the founding and early years of the massachusetts eye and ear infirmary

SURVEY OF OPHTHALMOLOGY VOLUME 23 l NUMBER 5 l MARCH-APRIL 1979

HISTORY OF OPHTHALMOLOGY PETER C. KRONFELD, EDITOR

The Founding and Early Years of

the Massachusetts Eye and Ear

Infirmary

CHARLES SNYDER

The Howe Library of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary. Boston, Massachusetts

Abstract. The Massachusetts Eye and Ear Infirmary, one of America’s first such institutions, was founded on October 1, 1824, and incorporated on February 23, 1827, by Edward Reynolds, John Jeffries, and a group of charity-minded Bostonians. The Boston men looked, as did the founders of other early U.S. eye infirmaries, to John Cunningham Saunders’ London Eye Infirmary for guidance. During its first years the Massachusetts Eye and Ear Infirmary knew economic insecurity, but once it earned in the Boston community the reputation of being a worthy charity, its fiscal affairs ceased to be a pressing problem, and it went on to know a growth worthy of the motives of its founders. (Surv Ophthalmol 23:323-331, 1979)

Key words. eye and ear infirmaries l Jeffries, John l

Massachusetts Eye and Ear Infirmary * Reynolds, Edward * Saunders, John Cunningham

E verything has one beginning and one birth date - that is, everything except the Massachusetts Eye and Ear

Infirmary. It has two beginnings and two birth dates. The first was October 1, 1824, when it was founded by Drs. Edward Reynolds and John Jeffries. The second was February 23, 1827, when the governor of the Commonwealth signed its Act of Incorpora- tion. Fortunately, documents of the two beginnings have been preserved in the Infir- mary Archives, and these are the basis for this study. Their contents, in some instances, have

never before been made public. Boston, in 1824, was a prosperous,

homogenous community with a population of 55,000 and a neighboring population of 25,000. Sixty-two regular physicians and a horde of irregulars practiced medicine in the city. The health care facilities were the public institutions of the Almshouse, the Rainsford Island Hospital, and the Marine Hospital. The private charity institutions, both modeled on the English voluntary hospital system, were the Boston Dispensary and the Massachusetts General Hospital with its

323

324 Surv Ophthalmol 23 (5) March-April 1979 SNYDER

FIG. 1. The founders of The Massachusetts Eye and Ear Infirmary, Edward Reynolds (left) and John Jeffries (right). (Courtesy of the Public Affairs Office, The Massachusetts Eye and Ear Infirmary)

medical-surgical unit and its unit for the care those who gained it. The record shows that all of the insane. Before 1824 ended, Boston had of John Jeffries’ medical education and all of another health care facility - the Boston Eye his medical experiences were Boston-based. Infirmary - the personal charity enterprise Such was not the case with his life-long friend of two of the city’s young doctors, Edward and partner in an ophthalmic charity enter- Reynolds and John Jeffries (Fig. 1). prise, Edward Reynolds.

The Founders

The younger of the two men, John Jeffries, was born on March 23, 1796, in his father’s mansion house on Tremont Street. The father, also named John, was a doctor of medicine and the younger John began his medical education at the age of five by holding a lancet for his father. At 15, he entered Harvard College, taking his bachelor’s degree four years later in 1815. In the pattern of the time, he did his years of formal study of medicine with his father as his preceptor. He also attended two terms of lectures at Harvard’s Medical College, receiving his A.M. degree in 1818 and his M.D. degree in 18 19. In 1825, he received an honorary M.D. degree from Brown University. John Jeffries did not follow the custom of many of his generation of going to Europe to further his medical education, although he ap- preciated the value of such study and envied

Edward Reynolds was born February 25, 1793. The son of a prosperous Bostonian, he received an excellent elementary education in the private schools of Boston. At the age of 14, he entered Harvard College, graduating with a bachelor’s degree in 18 11, and receiving an A.M. degree from the same institution a few years later. His right to use the title of “Doctor” with his name came in 1825 when both Brown University and Bowdoin College honored him with M.D. degrees. Reynolds never earned such a degree. This was not unusual for the times. A study of his medical education shows that he was as well educated, if not better, than many of his colleagues.

