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The first organised medical relief in Belfast was given by the Belfast Charitable Society in 1774 to persons attending the old poorhouse1,2. The Belfast Charitable Society is Belfast's oldest charitable foundation, and Clifton House is the oldest public building in the city still substantially in its original state. The aim of the Society was to grant support to the increasing population of the developing Belfast, with benevolent industrialists helping to assist the voluntary work of physicians, most of whom earned their income from lucrative private practice. In 1797, with the growth of epidemics, including typhus fever, the first hospital in Ireland for fever opened with six beds in a small terrace house in Factory Row, Belfast to be known as The Belfast Fever Hospital, which became the Belfast General Hospital (1847) and later, by royal charter, the antecedent of the Royal Victoria Hospital2. Dermatology in Belfast was to ultimately benefit from the Belfast Charitable Society, which provided two grants for land for the first dermatology hospitals, the first being in Regent Street, and later at Glenravel Street, as well as from its allied benefactors.
The Belfast City Hospital started as one of Belfast's workhouses, and built to deal with 1,000 patients, opened its doors in January 1841. Tents had to be used to increase its capacity during the Potato Famine between 1845–72.
The first medical school in Belfast was established in 1818 in the Royal Belfast Academical Institute and transferred in 1849 to the newly established Queen's college and later (1908) the Queen's University Belfast. Before this some 300 medical students left Ulster to train mainly in Dublin or Edinburgh, and for some years following the establishment of Queen's University, some students still preferred to receive their medical education outside Ulster, where the standard was still considered superior.
There is no record of any specific provision for the treatment of skin diseases in Belfast prior to 1865, although by this time a skin clinic was conducted in the Adelaide Hospital in Dublin by Dr Walter G Smith3.
Specialist hospitals began to appear across the British Isles around the 1860's. They treated conditions, which were seen as less glamorous areas of medicine, neglected by the general voluntary hospitals. Relatives of those affected by a disease sometimes started a specialist hospital and more entrepreneurial doctors, with an interest in these conditions started their own hospital, usually in a converted house with a few beds. Success or failure depended on attracting charitable interest, as attracting patients was never a problem. Specialists found that such hospitals gave them the opportunity to study more examples of any single disease than would be found in the general hospital. Common specialist hospitals included those for dermatology, venereal diseases and for “cripples” with orthopaedic conditions. Specialist hospitals caused struggles within the medical profession, and the British Medical Journal ran a campaign against them in the 1860's, arguing that they drew away interesting cases from general hospitals.
The first record of dermatology in Belfast is in 1865, when Henry Samuel Purdon (1843–1906), aged 22, established the ‘Belfast Dispensary for Diseases of the Skin’ at a house in Academy Street3. Purdon received his medical training in Glasgow, and when he returned to Belfast, he realised the need for a dermatological service and decided to specialise in skin disease. Finances were always stretched, and at stages Purdon asked his many sisters to donate some of their pocket money to keep the dispensary running. During that time Purdon used his artistic talents to create wax models of skin, particularly that of lupus vulgaris, particularly prevalent at the time. With increasing demand the clinics grew and the house in Academy Street in 1866 quickly assumed the title of “The Belfast Hospital for Diseases of the Skin”. Purdon's interests extended beyond dermatology: he was one of the physicians to the original Forster Green Hospital for Chest Diseases, which commenced its career at the corner of Great Victoria Street and Fisherwick Place.
By 1868 the original building was becoming too small for requirements and the committee were granted funding from the Belfast Charitable Society, to build a new hospital in Regent Street, which was opened in 1869. The new building provided mainly out-patient facilities, but also had 8 in-patient beds. The out-patient department and operating theatre were considered adequate, commodious and up-to-date. As reputation spread, patients came not only from Belfast but also from surrounding counties.
Within four years of the opening of the Regents Street Skin hospital, despite increased bed numbers of 14, clinical needs had become too great for the space available. Once again financial restrictions were to become too great and in 1873 a public benefactor; Edward H Benn financed the building of a brand new skin hospital at a cost of £40001. The hospital was regarded as the most complete of its kind in the United Kingdom, and Purdon stated in the preface to one of his books (“Cutaneous Medicine and Diseases of the Skin,” 1875), it “contained thirty beds and a suite of baths of every description.”3 It was also well equipped with its own pathology laboratories, operating rooms and pharmacy. The Belfast Charitable Society offered a site for construction at Glenravel Street and in 1875 the new Benn Skin Hospital was opened. Glenravel was the site of the iron ore deposits in County Antrim owned by the Benn family. Professor J.F. Hodges, whose home, Glenravel House, gave Glenravel Street its name, was Professor of Medical Jurisprudence at the developing Queen's University. He was elected president of the Benn Hospital and served in this capacity for 20 years.
In addition to his clinical commitments, Purdon was heavily involved in undergraduate teaching. He became widely known in developing dermatological circles in the UK, Europe and the US, as a corresponding member of the New York Dermatological Society. In 1870, Purdon acquired the position of Editor of the Journal of Cutaneous Medicine at the age of 26 years. Despite his best efforts, financial support for the journal became inadequate and the journal ceased publication, with the British Journal of Dermatology taking its place in 18881.
