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Ophthalmology and Vanity Fair
Special Article
Ophthalmology and Vanity Fair Andrew P. Ferry, MD Vanity Fair was the leading Society magazine of Victorian and Edwardian England. A key feature of each weekly issue was the inclusion of a chromolithographed caricature and biographic sketch of a prominent individual. The author undertook a survey of the more than 2000 caricatures published from 1869 to 1914 to determine if any portrayed an ophthalmologist. Seventy-nine of the caricatures depicted physicians and scientists, of whom three were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir Anderson Critchett. A brief sketch of their ophthalmic accomplishments is presented. Caricatures from Vanity Fair are avidly sought after and are often found in antique shops, sporting venues, and professional offices, especially those of lawyers and judges. It has been said that when seeking the true perspective of the Victorian and Edwardian eras, the most faithful mirror and record of representative men and the spirit of their times can be found in Vanity Fair. Ophthalmology 1993;100:429-437
Vanity Fair was the leading and most successful Society magazine of its day. It was written by and for the Victorian and Edwardian establishment. The first issue was published in London on November 7, 1868. The founding editor of Vanity Fair was Thomas Gibson Bowles (Fig 1). His introductory statement of purpose included the advice that, In this Show it is proposed to display the vanities of the week, without ignoring or disguising the fact that they are vanities, but keeping always in mind that in the buying and selling of them there is to be made a profit of Truth.
The magazine was made up of a wide variety of contents: social and political columns, book and play reviews, serialized novels, sports reports, word games and humor, travel articles, and advertisements. 1,2 Circulation volume was low at first. But the magazine's popularity surged with the appearance in the thirteenth issue, on January 30,
Originally received: September 14, 1992. Manuscript accepted: October 13, 1992. From the Department of Ophthalmology, Medical College of Virginia of Virginia Commonwealth University, Richmond, and the American Academy of Ophthalmology Foundation Museum, San Francisco. Presented at the Annual Meeting of The American Ophthalmic History Society, National Library of Medicine, Bethesda, Maryland, March 20, 1992. Supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York. Reprint requests to Andrew P. Ferry, MD, Department of Ophthalmology, Medical College of Virginia of Virginia Commonwealth University, Box 262, MCV Station, Richmond, VA 23298.
1869, of a full-page colored caricature of Benjamin Disraeli by the Italian-born artist Carlo Pellegrini. Thereafter, through January 14, 1914, each weekly issue of Vanity Fair contained a caricature (or cartoon, as they were called initially) of a prominent figure of the day. More than 2000 of them appeared from 1869 through January 1914. Bowles' past experience with Society publications convinced him of the need to make his magazine unique. His decision to publish in quarto dimensions of eight to ten pages per issue gave Vanity Fair instant identity. The grade of paper was above that of similar publications, to reproduce the color caricatures and to impart the aura of a high-quality magazine. 3 The caricatures became immensely popular, and are often found today in antique shops and in professional offices. They depicted a panoply of prominent men in many walks of life, particularly politicians, members of the legal profession, military figures, physicians and scientists, royalty, nobility, actors, members of the clergy and the academic world, athletes, men of letters, etc. Americans were represented prominently. Among them were Phineas Barnum, Samuel Clemens, Andrew Carnegie, Ulysses Grant, Horace Greeley, Bret Harte, Oliver Holmes, Sr., William McKinley, Theodore Roosevelt, Alfred Vanderbilt, and Woodrow Wilson. Several dozen women were among those whose caricatures appeared in Vanity Fair. These included Queen Victoria, Sara Bernhardt, and Marie Curie. Under various "signatures," Bowles wrote most of the material in each issue of Vanity Fair during his ownership, from 1868 to 1889. The caricature that was included each week was the publication's key feature, and was accom-
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Volume 100, Number 3, March 1993 icature appeared the terse caption, "He is a smart fellow
& an honest lawyer."
The other key men in the success of Vanity Fair were the artists. Some 90 of them have been identified. The two most important were Carlo Pellegrini (1839-1889) and Sir Leslie Ward (1851-1922). Pellegrini (Fig 2) was born to aristocratic parents in Italy. Upon arriving in London in 1864, he soon became the pet of English Society and a central figure in the Prince of Wales' set. It was Pellegrini who drew the first caricature to appear in Vanity Fair. in the issue of January 30, 1869. Pellegrini signed this full-page, colored caricature of Disraeli, "Singe." His splendid caricature of Gladstone appeared in the following issue, and also was signed, "Singe." Thereafter, he Anglicized "Singe" to "Ape," a nom de crayon that subsequently appeared on hundreds of his chromolithographs over the next 15 years. Many of Pellegrini's caricatures imparted ape-like features to his subjects, a quality that some readers found to be too cruel and grim to be regarded as good-humored satire. I The portrait charge that Pellegrini developed became the accepted idiom of Vanity Fair and an English institution. 3 In 1873, the first of Leslie Ward's caricatures appeared in Vanity Fair. Thereafter, despite contributions from
Figure 1. This chromolithographed caricature of Bowles was published in the July 13, 1889. issue of Vanity Fair. The artist was Sir Leslie Ward ("Spy").
panied by a brief letterpress biographic sketch signed "Jehu Junior," the sobriquet for Thomas Gibson Bowles during his editorship and one that was retained even after he left the magazine in 1889. I Bowles took this name from the Old Testament. The original or "senior" Jehu was a prophet and warrior who pronounced the downfall of his enemies and then proceeded to destroy them. 3 Jehu Junior's insights and innuendoes puzzled and amused the curious and knowledgeable members of Society. Bowles' caustic wit, turn of phrase, and veiled reference enabled him to capture, in a few words, the personality and life of the victim which, in another context, would have required pages. 3 His friends and heroes generally escaped unscathed. Among his goals in presenting the caricatures was "the unheroic representation of heroes." Although the magazine's political bias (pro-Tory and anti-Liberal) was obvious, no one was beyond Bowles' satiric rebukes when he believed such assaults were merited. I Libel actions were brought against him over the years. The fact that he lost only one case was largely the result of Vanity Fair's 10year employment of Arthur Hepburn Hastie, a lawyer caricatured in the July 20, 1893, issue. Beneath the car-
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Figure 2. This chromolithograph of Carlo Pellegrini was published in the April 27. 1889. issue of Vanity Fair. The artist was Arthur Marks.
Ferry . Ophthalmology and Vanity Fair dozens of other artists, for the remainder of Vanity Fair's history the great majority of the weekly caricatures were to be done by him (Fig 3). His first effort in Vanity Fair was unsigned. It was captioned, "OLD BONES," and depicted the versatile naturalist and anti-Darwinist, Professor Richard Owen. Ward's second caricature for Vanity Fair represented Edward Levy, and was the first to bear the later-famed "Spy" signature that would subsequently appear on hundreds of Ward's caricatures. Although in his early years at Vanity Fair, Ward was a very observant caricaturist, critics accused him in his later years of being less of a caricaturist and more of a portraitist. 3 Students of caricaturing have favored Pellegrini's drawings over those of Ward, and it has been said that "Spy spent forty years being a tamed Ape." There were 79 physicians and scientists caricatured in Vanity Fair. Their representations, and the accompanying biographic sketches, were generally more reserved, more pictorial, and less satiric than those of many of the other individuals who were depicted, especially clergymen and politicians. I This often resulted in a relative blandness in the illustrations, causing them to be of lesser artistic interest. Among the physicians and scientists depicted were
Figure 3. This chromolithographed caricature of Leslie Ward appeared in the November 23, 1889, issue of Vanity Fair. The artist was Jean de Paleologue.
Marie and Pierre Curie, Darwin, Paget, Pasteur, and Virchow. Many of the other physicians and scientists have passed into oblivion, and in some cases it is apparent that the physicians were better known for their prominent patients than for their contributions to science. Articles about some of the physicians (e.g., Richard Owen,4 Henry Thompson,5 James Gully and Richard Quain,6 and Erasmus Wilson 7 ) have been published from time to time in the standard medical journals. Three of the caricatured physicians were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir George Anderson Critchett. They are of particular parochial interest to readers of Ophthalmology.