Upon graduating from Harvard College, Reynolds began a four-year preceptorship under John Collins Warren, M.D. There is no record that he attended the courses of formal lectures given by Warren and others at Har- vard’s Medical College. However, there are excellent records, his memoirs and letters, that tell in a delightful way how he followed

HISTORY OF OPHTHALMOLOGY 325

his preceptor’s example and went to London and Paris for his didactic training.

He was in London and at Guy’s Hospital and St. Thomas’s Hospital at the beginning of 1816. Important to our story are two letters he wrote to Warren. On June 17, 1816: “I intend to take a ticket soon at the Eye In- firmary. This with the hospitals and midwifery, will, or ought to, make me a very busy man during the remainder of the year.” On July 4, 18 16: “He (Astley Paston Cooper) prefers the extraction of the lens in cataract to other modes of operating; he thinks it is on every account decidedly preferable and strongly advises all who intend pursuing this branch of the profession to make themselves perfectly familiar with it. It is practised almost exclusively by the Surgeons of the London Eye Infirmary.”

The cost to Reynolds for a three month ticket at the Eye Infirmary was five guineas; if he took a six-month ticket, the fee was eight guineas. Among his classmates were two young men from New York, Edward Delafield and John Kearney Rodgers. During their stay in London, all three of the young men came to realize how scant had been the recognition given to ophthalmology in their own country and how woefully inadequate ophthalmic care was in America.

During the months the three young Americans studied at Guy’s and St. Thomas’, Reynolds compiled fourteen volumes of hand-written notes and Delalield compiled live volumes. (Interestingly, among their classmates was John Keats, who sometime early in I8 17 left medicine never to return.) Sometime in mid- 18 18, Reynolds finished his studies in London and Paris and returned to Boston to begin his career in medicine.

When he returned, it was his misfortune to find his sixty-year-old father blind with bilateral cataracts. Reynolds, remembering his training in cataract surgery under Cooper at the London Eye Infirmary, felt he was probably better qualified than anyone available for the performance of the operation. He later wrote: “I went into my closet and offered a prayer to the deity for success, took a glass of sherry, and went ahead to do my best.” The operation was a success. In 1850. Reynolds commented publicly on the matter: “ . . . I may be pardoned in saying that the Massachusetts Charitable Eye Infir- mary partly originated in the fact that one of its founders had the happiness of restoring a

beloved father to sight by the operation for cataract. The tender relation in this case of surgeon and patient, becoming extensively known among the small population then com- posing our community, brought to his obser- vation, a large number of Ophthalmic patients; and soon revealed the fact that the poor and laboring classes are peculiarly liable to these diseases.” Then Reynolds spoke these important words: “Accordingly in the month of October, 1824, the speaker in con- junction with Dr. John Jeffries, hired a room in Scollay’s Buildings, fitted it with such con- veniences as their limited means enabled them to procure, and invited the poor, afflicted with diseases of the eye, to come there for gratuitous aid.”

The Eye Institutions of America

Reynolds’ and Jeffries’ Boston Eye Infirmary was not the first such institution in the United States. The first was the New Lon- don Infirmary for Curing Diseases of the Eye, founded by Elisha North, M.D., in 1817. The second was the New York Eye Infirmary founded in 1820 by Edward Delafield, M.D. and John Kearney Rodgers, M.D., Reynolds’ classmates in London. The third and fourth were founded in Philadelphia in 182 1 and 1822. So, the Boston Eye Infirmary - later the Massachusetts Eye and Ear Infirmary - founded in 1824, was the fifth such institution. Of the five institutions only two have survived to this day - the New York Eye and Ear Infirmary and the Massachusetts Eye and Ear Infirmary. With the exception of Elisha North’s one-man operation, all the hospitals had looked to John Cunningham Saunders’ London Dispensary for Curing Diseases of the Eye and Ear for inspiration and guidance.