Edward Benn, one of Belfast's greatest philanthropists.
Dr Henry Purdon was appointed as an attending physician to the General Hospital in 1870, with an interest in dermatology, though with no designated responsibility in dermatology. Dr Purdon resigned from the hospital staff in 1882, unusually without ever having been made a Consultant Physician. This left a hiatus in dermatology services until McGaw re-established dermatology at the Royal Victoria Hospital in the 1900's.
Amid a busy practice Purdon continued active work at Glenravel Street Hospital until about 1900; his assistants were his son, Elias Bell Purdon and Samuel William Allworthy, both of whom were appointed in 1893. The half-century of excellent work carried out at the Skin Hospital by these two physicians is well known, and only ceased there when the hospital was destroyed in an air-raid in May 1941. Elias Bell Purdon, Henry Samuel Purdon's son, was the fourth generation of his family to attend as physician to the Belfast Charitable Society, and at the time of his death, his family had given 143 years unbroken service to the Society1.
During a bombing raid in the Second World War the Benn Skin Hospital was badly damaged and it was decided not to rebuild it but to use funds for the improvement of the amenities in the nearby and developing Royal Victoria Hospital3. Dermatology remained a mainly outpatient specialty, with a few dermatology beds in ward 22 in the Royal Victoria Hospital, introduced in 1951. A dermatology ward was finally established in 1957 (ward 26) and H.S. Purdon's service to dermatology was recognised by naming this in-patient unit, ‘The Purdon Skin Ward’, a ward which was to become well know to generations of doctors and future dermatologists.
Samuel William Allworthy (1866–1952), a graduate of Trinity College, Dublin, had worked in the Finsen Institute Copenhagen and was instrumental in establishing radiotherapy in Belfast1. Like many of that era, he had not shielded his hands nor fingers against the effects of radiation and his hands became disfigured by X-ray burns and required amputation. During the air raid attacks on the Benn Hospital Dr Allworthy narrowly escaped being killed by an air raid on his own home.
Allworthy combined general practice with dermatology. He was also a consulting physician to the Royal Victoria Hospital and to the Belfast Charitable Institute. He served in the First World War as a skin specialist, and was a vice-president of the section of dermatology when the BMA met in Belfast in 19371.
William Calwell (1859–1943) was educated at Queen's University Belfast, and in 1893 he was the first appointed registrar in the Royal Victoria Hospital. He was initially appointed as a physician to the Royal Victoria Hospital in 1895, and established weekly skin clinics in the Royal Victoria Hospital in around 1910, which he continued until his retirement in 1924. He remained however, a general physician but the first at the Royal to be given the title of “dermatologist”.
Ivan Henry Mc Caw (1897–1961) was the only son of Dr John Mc Caw, a pioneer of paediatrics in Belfast. I.H. Mc Caw had been prevented from a surgical career because of a wound to his right shoulder in the Battle of Messines in 1917. After training in dermatology in Guy's hospital and Vienna, he returned to take charge of the Skin clinics after Calwell, where he single-handedly expanded the skin department at the Royal Victoria Hospital after his appointment in 1933 as its first full time dedicated dermatologist. It was under his stewardship that the Benn Hospital became integrated into the skin department at the Royal Victoria Hospital. He gave the annual lecture to new medical students at the Royal Victoria Hospital in 1944 on the subject of A Synopsis of the History of Dermatology. He became a president of the British Association of Dermatologists in 19481.
Jonathon Jefferson (1921–1968) after a period of dermatology training in London joined the staff of the Dermatology department of the Royal Victoria Hospital in Belfast where he greatly assisted Mc Caw in the expansion of specialty services in Northern Ireland. His main interest was in industrial dermatoses in which he had a very extensive practice. His early death at 47 years of age was a great loss to dermatology in this area. Jefferson was one of the first people to distinguish between the infective cases of Lyell's syndrome, occurring in childhood and caused, as he showed by a staphylococcal infection, from the largely drug induced toxic epidermal necrolysis of adults4. He proposed that the skin splitting occurring in the childhood form of Lyell's syndrome may be due to a staphylococcal toxin, which gave rise to the skin splitting5 and is probably the first description of the staphylococcal scalded skin syndrome. His paper in the British Medical Journal probably gives the first and best description of the entity of staphylococcal scalded skin in infancy.
Although little is written about Reginald Hall, he was held in the highest esteem by his colleagues. He was responsible for setting up the dermatology department in the Belfast City Hospital and had by far the largest number of beds in Northern Ireland at that time, “having 45 beds at our disposal for the treatment of skin diseases in the Belfast City Hospital, with an experienced nursing staff.”6 Because of his rather retiring personality, he seems less well known than many of his contemporaries, but has been described as an excellent clinician, and as he had qualified as a barrister, he was in much demand for medico-legal opinion. He was the founding member of the Irish Association of Dermatologists, having written to his counterparts in the Republic of Ireland requesting a closer association between dermatologists in both sections of the island.