Jonathan Hutchinson Jonathan Hutchinson was the first of the three to have his caricature published in Vanity Fair. It appeared in the September 27, 1890, issue (Fig 4). The caption beneath the caricature is, "Mr. Jonathan Hutchinson." The chromolithograph bears the familiar "Spy" signature of Leslie Ward. Accompanying the caricature is the biographic sketch shown in Figure 5. Hutchinson was by far the most important of the three ophthalmologists caricatured in Vanity Fair and is the only one who remains well-known in our field today.8 Duke-Elder9 used the Vanity Fair chromolithograph as the first illustration in Volume XII (Neuro-Ophthalmology) of his System of Ophthalmology. His assessment of Jonathan Hutchinson was as follows: A surgeon of great repute at Moorfields Eye Hospital, a general surgeon at the London Hospital and associated with the Royal College of Surgeons of England, no ophthalmologist has ever been more interested in general disease or appreciated its value to ophthalmology more than he; it is significant that he retired from Moorfields Hospital in 1878 before his period of office was completed because he could not bring himself to do the great amount of refractive work at that time rapidly mounting. His astute observations led to the incorporation of many eponyms in medical literature, the best known of which is Hutchinson's triad in congenital syphilis (interstitial keratitis, notched incisor teeth and labyrinthine disease). In neurology Hutchinson's mask in tabes and Hutchinson's facies in ophthalmoplegia are less well-known, but Hutchinson's pupil after cerebral trauma or haemorrhage is well-established, while he first noted irregularity of the pupils in meningitis and first established the existence of tobacco amblyopia, a condition previously known as "idiopathic symmetrical amaurosis occurring in the male sex." His Archives afSurgery in ten volumes, all written by himself (1889-99), is one of the greatest storehouses of original observations on disease compiled by a single man. An unrivaled clinical observer and a genius in clinical exposition, he did more than any other to wed ophthalmology to medicine and neurology, and in so doing he exercised a profound influence on our specialty at the end of the 19th and the beginning of the 20th century. For this he received full recognition in his lifetime: he was a founder of the New Sydenham Society and its secretary (18591907), president of the H unterian Society (1869), the
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Volume 100, Number 3, March 1993 Figure 4. This chromolithograph ofJonathan Hutchinson was published in the September 27, 1890, issue of Vanity Fair (original measurement, approximately 7 3fs X 12 liz inches).
Pathological Society of London (1879), the Ophthalmological Society of the U.K. (1883), the Neurological Society (1887), the Royal College of Surgeons (1889), the Medical Society of London (1892), the Royal Medical and Chirurgical Society (1894-96) and the International Congress of Dermatology (1896). He was elected a Fellow of the Royal Society (1882), a Knighthood was conferred on him in 1908, and he received a large number of honorary degrees. 9
Although Hutchinson was brought up in a Quaker family as an abstainer from alcohol, Duke-Elder remarked that". . .he had the wisdom to recognize later in life that he could work better if he took a little wine."10 Hutchinson's Quaker background carried over into weekend activities at his home in Haslemere mentioned in the biographic sketch that accompanied his caricature in Vanity Fair (Fig 5). He conducted services at the Friends' meeting house on Sunday afternoons that were, like everything else he did, entirely original. ll - 13 The casual passerby, wandering into the meeting house and expecting to hear a sermon based on some passage in Scripture, was probably astonished to see a tall, benevolent-appearing old gentleman begin to discuss a topic such as, "The Influence of Wordsworth's Poetry," or, "Whales and Their Habits," or, "Tuberculosis and Leprosy," depending on the afternoon. 14 At his home in Haslemere, he also had a large museum that, among other things, illustrated the progress of human knowledge from the days of ancient Egypt to the reign of Queen Victoria. Despite his great clinical acumen, Hutchinson was not unfailingly correct in his conclusions. For example, he
MEN
OF
THE
MR. JONATHAN
DAY.
HUTCHINSON,
F.R.S.
B
ORN at Selby two-and-sixty years ago, and educated in the place of his birth, he has devoted his life (0 the methods of observation and experiment; operating upon and curing innumerable fellow-creatures. He became successively a Fellow of the Royal College of Surgeons, President of the Hunterian Society, of the Pathological Society, and of 'the Ophthalmological Society, as well as Professor of Surgery and Pathology in the Royal College of Surgeons; and he has never read a paper before any Society without opening the eyes of his hearers. He has also sat upon a Royal Commission; and he has just ended his year of office as President of the Royal College of Surgeons. He is a quiet, very sensitive man, who treats his patients with quite fatherly care and with exceeding skill. He is a specialist of more than one kind, being a great His study is the whole of medicine, as authority upon defeClive or diseased eyes. Bacon's was the whole of Nature; and of him a great medicine man once said: .. I "do not believe in specialists, but I believe in Hutchinson because he is a specialist "in everything." And being so, he has well earned the gratitude of thousands. He has a pretty place at Haslemere; and he always carries with him four pairs of speClacles.
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Figure 5. This letterpress biographic sketch of Hutchinson accompanied his caricature in Vanity Fair.
Ferry . Ophthalmology and Vanity Fair assigned gout an unduly prominent role in the pathogenesis of uveitis that is no longer accepted. On the basis of his forceful teaching (particularly as summarized in the first Bowman Lecture) the "gouty diathesis" was regarded for decades as a leading cause of uveitis. 15 Hutchinson also held tenaciously to his theory that leprosy was the result of eating fish, particularly decayed fish. Fifteen years after Hutchinson began his studies of the cause of leprosy, Hansen published the results of his investigations demonstrating the presence of bacilli (now known as Mycobacterium leprae) in the lesions of patients who had leprosy, and he postulated that these were the cause of the disease. Hutchinson accepted Hansen's discovery of the lepra bacillus, but added politely that Hansen was mistaken if he thought leprosy had nothing to do with the eating of fish. He industriously set to work studying fish with the microscope, attempting to find in their bodies the lepra bacillus and thus prove the correctness of his theory. After the expenditure of a prodigious amount of time and energy, he was compelled to admit that he could not find a single lepra bacillus. Hutchinson then undertook travels to India and to South Africa to investigate the cause of leprosy. In 1906, he published a book in which he marshalled all the evidence in favor of his theory and, at the time of his death in 1913 (some 40 years after Hansen's demonstration ofiepra bacilli) he was as firmly convinced as ever that leprosy was caused by eating spoiled fish. 14
Robert Brudenell Carter The second ophthalmologist to have his caricature published in Vanity Fair was Robert Brudenell Carter. It appeared in the April 9, 1892, issue (Fig 6). The caption beneath the caricature is, "A Literary Oculist." The chromolithograph is signed "Stuff." The penchant of many of the caricaturists for using pseudonyms has, in some instances, resulted in uncertainty about who they were. The identity ofthe artist who signed his work "Stuff" is currently ).mknown. It is thought that this may have been the sobriquet for H.C. Sepping Wright. Accompanying the caricature is the biographic sketch shown in Figure 7. Carter was born in the same year as Jonathan Hutchinson, on October 2, 1828. He died at the age of 90 on October 24, 1918. Additional details regarding his life and contributions are to be found in several articles published in the British Journal of Ophthalmology.16,17 While serving in the Crimean War, Carter became acquainted with Sir W. H. Russell, the celebrated corre) Top, Figure 6, This chromolithograph of Robert Brudenell Carter was published in the April 9, 1892, issue of Vanity Fair (original measurement, approximately 7 3/8 X 12 liz inches), Bottom, Figure 7. This letterpress biographic sketch of Carter accompanied his caricature in Vanity Fair. It has been retyped to enhance clarity in reproduction.
lIEN OF THB DAY.
