Professor Frank Powell, who is writing a biography of Dr. William Wallace with Mary O’Doherty archivist in the Royal College of Surgeons in Ireland, has kindly written this essay on The Dublin Infirmary for the treatment of Diseases of the Skin. The Wallace collection of illustrations of skin ailments was purchased by the Royal College of Surgeons in Ireland in 1838 for £50 and the illustrations are reproduced from the collection with permission.


 

Dr. Wallace and Dublin’s first Skin Hospital

Dr. William Wallace opened a hospital for the treatment of diseases of the skin at No. 20 Moore Street, Dublin in 1818. This was, according to Wallace, not only the first such establishment solely dedicated to the treatment of skin diseases in Ireland but also in the vast British Empire of the time.

Wallace was a graduate of the Royal College of Surgeons in Ireland and can be said to have been Ireland’s first specialist in the treatment of skin disorders. He was a prominent figure in Dublin medicine of his time and had an international reputation due to his many publications. He was a Fellow of the Royal Irish Academy, received an MD degree from Edinburgh University, and was an Honorary Member of the Medical Society of New York. Wallace had spent three postgraduate years studying skin diseases under the famous Bateman at the Carey Street Clinic in London where Robert Willan, the great English dermatologist, had earlier worked and developed the classification of cutaneous diseases that is in use to this day.

When Wallace returned to Dublin in 1818 the population was increasing at an alarming rate. The poor migrated from the countryside into the city in the hope of employment and shelter. Families were often crowded into the large former entertaining rooms in the previously gracious dwellings in the inner city that had been vacated by the aristocrats after the Act of Union of 1800. There were little or no sanitation facilities available and these squalid conditions gave rise to frequent disease.

Wallace recorded that skin diseases were particularly prevalent at that time:

…when it is considered how extremely frequent these affectations are in Dublin, for poverty and uncleanliness are the causes of a large proportion of cutaneous diseases, and the lower orders of this city are unfortunately the victims of both. (2)

In the same publication Wallace explains the logic of setting up an establishment dedicated specifically to the treatments skin diseases:

In the infancy of establishments for the reception of invalids, patients laboring under every form of disease were indiscriminately admitted into the same hospital. As medical science advanced, it was observed, that important advantages would be likely to arise to society from the foundation of institutions limited to particular infirmities; Hence the establishment of distinct Medical and Surgical Hospitals, Fever Hospitals, Lunatic Asylums, Lying-in (Obstetric) hospitals, Lock (Venereal Diseases) Hospitals, Eye Infirmaries etc., etc. in Dublin. (2)

He goes on to explain why patients who suffered from skin diseases particularly required the establishment of a separate Hospital:

Of all the diseases there are none …which call more imperiously for a particular institution than those of the skin….Their peculiar nature and mode of treatment demand arrangements which cannot be made in a general hospital; and when we reflect that there are no diseases involved in greater obscurity, and therefore none more in need of investigation, the advantages are evident …from a hospital…limited …to diseases of the skin. (2)

As was the custom of the time he raised money for the running costs of the hospital by soliciting contributions from his colleagues, neighbours, friends, relatives and wealthy benefactors. Contributors included Sir James Bond, eight medical colleagues, two pastors and various other individuals. To entice individuals to subscribe and to recognize their generosity, the title of Governor of the Hospital for one year was conferred on those who had subscribed one guinea, while a person who subscribed 10 guineas became a Life Governor of the Hospital. The Governors could refer patients to the hospital or individual patients could present themselves to the hospital if they felt they needed treatment for a skin condition.

The hospital, which was named The Dublin Infirmary for the treatment of Diseases of the Skin, was situated at No. 20 Moore Street. The street, then as now, was a commercial hub close to the centre of the city. No. 19 Moore Street was active as a printing office, while an upholsterer occupied No. 21. The Hospital was open to receive patients every morning at eleven o’clock and all were seen free of charge. Advice and medicines were given as needed. On Mondays, Wednesdays, and Fridays medicated baths were administered. On Tuesdays, Thursdays and Saturdays patients were treated in the “Fumigation Apparatus”, one of Wallace’s main innovations in the Dublin Infirmary. This machine (in which patients sat for 30 minutes or longer) used a special heating mechanism to saturate the skin with a vapor of sulphur, the most effective treatment available at the time for many skin diseases.

