A patient remembers Sir Stewart Duke-Elder

SURVEY OF OPHTHALMOLOGY

VOLUME 31 . NUMBER 4. JANUARY-FEBRUARY

REMEMBRANCES BARRIE

1987

OF THINGS

PAST

JAY, EDITOR

A Patient Remembers Sir Stewart Duke-Elder KATHALEEN

S. SMITHFORD

Abstract. The author shares a personal glimpse of Sir Stewart’s wit, candor, observed during her more than 15-year relationship with him as a glaucoma Ophthalmol 31:267-269, 1987)

Key words.

Iluke-Elder,

and gallantry, (Surv

patient.

Sir Stewart

my teen years, to remarry and settle, I believed for good. I was 41, resumed my annual eye check-ups, but because no problems were encountered, I failed to report the Makapansgat Caves experience. Four years later, one June day in 1956, I struck a match for an after-lunch smoke and chat with my mother who was visiting us for a couple of weeks. ,4 spark flew into my left eye and burned it. Yet, only upon my mother’s insistent urging did I phone my eye doctor. He was on holiday at the Cape, but the nurse advised me to hurry in and she would fit me into his partner’s afternoon appointments. Dr. Peter Pittman examined me carefully with, to me, unusual apparatus. “No burn problems,” he finally reported, “but I am sorry to have to tell you that you are suffering from glaucoma.” Six months of, firstly, eserine drops followed b) pilocarpine six times daily failed to reduce the pressure readings of 30 in the right eye and 35 in the left. Dr. Pittman was worried, and admitting that South African ophthalmology had not reached the point where it could cope with my glaucoma, advised me to consult “the greatest eye man in the world, the father of modern ophthalmology. Sir Stewart DukeElder, in London” (Fig. 1) My husband, Al, pushed the button at 63 Harley Street to keep a 10 a.m.consultation with Sir Stew-

One late afternoon in February 1952, Professor Raymond A. Dart* and I emerged from the gloom of the hlakapansgat Caves in northeastern Transvaal. I paused uncertainly on the high bank fronting the historical caves preparatory to climbing down, an easy descent, to where Marjorie Dart, the professor’s wife, and their 1 l-year-old son, Galen, awaited us. The bush below looked most peculiar, and I shrank, actually frightened, from climbing down. I’ve ne\‘er suffered from vertigo, but .. “Come down on your bottom,” Marjorie called up, and I did so to find that the ‘bewitched’ bush had changed back to normal as I gazed about me, puzzled. “It could be your eyes,” Professor Dart commented. “Mention it to your ophthalmologist at your next checkup.” But I forgot. Instead of resettling in New York City when I returned from a promotional trip for ‘Ijungle Pathfinder” (Hutchinson, London), I hastily packed up and returned to Rhodesia, the land of *.hnatomist and anthropologist who, in 1925, discovered and &ISsified the Taun,g Skull. ,4ustrafoj~ithecus ajiunus (Bechuanaland, now Botswana). He established thr medical school at the University uf Witw;itrrsrand, Johannesburg. He is still living, and celebrated his 94th birrhd.iy, Frb. 4th. 1987 midst great celebrations in South Africa and Australia, his motherland. Despite recent blindness from degcneratioll of rhr retinas, hc is working on brain research, for 6 months of thr y-rar. in Chestnut Hill, Pa. 267

268

Surv Ophthalmol

3 l(4) January-February

art, which Dr. Pittman had arranged by letter. I remember thinking, “The Queen comes here for her eye tests, but then the door would be open with Sir Stewart on the steps to greet her.” I had learned that after saving Ramsay MacDonald’s eyesight in the 193Os, Sir Stewart had received his title and had been the reigning monarch’s ophthalmologist ever since. The door was opened by a young woman, a secretary who, after ushering my husband into a bright (daylit) waiting room, proceeded to interview me. That over, she pushed a bell, rose, knocked on an adjacent closed door, opened it and waved me through. I was first struck by the dim indirect electric lighting of a long beige-and-brown consulting room. Behind a great mahogany desk a trim, bespectacled, clean-shaven man of apparent middle age rose, came around the desk to greet me and said, “And how is Federation working in the Rhodesias and Nyasaland?“* Thus, on Monday, April 1st. 1957, the consultation began. Finally, Sir Stewart led me into a surprisingly small examination room and proceeded with his routine. At one point I said, “Sir Stewart, my husband and I plan on going to Rome on Friday next-our first trip there. ” “Ah, Rome!” he said, and calculated. “That’s the 5th - five days from now.” He smiled unexpectedly. “I shall keep you very busy meanwhile!” After instructing me to stop my drops completely until he saw me again, Sir Stewart turned me back to his secretary who gave me the addresses of two ophthalmologists I was to visit on Tuesday and Thursday. The first ophthalmologist was a woman who measured my fields and made other tests. On Thursday our taxi deposited Al and me before an aged building called the Glaucoma Clinic. Within, a fair-haired young eye doctor put me through several tests, including the tonometer held on each eye for four measured minutes. When he helped me up from the examination table the ophthalmologist said, “You have had glaucoma for some years.” Only then did I recall, but found it pointless to mention, the Makapansgat Caves experience. “Sir Stewart is here,” he went on, “and after I’ve had a talk with him, he wants to see you.” Perhaps 30 minutes later, the young doctor led me to a plainly appointed office and withdrew. Sir Stewart stood in the middle of the room, expression noncommittal, an eye dropper in hand. He approached me with his quick step, saying as he delivered the drops into my eyes, “My dear, you are not going to Rome tomorrow! Your pressure is 45 in the right eye and 48 in

*Federation, during 1953.

under Sir Roy Welensky

(19561963),

SMITHFORD

1987

was voted in

Fig. 1.