No. 536
11K. ROBERT BRUDENBLL CARTER, F.R.C.S. His grandfather was a brother of that Elizabeth Carter who translated Epictetus, and Rector for many years of the Parish of Little Wittenham, in Berkshire. Thither his father, retiring from the Royal Marines with the l'Iink of Major, and a wife, returned; and there was born his son four-and-sixty years ago, and named Robert Brudenell after his godfather, the sixth Lord Cardigan. He inclined to surgery. but inherited enough of his father's warlike spi-rit to impel him to serve as a civilian volunteer in the Crimea; which he did with local rank as a Staff Surgeon. Thereafter he enjoyed, for a dozen years, such reputation as he might gain by provincial practice; and then Clime to London, and so successfully started business as an Ophthalmic Specialist that he was presently made Ophthalmic Surgeon to St. George's Hospital, where he has now for more than twenty years been persuading the blind to see. He is not a doctor, though he believes that drugs, rightly used, are upon occasion invaluable; but he has written very much very well. Besides many books on eyesight, diseases of the eye, and kindred subjects, he has been guilty of a work on "The Influence of Education and Training in Preventing Diseases of the Nervous System"; which shows that he has a comprehensive mind. He is also an authority on colour-blindness, the Tintometer, and other mysterious things; and, unlike many Men of Science, he can, when necessary, write quite intelligibly and in admirable English even on obscure matters. He is so public-spirited that he condescended to sit upon the first London County Council, where he worked bravely in the interests of the insane; but the Council, with peculiar insanity of their own, refused to act upon the recommendations of his Special Committee, so that he thought better of it and declined to stand for re-election. He is a hard· working man who well fills several professional offices. He uses two pairs of spectacles, and among many other things he is a Knight of Grace of the Order of st. John of Jerusalem in England.
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Volume 100, Number 3, March 1993
spondent of The Times, who induced him to furnish the newspaper with a series of graphic letters describing his experiences at the front. These letters to The Times attracted much attention. Upon relocating in London 14 years later, Carter reopened his association with The Times and became well known to the public by his signed contributions on professional subjects. He also wrote anonymous editorials on numerous scientific, social, and educational subjects. He did this for 50 years and wrote in a similar capacity for The Lancet for most of the same long period. 17 Carter was in general practice until he was 40 years of age. After his late entry into ophthalmology, he took an active role in establishing the Nottingham and Midland Eye Infirmary. In 1862, he moved to Stroud and was prominent in founding the Gloucester Eye Hospital. Carter moved to London in 1868, and in the following year was elected to the staff of the Royal South London Hospital, which subsequently underwent a change in name to the Royal Eye Hospital. In 1870, he was appointed ophthalmic surgeon to St. George's Hospital, a post he retained for 23 years. Carter was a superb clinician, his background in general
PRACTICAL TREATISE
George Anderson Critchett
ON
DISEASES OF THE EYE. DY
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Figure 8. Title page of the first American edition of Carter's, A Practical Treatise on Diseases of the Eye.
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medicine and surgery being apparent in his management of patients. As a surgeon, he is described as "probably unsurpassed,,16 and as "one of the most accomplished men of his day.,,17 He wrote many books, among which are On the Pathology and Treatment of Hysteria (1853), The Influence of Education and Training in Preventing Diseases ofthe Nervous System (1855), Hints on Diagnosis of Eye Disease (1865), Ophthalmic Surgery (1887, with W. A. Frost as co-author), and Doctors and Their Work (1903).18 His best-known contribution was A Practical Treatise on Diseases of the Eye. He completed work on this in 1875, and the first American edition appeared in 1876 (Fig 8). The book is 505 pages in length and is based heavily on lectures he gave on ocular disease at St. George's Hospital. Among the honors Carter received was his knighthood in the Order of St. John of Jerusalem, mentioned in the biographic sketch that accompanied his caricature in Vanity Fair (Fig 7). He was a consulting ophthalmic surgeon to the British Ophthalmic Hospital at Jerusalem connected with the Order. 16 The St. John Ophthalmic Hospital in Jerusalem dates its origin to the time of the Crusades and currently continues to play an extremely active and important role in treatment of ocular disease in that part of the world.
The last of the three ophthalmologists to have his caricature published in Vanity Fair was George Anderson Critchett. It appeared in the May 18, 1905, issue (Fig 9). Beneath the caricature is the caption, "The King's Oculist." The chromolithograph bears the familiar "Spy" signature of Sir Leslie Ward and is accompanied by the biographic sketch shown in Figure 10. Critchett's contributions to ophthalmology were less than those of Carter, and were incomparably less than those of Jonathan Hutchinson. He also suffers by comparison with another outstanding ophthalmologist, his father, George Critchett. The senior Critchett was born in 1817 and died in 1882. Duke-Elder (whose work makes no mention of Anderson Critchett) remarked that George Critchett ". . .was one of the brilliant band of ophthalmologists constituting the staff of Moorfields Eye Hospital in the second half of the 19th century. He was a remarkable surgeon of great dexterity and introduced a number of operations into ophthalmic practice including the procedure of iris inclusion for glaucoma." 19 George Anderson Critchett was born in 1845. Early in his professional career, he decided to avoid using the name George, and became known as G. Anderson Critchett. In later years, he dropped the G. and was known simply as Anderson Critchett. He began his studies of medicine at the Middlesex Hospital and qualified in 1872. 20 In 1879, he became ophthalmic surgeon to the Royal Free Hospital, and in 1881 he was elected ophthalmic surgeon to St. Mary's Hospital. Some of the milestones in his life are noted in the biographic sketch that appeared in Vanity Fair (Fig 10),
FeTTY . Ophthalmology and Vanity FaiT
MEN OF THE DAY.
No. 11M.
SIB ANDI!RSON CRITCIIBTT.
Father and son the Crltchetts have been great oculista and kindly men. There were many ..d heart. amongst the oufferlng poor when George Crltchett dled; hto son, also a George, though to avoid confusion he caIJa hlmaelf by hto second name of Anderson, baa followed In hto father'. steps. His skill as an operator baa brought him a reputation amonpt the medlcel schools of Europe. HIa method of operating upon cataract without a spectrum, and with no other aid than thet of hto own sensitive yet powerful fingers, baa won the admiration of hto ophthelmlc contemporaries. It provides an unequalled illustration of finished craftsmanship. When In 1901 he received hto present appointment as Surgeon Oculist to the King, a distinction supplemented a few months later by a knighthood, hto honours provoked no jealousy In hto profesalon. He had well deserved that which came to him. Some forty years ego, when he bed passed from prlze-toklng at Harrow to Caius College, Cambridge, where he was a contemporary of his
llfelong friend, Frank Lockwood, it seemed likely enough that young Critchett would turn to literature instead of the profession whereof his father was an acknowledged leader. If, however, it was in the latter that he made hto mark, hto pen aided to establish hto reputation. His various scientific monographs and addresses show a sense of literary style very rare In the writings of medicel men. After graduating at Cambridge, Anderson Critchett studied for some time in Germany and France, and on his return to England became assistant to his father. He is ever eager to edmlt hto indebtedness to peternal precept and eumple during that period of his career. For seven years from 1872 he was clinical assistant at Moorfields Eye Hospital. From a post as Ophthalmic Surgeon to the Royal Free Hospital he passed In 1881 to S1. Mary's Hospital, where during twenty years of office he had the satisfaction of raising the Eye Department from a state of starved degradation to such an efficient perfection as gained for It the edmIrIng Interest of expert visitors. HIa Introductory lecture at St. Mary's In 1887 Is still remembered by those who appreciated the force of its conclusions and the readiness of its delivery. Anderson Critchett had not forgotten the skill acquired in the Union debates. Neither the demand made upon his time by his reputation, nor his rigid rule thet makes a dally practice of the Simple Life, prevents hto being an admirable and habitual entertainer. Art and letten have alreedy begun to recogniae in him the social successor to Sir Henry Thompson, of "Octave" memory. He still singa a good song in his musical baritone. His tastes allow him to enjoy the diverae charms of the Athenaeum and the Garrick. HIa membership of I Zlnpr! proves that he baa not lost hto early affection for cricket. Sir Anderson has a pIlSsion for a joke. It is his single weakne88. There are few, indeed, who lighten our darkness 80 merrily as the King'8
Oculist.
