James Wardrop 1782-1860

Introduction

Childhood

Medical Studies

Edinburgh Surgeon

The medical career of a Scottish doctor, James Wardrop, in the 19th century is described. An early interest in the developing science of Pathology in the Royal College of Surgeons of Edinburgh was expanded further when he moved to London, due to financial needs. Despite being outside the London teaching hospital scene, he continued to publish and teach in the private schools of the time. His interest in ophthalmology led him to describe what we now know as retinoblastoma, with recommendation for treatment. He also described sympathetic ophthalmitis and performed paracentesis in acute angle-closure glaucoma. He became surgeon to the Prince of Wales, later King George IV, but his criticism of other medical men at court led to his exclusion from the King at the scene of his death. He owned a notable collection of pictures and presented two of them to the National Gallery of Scotland on its foundation in 1850. In recent years, his work has been recognised by leading ophthalmologists, particularly in the USA. The Library of the Royal College of Surgeons of Edinburgh contains several of his works, and his portrait hangs in the College.

Keywords: closed-angle glaucoma, fungus haematodes, James Wardrop, King George IV, Prince Regent, retinoblastoma, sympathetic ophthalmitis

Edinburgh, in the last years of the 18th century, was an excellent centre for medical education. At the University, Alexander Monro Secundus was still teaching anatomy and Hope, who was soon to describe Strontianite (from which the element Strontium was subsequently to be extracted), and discover that water reaches its maximum density at 39.5 慚, was Professor of Chemistry. The alternative fount of medical knowledge was to be in the private teachings of John Barclay and others around Surgeons’ Square, where the Royal College of Surgeons had their Hall.

James Wardrop was born in 1782, the youngest son of James and Marjory Wardrop, at Torbanehill in Linlithgowshire, where the family had lived for several generations. His father had begun to study law, but when he was 20-years-old his own father died and he gave up studying in favour of a country life. His younger brother Andrew had graduated MD from Edinburgh University in 1775 and was a member of the Incorporation of Surgeons of Edinburgh, to whom we shall refer later. His mother, Marjory, who died in childbirth a year after James was born, was a daughter of Andrew Marjoribanks who owned Balbardie House, an Adam mansion in Bathgate. When young James was 4-years-old in 1786, the family estate was offered for sale, and his father, with his seven children, moved to a house in south Edinburgh overlooking The Meadows. The old family home was described as “lying in the parish of Whitburn upon the great road from Edinburgh to Glasgow, within a quarter of a mile of the town of Whitburn and a mile and a half of the town of Bathgate; consisting of about 370 Scots acres and yielding about 220 L sterling of rent. Upon the lands of Torbanehill there is a genteel modern house and offices, built within these seven years, and surrounded by a lawn, well laid out and neatly kept. The houses and policy* were designed by the ingenious Mr Robertson.”1 In the late 19th century the area was described as “a wild and uncultivated area of Scotland.”²

Before the age of 7, James was enrolled in the High School in Edinburgh where the rector was the famous Dr Alexander Adam. There were 570 boys at the school, the largest in the United Kingdom, and the curriculum was based on the study of Greek and Latin with 70-90 boys in a class. Adam Black, later Member of Parliament for Edinburgh and Lord Provost of the city recalled “last summer we read Livy for a great part of the day”, and Lord Cockburn wrote “The great educator was the tawse, a thick leathern thong, cut into stripes, which when brought down with great force upon the hand, was very painful, often leaving marks of coagulated blood.”3 Other contemporaries were James Abercromby, Speaker of the House of Commons, and the brothers Leonard and Francis Horner. Leonard was a founder of the School of Arts for the Instruction of Mechanics, (now Heriot-Watt University), and of the Edinburgh Academy and later the first Warden (Principal) of University College, London. Francis went on to Edinburgh University, where he read for the Scottish Bar and later for the English Bar, becoming a Member of Parliament and dying at the early age of 39 - he is commemorated by a memorial in Westminster Abbey. Another contemporary was Andrew Geddes; later to paint the portraits of both James Wardrop, now hanging in the Royal College of Surgeons, Edinburgh (Figure 1), and his father, whose portrait is in the Aberdeen Art Gallery.