Bust of Sir Stewart Duke-Elder

the left. You could suffer an acute attack aboard the Blue Train, and if an eye doctor was not at hand, you could lose your sight.” I suppose I just gaped. He smiled. “So, into the London Clinic you go on Sunday night! First operation - on the left eye on Monday afternoon.” On Sunday evening, on going to bed in a cheerful room, Mr. Allen Goldsmith (later Sir Allen) visied me, advising that he was to undertake the surgery, with Sir Stewart “standing by.” Sir Stewart came forward as I was wheeled into the operating theatre, bent over my tense person saying kindly, “I am here to hold your hand !” And he did throughout the 30 minutes’ operation on the left eye. At one point I spoke, “Will I be able to roll my eyes again?” “Indeed, yes!” Sir Stewart, seated at my left side and holding my hand, replied. “At your husband - and at Mr. Goldsmith!” Back in my room, I was arranged in a semi-seated position, which was maintained for two weeks, and left to sleep. But after nightfall on the day of my operation, the eye suffered excruciating pain. It was unusual, and the London Clinic telephoned Sir

A PATIENT

REMEMBERS

SIR STEWART

2ti9

DUKE-ELDER

Stewart for instructions. He chose to come straight to my bedside, dressed in black tie and a handsome overcoat. He ordered an injection of morphine which, almost immediately, alleviated the pain. After a week he took out a stitch and, one midday said, “It’s Easter this weekend. You may return to your hotel for a week, and then come back to us to operate on the right eye. Or, if you prefer, stay on and we’ll operate on Monday.” I decided on the latter course. The second operation, performed on the Monday, took only 27 minutes. At one point I said, “Don’t cut too much of the blue away.” Sir Stewart replied with gallantry, “Oh, dear no! It’s far too beautiful!” A moment later, I felt him stiffen. “No, no!” he said to Mr. Goldsmith, “not so much!” A fortnight passed as previously, during which time I heard for the first time and became a fan of Alistair Cooke with his “Letter from America.” I was discharged on a Monday from the London Clinic, and returned to the Cumberland Hotel, where my husband and my mother had waited for me. Almost immediately I felt discomfort in the right eye. It was difficult to open, and when I did, vision became increasingly blurred. I’ll never know why we waited four days to report it; probably optimism that “next morning” all would be well. When Sir Stewart had spoken to me the day before leaving, he had advised with a twinkle in his eye, “Now, have a couple of Martinis tomorrow night and go to a show!” We did exactly that, but on the Tuesday, the second day out of hospital, the condition of the right eye worsened. I saw Sir Stewart at his consulting rooms in Harley Street. He blanched when he examined the eye, disinfected it and said, “Back you go to the Clinic- at once! I’ll see you tonight.” At my bedside in my new room Sir Stewart said, “We cut a bit too much in the bleb. It is emitting more fluid than it should, and retarding healing. But we shall administer Diamox which should dry.it up enough to hasten healing.” He turned and to my great surprise, bent down and knocked on wood (the leg of a small table), saying, “All should be well within five days.” And it was. I rejoined my husband and mother, and life carried on. But in July 1959, the bleb ofwhat now felt like my weak eye, burst. It spontaneously healed itself, but vision was always somewhat blurred in that eye, and I never felt really confident of it. In 1970, back in Salisbury, Rhodesia, Dr. Pittman advised, “There is a sign of what might turn out to be cataracts in both eyes. On the other hand,

they may never develop beyond this point, so forget about it.” Two years later, I unexpectedly visited London, arriving on a Tuesday night in August (1972). On Wednesday morning I phoned Sir Stewart’s secrctary, saying I was in England for a week, and may I see Sir Stewart? Bidding me wait a moment, she returned to the phone advising me that Sir Stewart would

see me at 4 o’clock

When ing

room,

I entered

that

the familiar,

Sir Stewart

very

dav.

still so dim

hurried

around

his

consultdesk

to

changed but little and was kind enough to say the same of me. I told him about the burst bleb - when he actually flinched, face contorting for an instant - and of Dr. Pittman’s remarks about possible cataracts developing. After a most friendly chat, Sir Stewart led me into the small chin examination room. “Now put your beautiful there,” he said, gesturing to the chin rest, and got down to business. It was all most relaxed, and I cheered up immediately when he said, “I agree with Pittman! Nothing may come of this. bleanwhile. go out and enjoy life.” He put a hand on my right shoulder and looking me directly in the eye said, “Good girl!” My last contact with Sir Stewart Duke-Elder was in 1973. I had moved to Spain. and my new Spanish ophthalmologist gave me drops to arrest the cataracts. ‘Clarvison’ was the name. 1 took them for several months but my eyes always felt so wet that I wrote to Sir Stewart and enclosed the Clarvison formula, asking his opinion as to whether I should continue them. His reply was direct and typical of the man: “There are no drops ‘yet’ that can arrest cataracts.” greet

me.

He had

Editor’s Note The bust of Sir Stewart Duke-Elder shown in Fig. I, was presented by the Ophthalmological Society of the United Kingdom to the Institute of Ophthalmology, London, as a permanent memorial to its founder. Sir Stewart’s patients will always remember him as did the author of this vignette, as a kind, sympathetic and considerate doctor. In addition to being an outstanding ophthalmologist, Sir Stewart was a relative rarity in his day, the supreme physician.

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Calle Posada

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