The London Dispensary: The Prototype

The first eye and ear institution, which was opened on March 25, 1805, and its later American counterparts, might never have been had it not been for an unusual rule in London requiring that in order to be a general surgeon on the staff of one of London’s teaching hospitals, it was necessary to have been articled at the College of Surgeons for a period of six years. Saunders, although well trained and employed in one of the teaching hospitals, had no hope of getting a hospital surgical appointment because he lacked this

326 Surv Ophthalmol 23 (5) March-April 1979 SNYDLR

essential qualification. His friend and superior, the eminently successful Astley Paston Cooper, suggested that Saunders work for him in a teaching hospital in a part- time capacity and also begin a private practice as surgeon for diseases of the eye and ear. Saunders was not long in his new practice before he began to believe that more could be accomplished, particularly for the poor, if there were a public dispensary for eye and ear diseases. Cooper agreed, knowing there were insufficient accommodations in the general hospitals of London for the treatment of diseases of the special organs. Along with Cooper, the staff of physicians and surgeons of Guy’s and St. Thomas’s approved of the idea and put their names to a proposal that Saunders circularized in the city. As a result, a public committee was formed, which in- stituted the London Dispensary, defined the area and mode of its clinical activities, selected its officers, and appointed Saunders its first surgeon. The dispensary was to be financed by voluntary subscriptions. Every step that Saunders, and later his public committee, took would be followed religiously by the founders of the eye and ear infirmaries in New York, Philadelphia, and Boston. Saunders’ London infirmary was the acknowledged prototype of them all.

Saunders was the first to bring the eye and ear specialties together in one infirmary. Why? A clue to his motivation can be found in a letter he wrote to his committee in December of 1807. It reads: “Those who have practiced on the eye have always partially cultivated the ear, and when I chose the former for my professional pursuit, the latter also became the subject of my serious in- quiry.” As simple as that. The eye and the ear had always been together in private practice, so, when he established his special hospital it was natural they should be together there. This seemingly casual action of Saunders led directly to the world-wide acceptance of the pattern of eye and ear infirmaries and of what was to become the twin specialty of ophthalmology and otology. Having unwit- tingly sown such a seed, it is odd to find Saunders writing in the same letter for per- mission to cease treating diseases of the ear in the London Dispensary because of the vast number of incurable cases seen there. His best success had been with cases of inspissated wax. He wrote that to try to treat ear diseases and know so little success exhausted the in-

stitution’s funds and diminished his reputation.

The dispensary’s governors considered the matter and then voted: “That diseases of the Eye shall in the future be the sole object of the charity; and its name shall be changed to the London Infirmary for Curing Diseases of the Eye.” In later years the hospital be came known as the Royal London Ophthal- mic Hospital, or Moorfields. So the first eye and ear infirmary became an eye infirmary. Such would not be the case with many of the institutions who would model themselves on Saunders’ original idea; it can therefore be said that John Cunningham Saunders was the “father” of the eye and ear infirmary movement.* Saunders died in 1810 at the age of 38, five years after he had founded his eye and ear infirmary.

The Massachusetts Eye and Ear Infirmary

Facts on the early months of Reynolds’ and Jeffries’ Boston Eye Infirmary are found in the minutes of a meeting held on Thursday evening, December 29, 1825, when several Boston gentlemen met in the Exchange Coffee House “to take into consideration the expediency of establishing an Institution in this City, for the relief of the poorer classes afflicted with Diseases of the Eye.” The first order of business that evening was to hear a report by two surgeons, Edward Reynolds and John Jeffries. They began by stating that they were desirous of inviting the gentlemen’s attention to the Boston Eye Infirmary, an institution they had founded on October 1, 1824 for the treatment of diseases of the eye among the poor. They related how they had been in- duced to engage in their undertaking after ex- tensive observations of the incidence and prevalence of eye diseases in Boston during a six year period had shown them that it was the poor who knew annually the greatest amount of serious suffering and that there was no efficient provision in the city to alleviate their lot. A public eye infirmary, properly founded and funded, was their

*Recognition should be given here also to George Beer of Vienna, who created the Beer Free Eye Clinic in 1786 at his own expense. By 1806, the government had adopted the idea and opened a public clinic for the treatment of eye diseases in Vienna.


answer. They had established their eye infirmary, had operated it on their own funds for almost 15 months as an experiment to prove or disprove their convictions. The gentlemen would now hear of their experiences.