*”the pleasure grounds of a country mansion”, Chambers’s Scots Dictionary

Figure 1: James Wardrop in his twenties. Portrait by Andrew Geddes. Reproduced by kind permission of the Royal College of Surgeons of Edinburgh

Although it had been intended that he should join the Navy, Wardrop became very interested in Natural History. As a result, he was apprenticed when he was 18, on the same day as James Keith, to the celebrated Benjamin Bell, James Russell and his Uncle Andrew Wardrop, ‘surgeon apothecaries’, in 1800.⁴ Three months earlier the same masters, who combined to take on apprentices, had accepted John Henry Wishart of Foxhall to whom Wardrop was later to dedicate one of his books.⁵ Andrew Wardrop had been elected one of the Presidents of the Royal Medical Society in 1777, Deacon of the Incorporation of Surgeons and the first President of the Royal College of Surgeons of Edinburgh, James Russell became the first Regius Professor of Clinical Surgery in 1803, a chair he held for 30 years. The young student learned anatomy from Alexander Monro Secundus and John Barclay in his extra-mural school. It was the need to provide accommodation for Barclay’s collection of specimens, principally of comparative anatomy, later given to the College, which required the removal of the College to new premises in 1832. Wardrop was elected a house surgeon to the Royal Infirmary, then in the William Adam building in Infirmary Street, and while there he performed the experiment of amputating the thigh of a boy to ascertain whether he possessed that temperament which would enable him to undertake the practice of surgery. He went to London in 1801 for studies under John Abernethy and Astley Cooper at St Thomas’s, Guys and St George’s Hospitals. Astley Cooper, who had himself studied in Edinburgh in 1787, had a large practice and once charged a wealthy planter from the West Indies a fee of 1000 guineas for the removal of a bladder stone.

Wardrop subsequently moved to Paris in 1803 “with pluck and perseverance” for further studies evidently becoming aquainted with the work of Dupuytren and Marie Francois Xavier Bichat. Three weeks after his arrival war was declared between France and Britain and Wardrop, who lived in a room in a quiet spot in the Ecole de Medecine, contrived to keep his whereabouts a secret from the police, as British subjects were arrested as prisoners of war during the Napoleonic war. However, he was eventually interned in Fontainbleau with other Britons where they diverted themselves with picnics in the woods. He practised swimming in the canals, thinking he might have to swim across the river Rhine in order to escape, but also travelled secretly back to Paris on several occasions to resume his studies, and made sketches in the Louvre. Wardrop obtained a false passport as an American merchant and made for Antwerp, hoping to sail to America, but when he reached the port there were no more sailings. He then headed for Germany, crossing the Rhine at Coblenz and being greatly relieved on reaching freedom. He travelled to Vienna in 1803, where his friend John Wishart was studying ophthalmology with George Joseph Beer,² then the most eminent eye surgeon in Europe. Fourteen years later William Mackenzie from Glasgow was also to study under Beer.

Upon his return to Edinburgh, Wardrop at first concealed his preference for surgery, but was admitted a Fellow of the Royal College of Surgeons there in 1804 after an examination. He worked in the Public Dispensary in the Cowgate and set up in surgical practice at 4 South Hanover Street with his uncle to whom he had been apprenticed. He began to take a special interest in diseases of the eye and, in 1807, became assistant to Professor John Thomson, then College Professor of Surgery and first Regius Professor of Military Surgery as a curator of the museum of the College of Surgeons. The first volume of the General Catalogue contains entries in his own hand of specimens, some of which he donated himself. ^7,8He took part in the meetings of the Royal Medical Society and the Medico-Chirurgical Society, and his first publication was in the Edinburgh Medical and Surgical Journal, in 1806,9 reporting a case of crural hernia which he had seen in Paris illustrated with a drawing of his own (Figure 2).

