best to encourage contributors. He succeeded at first in gotthigarticles from the United States, and from European and United Kijigdom centres;but by 1871 the support became inadequate and the joui'iial ceased publication.It was not until 1888 that the British Journal of Dermatology took its place.

Meanwhile Pui'don and his hospital committee were very disturbed to find that,within a relatively short time of the opening of the new hospital in Regent Street,where the beds had been increased to 14, the out-patient and in-patient needs hadbecome too great for the available space. The hospital's limitations becamewidely laiown; and, in 1873, a public benefactor, Edward H. Beim, informedPurdon that he was prepared to finance the erection of a thoroughly up-to-dateskin 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 approachwas again made to the Belfast Charitable Society for a site for tlie new hospital.

— THE -

GLENRAVEL STREET, BELFAST.

ESTABLISHED A 0. ISSS.

Hew Hospital and BaUis btilll by Edward Benii, Esq., ISTG,

Kadlutl Tnatmiint kad Rcll«f of the Poor aSlteted «IC1> Chronio CutaneousDiMAtei. including Ihoae produced by Cnnccr. Sorofala. Lnpui, or atbernlnefBlive niKlady or the Skin, or from Varleaae Veins. Private patlenti

pajment.

FlO. 2.

694 REGINALD HALL

This WU8 forthcoming a few hundred yards away in nearby Glenravel Street; andin 1875. the new building was completed. Mr Benn. who also financed thebuilding of an Eye. Kar, Nose and Throat Hospital, and the Samaritan Hospital forDiseases of Women, unfortunately diodsliortly beforethonewhosjiitul wasopened.

The licnii Skin Hn.spital cost £3.3110. It was a substantial and commodious3-stitrcy building (Kig. 2). On the grinitid floor wore the administrative depart-mcntH. (--Dnsistiiig uf hoard room, drug room, patliological laboratory, operatingroom, elei-tric- room, and kitchens: and at the rear were the wash-house andhiundry. On the first floor there were bathrooms, male public wards, and '1 maleprivate wards. On the .sciond Hoor were the corresponding wards for women andchildren.

The hosjiital was then regarded as the most complete of its kind in tho UnitedKingdom, furnished with the best a])pliances and having in all 30 beds and "asuite of baths of every description ".

ProfesMor J. F. Hodges. M.U.. F.K.C.S., Professor of Mctlical Junsprudciife. waaelected jtresident of thf new hospital imd iserv ed in tliis cajjacity for over 20 yeara.On his retii-ement he was succeeded by Purdon. who retained the office until hisdeath iu 1 iMMi at the age of (i2. The hospital was fortunute in having an energeticcommittee which kept it up-to-date. Some of these m(Mnliers gave long service tothe successive hosj^itals. notably Elias H. Thomi)son. the first president, and JohnBell, the secretary for 21 yeai-s. It is likely that it was in apj)rei'iation of these'2 friends, Purdon's son, born on June (ith. 1870, was named Elias Bell Purdon.

In !8»3 Purdon was joined on tho hospital staff by Samuel W. Allworthy andby his own son, Flias Bell Purdon. li(»th continued the work begun by thefounder until the hospital was severely damaged iu an enemy air-raid in 1941,when it had to close down. In this air attack on the hospital JJr Allworthynarrowly escaped being killed.

Samuel William AlhmHhy (1866-1952)

S. W. Allworthy entered Trinity College, Dublin, at the age of 15 years and hada distinguished undergraduate career. Among other awards he obtained the

Ekenhead Scholarshijt in Experimental Scienceand graduated B.A. (IHHli). M.B.. B.Ch. (1888) andM.l). (|H!Hi), Following u period of general prac-tice in Dar-lington he returned to his native Belfastand combined his general practice with specialistwork in dermatology. He was also consulting])hysii'ian to the Kityal Victoria Hosjiitai and tothe licHaHt Charitable Institute. He publishednutui'rous papers in the British Journal of Derma-tology, and in the British Medical Journal. Heworked for a time in tho Finsen Institute in Copen-hagen and was a pioneer in radiotherapy inBclCasl. Mke many early radiologists wiio omit-ted to avoid over-exposure, his hands in lateryears were disfigured with X-ray burns, and 3

FIO. 3.-Sanmc.i w.iham Atlworthy. ^^^^''^^l. '"' 'J *" ^^ a«nputated. He served in theI8titi-I952. fii'st Wtirld War as a skin specialist.

HISTORY OF DERMATOLOGY IN NORTHERN IRELAND 695

Allworthy was a man of great energy and many interests. He pursued hisfamily's interest in local goveniment and became an alderman. His many andvaried distinctions hicludcd: Fellow of the Jeiiner Institute; Fellow of the ChemicalSociety; Member of the Lister Institute of Preventive Medicine; Member of theRoyal Irish Academy; President of the Jielfast Natural History and PhilosophicalSociety; President of the Ulster Photographic Society. Member of the Senate ofQueen's IJnivprsity. Belfast, and of Trinity (College, Dublin; Chairman of theBelfast Water Commissioners.

He was vice-president of tlie Section of Dermatology when, as has been men-tioned earlier, the 15.M.A. met iu Belfast in 1037.

He di<'d on September 18th, I!)52. aged 86.

Elias Bell Purdon (1870-1947)E. B. Purdon was the fourth generation of his

family to practise medicine and the last Purdonto attend as physician to the Belfast CharitableSociety. At tlie time of his death the family hadgiven unbroken service to the Society for 143yeai-s.

E. B. Purdon was educated at Methodist College,Belfast, Morrison's Academy, Oielf, Queen'sUniversity, Belfast, and at Kdinburgli University.He graduated M.B., C.M.(Ed.) IH93, and L.R.C.P.& S.(Ed.) and L.F.P.S.(Glasgow).