wherein mention is made of his having been appointed Surgeon Oculist to King Edward VII. He subsequently served as Surgeon Oculist to Edward's son and successor, George V, the grandfather of Queen Elizabeth II. Critchett received many other honors in his lifetime. In 1889, he was elected President of the Ophthalmic Section of the British Medical Association. In 1894, at Edinburgh, and again in 1899 at Utrecht, he was elected honorary President of the International Ophthalmological Congress. From 1899 to 1901, he was President of the Ophthalmological Society of the United Kingdom. In 1901, the year in which he became Surgeon Oculist to King Edward VII, he was knighted. In 1912, when a new section of ophthalmology was started in the Royal Society of Medicine, he was the first president. In 1913, he was President of the Section of Ophthalmology of the International Medical Congress at London, and in 1918, on the founding of the New Council of British Ophthalmologists, he was elected the first president of that body. In recognition of his war services to King George the Fifth Hospital, in 1919 he was made a Knight of Grace of the Order of St. John of Jerusalem. In 1924, he was elected Master of the Oxford Ophthalmological Congress. 20 Critchett is described as " . . .a great clinician and unrivaled as an operator. ,,20 The reason he is so little known today was presaged in his obituary notice, wherein it was stated that, "He was never a prolific writer, to the regret of many of his pupils, and much of his teaching which would have been of great value is lost for want of recording.... "20 Critchett died on February 9, 1925. At the Convention of English-Speaking Ophthalmological Societies held at London University on July 14, 1925, William T. H. Spicer presented to President Edward T. Collins the newly fashioned Critchett Memorial Presidential Badge. It is obvious from Spicer's remarks that Anderson Critchett's personal qualities were held in the highest regard by his COUeagues. 21 The badge (Fig 11) bears medallion portraits of George and Anderson Critchett, beneath which is a representation of the arms of the Critchett family. The badge was intended to be worn by the president of the society at all meetings of the organization and on such other occasions as it was thought desirable. In 1988, the Ophthalmological Society of the United Kingdom and the Faculty of Ophthalmologists joined together by Royal Charter to form the College of Ophthalmologists. (In a personal communication dated September 14, 1992, Margaret Hallendorif, the Executive Officer of the College, advised me that the Critchett Memorial Badge has not been worn by the presidents for many years, presumably because the coat of arms it bears are those of the Critchett family, rather than those of the organization. The Critchett Memorial Badge remains in the possession
Top, Figure 9. This chromolithograph of Anderson Critchett appeared in the May 18, 1905, issue of Vaniry Fair (original measurement, approximately 7 3/. X 12 3J. inches). Bottom, Figure 10. This letterpress biographic sketch of Critchett accompanied his caricature in Vaniry Fair. It has been retyped to enhance clarity in reproduction. In the first paragraph, the author of the biographic sketch says that Critchett performed cataract surgery without using a spectrum. I believe he probably confused that word with speculum.
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Volume 100, NumbeT 3, MaTch 1993 and Home, with nothing remaining of its original format except its name in the shared title. Neither the American Vanity Fair of the 1920s nor the American magazine of the same name that has appeared during the past several years is a successor to the English Vanity Fair that was published from 1868 into 1914. With regard to the origin of Vanity Fair's name, Bowles took it from the title of William Thackeray's novel, Vanity Fair. In that work, Thackeray expressed his intense hatred of sham and pretense in a satiric and wonderfully realistic picture of the life of the English upper class, a picture in which sordid desire for rank and wealth, and snobbish deference to the possessors of those prizes, were held up to ridicule and rebuke. Thackeray's source for the title of his novel was a memorable episode in one of the greatest allegories ever written, The Pilgrim's Progress by John Bunyan. This was published in the roid-1600s and describes the spiritual life of man. It is the account of Christian's (the pilgrim) journey through the world and his final triumph in the Celestial City. One episode concerns a dream in which the narrator says that, " . . .they presently saw a town before them, and the name of that town is Vanity; and at the town there is a fair kept, called Vanity Fair. It is kept all the year long: it beareth the name of Vanity Fair, because the town where it is kept is lighter than vanity, and also because all that is there sold, or that cometh thither, is vanity.'m Acknowledgment. The author thanks Margaret Hallendorlf of London and Dr. Peter G. Watson of Cambridge for providing detailed information regarding the current status of the Critchett Memorial Badge.
References Figure 11. The Critchett Memorial Presidential Badge bears medallion portraits of George and Anderson Critchett, beneath which is a repre-
sentation of the arms of the Critchett family.21
of the College of Ophthalmologists. Following the 1988 merger, the College commissioned a new badge bearing the coat of arms of the new organization, and this is worn on the appropriate occasions.)
Epilogue Bowles sold Vanity Fair in 1889 and entered a career in politics. By the mid-1890s, the magazine had lost some of its pungent wit and sophisticated irreverence. Its tone changed; it became more a gossip sheet, a record of Society's activities, a purveyor of advertisements, and less an affectionate and perceptive critic of British life. Reminiscences about a glorious past, which it felt it had helped create, began to appear. The last issue of Vanity Fair was published on January 28, 1914. In the following month, what had been the leading Society magazine of its day was absorbed by a magazine for women entitled, Hearth
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1. Savory JJ. The Vanity Fair Gallery: A Collector's Guide to the Caricatures. South Brunswick: AS Barnes, 1979. 2. Savory J. The Vanity Fair Lithographs: An Illustrated Checklist. New York: Garland, 1978. 3. Matthews RT, Mellini P. In 'Vanity Fair'. London: Scolar Press, 1982. 4. Moxon RK. Doctors Afield: Richard Owen (1804-1892), naturalist and anti-Darwinist. N Engl J Med 1962;267: 35-7. 5. Moxon RK. Doctors Afield: Sir Henry Thompson (18201904}-cremationist, artist and host extraordinary. N Engl J Med 1962;267:927-9. 6. Mann RJ. Historical Vignette: The unheroic representation of heroes. Mayo Clin Proc 1971;46:197-9. 7. Moxon RK. Doctors Afield: Erasmus Wilson (1809-1884). The dermatologist and the obelisk. N Engl J Med 1976;294: 762-4. 8. Henkind P. Jonathan Hutchinson-1828-1913 [editorial]. Am J Ophthalmol 1978;85:265-6. 9. Duke-Elder S, Scott GI. Neuro-Ophthalmology. In: DukeElder S, ed. System of Ophthalmology. Vol. XII: St. Louis: CV Mosby, 1971;3-5. 10. Duke-Elder S, Leigh AG. Diseases of the Outer Eye. Pt. 2. In: Duke-Elder S, ed. System of Ophthalmology. Vol. VIII: St. Louis: CV Mosby, 1965;1059. 11. Sir Jonathan Hutchinson, [Obituary]. Lancet 1913;1: 1832-5.
Ferry . Ophthalmology and Vanity FaiT 12. Fox RH. The late Sir Jonathan Hutchinson [letter]. Lancet 1913;2:43-4. 13. Sir Jonathan Hutchinson's Museums. Lancet 1913;2:818. 14. Major RH. Disease and Destiny. New York: D. AppletonCentury, 1936;204-11. 15. Ferry AP. Gout. In: Gold DH, Weingeist TA, eds. The Eye in Systemic Disease. Philadelphia: JB Lippincott, 1990, chap. 134. 16. Robert Brudenell Carter [obituary]. Br J OphthalmoI1918;2: 637-40. 17. James RR. Robert BrudeneU Carter. Br J Ophthalmol 1941;25:330-9.