Wardrop published further case reports in 1807, and in the same year a series of “Observations on the effects of evacuating the aqueous humour in inflammation of the eyes and on the changes produced in the transparency of the cornea, from the increase or diminution of the contents of the eyeball.” ^10-12 This followed on work by John Barclay who had described opacification of the cornea of a bullock’s eye after the ophthalmic veins had been injected with mercury. ¹³ Five cases are described in patients between 13 and 45 years, who were suffering from uveitis and possibly secondary glaucoma, but not primary angle-closure glaucoma. This was followed in 1808 by “Practical observations on the mode of making the incision of the cornea for the extraction of the cataract” in which Beer’s knife, oiled to make it cut more keenly, was used perpendicular to the surface, preventing aqueous escape. ¹⁴ Nearly 200 years later, the incision for removal of cataract is still a contentious issue among ophthalmologists. In the same year he produced his first textbook, volume one of “Essays on the Morbid Anatomy of the Human Eye”. ¹⁵ He dedicated this to his uncle Andrew Wardrop MD, FRS with these words, “This essay is inscribed as a testimony of the author’s gratitude, for the professional advantages derived, and the benefits experienced, from the kindness of an affectionate relative, and sincere friend.” It is devoted to corneal disease and he uses the word “keratitis” for the first time and describes diseases of the eye in terms of its different component parts, whereas writers had previously referred to “Ophthalmia.” He describes keratitic precipitates accurately, but attributes them to inflammation of Descemet’s membrane. In the “Preliminary Observations” he states “For this beautiful organ is not only composed of a great variety of textures, but the transparency and ready examination of many of its parts in the living body, admit of a great minuteness and accuracy of observation, and the various morbid changes can be seen going on much more distinctly than in any other part of the body.” In 1809 this was followed by another key work, “Observations on the Fungus Haematodes” ¹⁶ (Figure 3), a description of 17 cases of a condition named in 1805 by William Hey of Leeds, who was an Honorary Member of the Royal Medical Society of Edinburgh, although this was subsequently renamed retinoblastoma. ¹⁶ Wardrop amassed information from previous authors, adding information from his own clinical and pathological experience identifying that the disease arose in the retina, spread into the optic nerve and recommended early enucleation, although in a tumour of childhood this was not feasible prior to the advent of effective general anaesthesia. Wardrop also wrote the article on Surgery for the Encyclopedia Britannica at this time. ¹⁷

Figure 2: Crural hernia; engraving of a drawing by James Wardrop. Reproduced by kind permission of the Royal College of Surgeons of Edinburgh

Wishart was to remain in Edinburgh until he died in 1854 but Wardrop, wanting a practice of his own and finding no immediate opening in surgery, decided to return to London in 1808 living first in rented accommodation in York Street before finding a house at 2 Charles Street, St James Square, where he lived until his death. He consulted from his house and drew patients from the expatriate Scots while probably teaching at private schools of medicine. He also treated members of the Prince Regent’s household in Carlton House nearby, and came to the attention of Sir Benjamin Broomfield, the Prince’s secretary and Lord Lowther, a close friend, who recognised his service to the Royal Household by appointing him Surgeon Extraordinary. He also knew Matthew Baillie, whose mother, Dorothea, was the sister of John and William Hunter to whose private museum he had access. He did not publish much, probably trying to make his way in London without obtaining a teaching hospital appointment.

He published the 2nd volume of “Essays on the Morbid Anatomy of the Human Eye” in 1818 with a view to enhancing his practice and increasing his income. ¹⁸ This work of 55 short chapters he dedicated to his friend John Wishart. Topics include aqueous humour, iris, choroid, lens, vitreous, sympathetic ophthalmia, amaurosis, night-blindness, colour vision, squint and “involuntary motion of the eyeball” (nystagmus). Of the iris he aptly describes, “In some cases where the operation for cataract has been performed, and where the iris remains apparently uninjured and the pupil of its natural form, the iris has been observed to have a very singular undulatory motion being agitated to and fro like a piece of cloth exposed to a fluctuating wind,” an excellent description of iridodonesis. This book contains the first published reference to sympathetic ophthalmitis.¹⁹ As a text, it remained influential into the second half of the 19th century and preceded William Mackenzie’s “Treatise on the Diseases of the Eye” by12 years. ²⁰

In 1818, he also published a report “On the effects of evacuating the aqueous humour on the different species of the inflammation of the eyes and in some diseases of the cornea.” ²¹In 57 pages he describes 17 cases including two of particular interest. The first was a 50-year-old man whose condition was of 2 weeks duration and who, after the paracentesis performed with Cheselden’s needle ”immediately could perceive a finger with a ring” and whose cornea “immediately regained natural transparency.” The second was a middle-aged woman with a 4-day history of violent pain in the forehead, and large vessels (ciliary flush), who “at once lost all the appearances of inflammation.” He compares the sudden removal of tension to the evacuation of an abscess, and was obviously treating angle-closure glaucoma although he did not know it.