In its first year of operation 1,775 patients attended The Dublin Infirmary for Diseases of the Skin in Moore Street. An analysis of the medical problems afflicting attending patients is given in the first Annual Report. (3) Scabies, a contagious and extremely itchy skin disease, was the commonest diagnosis with 249 patients receiving treatment for this complaint. However patients had a wide variety of other diseases, the majority of which were infectious in nature. There were 27 cases of leprosy, 47 cases of measles, 39 cases of scarlet fever and 13 cases of smallpox seen that first year, which gives a sense of the wide spectrum of problems that a physician like Wallace had to deal with in the pre-antibiotic era. Ringworm, lice infestation, anthrax, tuberculosis of the skin and impetigo (called “running tetter” by the patients) were other common skin complaints. At the end of the year Wallace reported that 1400 patients had been “cured”, 96 were still under the care of the Charity, 185 had absented themselves, 57 were “relieved” (improved), 28 were incurable and 9 were dismissed for misconduct. This represented a considerable amount of work and a very high success rate in treating such diseases for that period.

A colleague, Dr Robert Read MD, described as a “physician to the hospital” joined Wallace at the Infirmary and an Anatomy School for medical students was opened at the rear of the building. Wallace also admitted pupils from the School of Art of the Royal Dublin Society to attend a selection of the lectures on anatomy free of charge. This not only provided excellent experience for the budding artists, but also gave Wallace the opportunity to have interaction with medical artists, an important aspect of his grand plan to produce an illustrated guide or atlas on the cutaneous manifestations of the venereal diseases. This was a work that Wallace felt would have an impact as great as the publications of Willan and Bateman had some years earlier on the general classification of skin diseases. Over the next 18 years Wallace put together a remarkable collection of illustrations of skin diseases (particularly those caused by syphilis) and carefully documented the various treatments and experiments he carried out.

The hospital Treasurer, George Thompson of Temple Lane, took in the subscriptions and drew up the accounts. An apothecary, Thomas Stoker, was employed to make up the various medications and fee-paying medical students and postgraduates were allowed to attend lectures and see patients. By 1837 it was recorded that 25,000 cases had been dealt with in the Dublin Infirmary. (4)

Wallace became internationally recognized for his innovative treatments and astute clinical observations and publications. He had completed and published several monographs on different medical conditions and treatments including a work on the uses of Moxa, a traditional Japanese treatment, for muscle and nerve disease. (5) In particular he became recognized for his innovative use of potassium iodide in the treatment of certain types of venereal diseases. His technique of regulating the dosage levels of iodine was innovative. Iodine and chlorine were considered agents of interest at the time and investigators were trying to determine if they could be used in the treatment of various diseases.

Finding that iodine caused violent gastric irritation when given to dogs, Wallace experimented until he found that iodine, when altered to potassium iodide was well tolerated by the animals. He then made up a mixture of potassium iodide diluted in water and administered a tablespoon three times daily to his patients. He collected the urine of the patients who were treated and was able to find if the iodide had been absorbed into the body by its presence in the excreted urine. He devised a biochemical test to check for the presence of iodine by adding sulphuric acid, chlorine and a starch indicator to it. When urine from his patients was analysed in this way and turned as “black as ink” he knew that a sufficient dosage had been both given and absorbed by his patient. (6) He used this unique test to detect the presence of the iodine in his patient’s saliva, tears and even in the milk of nursing mothers. He then treated 142 patients with secondary syphilis with potassium iodide. According to his report on the results his success was “of no ordinary kind”. An unusual aspect of syphilis transmission from nursing mothers to suckling infants was defined by him and referred to as “Wallace’s Law”. (7) In 1833 he published a volume on Venereal Disease and its Varieties, that was to be the forerunner of a more extensive work he was planning later. (8) The fact that this volume, which ran to 383 pages, dealt only with primary syphilis gives an indication of the scale of the undertaking that Wallace had embarked upon. However, he was to be denied the time to develop this work to fruition.