First, 859 patients had applied for relief in the less than fifteen-month history of the Boston Eye Infirmary. It was believed that these represented only a part of those who suffered, that more would have applied had they been acquainted with the existence of the institution. Of the number that did apply, 82 suffered from diseases of the ear, and 777 from diseases of the eye. Thirty eye patients and 27 ear patients were found to be incurable; 7 18 patients were cured and 26 were relieved. At least a fourth of the cases were various ophthalmias and infections of the lid and conjunctiva.

The report did not detail where the surgery on the 46 cases of cataract had been done. In- formation was given on one case of congential cataract that was successfully treated so that the child no longer had “to grope its helpless way through a world of darkness and inac- tivity.” Four patients, led to the Infirmary blind, with certificates from their physicians, that their diseases were incurable, were returned home to their friends enjoying good vision. Each day’s experience, Reynolds and Jeffries said, afforded them striking proofs of the importance of their labors. To them it was obvious that the evils of eye diseases added to the miseries of want, that every benevolent heart should answer the loud call for sym- pathy. Yet, most of these diseases, if early attended to, knew an easy and rapid cure. If support came to the Boston Eye Infirmary, the Almshouse and the charities would know fewer inmates. Those who from charitable sentiment financially supported an eye infirmary performed a double service - they often helped to put an end to the deplorable and unnecessary suffering of their less for- tunate brethren, and they enabled the city to lower its tax levy.

The surgeons had a third reason for want- ing a public eye infirmary in Boston. It could become a teaching center. In time, the public would derive benefit when new, well-trained practitioners from the Infirmary would cer- tainly bring relief to many suffering members of the community regardless of their class. With that said they cheerfully committed their Boston Eye Infirmary to the “fostering care and benevolence” of the assembled

gentlemen. The gentlemen responded by unanimously

adopting a resolution: “ . . . that, a Public Institution, similar to those in London and New York, for Curing diseases of the Eye, has become highly important, and will essen- tially serve the cause of humanity.” It was their opinion that the proposed Boston public institution should have as its basis the Reynolds’ and Jeffries’ Boston Eye Infir- mary. To implement the resolution, they appointed a committee of eight to solicit subscriptions from the public for its support.

Three months later, March ZOth, 1826, the gentlemen met again at the Exchange Coffee House. This time they met as the Subscribers of the Boston Eye Infirmary. To preserve a record of tbeir deliberations, a leather bound ledger with the words “Boston Eye Infir- mary” stamped on its cover had been purchased. The drive to obtain subscriptions to the institution had been a success. Sixty names, all good Boston names, were on the roster. In the treasury was $2,670.00. One committee member, Lucius Manlius Sargent, by his personal exertions had in one week collected more than $2,000.00 as a permanent fund, and nearly $300.00 in annual subscriptions. Now, in keeping with a resolution of the earlier meeting, the group formally organized itself. A president and twelve directors were elected and Edward Reynolds and John Jeffries were appointed surgeons. A committee was appointed to draft the by- laws.

Things moved rapidly. One week later, April 6th, 1826, the by-laws committee reported back to the parent body. With a few amendments their report was accepted. The first article read: “This Institution shall be denominated the Massachusetts Charitable Eye & Ear Infirmary.” No reason appears in the records for dropping the name Boston Eye Infirmary and adopting the new one. However, it can be speculated that “Massachusetts” was substituted for “Boston” because the directors planned to solicit financial aid from the state, and the surgeons were prepared to treat any eligible resident of the state, not those from Boston alone. The word “Charitable” was truly descriptive of the nature of the Institution. And, “Eye & Ear” left no doubt that both organs would receive medical and surgical attention. Why was “Infirmary” retained in the name? No answer, except that it had been


there and it was used by the prototype institutions in London and New York.