Figure 3: Illustration from “Observations on the fungus Haematodes”. Reproduced by kind permission of the Royal College of Surgeons of Edinburgh

In the same year he was appointed Surgeon Extraordinary to the Prince Regent, the eldest son and heir to King George III who was intermittently incapacitated by mental illness now thought to have been an effect of acute porphyria. It is a matter of conjecture how Wardrop came to the attention of the Prince Regent, but they both shared an interest in hunting and horse racing. Wardrop has been described as “one of the best judges of horseflesh in the kingdom,” and at this time he treated one of Lord Lowther’s horses for an eye condition. This, and a long-standing love of horses, would help him achieve recognition at court. The Prince of Wales had enjoyed great success with 190 winners between 1778 and 1791. ²² However, on 20th October 1791 the King’s horse Escape ridden by Sam Chifney was badly beaten at Newmarket, only to run again the next day and win easily at 5-1 against. There was an enquiry and no impropriety was proved, but the King gave Chifney �200 and gave up racing for several years. ²³ It may have been at Newmarket, Epsom, Ascot or Lewes that the Prince and Wardrop met. Certainly, Wardrop occasionally went to see the king’s horses professionally at Windsor, and in conversation with the grooms established that when a horse suffered a severe injury to one eye, they treated it with caustic or by eviscerating it with a nail to avoid the onset of inflammation in the fellow eye. This observation is one of the earliest on the subject of sympathetic ophthalmitis, and the principles of treatment remained valid until the arrival of corticosteroid drugs in 1950. In 1819, he won a prize offered by the Board of Agriculture for an essay on the diseases of the eye of the horse and on their treatment. ²⁴

On the death of his father in 1820 the Prince Regent succeeded to the throne as George IV and in 1822, took his famous jaunt to Scotland when he was accompanied by two medical advisers, Sir William Knighton and James Wardrop. Knighton had trained in Guy’s Hospital, London, and obtained an MD degree from St Andrews University in 1800 with testimonials from Dr Luke of Falmouth and Dr Aimsworth of Devon. ²⁵ He attended classes in Edinburgh in 1803, at the time Wardrop was in Paris and Vienna, and obtained an MD from Aberdeen in 1806. He was a courtier, and was created baronet in 1812 at the age of 36. He gave up medical practice in 1822 to be full time Keeper of the Privy Purse to George IV. The Royal Party stayed at Dalkeith Palace where Wardrop was called to attend Knighton on account of “ophthalmia”, for which he “bled him copiously which gave him instant relief.” The King himself had entered the room during the procedure and began talking to Wardrop about what he was doing, and then about their common interest in horses. Wardrop then returned to stay with his father at his house in Lauriston Lane.

In 1825 Wardrop edited the 6th edition of Morbid Anatomy, the Works of Matthew Baillie with an account of his life. ²⁶Baillie had died in 1823 after having the largest medical practice in London. He was born in the manse of Shotts, Lanarkshire where his father was a minister, later to be Professor of Divinity at Glasgow University. The first edition of his work was published in 1793 and the engraving of emphysema of the lung is in fact that of Dr Samuel Johnson. He is credited with being the first British pathologist.

Wardrop joined with William Willocks Sleigh in 1826 to found the West London Hospital of Surgery, first in Nutford Place, off Edgware Road, then in Panton Square. This charitable institution was where he gave the service to the sick poor formerly provided from his own house. A feature was the weekly concours attended by 50-80 doctors, including every scientific foreigner who happened to be in the metropolis. It was paid for largely by Wardrop himself, but closed after 7 years. Also in 1826, with William Lawrence he began to lecture on surgery at the Aldersgate Street School of medicine. Some years later, Wardrop is said to have joined the Hunterian or Great Windmill Street school as a lecturer in surgery. ²⁷ Lawrence was one year younger than Wardrop, and in 1814 he was appointed to the Infirmary for Diseases of the Eye, later Moorfields Eye Hospital. He was accused of blasphemy for writing “Physiology, Zoology and Natural History of Man” and “An Introduction to Comparative Anatomy and Physiology”, because they described mankind as one of the animal species. He withdrew the publications, but being popular they continued to be printed without his consent. With Thomas Wakley, who had founded The Lancet in 1823, he headed a public agitation against the management of the Royal College of Surgeons of England in 1826, chairing meetings - at which Wardrop was prominent - held in the Freemason’s Tavern. In 1824, the court of examiners had issued a by-law making it compulsory for medical students to attend the lectures of the surgeons appointed to London hospitals unless they obtained certificates from the professors of anatomy and surgery of Dublin, Edinburgh, Glasgow or Aberdeen Universities. ²⁸ This would be disadvantageous to the students of many excellent anatomists outside London, as well as being an abuse of power. Wardrop and Lawrence subsequently appeared before a committee of the House of Commons to give evidence. Elected to the council of the English College, in 1828, Lawrence was President twice, in 1846 and 1855 when he “steadily maintained its privileges against all agitations”. He had written a treatise on “Some Practical Points Relating to Diseases of the Eye” ²⁹ in 1833 in which he referred extensively to published work by Wardrop. He has been credited wrongly with being the first to describe sympathetic ophthalmia, as a distinct disease, and to draw attention to the increase of intra-ocular pressure in glaucoma. ³⁰ Lawrence was appointed first Surgeon Extraordinary, then Sergeant-Surgeon to Queen Victoria, and died in 1867 aged 84 after being seized with a paralysis of the right side while walking up the staircase to examine in the Royal College of Surgeons in Lincoln’s Inn Fields.