On December 2nd 1837, Wallace attended his duties at The Charitable Infirmary on Jervis Street where he had been a senior consultant for almost 20 years. On the following Friday at the age of 47 years he was dead. It was thought that he had acquired typhus from a patient under his care, a not uncommon risk for doctors of that time. He was buried in Mount Jerome cemetery in Dublin. Wallace’s short obituary was published in the Lancet early the next year. (9)

The Dublin Infirmary for Diseases of the Skin in Moore Street did not survive the demise of Wallace and closed down within months. The lease was taken over by a butcher, who one imagines made good use of the anatomy facilities that Wallace had instituted at the rear of the building. A few years later a fishmonger moved into 20 Moore Street and this business lasted far longer than the Dublin Infirmary. This was the rather ignoble demise of the laudable endeavour that gave Dublin its first specialist hospital for the treatment of diseases of the skin.

Other institutions also catered for patients with skin diseases (in addition to other ailments) in Dublin in the early nineteenth century. A charitable Institution for the Treatment of Diseases of the Skin and Eye was established in Kildare Street on the south side of the city in 1818 with the eminent surgeon and oculist Arthur Jacob listed as staff member together with a Dr. James Macartney who apparently looked after patients with skin complaints. However by 1822 it was listed as being available for treatments of patients with eye disorders only and Dr. Macartney was no longer a staff member. (10 A Maison de Santé or Asylum for Recovery of Health and Cure of Diseases of the Skin existed on Dorset Street. Sir Arthur Clarke, Richard Carmichael and a Dr. Jackson are listed as staff members in 1826. It is stated that the asylum was founded in 1816, two years before Wallace established his hospital in Moore Street. (10) However the exact status of this institution is unclear and it is unlikely that it served only to treat patients with diseases of the skin. None of these institutions appears to have had as high a profile or the expertise to provide the sophisticated treatments that were available at the Dublin Infirmary in Moore Street under the direction of Dr Wallace.

Wallace’s contribution was significant if somewhat short-lived. He established the necessity of an institution dedicated to the treatment of skin diseases and raised the quality of treatment being offered to patients at that time. A contemporary of Graves, Colles, Cheyne and a colleague of Adams and Corrigan at the Charitable Infirmary, his name deserves better recognition than it has been heretofore given.

References

(1) Morton RS. Dr. William Wallace (1791-1837) of Dublin. Med Hist. 1966; 10: 38–43.
(2) Wallace W., Lectures on Cutaneous and Venereal Diseases Lancet.1836, 2, 129-133.
(3) Wallace W., First Annual Report of the Dublin Infirmary, Moore Street, instituted for the investigation and treatment of Diseases of the Skin and opened for patients on the 1st of October 1818. 2nd Edition, Goodwin. Dublin: 1820.
(4) Pettigrew and Outon. Gentleman’s Almanac 1837.
(5) Wallace W. A Physiological enquiry into the action of moxa, and its utility in inverterate cases of sciatica, lumbago, paraplegia, epilepsy and some other painful, paralytic and spasmodic diseases of the nerves and muscles. Dublin. 1827.
(6) Wallace W. Treatment of the Venereal Disease by the hydriodate of potash or iodide of potassium. Lancet. 1836, 2, 5-11.
(7) Shaw-Mackenzie J. A. “Colles’s Law” or “Wallace’s Law”? Lancet. 1. 511-512. 1899.
(8) Wallace W. A Treatise on the Venereal Disease and its Varieties Burgess and Hill, London,1833.
(9) Lancet, 1838, 1, 524.
(10) Wilson’s Dublin Directory 1826.