Time proved that the new name was too long and cumbersome for everyday use. In print and elsewhere it was referred to as the Infirmary, the Eye and Ear, the Eye and Ear Infirmary, the Boston Eye and Ear Infir- mary, the Eye and Ear Foundry, and the Mass Eye and Ear. In 1924, the Legislature legally shortened the name to Massachusetts Eye and Ear Infirmary.

And so it was that after 18 months of existence the Boston Eye Infirmary ceased to be and the Massachusetts Charitable Eye and Ear Infirmary came into being. The next step was to obtain a charter from the Com- monwealth and become a legal entity. Such a move was made and on February 23, 1827, an act of incorporation was approved by the governor, Levi Lincoln. At the same time the state turned down the Infirmary’s respectful petition for financial aid.

Some of the powers and limitations of the now incorporated Infirmary are made clear by these words that appear within its Act: ‘I . . . hereby incorporated and made a body politic for the purpose of gratuitously relieving and curing diseases of the Eye and Ear, and of enabling poor persons afflicted with such diseases, to submit to a course of Medical treatment for the same reason . . . hereby licensed and empowered to make purchases, and to receive grants, devises and donations of real estate to the amount not exceeding Thirty thousand dollars & personal estate to an amount not exceeding Seventy thousand dollars. . . . Said managers shall appoint surgeons . . . and provide medical and surgical instruments. To distribute money among poor patients to defray expenses of board whilst under treatment . . . ”

These words and others made the Massachusetts Charitable Eye and Ear Infir- mary a private voluntary charity with the purpose of gratuitiously relieving and curing the eye and ear diseases of the sick-poor. It was a self-governing body. As long as none of its ac- tions were repugnant to the state laws, it was answerable only to its subscribers, not to the public. All monies came from subscriber donations. Of its subscribers, there were two types. The first, a life subscriber who was any person not disapproved by the Managers who had paid $40.00 or any larger sum. Such a subscriber could participate in annual business meetings, vote for officers, and be a

candidate for office. The second type of subscriber was the annual subscriber, one who had paid $5.00 or less. Such subscribers could participate in the annual business meeting affairs, but only during the year of their pay- ment. It is estimated that in 1827 there were over 60 subscribers of both types.

The officers, chosen from the subscribers and by the subscribers, were president, secretary, and treasurer, with the powers usual to those positions. The governing body, meeting quarterly, was the Board of Managers, twelve in number, again chosen from the subscribers. The two surgeons, Rey- nolds and Jeffries, were appointed by the full Board of Managers and were given the power to receive into the Infirmary, or otherwise provide for any patients whom in their judge- ment were proper objects of the charity as far as the funds of the institution permitted. At least one surgeon was to attend at the Infir- mary every Wednesday and Friday from twelve to one, and every Monday both surgeons were to attend from twelve to one.

On the wall of the main room of the Infir- mary the Managers had a sign hung: “This Institution is designed for the benefit of the poor who are not able to procure relief elsewhere.” This was a public declaration of the purpose of the Infirmary. Coupled with it was the private determination of the Managers and the Surgeons that: “ . . . the Infirmary doors will never close upon any applicant, whom it was able to receive, and its last dollar would be expended for their benefit.” In 1828, the first full year of operation, according to the Treasurer’s Report, they did expend that last dollar and more.

The total receipts for that year, income from the permanent fund plus the annual subscriptions, totalled $355.62. The expenditures for the same time were $376.76; an overrun of $41.14. Added to this was $24.00 for the porter’s services that the Surgeons had paid out of their pockets. And, there was a large bill for medicines that had not been settled, amounting, it was thought, from $150.00 to $200.00. The fuel bill had not been paid and there were perhaps some other expenses. The total deficit for the year could be as much as $250.00.