18. Albert OM. Ophthalmic Surgery: Robert BrudeneU Carter and William Adams Frost. Delran (New Jersey): Oassics of Ophthalmology Library, 1991. 19. Duke-Elder S. Diseases of the Lens and Vitreous; Glaucoma and Hypotony. In: Duke-Elder S, ed. System of Ophthalmology. Vol. XI. St. Louis: CV Mosby, 1969;530-1. 20. Sir Anderson Critchett: Surgeon-Oculist to the King. Br J Ophthalmol 1925;9:140-3. 21. Spicer WTH. Presentation to the President of the Critchett Memorial Badge. Trans Ophthalmol Soc UK 1925;45(1): LXXIX-LXXXII. 22. Bunyan J. The Pilgrim's Progress. Philadelphia: Presbyterian Board of Publication, 1844, 204-5.
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Ophthalmology and Vanity Fair Andrew P. Ferry, MD Vanity Fair was the leading Society magazine of Victorian and Edwardian England. A key feature of each weekly issue was the inclusion of a chromolithographed caricature and biographic sketch of a prominent individual. The author undertook a survey of the more than 2000 caricatures published from 1869 to 1914 to determine if any portrayed an ophthalmologist. Seventy-nine of the caricatures depicted physicians and scientists, of whom three were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir Anderson Critchett. A brief sketch of their ophthalmic accomplishments is presented. Caricatures from Vanity Fair are avidly sought after and are often found in antique shops, sporting venues, and professional offices, especially those of lawyers and judges. It has been said that when seeking the true perspective of the Victorian and Edwardian eras, the most faithful mirror and record of representative men and the spirit of their times can be found in Vanity Fair. Ophthalmology 1993;100:429-437
Vanity Fair was the leading and most successful Society magazine of its day. It was written by and for the Victorian and Edwardian establishment. The first issue was published in London on November 7, 1868. The founding editor of Vanity Fair was Thomas Gibson Bowles (Fig 1). His introductory statement of purpose included the advice that, In this Show it is proposed to display the vanities of the week, without ignoring or disguising the fact that they are vanities, but keeping always in mind that in the buying and selling of them there is to be made a profit of Truth.
The magazine was made up of a wide variety of contents: social and political columns, book and play reviews, serialized novels, sports reports, word games and humor, travel articles, and advertisements. 1,2 Circulation volume was low at first. But the magazine's popularity surged with the appearance in the thirteenth issue, on January 30,
Originally received: September 14, 1992. Manuscript accepted: October 13, 1992. From the Department of Ophthalmology, Medical College of Virginia of Virginia Commonwealth University, Richmond, and the American Academy of Ophthalmology Foundation Museum, San Francisco. Presented at the Annual Meeting of The American Ophthalmic History Society, National Library of Medicine, Bethesda, Maryland, March 20, 1992. Supported in part by a grant from Research to Prevent Blindness, Inc., New York, New York. Reprint requests to Andrew P. Ferry, MD, Department of Ophthalmology, Medical College of Virginia of Virginia Commonwealth University, Box 262, MCV Station, Richmond, VA 23298.
1869, of a full-page colored caricature of Benjamin Disraeli by the Italian-born artist Carlo Pellegrini. Thereafter, through January 14, 1914, each weekly issue of Vanity Fair contained a caricature (or cartoon, as they were called initially) of a prominent figure of the day. More than 2000 of them appeared from 1869 through January 1914. Bowles' past experience with Society publications convinced him of the need to make his magazine unique. His decision to publish in quarto dimensions of eight to ten pages per issue gave Vanity Fair instant identity. The grade of paper was above that of similar publications, to reproduce the color caricatures and to impart the aura of a high-quality magazine. 3 The caricatures became immensely popular, and are often found today in antique shops and in professional offices. They depicted a panoply of prominent men in many walks of life, particularly politicians, members of the legal profession, military figures, physicians and scientists, royalty, nobility, actors, members of the clergy and the academic world, athletes, men of letters, etc. Americans were represented prominently. Among them were Phineas Barnum, Samuel Clemens, Andrew Carnegie, Ulysses Grant, Horace Greeley, Bret Harte, Oliver Holmes, Sr., William McKinley, Theodore Roosevelt, Alfred Vanderbilt, and Woodrow Wilson. Several dozen women were among those whose caricatures appeared in Vanity Fair. These included Queen Victoria, Sara Bernhardt, and Marie Curie. Under various "signatures," Bowles wrote most of the material in each issue of Vanity Fair during his ownership, from 1868 to 1889. The caricature that was included each week was the publication's key feature, and was accom-
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Volume 100, Number 3, March 1993 icature appeared the terse caption, "He is a smart fellow
& an honest lawyer."
The other key men in the success of Vanity Fair were the artists. Some 90 of them have been identified. The two most important were Carlo Pellegrini (1839-1889) and Sir Leslie Ward (1851-1922). Pellegrini (Fig 2) was born to aristocratic parents in Italy. Upon arriving in London in 1864, he soon became the pet of English Society and a central figure in the Prince of Wales' set. It was Pellegrini who drew the first caricature to appear in Vanity Fair. in the issue of January 30, 1869. Pellegrini signed this full-page, colored caricature of Disraeli, "Singe." His splendid caricature of Gladstone appeared in the following issue, and also was signed, "Singe." Thereafter, he Anglicized "Singe" to "Ape," a nom de crayon that subsequently appeared on hundreds of his chromolithographs over the next 15 years. Many of Pellegrini's caricatures imparted ape-like features to his subjects, a quality that some readers found to be too cruel and grim to be regarded as good-humored satire. I The portrait charge that Pellegrini developed became the accepted idiom of Vanity Fair and an English institution. 3 In 1873, the first of Leslie Ward's caricatures appeared in Vanity Fair. Thereafter, despite contributions from
Figure 1. This chromolithographed caricature of Bowles was published in the July 13, 1889. issue of Vanity Fair. The artist was Sir Leslie Ward ("Spy").
panied by a brief letterpress biographic sketch signed "Jehu Junior," the sobriquet for Thomas Gibson Bowles during his editorship and one that was retained even after he left the magazine in 1889. I Bowles took this name from the Old Testament. The original or "senior" Jehu was a prophet and warrior who pronounced the downfall of his enemies and then proceeded to destroy them. 3 Jehu Junior's insights and innuendoes puzzled and amused the curious and knowledgeable members of Society. Bowles' caustic wit, turn of phrase, and veiled reference enabled him to capture, in a few words, the personality and life of the victim which, in another context, would have required pages. 3 His friends and heroes generally escaped unscathed. Among his goals in presenting the caricatures was "the unheroic representation of heroes." Although the magazine's political bias (pro-Tory and anti-Liberal) was obvious, no one was beyond Bowles' satiric rebukes when he believed such assaults were merited. I Libel actions were brought against him over the years. The fact that he lost only one case was largely the result of Vanity Fair's 10year employment of Arthur Hepburn Hastie, a lawyer caricatured in the July 20, 1893, issue. Beneath the car-
430
Figure 2. This chromolithograph of Carlo Pellegrini was published in the April 27. 1889. issue of Vanity Fair. The artist was Arthur Marks.
Ferry . Ophthalmology and Vanity Fair dozens of other artists, for the remainder of Vanity Fair's history the great majority of the weekly caricatures were to be done by him (Fig 3). His first effort in Vanity Fair was unsigned. It was captioned, "OLD BONES," and depicted the versatile naturalist and anti-Darwinist, Professor Richard Owen. Ward's second caricature for Vanity Fair represented Edward Levy, and was the first to bear the later-famed "Spy" signature that would subsequently appear on hundreds of Ward's caricatures. Although in his early years at Vanity Fair, Ward was a very observant caricaturist, critics accused him in his later years of being less of a caricaturist and more of a portraitist. 3 Students of caricaturing have favored Pellegrini's drawings over those of Ward, and it has been said that "Spy spent forty years being a tamed Ape." There were 79 physicians and scientists caricatured in Vanity Fair. Their representations, and the accompanying biographic sketches, were generally more reserved, more pictorial, and less satiric than those of many of the other individuals who were depicted, especially clergymen and politicians. I This often resulted in a relative blandness in the illustrations, causing them to be of lesser artistic interest. Among the physicians and scientists depicted were
Figure 3. This chromolithographed caricature of Leslie Ward appeared in the November 23, 1889, issue of Vanity Fair. The artist was Jean de Paleologue.