After qualifying in Medicine in 1943 at Queen's University, Dr Martin Beare volunteered for service with the Royal Navy (1943–1946) where he served as a surgeon lieutenant7. After the war he spent time at St Thomas' Hospital studying dermatology under the renowned Geoffrey Dowling. He returned to his native Belfast and further trained under the only two dermatologists in Northern Ireland at the time, until his appointment in 1949 as consultant dermatologist at the Royal Victoria Hospital. He developed interests in paediatric dermatology, fungal diseases of the skin and small animal dermatology and contributed widely to the dermatology literature, including several original chapters in the first edition of the internationally renowned “Rook Book”, to which he was a regular contributor in subsequent editions. Dr Beare was president of the British Association of Dermatologists in 1984, when he hosted the BAD Annual meeting in Belfast. He was involved in the foundation of the Irish Association of Dermatologists.
Professor Desmond Burrows was the first professor of Dermatology in Ireland, holding an Honorary Chair at Queen's University, Belfast. He was President of the British Association of Dermatologists in 1992 and became President of 6th EADV, in Dublin, 1997. His major interest was in contact dermatitis and he was a world authority on chromate dermatitis, with much of his work on metal dermatitis being cited today. Together with Martin Beare, he was instrumental in the establishment of the Irish Association of Dermatologists. Desmond Burrows was the inaugural secretary of the Irish Association of Dermatologists, and struggled hard to get the organisation onto a firm footing.
Abraham Colles (1773–1843) begins the story of dermatology in Dublin. He was a surgeon and is best known for his famous description of the Colles fracture. In 1837, his published work, entitled ‘Observations on the venereal disease and the use of mercury’ clearly defined and differentiated the spectrum of cutaneous syphilis and his observations on the infectivity of neonatal syphilis, later known as Colles Law. This law was used to describe his observation that syphilitic infants with oral lesions could not transmit the disease to their infected mothers but were infective to previously healthy hired wet nurses, indicating the immunity of previously infected individuals8.
Arthur Jacob (1790–1874) an ophthalmologist, who served his apprenticeship under Abraham Colles, achieved his eponym at the age of 28, like his master, when he published his paper in 1819 on the nervous layer of the retina- Membrana Jacobi. His contribution to dermatology was in 1827 when he published the first description of the basal cell carcinoma, called at the time the ‘Jacobs ulcer’. His eloquent observations included the description of ‘ulcers with edges which are elevated, smooth and glossy, with a serpentine outline….veins of considerable size ramifying over it. …remaining unchanged in size and form for a great length of time’8.
William Wallace (1791–1837) was probably the first true dermatologist in Dublin. On 1st October 1818, he opened ‘The Dublin Infirmary for diseases of the Skin, 20 Moore Street, Dublin, entirely founded and maintained at his own personal expense. In the 17 years the institution was open, 25000 cases of skin disease were reported to be treated. He made two original contributions to medical literature. He introduced potassium iodide to the Material Medica and made experimental proof of the infectivity of the secondary lesions of syphilis. He also introduced the use of a sulphur fumigating cabinet for the treatment of scabies. Unfortunately his pioneering advances and the activity of the Dublin Infirmary for diseases of the skin were brought to an abrupt end with his sudden death from typhus in 1837 at the age of 46. The hospital never re-opened as he had no colleagues and had not had time to train a successor8.
Robert Graves (1796–1853) famous for his description of exophthalmic goitre (Graves Disease) recorded the first accurate clinical description of ‘Angioneurotic Oedema’ published in his ‘Lectures in Clinical Medicine’ in 1843. He described how ‘tumours rise, run through their course and disappear in the space of a few hours…sometimes on the lips….inside of the mouth and uvula are attacked…On the following day there is no trace of their existence’. His description predates by 40 years that of Heinrich Quincke, a German Professor of medicine in 1882.
John Neligan (1815–1863) a physician at Jervis Street Hospital, was responsible for several dermatological publications, including ‘Practical Treatise on diseases of the skin’ in 1852 and later in 1855 his ‘Atlas of Cutaneous diseases’. He was one of the commissioners to the first British Pharmacopoeia, but he did not live to see the completed work, which was published in 18648.
Walter Smith (1844–1932), who was Assistant Physician to the Adelaide Hospital, Dublin, where he worked from 1866–1881, started the special dispensary for skin diseases. He was well regarded for his wide knowledge and skill as a dermatologist. He was credited with the first inoculation of Achorion schoenleini into human skin- his own - producing the lesions of favus. In 1879 he published in the British Medical Journal the first description of Monilethrix8.
Wallace Beatty (1853–1923) was Walter Smith's successor in the Adelaide Hospital. He greatly extended the work of the skin clinic and developed a large private practice. He was a popular teacher and was honoured by the University in a special appointment of Honorary Professor of Dermatology. He was on the editorial staff of the British Journal of Dermatology, and was described as “modest, gentle, courteous and beloved by all”8.
The authors are grateful for the valuable suggestions from our retired colleagues Professor Desmond Burrows and Dr Andrew TA Dawson for bringing to our attention many of the lesser known aspects of the history of dermatology in Ireland.
The authors have no conflict of interest.