The financial outlook of the Infirmary for the next year, 1829, disturbed William T. An- drews, the Treasurer. If all went well, he estimated there would be an income of $320.00. From those dollars he would need $200.00 for


rent, $52.00 for the porter’s salary, $50.00 for the apothecary’s bill, and $20.00 for wood and incidental expenses. He knew there would be other expenditures, the amount of which and the nature of which he was ignorant.

He had mentioned the out-of-pocket ex- penditure by the Surgeons for the porter’s salary. In the early years of the Infirmary this was a common practice of the Surgeons and Managers. The Surgeons, with their daily experiences, knew best the growing pressures that were being made on the institution. There had never been any advertisement, or public notice of the existence of the Infir- mary, but those patients who had been cured sent others, and thus the number of applicants had increased. The amount of money available did not increase. Considerable sums for all purposes were obtained privately by the Surgeons from Managers and friends. These sums never appeared in the Treasurer’s accounts. Reynolds described the situation by saying: “We often deplored our small resources and exhausted the scripts of charitable friends.”

What in the way of surgical and clinical activities had Reynolds and Jeffries done to so deplete the Infirmary’s slim financial resources to bring the institution they had founded to the brink of bankruptcy? Here is part of their 1828 report. As stated earlier, the infirmary was open to treat patients three days a week, Monday, Wednesday, and Fri- day from twelve to one. In 1828 there was a total of 681 patients treated; a daily average of about five patients. One patient in six suffered from diseases of the ear. Of the total number of patients seen, 540 were cured, 25 relieved, 68 not treated or declined treatment, and 48 continued under treatment. Of the 583 ophthalmic cases listed, at least 100 would by today’s standards have required surgical treatment of some sort. Some of these, such as the two cases of warts of the lid, would have been minor surgery that was performed in the Infirmary’s rooms. Other cases, such as the 28 cases of cataract, as major surgery would have been performed in the patients’ homes, or in boarding house rooms paid for by the Infirmary. This did not handicap the Surgeons for they were able to report that “Every case of cataract, for which operations have been performed, had been successful, so far as the result has been ascertained.” As for diseases of the ear, they wrote: “Diseases of the Ear are of necessity less satisfactory in the

result of treatment than those of the Eye; many of its diseases will most probably ever remain the opprobria of the profession. But the success had been as great in this neglected branch as ought to be expected.”

681 patients - total cost $376.76 - average cost per patient, about 55 cents. The Managers pondered these figures and remembered that the Infirmary was a charitable institution with the purpose of gratuitously relieving the eye and ear diseases of the poor of Boston. “They were the stewards of God’s bounty and were bound and directed to distribute it.” They could not allow the doors to close because of a deficit of $250.00. They appealed to the state for aid. The state answered no. They appealed to the public. The public responded with $400.00 in donations. Thus it was possible for the Infir- mary to survive through the year of 1829.

It is in the minutes of the July 29th, 1830 meeting of the Managers that we learn of a change in the financial fortunes of the Infir- mary. “Voted: That the Secretary be directed to communicate to the executors of the late Jeremiah Belknap the grateful sense which this board entertains for the bequest of one thousand dollars which they hereby acknowledge to have received . . . ” This was the first such bequest the Infirmary had received. In the months to come there would be more including one from Sarah Belknap, sister of the “venerable” Jeremiah.

The Managers concluded that memorable meeting with a burst of uncharacteristic generosity. They authorized the Surgeons to appoint some medical gentleman to be apothecary for the salary of fifty dollars per annum. And, the Surgeons were further authorized to import for the institution such anatomical preparations in wax as they may require to enable them to give a course of lectures on the subject of diseases of the eyes and ears. This they could do provided the cost was no more than $140.00. This was the beginning of the Infirmary as a teaching institution.