Marie and Pierre Curie, Darwin, Paget, Pasteur, and Virchow. Many of the other physicians and scientists have passed into oblivion, and in some cases it is apparent that the physicians were better known for their prominent patients than for their contributions to science. Articles about some of the physicians (e.g., Richard Owen,4 Henry Thompson,5 James Gully and Richard Quain,6 and Erasmus Wilson 7 ) have been published from time to time in the standard medical journals. Three of the caricatured physicians were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir George Anderson Critchett. They are of particular parochial interest to readers of Ophthalmology.
Jonathan Hutchinson Jonathan Hutchinson was the first of the three to have his caricature published in Vanity Fair. It appeared in the September 27, 1890, issue (Fig 4). The caption beneath the caricature is, "Mr. Jonathan Hutchinson." The chromolithograph bears the familiar "Spy" signature of Leslie Ward. Accompanying the caricature is the biographic sketch shown in Figure 5. Hutchinson was by far the most important of the three ophthalmologists caricatured in Vanity Fair and is the only one who remains well-known in our field today.8 Duke-Elder9 used the Vanity Fair chromolithograph as the first illustration in Volume XII (Neuro-Ophthalmology) of his System of Ophthalmology. His assessment of Jonathan Hutchinson was as follows: A surgeon of great repute at Moorfields Eye Hospital, a general surgeon at the London Hospital and associated with the Royal College of Surgeons of England, no ophthalmologist has ever been more interested in general disease or appreciated its value to ophthalmology more than he; it is significant that he retired from Moorfields Hospital in 1878 before his period of office was completed because he could not bring himself to do the great amount of refractive work at that time rapidly mounting. His astute observations led to the incorporation of many eponyms in medical literature, the best known of which is Hutchinson's triad in congenital syphilis (interstitial keratitis, notched incisor teeth and labyrinthine disease). In neurology Hutchinson's mask in tabes and Hutchinson's facies in ophthalmoplegia are less well-known, but Hutchinson's pupil after cerebral trauma or haemorrhage is well-established, while he first noted irregularity of the pupils in meningitis and first established the existence of tobacco amblyopia, a condition previously known as "idiopathic symmetrical amaurosis occurring in the male sex." His Archives afSurgery in ten volumes, all written by himself (1889-99), is one of the greatest storehouses of original observations on disease compiled by a single man. An unrivaled clinical observer and a genius in clinical exposition, he did more than any other to wed ophthalmology to medicine and neurology, and in so doing he exercised a profound influence on our specialty at the end of the 19th and the beginning of the 20th century. For this he received full recognition in his lifetime: he was a founder of the New Sydenham Society and its secretary (18591907), president of the H unterian Society (1869), the
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Volume 100, Number 3, March 1993 Figure 4. This chromolithograph ofJonathan Hutchinson was published in the September 27, 1890, issue of Vanity Fair (original measurement, approximately 7 3fs X 12 liz inches).
Pathological Society of London (1879), the Ophthalmological Society of the U.K. (1883), the Neurological Society (1887), the Royal College of Surgeons (1889), the Medical Society of London (1892), the Royal Medical and Chirurgical Society (1894-96) and the International Congress of Dermatology (1896). He was elected a Fellow of the Royal Society (1882), a Knighthood was conferred on him in 1908, and he received a large number of honorary degrees. 9
Although Hutchinson was brought up in a Quaker family as an abstainer from alcohol, Duke-Elder remarked that". . .he had the wisdom to recognize later in life that he could work better if he took a little wine."10 Hutchinson's Quaker background carried over into weekend activities at his home in Haslemere mentioned in the biographic sketch that accompanied his caricature in Vanity Fair (Fig 5). He conducted services at the Friends' meeting house on Sunday afternoons that were, like everything else he did, entirely original. ll - 13 The casual passerby, wandering into the meeting house and expecting to hear a sermon based on some passage in Scripture, was probably astonished to see a tall, benevolent-appearing old gentleman begin to discuss a topic such as, "The Influence of Wordsworth's Poetry," or, "Whales and Their Habits," or, "Tuberculosis and Leprosy," depending on the afternoon. 14 At his home in Haslemere, he also had a large museum that, among other things, illustrated the progress of human knowledge from the days of ancient Egypt to the reign of Queen Victoria. Despite his great clinical acumen, Hutchinson was not unfailingly correct in his conclusions. For example, he
MEN
OF
THE
MR. JONATHAN
DAY.
HUTCHINSON,
F.R.S.
B
ORN at Selby two-and-sixty years ago, and educated in the place of his birth, he has devoted his life (0 the methods of observation and experiment; operating upon and curing innumerable fellow-creatures. He became successively a Fellow of the Royal College of Surgeons, President of the Hunterian Society, of the Pathological Society, and of 'the Ophthalmological Society, as well as Professor of Surgery and Pathology in the Royal College of Surgeons; and he has never read a paper before any Society without opening the eyes of his hearers. He has also sat upon a Royal Commission; and he has just ended his year of office as President of the Royal College of Surgeons. He is a quiet, very sensitive man, who treats his patients with quite fatherly care and with exceeding skill. He is a specialist of more than one kind, being a great His study is the whole of medicine, as authority upon defeClive or diseased eyes. Bacon's was the whole of Nature; and of him a great medicine man once said: .. I "do not believe in specialists, but I believe in Hutchinson because he is a specialist "in everything." And being so, he has well earned the gratitude of thousands. He has a pretty place at Haslemere; and he always carries with him four pairs of speClacles.
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Figure 5. This letterpress biographic sketch of Hutchinson accompanied his caricature in Vanity Fair.
Ferry . Ophthalmology and Vanity Fair assigned gout an unduly prominent role in the pathogenesis of uveitis that is no longer accepted. On the basis of his forceful teaching (particularly as summarized in the first Bowman Lecture) the "gouty diathesis" was regarded for decades as a leading cause of uveitis. 15 Hutchinson also held tenaciously to his theory that leprosy was the result of eating fish, particularly decayed fish. Fifteen years after Hutchinson began his studies of the cause of leprosy, Hansen published the results of his investigations demonstrating the presence of bacilli (now known as Mycobacterium leprae) in the lesions of patients who had leprosy, and he postulated that these were the cause of the disease. Hutchinson accepted Hansen's discovery of the lepra bacillus, but added politely that Hansen was mistaken if he thought leprosy had nothing to do with the eating of fish. He industriously set to work studying fish with the microscope, attempting to find in their bodies the lepra bacillus and thus prove the correctness of his theory. After the expenditure of a prodigious amount of time and energy, he was compelled to admit that he could not find a single lepra bacillus. Hutchinson then undertook travels to India and to South Africa to investigate the cause of leprosy. In 1906, he published a book in which he marshalled all the evidence in favor of his theory and, at the time of his death in 1913 (some 40 years after Hansen's demonstration ofiepra bacilli) he was as firmly convinced as ever that leprosy was caused by eating spoiled fish. 14
Robert Brudenell Carter The second ophthalmologist to have his caricature published in Vanity Fair was Robert Brudenell Carter. It appeared in the April 9, 1892, issue (Fig 6). The caption beneath the caricature is, "A Literary Oculist." The chromolithograph is signed "Stuff." The penchant of many of the caricaturists for using pseudonyms has, in some instances, resulted in uncertainty about who they were. The identity ofthe artist who signed his work "Stuff" is currently ).mknown. It is thought that this may have been the sobriquet for H.C. Sepping Wright. Accompanying the caricature is the biographic sketch shown in Figure 7. Carter was born in the same year as Jonathan Hutchinson, on October 2, 1828. He died at the age of 90 on October 24, 1918. Additional details regarding his life and contributions are to be found in several articles published in the British Journal of Ophthalmology.16,17 While serving in the Crimean War, Carter became acquainted with Sir W. H. Russell, the celebrated corre) Top, Figure 6, This chromolithograph of Robert Brudenell Carter was published in the April 9, 1892, issue of Vanity Fair (original measurement, approximately 7 3/8 X 12 liz inches), Bottom, Figure 7. This letterpress biographic sketch of Carter accompanied his caricature in Vanity Fair. It has been retyped to enhance clarity in reproduction.
lIEN OF THB DAY.
