Lives of the fellows

William Stewart (Sir) Duke-Elder

b.22 April 1898 d.27 March 1978
GCVO(1958) KCVO(1946) Kt(1933) GC St J(1960) K St J(1948) MA BSc St And(1919) MB ChB(1923) FRCS(1924) MD(1925) PhD Lond(1925) DSc St And(1927) FRS(1960) FRCP*(1962)†

Stewart Duke-Elder was born in Dundee, the second of three sons of the Revd. Neil Stewart Elder, minister of the United Free Church of Scotland, and Isabelle, née Duke, who was the daughter of the Revd. John Duke, also a minister of the United Free Church, who lived at Camsie, Stirlingshire. The Elder family lived at the manse in Tealing, a village nestling in the Sidaw Hills.

His early education was taken at the Morgan Academy, Dundee, where he was usually top of his class and gained the Dux Medal in 1914—1915 and also gold medals for English, Greek, Biology and Religious Knowledge. He entered the St Andrews Bursary competition in which he came top of the list, with the result that he was given the first foundation scholarship, with a bursary of £50 a year for four years. In 1919 he graduated MA with first class honours in natural sciences, and passed the examination for the BSc with distinction in physiology. He was a demonstrator in physiology in the 1918-1919 session at St Andrews and a demonstrator of anatomy in 1920—1921 at University College, Dundee, where he finished his medical course. He was a member of the council of the Students Union and was its president in 1921 -1922. He played rugby football and also took part in motor-cycle racing.

Duke-Elder qualified in medicine at St Andrews in 1923. After graduating, he went to London to do house appointments at St George’s Hospital, but en route he took a locum post for a Dr Arthur, a general practitioner in Wellingborough, Northants. At St George’s he gained the post of resident casualty officer for three months, and then became house physician for six months. He worked as a clinical assistant in the eye department in 1924, and in the same year passed the final examination for the fellowship of the Royal College of Surgeons of England.

At this stage he became interested in research concerning the physiology of the eye, and on the advice of Sir John Parsons FRS, a senior ophthalmic surgeon at University College Hospital, London, and Moorfields, he started research work at University College under the direction of Professor Starling FRS in the department of physiology and of Dr Drummond in the department of biochemistry. With the help and advice of Parsons, Duke-Elder obtained in 1925 a part time MRC grant to work in the physiology department, where Parsons had the use of a laboratory and the benefit of the help of three professors of physiology, Ernest Starling FRS, who was the Foulerton research professor, AV Hill, FRS, who was second Foulerton research professor, and C Lovat-Evans FRS, who held the chair of physiology.

Duke-Elder also had help and advice from three successive secretaries of the Medical Research Council, Sir Walter Fletcher, Sir Edward Mellanby and Sir Harold Himsworth.

His thesis entitled Reaction of the Eye to Change in the Osmotic Pressure of the Blood won him in 1925 the MD of St Andrews and the gold medal. In 1927, his thesis entitled The Nature of the Intraocular Fluids and the Pressure Equilibrium in the Eye gained him the DSc (St Andrews). He collected a number of prizes and research fellowships during this period including the Henry George Plimmer research fellowship, the Sir Francis Laking research scholarship and the BMA Scholarship. In 1926, at the early age of 28, he was appointed assistant ophthalmic surgeon to St George’s Hospital, and five years later was promoted to the full status of ophthalmic surgeon, later becoming consultant ophthalmic surgeon when he retired from hospital work in 1963.

At Moorfields Eye Hospital he became clinical assistant to Sir John Parsons, and he was also appointed medical officer in the ultra-violet ray department. He became surgeon at Moorfields in 1928 but subsequently retired from the hospital staff in 1936 on account of illhealth, and because of the many other commitments in which he was involved. However, many years later he was appointed consulting surgeon to Moorfields.

The year 1928 was a happy one for Stewart Duke-Elder because a certain young doctor came on the scene who was studying ophthalmology at Moorfields. She was Phyllis Mary Edgar. It was a short romance and they got married within a few months. In 1930, Phyllis accompanied Stewart on his first visit to the USA, where he had been invited to give the Howe Lecture at Harvard University. In the States they made many friends, with whom they were to keep in touch throughout their lives. Phyllis Duke-Elder was a great help to her husband in his work, especially when he was writing papers and books. She was frequently to be seen sitting in the library of the Royal Society of Medicine, looking up references and making abstracts for him. Unfortunately she developed pulmonary tuberculosis, which involved her in having to submit herself to operations on the chest and to be away in Switzerland for long periods of convalescence, but they took it all in their stride, and eventually Phyllis was again able to join Stewart in all his activities.