In 1828, Wardrop published “On Aneurism and its cure”,³¹ a book of 117 pages and seven plates. He presented a copy to the Royal College of Surgeons of Edinburgh, and describes distal ligation of the root of the carotid artery with an aneurysm of recent origin, brought on by a fit of coughing. The patient aged 75 years, survived for some years thereafter. The operation of distal ligation had been described by Brasdor of Paris and Desault and performed by Deschamps and Astley Cooper with unsatisfactory results. Astley Cooper was appointed Sergeant-Surgeon in the same year as Wardrop became Surgeon-in-Ordinary to the king, although Wardrop declined a baronetcy because, it is said, he could not afford it.

By the spring of 1830, King George IV became ill. More obese than his portrait painters or sculptors dared to depict, he was increasingly immobilised, breathless and lacking sleep. He was visited by Wardrop at the end of March who was alarmed by what he found and urged Sir Henry Saunders to see him on account of the condition of his heart. A month later he was summoned back to Windsor. We are told that the following conversation took place:

The King in a firm tone, “Tell me, my good friend, what you think, really and truly is the matter with me, for I am confident that there is something more serious than - and the name is omitted - either thinks or chooses to tell me”, and then in a manly tone, “Tell me Wardrop, honestly if you think I shall recover.” ³²

Wardrop recommended stimulants to the legs and feet and leeches to the region of the heart.

Thereafter, Wardrop was denied access to the King, who was attended by Sir Henry Halford and Sir Benjamin Brodie. Halford was the King’s physician, and seems to have been an unattractive man. He married an aristocrat and had changed his name from Vaughan in 1809 on inheriting a large property. When the body of Charles I was exhumed in 1813 he removed the fourth cervical vertebra through which the executioner’s axe had passed, and used to show it to his dinner guests. ³³ He was President of the Royal College of Physicians of London for 24 years from 1820 until his death and was physician to four monarchs, George III and IV, William IV and Queen Victoria. George IV expired at a “quarter past 3 o’clock without pain” ³⁴ on the morning of June 26 1830. The daily bulletins which had appeared for 2 months on the King’s condition had not prepared the country for his death. Immediately, Henry Brougham, former pupil of the High School in Edinburgh, spoke in the Commons criticising the government for fraud and deception, falsehood and treachery. The speech was reported in the next week’s Lancet ³⁵ with an editorial strongly critical of Sir William Knighton “this obstetric doctor”, who was dismissed from the office of Keeper of the Privy Purse.

There follows the report of the post mortem examination conducted by Sir Astley Cooper commenting on pleural effusions and ossification of the aortic valve with rupture of a blood vessel in the stomach as the immediate cause of his Majesty’s dissolution. ³⁶ Wardrop had been friendly with Wakely, the editor of The Lancet and the publication of Saturday 3rd July 1830 bears his stamp. On the King’s death, Wardrop sent an account to the executors for 1200 guineas. Knighton objected to the size of the demand, but the Duke of Wellington inquired what services had been rendered. Knighton replied that he had been down to Windsor occasionally to see the King’s horses. “If he has done the work,” said the Duke, “for which he charges, he shall be paid.” And he was paid every farthing. ³⁷ More was to follow, for from 1833 there appeared also in the Lancet a series of “intercepted letters” written anonymously and purporting to come from Brodie, Halford and MacMichael, librarian of the Royal College of Physicians of England. These referred to medical affairs in London and at the court of George IV in defamatory terms. The effect of this was to diminish Wardrop’s private practice and alienate him from the medical establishment of the time. He became a pariah, an outcast, further aggravated by his jealousy of Robert Liston who came to the chair of surgery at University College, London in 1835 who bemoaned the fact that “Jemmy Wardrop blocks me out of practice with the Scotch nobility.” ³⁸ Liston, son of the manse of Ecclesmachan, had also been in dispute with Barclay and Syme in Edinburgh, and been “prohibited from entering the Royal Infirmary at any time, or on any pretence whatever,” ^3,39 He displaced Wardrop in his close relationship with the editor of the Lancet and further articles about him appeared. ^40-42 He was also generous to those less fortunate than himself but his star waned with the death of George IV and he was left with very little consulting practice except among the old Scottish nobility in London.