No. 536
11K. ROBERT BRUDENBLL CARTER, F.R.C.S. His grandfather was a brother of that Elizabeth Carter who translated Epictetus, and Rector for many years of the Parish of Little Wittenham, in Berkshire. Thither his father, retiring from the Royal Marines with the l'Iink of Major, and a wife, returned; and there was born his son four-and-sixty years ago, and named Robert Brudenell after his godfather, the sixth Lord Cardigan. He inclined to surgery. but inherited enough of his father's warlike spi-rit to impel him to serve as a civilian volunteer in the Crimea; which he did with local rank as a Staff Surgeon. Thereafter he enjoyed, for a dozen years, such reputation as he might gain by provincial practice; and then Clime to London, and so successfully started business as an Ophthalmic Specialist that he was presently made Ophthalmic Surgeon to St. George's Hospital, where he has now for more than twenty years been persuading the blind to see. He is not a doctor, though he believes that drugs, rightly used, are upon occasion invaluable; but he has written very much very well. Besides many books on eyesight, diseases of the eye, and kindred subjects, he has been guilty of a work on "The Influence of Education and Training in Preventing Diseases of the Nervous System"; which shows that he has a comprehensive mind. He is also an authority on colour-blindness, the Tintometer, and other mysterious things; and, unlike many Men of Science, he can, when necessary, write quite intelligibly and in admirable English even on obscure matters. He is so public-spirited that he condescended to sit upon the first London County Council, where he worked bravely in the interests of the insane; but the Council, with peculiar insanity of their own, refused to act upon the recommendations of his Special Committee, so that he thought better of it and declined to stand for re-election. He is a hard· working man who well fills several professional offices. He uses two pairs of spectacles, and among many other things he is a Knight of Grace of the Order of st. John of Jerusalem in England.
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spondent of The Times, who induced him to furnish the newspaper with a series of graphic letters describing his experiences at the front. These letters to The Times attracted much attention. Upon relocating in London 14 years later, Carter reopened his association with The Times and became well known to the public by his signed contributions on professional subjects. He also wrote anonymous editorials on numerous scientific, social, and educational subjects. He did this for 50 years and wrote in a similar capacity for The Lancet for most of the same long period. 17 Carter was in general practice until he was 40 years of age. After his late entry into ophthalmology, he took an active role in establishing the Nottingham and Midland Eye Infirmary. In 1862, he moved to Stroud and was prominent in founding the Gloucester Eye Hospital. Carter moved to London in 1868, and in the following year was elected to the staff of the Royal South London Hospital, which subsequently underwent a change in name to the Royal Eye Hospital. In 1870, he was appointed ophthalmic surgeon to St. George's Hospital, a post he retained for 23 years. Carter was a superb clinician, his background in general
PRACTICAL TREATISE
George Anderson Critchett
ON
DISEASES OF THE EYE. DY
ROBERT BRUDEXELL CARTER, F.R.C.S., O I' HTH ALMIC SliRGEOS TO ST. GI!OI!(;R'~ HOSPITA L:
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Figure 8. Title page of the first American edition of Carter's, A Practical Treatise on Diseases of the Eye.
434
medicine and surgery being apparent in his management of patients. As a surgeon, he is described as "probably unsurpassed,,16 and as "one of the most accomplished men of his day.,,17 He wrote many books, among which are On the Pathology and Treatment of Hysteria (1853), The Influence of Education and Training in Preventing Diseases ofthe Nervous System (1855), Hints on Diagnosis of Eye Disease (1865), Ophthalmic Surgery (1887, with W. A. Frost as co-author), and Doctors and Their Work (1903).18 His best-known contribution was A Practical Treatise on Diseases of the Eye. He completed work on this in 1875, and the first American edition appeared in 1876 (Fig 8). The book is 505 pages in length and is based heavily on lectures he gave on ocular disease at St. George's Hospital. Among the honors Carter received was his knighthood in the Order of St. John of Jerusalem, mentioned in the biographic sketch that accompanied his caricature in Vanity Fair (Fig 7). He was a consulting ophthalmic surgeon to the British Ophthalmic Hospital at Jerusalem connected with the Order. 16 The St. John Ophthalmic Hospital in Jerusalem dates its origin to the time of the Crusades and currently continues to play an extremely active and important role in treatment of ocular disease in that part of the world.
The last of the three ophthalmologists to have his caricature published in Vanity Fair was George Anderson Critchett. It appeared in the May 18, 1905, issue (Fig 9). Beneath the caricature is the caption, "The King's Oculist." The chromolithograph bears the familiar "Spy" signature of Sir Leslie Ward and is accompanied by the biographic sketch shown in Figure 10. Critchett's contributions to ophthalmology were less than those of Carter, and were incomparably less than those of Jonathan Hutchinson. He also suffers by comparison with another outstanding ophthalmologist, his father, George Critchett. The senior Critchett was born in 1817 and died in 1882. Duke-Elder (whose work makes no mention of Anderson Critchett) remarked that George Critchett ". . .was one of the brilliant band of ophthalmologists constituting the staff of Moorfields Eye Hospital in the second half of the 19th century. He was a remarkable surgeon of great dexterity and introduced a number of operations into ophthalmic practice including the procedure of iris inclusion for glaucoma." 19 George Anderson Critchett was born in 1845. Early in his professional career, he decided to avoid using the name George, and became known as G. Anderson Critchett. In later years, he dropped the G. and was known simply as Anderson Critchett. He began his studies of medicine at the Middlesex Hospital and qualified in 1872. 20 In 1879, he became ophthalmic surgeon to the Royal Free Hospital, and in 1881 he was elected ophthalmic surgeon to St. Mary's Hospital. Some of the milestones in his life are noted in the biographic sketch that appeared in Vanity Fair (Fig 10),
FeTTY . Ophthalmology and Vanity FaiT
MEN OF THE DAY.
No. 11M.
SIB ANDI!RSON CRITCIIBTT.
Father and son the Crltchetts have been great oculista and kindly men. There were many ..d heart. amongst the oufferlng poor when George Crltchett dled; hto son, also a George, though to avoid confusion he caIJa hlmaelf by hto second name of Anderson, baa followed In hto father'. steps. His skill as an operator baa brought him a reputation amonpt the medlcel schools of Europe. HIa method of operating upon cataract without a spectrum, and with no other aid than thet of hto own sensitive yet powerful fingers, baa won the admiration of hto ophthelmlc contemporaries. It provides an unequalled illustration of finished craftsmanship. When In 1901 he received hto present appointment as Surgeon Oculist to the King, a distinction supplemented a few months later by a knighthood, hto honours provoked no jealousy In hto profesalon. He had well deserved that which came to him. Some forty years ego, when he bed passed from prlze-toklng at Harrow to Caius College, Cambridge, where he was a contemporary of his
llfelong friend, Frank Lockwood, it seemed likely enough that young Critchett would turn to literature instead of the profession whereof his father was an acknowledged leader. If, however, it was in the latter that he made hto mark, hto pen aided to establish hto reputation. His various scientific monographs and addresses show a sense of literary style very rare In the writings of medicel men. After graduating at Cambridge, Anderson Critchett studied for some time in Germany and France, and on his return to England became assistant to his father. He is ever eager to edmlt hto indebtedness to peternal precept and eumple during that period of his career. For seven years from 1872 he was clinical assistant at Moorfields Eye Hospital. From a post as Ophthalmic Surgeon to the Royal Free Hospital he passed In 1881 to S1. Mary's Hospital, where during twenty years of office he had the satisfaction of raising the Eye Department from a state of starved degradation to such an efficient perfection as gained for It the edmIrIng Interest of expert visitors. HIa Introductory lecture at St. Mary's In 1887 Is still remembered by those who appreciated the force of its conclusions and the readiness of its delivery. Anderson Critchett had not forgotten the skill acquired in the Union debates. Neither the demand made upon his time by his reputation, nor his rigid rule thet makes a dally practice of the Simple Life, prevents hto being an admirable and habitual entertainer. Art and letten have alreedy begun to recogniae in him the social successor to Sir Henry Thompson, of "Octave" memory. He still singa a good song in his musical baritone. His tastes allow him to enjoy the diverae charms of the Athenaeum and the Garrick. HIa membership of I Zlnpr! proves that he baa not lost hto early affection for cricket. Sir Anderson has a pIlSsion for a joke. It is his single weakne88. There are few, indeed, who lighten our darkness 80 merrily as the King'8
Oculist.