The rapidity with which Stewart Duke-Elder achieved fame was quite remarkable. Less than three years after he had gained his FRCS he was an author in the Recent Advances series, producing the first edition of Recent Advances in Ophthalmology. This was followed by an excellent work entitled The Practice of Refraction. His private practice grew apace, especially in 1932 when, after joint consultations with senior colleagues, he operated upon the then Prime Minister, Ramsay Macdonald, for glaucoma. But despite his long lists of operations and his many patients he found time to work hard at the first volume of his Textbook of Ophthalmology, which dealt with the development, form and function of the visual apparatus. In the preface Duke-Elder worte ‘It seems to me anomalous that no reference textbook of ophthalmology should exist in our literature, and it is in order to make such a work available that I have written this book’. He stated that hitherto ophthalmologists had confined their interests to the structural ruins which disease had left behind, but now the tendency would be to probe more deeply and examine the more subtle nature of the initial defect, and to pass from the study of structures composed of cells to the study of cells composed of atoms and molecules, and to look beyond anatomy and pathology to biophysics and biochemistry. ‘This first volume’ he wrote, ‘is entirely devoted to the fundamental sciences upon which alone a thorough understanding of clinical ophthalmology can rest’. The book was one of the most valuable contributions that Duke-Elder made to ophthalmology.

After the death of King George V in 1936, to whom Sir Richard Cruise had been surgeon oculist, Duke-Elder was given the Royal appointment to King Edward VIII, and subsequently was appointed surgeon oculist to King George VI and then to the present queen Elizabeth II, until he retired from the post in 1965, having occupied it for 29 consecutive years.

In the second world war Duke-Elder joined the RAMC in 1940, starting with the rank of lieutenant and then rapidly becoming promoted to colonel, and subsequently to brigadier in the Army Medical Service, when he was appointed to the post of consultant ophthalmic surgeon to the Army. His wife volunteered for service with the Red Cross and was in charge of the Zachary Merton Convalescent Home at Kingswood, Surrey, which had been taken over by the Red Cross and was essentially used by Duke-Elder as a place where he could refer problem cases from the Army for whom special investigation and treatment might be needed. Whilst Duke-Elder was engaged in army duties visiting hospitals in various theatres of war, his private practice was looked after partly by his wife and partly by his colleague Allen Goldsmith, whose general health prevented him from joining the Armed forces. Goldsmith continued to work in private practice with Duke-Elder until illness overtook him, resulting in his death in 1977.

After the second world war, Duke-Elder was the leader of a number of ophthalmologists including Sir John Herbert Parsons and Miss Ida Mann, who were anxious to improve the standard of British ophthalmology, especially in the context of education and research. With this end in view they planned to amalgamate the three main ophthalmic hospitals in London, Moorfields, the Royal Westminster and the Central London. The Central London Hospital became the Institute of Ophthalmology, where research laboratories, a library and a lecture room were set up. Also included in the Institute was a large department of pathology under the direction of a full time pathologist, Norman Ashton (later Professor Norman Ashton, FRCP, FRS). The other two hospitals confined their attentions to inpatients’ and outpatients’ care and clinical teaching. With Duke-Elder as director of research, the Institute soon became well known for the excellence of its work, and many young doctors and scientists came to work there from universities overseas. It was largely his work at the Institute that won for Duke-Elder a distinction now rarely conferred upon members of the medical profession who are primarily engaged in clinical work, namely the Fellowship of the Royal Society. When he retired from the post of director of research at the Institute in 1965, he was appointed its life president, and emeritus director of research. Apart from his research work at the Institute, Duke-Elder was instrumental in collecting money from numerous charitable organizations for the ‘Fight for Sight’ campaign, helped by Ashton and the secretary of the Institute, Clifford Seath.

There is little doubt that the establishment of the Institute, a year before the National Health Service, was a great stimulus to the development of scientific ophthalmology in the United Kingdom, and so was the inauguration in 1945 of the Faculty of Ophthalmologists, with its headquarters at the Royal College of Surgeons of England in Lincolns Inn Fields. The Faculty persuaded the College to initiate a special examination for an FRCS in ophthalmology. (Such an examination already existed, but no-one was allowed to take it until he or she had first passed the FRCS in general surgery, and only one man, FA Williamson Noble had ever taken the exam - and he passed with distinction.) Duke-Elder was the first president of the Faculty and occupied the post for four years. He was also one of the first examiners for the new ophthalmic fellowship.