Figure 4: Inscription on the flyleaf of On the Nature and Treatment of Diseases of the Heart. Reproduced by kind permission of the Royal College of Surgeons of Edinburgh

Wardrop hated to be imposed upon and told with glee how he had unmasked one who sought to take advantage of his generosity. He was in the habit of giving advice in the morning to the poor and was one day called out to see a patient in St James’s Square. On returning to his house he observed an old gentleman very shabbily dressed alighting from a carriage with a coronet on the panels. He immediately recognised one of his “gratuitous” patients. He waited unobserved until the old fellow had turned the corner of Charles Street. He then ascertained that his patient was actually an Earl. In due course the Earl was ushered into the presence of Wardrop, who rose from his seat and received the shabby nobleman with great courtesy, and addressed him by his proper name. The detected imposter was thunderstruck, and anxious to beat a hasty retreat, but was not allowed to do so. Wardrop upbraided him for his meanness and duplicity, and made him pay a guinea for every visit he had made. ⁴²

In 1813 Wardrop married Margaret, daughter of Col. George L Dalrymple of Leuchie House, North Berwick, East Lothian. She had been married before, to a Captain Burn in 1796, so would have been older than him. They had four sons and a daughter together.

Sir William Knighton died in 1836 and on the day he died his widow wrote to Wardrop, “It was the earnest desire of my late dearest husband, towards the close of his illness, to have requested you to come to his bedside, in order that he might have expressed to you his entire good-will after the misunderstanding that occurred between you at the time of the late King’s illness, when hurry and anxiety of mind caused what you imagined an omission towards you.” ⁴³ In the 7 years after the King’s death he published a second edition of “Essays on the Morbid Anatomy of the Eye”, On blood-letting, a second edition of “On Aneurism and its Cure” and “On the Nature and Treatment of Diseases of the Heart”, which ran to three editions in 1837, 1851 and 1859. ^44-47 The copy of the second edition of the last named is in the Royal College of Surgeons of Edinburgh and is uncut after 150 years; it is inscribed “For the Royal College of Surgeons from the Author” (Figure 4). He also presented a copy to the University of St Andrews. The book is dedicated “From the Author to James Simpson M.D. It is a particular pleasure to me to think, that it should have been on the same spot of that land as yourself wherein I drew the first breath of life!”, a reference to their origins in West Lothian. Simpson had introduced the anaesthetic effects of chloroform 4 years earlier. Wardrop had also obtained an honorary degree of Doctor of Medicine from St Andrews University in 1834. ⁴⁸

This was followed by the Fellowship of the Royal College of Surgeons of England, one of the founder fellows in 1843. He contributed two sections to a Cyclopedia of Surgery, an ambitious project with several notable authors, which ceased publication after the letter ‘G’. ⁴⁹

Wardrop was a notable collector of pictures and in 1850 he gave two of them to the newly founded National Gallery of Scotland. He wrote, “Having spent so many of my early days in Scotland, and been there taught the first elements of drawing by Professor Grahame I naturally associate the enjoyments which the fine arts have throughout a long life afforded me, as well as the professional benefits I have derived from them, and I am therefore proud to be permitted to contribute, in the smallest degree, to my fellow countrymen that source of pleasure.” ⁴⁹

As well as the portrait of him as a young man, there were portraits by Thomas Musgrove Joy in the Scottish National Portrait Gallery, and Robert Frain. The portraits do not show it clearly but he had a divergent squint with one eye more prominent than the other, probably the left, and in later life the cornea became opaque. Possibly he was highly myopic in that eye and developed a retinal detachment later, a condition which was described as amaurotic cat’s eye and which he wrote about in “Essays on the Morbid Anatomy of the Human Eye”. This was first successfully treated in 1919 by the Swiss ophthalmologist Jules Gonin. Wardrop eventually became blind from some time in the 1850’s and became an invalid seldom leaving his house, although generally cheerful and chatty with friends who came to see him (Figure 5). He died shortly after his wife, on February 13th 1869 at the age of 87 in his house in St James’s, London. At his request he was buried in the Old Kirk in Bathgate near his mother, who had died when he was very young. His resting place there is marked in the simplest way by a small stone inscribed “J Wardrope 1869.”