wherein mention is made of his having been appointed Surgeon Oculist to King Edward VII. He subsequently served as Surgeon Oculist to Edward's son and successor, George V, the grandfather of Queen Elizabeth II. Critchett received many other honors in his lifetime. In 1889, he was elected President of the Ophthalmic Section of the British Medical Association. In 1894, at Edinburgh, and again in 1899 at Utrecht, he was elected honorary President of the International Ophthalmological Congress. From 1899 to 1901, he was President of the Ophthalmological Society of the United Kingdom. In 1901, the year in which he became Surgeon Oculist to King Edward VII, he was knighted. In 1912, when a new section of ophthalmology was started in the Royal Society of Medicine, he was the first president. In 1913, he was President of the Section of Ophthalmology of the International Medical Congress at London, and in 1918, on the founding of the New Council of British Ophthalmologists, he was elected the first president of that body. In recognition of his war services to King George the Fifth Hospital, in 1919 he was made a Knight of Grace of the Order of St. John of Jerusalem. In 1924, he was elected Master of the Oxford Ophthalmological Congress. 20 Critchett is described as " . . .a great clinician and unrivaled as an operator. ,,20 The reason he is so little known today was presaged in his obituary notice, wherein it was stated that, "He was never a prolific writer, to the regret of many of his pupils, and much of his teaching which would have been of great value is lost for want of recording.... "20 Critchett died on February 9, 1925. At the Convention of English-Speaking Ophthalmological Societies held at London University on July 14, 1925, William T. H. Spicer presented to President Edward T. Collins the newly fashioned Critchett Memorial Presidential Badge. It is obvious from Spicer's remarks that Anderson Critchett's personal qualities were held in the highest regard by his COUeagues. 21 The badge (Fig 11) bears medallion portraits of George and Anderson Critchett, beneath which is a representation of the arms of the Critchett family. The badge was intended to be worn by the president of the society at all meetings of the organization and on such other occasions as it was thought desirable. In 1988, the Ophthalmological Society of the United Kingdom and the Faculty of Ophthalmologists joined together by Royal Charter to form the College of Ophthalmologists. (In a personal communication dated September 14, 1992, Margaret Hallendorif, the Executive Officer of the College, advised me that the Critchett Memorial Badge has not been worn by the presidents for many years, presumably because the coat of arms it bears are those of the Critchett family, rather than those of the organization. The Critchett Memorial Badge remains in the possession
Top, Figure 9. This chromolithograph of Anderson Critchett appeared in the May 18, 1905, issue of Vaniry Fair (original measurement, approximately 7 3/. X 12 3J. inches). Bottom, Figure 10. This letterpress biographic sketch of Critchett accompanied his caricature in Vaniry Fair. It has been retyped to enhance clarity in reproduction. In the first paragraph, the author of the biographic sketch says that Critchett performed cataract surgery without using a spectrum. I believe he probably confused that word with speculum.
Ophthalmology
Volume 100, NumbeT 3, MaTch 1993 and Home, with nothing remaining of its original format except its name in the shared title. Neither the American Vanity Fair of the 1920s nor the American magazine of the same name that has appeared during the past several years is a successor to the English Vanity Fair that was published from 1868 into 1914. With regard to the origin of Vanity Fair's name, Bowles took it from the title of William Thackeray's novel, Vanity Fair. In that work, Thackeray expressed his intense hatred of sham and pretense in a satiric and wonderfully realistic picture of the life of the English upper class, a picture in which sordid desire for rank and wealth, and snobbish deference to the possessors of those prizes, were held up to ridicule and rebuke. Thackeray's source for the title of his novel was a memorable episode in one of the greatest allegories ever written, The Pilgrim's Progress by John Bunyan. This was published in the roid-1600s and describes the spiritual life of man. It is the account of Christian's (the pilgrim) journey through the world and his final triumph in the Celestial City. One episode concerns a dream in which the narrator says that, " . . .they presently saw a town before them, and the name of that town is Vanity; and at the town there is a fair kept, called Vanity Fair. It is kept all the year long: it beareth the name of Vanity Fair, because the town where it is kept is lighter than vanity, and also because all that is there sold, or that cometh thither, is vanity.'m Acknowledgment. The author thanks Margaret Hallendorlf of London and Dr. Peter G. Watson of Cambridge for providing detailed information regarding the current status of the Critchett Memorial Badge.
References Figure 11. The Critchett Memorial Presidential Badge bears medallion portraits of George and Anderson Critchett, beneath which is a repre-
sentation of the arms of the Critchett family.21
of the College of Ophthalmologists. Following the 1988 merger, the College commissioned a new badge bearing the coat of arms of the new organization, and this is worn on the appropriate occasions.)
Epilogue Bowles sold Vanity Fair in 1889 and entered a career in politics. By the mid-1890s, the magazine had lost some of its pungent wit and sophisticated irreverence. Its tone changed; it became more a gossip sheet, a record of Society's activities, a purveyor of advertisements, and less an affectionate and perceptive critic of British life. Reminiscences about a glorious past, which it felt it had helped create, began to appear. The last issue of Vanity Fair was published on January 28, 1914. In the following month, what had been the leading Society magazine of its day was absorbed by a magazine for women entitled, Hearth
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Ferry . Ophthalmology and Vanity FaiT 12. Fox RH. The late Sir Jonathan Hutchinson [letter]. Lancet 1913;2:43-4. 13. Sir Jonathan Hutchinson's Museums. Lancet 1913;2:818. 14. Major RH. Disease and Destiny. New York: D. AppletonCentury, 1936;204-11. 15. Ferry AP. Gout. In: Gold DH, Weingeist TA, eds. The Eye in Systemic Disease. Philadelphia: JB Lippincott, 1990, chap. 134. 16. Robert Brudenell Carter [obituary]. Br J OphthalmoI1918;2: 637-40. 17. James RR. Robert BrudeneU Carter. Br J Ophthalmol 1941;25:330-9.
18. Albert OM. Ophthalmic Surgery: Robert BrudeneU Carter and William Adams Frost. Delran (New Jersey): Oassics of Ophthalmology Library, 1991. 19. Duke-Elder S. Diseases of the Lens and Vitreous; Glaucoma and Hypotony. In: Duke-Elder S, ed. System of Ophthalmology. Vol. XI. St. Louis: CV Mosby, 1969;530-1. 20. Sir Anderson Critchett: Surgeon-Oculist to the King. Br J Ophthalmol 1925;9:140-3. 21. Spicer WTH. Presentation to the President of the Critchett Memorial Badge. Trans Ophthalmol Soc UK 1925;45(1): LXXIX-LXXXII. 22. Bunyan J. The Pilgrim's Progress. Philadelphia: Presbyterian Board of Publication, 1844, 204-5.
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