One of the appointments that Duke-Elder much enjoyed was that of ‘Hospitaller of the Order of St John’, where he succeeded Lord Webb-Johnson. His duties in that capacity involved being in charge of the St John Ophthalmic Hospital in Jerusalem, which at that time was situated in makeshift conditions in the Old City; Duke-Elder was determined to set up a much better and thoroughly up to date building. He also conceived the idea of inaugurating research work at the hospital in order to discover more about the organism causing trachoma, and to find a method of prevention and cure. He aroused the interest of many influential people, including the rulers of several of the Gulf States, with the result that six years later - in 1960 - a splendid well equipped St John Ophthalmic Hospital had been built on the Nablus Road in Jerusalem. But already, five years before the new hospital started its clinical work, the trachoma research project had been going on in conjunction with the Medical Research Council and the Institute of Ophthalmology in a set of laboratories which had been built in the grounds of the hospital. For various reasons the work had to be transferred to the Gambia in West Africa, and subsequently to Iran, where it was for many years under the direction of Barrie Jones of the Institute of Ophthalmology (London), and fulfilled its purpose most satisfactorily.

But of all the useful things Duke-Elder did in his busy life there is no doubt that his contribution to ophthalmic literature was the most important. His Textbook of Ophthalmology in seven volumes (1932 — 1954) was a stupendous piece of work by a man who wrote every word himself before it was submitted for typing. This won for him the Fothergillian prize awarded by the Medical Society of London, for the best contribution to the whole of British medical literature for the current decade. But having finished this book and realizing that some of it needed to be brought up to date and to be rewritten, he decided to write a much larger work entitled A System of Ophthalmology in 15 volumes, of which the first volume appeared in 1958 and the last in 1976. For most of these volumes he enlisted the help of certain of his colleagues, but there is no doubt that the inspiration and direction of the work were entirely his. The speed and high quality of his output of medical books and articles were phenomenal. This was partly because early in his life he had learnt to depend upon fewer hours of sleep than most people need - indeed it was not unusual for him to write steadily throughout the night and then begin an arduous day’s work without any sleep at all. But that is only part of the explanation of his amazing output of learned papers and books. Duke-Elder had a tremendous power of mental concentration. He had the ability to read a mass of scientific papers and reports, extract the essential facts and then put them into an orderly form which was easy to read and understand. Altogether he published some 147 scientific articles and papers and gave no less than 12 eponymous lectures. He was also editor-in-chief of the British Journal of Ophthalmology and of Ophthalmic Literature.

Duke-Elder was constantly in demand to travel overseas to give lectures, especially in the USA where he had many medical friends. He was awarded no less than 17 medals in recognition of his work. With such a high reputation his private practice became enormous. His opinion was regarded as the best that could be obtained in the entire world, and patients were referred to him from every continent.

After the 1939-1945 war he was civilian consultant to the RAF, ophthalmic adviser to the Ministries of Health, Supply and Labour, and to the London Transport Board, and he was honorary member of virtually all the ophthalmological societies of the world and of many other scientific bodies. The XVI International Ophthalmological Congress held in London in 1950, of which he was chairman, was a successful and happy occasion. He was subsequently elected president of the International Council of Ophthalmology and held that post for 12 years (1950-1962), at the termination of which he was made honorary life president. In 1958, at the request of the International Council of Ophthalmology, Duke-Elder wrote a history of the activities of the International Council during its first 100 years: A Century of International Ophthalmology 1857—1957. Of all his honorary degrees the one that gave him the greatest pleasure was the LLD of his old college, St Andrews. He was president of the Ophthalmological Society of the UK in 1965 and 1966. During those years, the Duke-Elders were well known for the hospitality in their home in London to vast numbers of ophthalmologists and their wives, from the British Isles and from most countries overseas.

Stewart Duke-Elder was a warm-hearted Scot with an informal manner, his sense of humour and his charming smile would at once put strangers at their ease. He was invariably cheerful and never pompous. He was a good listener and always took a great interest in the personal problems of his colleagues, especially those of the younger generation. He was, however, reserved and reticent about himself. Throughout his professional life he was fortunate in having love, support and help from a marvellous wife. She took an important part in all his activities and was an ideal hostess.

TK Lyle

* Elected under the special bye-law which provides for the election to the fellowship of "Persons holding a medical qualification, but not Members of the College, who have distinguished themselves in the practice of medicine, or in the pursuit of Medical or General Science or Literature.." † The list of honorary degrees is too lengthy to include in entirety.

[Biog.Mem.Roy.Soc., 1980, 26, 85-105; Brit.med.J., 1978,1, 993; Lancet, 1978,1, 834; Times, 3 Apr 1978; Institute of Ophthalmology Annual Report, 1977-78]

(Volume VII, page 172)

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