Figure 5: James Wardrop in old age. Reproduced by the kind permission of the President and Council of the Royal College of Surgeons of England

How was his work perceived by his contemporaries and those who came after him? In his Hunterian Oration of 1871, Sir William Fergusson, Professor of Surgery at King’s College and President of the Royal College of Surgeons of England said, “The grave has recently closed over the mortal remains of James Wardrop, Sir William Lawrence, Joseph Hodgson, Sir James Young Simpson and James Syme. It has seldom happened that so many distinguished men have had claims for notice on occasions similar to this.

James Wardrop possessed great natural abilities, and was an original thinker and actor......his Observations on Fungus
Haematodes forms to this day the standard work, I may say the only one on the subject worthy of special note. The fact that he was the first surgeon in England who, after the example of Dupuytren, removed a tumour in the lower jaw by total vertical section of the bone, places his name on the list of high-class practical surgeons, and his modification of Brasdor’s operation (for aneurism), his original distal operation and the effect that all have had on this department of practice bring his name in association with Hunter’s as closely as any other in British surgery.” ⁵¹

In the 20th century, in the of 1964 Edward Jackson Memorial Lecture to the American Academy of Ophthalmology E.B.Dunphy said, “I think the credit for really establishing retinoblastoma as an entity belongs to James Wardrop of Edinburgh.” ⁵² Albert and Edwards in their History of Ophthalmology state “The founder of ophthalmic pathology was James Wardrop. He was the first to describe retinoblastoma as a specific entity with enucleation as its suggested treatment.” ⁵³

James Wardrop kept a journal that was passed down to his family and has never been published. How fascinating it would be to discover his record of the medical, social and political events of his time at the forefront of clinical practice and in a spectrum of circumstances.

We do well to recall the difficulties of both patient and surgeon in those times. Perhaps the last word should be with William Mackenzie in whose “Treatise on Diseases of the Eye”, the first British textbook of ophthalmology, there is a description of a couching operation for cataract, of which the outcome is not reported, performed by Wardrop in 1813. “The patient was a deaf and blind boy of 15 who seemed to be quite reconciled to his operation. However, when pressure was applied to the eye, he became very violent and it was impossible to secure his head. A second attempt was equally unsuccessful, but he was finally immobilised in a wooden box that folded over his body and was secured by ropes. There was naturally much difficulty in opening the eyelids and steadying the eye, but once the needle touched the eye he remained quite steady and his dreadful frenzy ceased.” ⁵⁴