On his return to Belfast he began the practiceof dermat(tlogy with his father and w itii Allworthy.

Aj)art from (lcrmatolt)gy his groat intei'cst waamusic. Ho was a liienibcr of the PhilharmonicSociety and waa one of its cellists for many years.He was unmarried. His cousin. Major-GeneralWilliam Brookc-Purdon, was for a time UlsterAgent in London.

Fio. 4.- -Eliu-s Bell l'unloii,I87t>-1&47.

William Calwe.ll (1859-1943)Apart from the Benn Skin Hosjiital there wsa

established, at the turn of the century, a clinicfor skin diseases in the Koyal Victoria Hos])italin the charge of Dr William C'alwell. an assistantphysician to tlie hospital. The hos]>ital ro{iordHlist him as " Attending Physician for the Derma-tologicai Department ".

Calwell wjvs the fii-st (ihysician at the RoyalVictoria Hospital to bear the title of dermatolo-gist. He wiis born in Belfast and educatedat the Royal Belfast Acadoinical Institution,Queen's University, and in Dublin and London.Hegraduatcd M.A., M.I)., M.Ch.. Queen's Univer-sity, and L.M. (R.C.P.I.). He was the firstregistrar in the Royal Victoria Hospital; he was . 1H.VJ 11143.

696 REGINALD HALL

appointed to this post in 1893. Two years later he became assistant physician;and sliortly afterwards he established the clinic for skin diseases. The hospitalrecords show that this clinic was held regularly until his retirement from thestaff 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 iuBelfast. He was educated at the Royal Belfast Academical Institution and wasa medical student at Queen's Univei-sity at the begimiing of the First World War.He volunteered for service and was commissioned in the Royal Irish Riiies. Hewas severely wounded in the right shoulder at tho battle of Messines in 1917.When he recovered and was invalided home, lie resumed liis medical course,graduating with honours in 1922, The war injury left him with a partial paralysisof tlio ! iL it arm and hand, making it imjiossible for him to follow tho surgical

career which he !iad planuod. Hej^ttttU^^^^ soon began training iis a dermatolo-

-^f^ ^ ^ ^ ^ ! ^ ^ ^ ^ ''*'' ' ""*^ worked midor H. W. Bar-

/

^^l^^^k^ ber at CJuy's Hospital, and later in

^ ^ ^ ^ ^ Vienna. Wlien he returned to Belfast^ Bfj L he took cliarge of the Skin Clinic in

^ ^ k the Royal Victoria Hospital Group,^ ^ ^ ^ ^ B vacated by William Calwell, and^^gk . d^H steadily and for many yeai-s single-

handed, c.\i)amled tho service consid-erably. His full clini( al conimit-ments left him little time for writhigand rosoarch, but he amassed a vastclinical experience. He was a giftedteacher and an excellent speaker.He regularly attended the meetingsof the British Association of Derma-tology and, in 1948, was electedpresident. Despite his physical dis-ability he was a keen golfer; and,wit h Dr Geoffrej' Dowling, jointlypi-esented tlie cup which bears theirnames and which is competed for ateach annual meeting of the Associ-ation.

McCaw made a notable contri-bution to dermatology in NortlierjiIreland and, under his direction, the

foundations of the present extensive service were securely laid.Folio whig the destruction of the Bonn Skin Hospital in 1941, it was decided not

to rebuild it but to use the funds for the improvomont of the amenities in McCaw'sdepartment in the Royal Victoria Hospital. Purdon's name was peiiietuated bynamhig the in-patient unit " The Purdon Skin Ward ". A memorial plaque isdisplayed at the entrance to the ward.

Fm. 6. Ivan Hcin\ 1897-1901

HISTORY OF DERMATOLOGY IN NORTHERN IRELAND 607

THE PURDON SKIN WARD :1957

rms WARD IS NAMED TO COMMEMORATE HEMRY S PURDON, M.DI H t PIONEER OF DERMATOLOGY IN BEIFAST. WHO IN 186^OPENED A SMALL DISPENSARY IN ACADEMY STREbT FORTRIAf lNG SKIN DISEASES THROUGH THE GENEROSITY OfID^ARD BENN. ESQ., THE BHNN SKIN HOSPITAL WAS BUILT INGlENRAVEL STREET AND OPENED IN 1875. DR PURDON WASDFRMATOLOGIST THERE UNTIL l9Ob. AND WAS SUCCEEDEDBY HIS SON ELIAS B. PURDON, M D &' BY S W ALi MfORTHY, M DTHE BENN SKIN HOSPITAL WAS DESTROYED DURING A (iFRMANAIR RAID IN 1941 AND ITS ASSETS WTRE GIVEN TO M i l

ROYAL VICTORIA HOSPITAL

FIG, 7,-—Coinmeniuration Plaque, Royal Victoria Hospital, Belfast

Jonathan Jefferson (1921-1968)Jefferson was educated at Portora

Royal School and Queen's University,where he graduated in 1043 and waslater awarded the M.D. with commen-dation. After a period of training indermatology in London he began towork with McCaw in 1947 and lielpedconsiderably in the expansion of thespecialty in Northern Ireland. Hemade many useful contributions tovarious journals.

His main interest was in industrialdermatoses in wliich he had a very ex-tensive practice. He was much interested in teaching; and, until his firstillness in 1966, w'as a post-graduateclinical tutor. His early death at 47years of age was a great loss to derma-tology in this area.

Northern Ireland, with its popula-tion of 11 million, now has a derma-tological service in 20 hospitals staffedby 8 consultants, 2 senior registrars,and a number of more junior staff,who, between them, deal with approximately 40,000 cases per annum.

8.-—Jonathan Jeti'erBoii,

52