For the lirst years of its existence the Infir- mary was a dispensary, not a hospital. That is, patients were seen and treated free of charge as out-patients in the Infirmary’s rooms. Patients requiring major surgery, and those who were non-ambulatory and called for constant treatment, were taken care of in their own homes, or, if they were from out-of- town, they were placed in boarding houses at the Infirmary’s expense. Such a patient was


MASSACHUSETTS CII.4RITAllLE EYE AND EAR INFIRhIART. PlL4nLEP PTTIEET. EI:T:CTF.“. I&“.

FIG. 2. The Massachusetts Charitable Eye and Ear Infirmary, erected 1850. (Cour- tesy of the Public Affairs Office, The Massachusetts Eye and Ear Infirmary)

Richard Blood, aged 41, of Groton, Massachusetts, married and the father of four. Two years earlier both of his eyes had been severely injured while he was blasting rocks. The injuries were so severe and in- capacitating that he was forced to become an inmate of the almshouse at Groton. There - to use the language of the time - he languished for almost a year before applying to the Infirmary for relief. After his examina- tion he was sent to be boarded in a private lodging house. There, at the Infirmary’s expense, he was kept on a nutritious -diet for about six weeks until his state of depletion was corrected. Then Dr. Jeffries treated the cataract in his right eye by the operation of absorption. Blood was sent back to Groton; three months later he returned to the Infir- mary with clear pupil and very comfortable vision.

Fortunately for the Surgeons, the Mana- gers, and the patients, the poor state of financial affairs did not last long. Gifts and donations to the Infirmary grew. These knew the judicious husbanding characteristic of Boston of the time so that by the close of 1837, the end of its first ten years as a cor- porate entity, the Infirmary’s worth was $31,079.68. Of this sum, $22,149.34 was in- vested in a mansion house that was converted

into a hospital with twenty beds, quarters for a domestic staff of three and one house physi- cian, and clinics and operating rooms to be used daily by four surgeons. Impressed by the Managers’ efforts and the demonstrated worth of the Infirmary to the community, the Commonwealth of Massachusetts agreed to give to the Infirmary $2,000.00 each year for five years for current expenses. This, plus the income from the endowments, assured the In- firmary of a certain life. The hard years were in the past not to be known again for half a century. The Massachusetts Eye and Ear In- firmary was a recognized member of the Boston charity health care community.

It has been said that today the eye and ear infirmary is an “endangered species” - there are not many of them left and no new ones in the classic pattern have come into being in re- cent years. If this is so, the Massachusetts Eye and Ear Infirmary does not belong on the list. Consider these figures taken from the first annual report and from the latest annual report. The first report tells us there were two surgeons, today there is a surgical staff of 279. Then there was a two room out-patient dispensary, today there is a modern 174 bed structure. In 1828 there were 681 patients treated. The last annual report of the Infir- mary tells of 8 1,629 visits to the out-patient


clinics, of 11,180 admissions, and of 10,934 operations. Today the total operating expense for one year is $22,150,430.00 and the total assets are $39,937,997.00. This is the Massachusetts Eye and Ear Infirmary, an institution that almost went into bankruptcy at the end of its first year because of a $250.00 deficit.

In its early years the Infirmary could have known a bankruptcy of another sort - a bankruptcy of spirit, ofpurpose. This was not allowed to happen because the Infirmary was founded by men who lived in a city ” . . . where there was so much mutual helpfulness, so little neglect and ignorance of other classes.” In keeping with the city’s tradition, the founders, after searching their souls and

their substance, agreed to provide medical care for the eyes and ears of their less for- tunate brethern. Having once assumed this responsibility, their Calvinistic sense of duty and their Yankee stubborness would not allow them to fail, to lose spirit or purpose, even if they had to spend their own money as they did in 1828. To repeat an earlier quota- tion from this paper: “ . . . they were all stewards of God’s bounty and were bound and directed to distribute it.”

Requests for reprints should be addressed to Mr. Charles Snyder, Librarian, Howe Library of Ophthalmology, Massachusetts Eye and Ear Infir- mary, 243 Charles Street, Boston, Massachusetts 02114.

the founding and early years of the massachusetts eye and ear infirmary

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