1. Edinburgh Evening Courant, 6 March 1786
2. Pettigrew TJ. Medical Portrait Gallery, Vol 2. London:Fisher, 1839
3. Murray J. History of the Royal High School published privately, Edinburgh 1997
4. Wood M (Ed.) Register of Edinburgh Apprentices, 1756-1800. Edinburgh:Scottish Record Society, 1963
5. Wardrop J. Essays on the Morbid Anatomy of the Human Eye, Vol. 2. Edinburgh: Constable. 1818
6. Gray J. History of the Royal Medical Society 1737-1937. Edinburgh: Edinburgh University Press, 1952
7. General Catalogue of the Pathological Museum of the Royal College of Surgeons of Edinburgh, Vol.1. Edinburgh: The Royal College of Surgeons of Edinburgh, 1807
8. Tansey V. and Mekie DEC. The Story of the Museum, Royal College of Surgeons of Edinburgh, 5 (typescript). Edinburgh, 1978
9. Wardrop J. Edin Med Surg J 1806; 2: 203
10. Wardrop J. Observations on the effects of evacuating the aqueous humour in inflammation of the eyes. Edin Med Surg J 1807; 3: 56
11. Wardrop J. Movable body in the vaginal coat of the testis.
12. Wardrop J. Observations on the Effects of Evacuating the Aqueous Humour in Inflammation of the Eyes and on the Changes Produced in the Transparency of the Cornea, from the Increase or Diminution of the Contents of the Eyeball. Edinburgh: Constable, 1809 Edin Med Surg J 1807; 3: 421
13. Barclay J. The Muscular Motions of the Human Body. Edinburgh: Laing, Constable, London: Longman, Hurst, Rees and Orme, Longmans, 1808: 479-80
14. Wardrop J. Practical observations on the mode of making the incision of the cornea for the extraction of the cataract. Ed Med and Surg J 1808; 5: 1
15. Wardrop J. Essays on the Morbid Anatomy of the Human Eye, Vol.1. Edinburgh: Constable, London: Murray, 1808
16. Wardrop J. Observations on the fungus haematodes. Edinburgh: Constable, 1809
17. Encyclopaedia Britannica, 5th ed. Vol.20 Edinburgh:Constable, London: Gale and Fenner, York:Wilson, 1817
18. Wardrop J. Essays on the Morbid Anatomy of the Human Eye, Vol 2. Edinburgh: Constable, 1818
19. Rutkow IM. Surgery, an Illustrated History. St Louis: Little Brown, 1993
20. Mackenzie W. Treatise on Diseases of the Eye. London: Longman, Rees, Orme, Brown and Green, 1830
21. Wardrop J. On the effects of evacuating the aqueous humour on the different species of the inflammation of the eyes and in some diseases of the cornea. London,1818
22. Clarke JF. Med Times Gaz, 1869;1: 229
23. Richardson J. George IV: a Portrait. London: Sidgwick and Jackson, 1966
24. Wardrop J. An Essay on Diseases of the Eye of the Horse and on their Treatment. Macmillan: London, 1819
25. Minutes of the University of St Andrews, 1800; 10: 256 (It is interesting to note that at the subsequent meeting the following occurred: “The Rector informed the meeting that he had called it for the purpose of considering the propriety of an address to his Majesty on the occasion of his providential escape from the late treasonable attempt made on his life at the Theatre in Drury Lane” p 257.
26. Wardrop J. Morbid Anatomy, the Works of Matthew Baillie with an account of his life. London, 1826
27. Power D’A, Spencer, WG. and Gask, GE. Plarr’s Lives of the Fellows of the Royal College of Surgeons of England. London: John Wright & Sons Ltd., Simpkin Marshall Ltd., Vol 2, 1930
28. Wakley T. Dictionary of National Biography, Vol. 59. London: Smith Elder, 1899
29. Lawrence W. Treatise on Some Practical Points relating to Diseases of the Eye. London: Bohn, 1833
30. Rutkow IM. Surgery, an Illustrated History. St Louis: Little Brown, 1993
31. Wardrop J. On Aneurism and its Cure by a New Operation. London: Longman, 1828
32. Obituary. James Wardrop M.D. Lancet 1869; 20: 280-1
33. The Late Mr Wardrop (with a note on Brodie and Halford). Med Times Gaz 1869; 27: 229
34. The King’s Death. Lancet, 1830; 1: 546
35. The Bulletins. Lancet, 1830; 1: 546-50
36. Official report of the morbid appearances which were observed at the post-mortem examination of the body of his late majesty George The Fourth. Lancet, 1830; 1: 550-1
37. The Late Mr Wardrop. Med Times and Gaz 1869; 1: 229
38. Clarke JF. Obituary, James Wardrop, M.D., Surgeon to George IV. Med Times Gaz 1869; 20: 207-8
39. Comrie JD. History of Scottish Medicine, Vol 2. London: Wellcome Historical Medical Museum, 1932
40. Wardrop J. Lectures on the Sanguineous System. Lancet 1833; 1, Lectures in Surgery. Lancet 1833; 2
41. Barry J. Lancet 1833; 2:421
42. Clarke JF. Obituary. Med Times Gaz 1: 207 1869
43. Pettigrew TJ. Medical Portrait Gallery, Vol. 2. London: Fisher, 1839
44. Wardrop J. Essays on the morbid anatomy of the eye, 2nd edn. London: Churchill, 1834
45. Wardrop J. On Blood Letting. London: Baillere,1830
46. Wardrop J. On Aneurysm and its Cure by a New Operation. London: Longman 1828
47. Wardrop J. On the Nature and Treatment of Diseases of the Heart. London: Churchill, 1837
48. University of St Andrews Minutes, 1834; 15: 103
49. Costello WB. Cyclopedia of Surgery. London: Sherwood, Gilbert and Piper, 1841
50. Thompson C. Pictures for Scotland - The National Gallery of Scotland and its Collection. Edinburgh: National Gallery of Scotland, 1972
51. Fergusson W. Harveian Oration, 1871
52. Dunphy EB. AJO 1964; 58: 539
53. Albert DM and Edwards CC. History of Ophthalmology. Oxford: Blackwell Scientific, 1996
54. Mackenzie W. Treatise on the Eye. London: Longman, Rees, Orme, Browne and Green, 1830

HISTORICAL REVIEW

James Wardrop (1782-1869): from Whitburn to Windsor Castle

SIR JULES THORN EXHIBITION AND MENZIES CAMPBELL DENTAL MUSEUM

6th August - 1st September 2001

AN EXHIBITION OF THE HISTORY OF SURGERY FROM 1505 TO THE PRESENT DAY

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