Sir Stewart Duke-Elder: Of a Prime Minister, Three Monarchs, and a Knight

Sir Stewart Duke-Elder (April 22, 1898–March 27, 1978)[1]

“The life of every man is a diary in which he means to write one story, and writes another; and his humblest hour is when he compares the volume as it is with what he vowed to make it.” James M. Barrie

Is Duke-Elder one person or two? Ever been confused about the answer to that one? If you have answered two, you may not be absolutely wrong, for how can one person achieve so much?

William Stewart Duke-Elder was born on April 22, 1898 in Dundee. He, along with his two brothers, drove down to school by a pony and trap by day and saved his lunch money to buy candles to read at night. If morning shows the day, it was definitely bright and sunny. At school, he was awarded the Gold Dux Medal and gold medals in English, Greek, Biology, and Religious Knowledge; he topped the Bursary Competition to enter St. Andrews and graduated MA with first-class honors and special distinction in physiology.[1]

Stewart continued his medical education in the Royal Infirmary, Dundee and Edinburgh, where he was the president of the Students’ Representative Council and president of the Students’ Union from 1921 to 1922. His first publication was in the Students’ Bazaar Supplement of the Dundee Advertiser on “A Varsity – Its Privileges and its Duties.” Few lines from his article catch one’s attention: “Just one person in a hundred understands what a University is really for. It is not to turn abroad clever fools, intellectual hermits, or studious recluses; but rather to rear men and women who can take an active and integral part, not in one but in every sphere of activity—not mere straws upon the current of life’s energies, but leaders of thought and leaders of action.”[1] Sir Duke-Elder played a key role in the establishment of the Institute of Ophthalmology, London, 1948, understanding and fulfilling the need for an institute with facilities for research and training of new ophthalmologists. Here, he nurtured clinicians and scientists, as the Director of the institute for 17 years.[2] “He was tireless in encouraging young research workers especially by emphasizing in glowing and almost exhilarating terms the potential value of their ideas, so that they left his presence with a Nobel prize in their pocket! Many a long evening he would spend checking their manuscripts—not least the English; and seeing him on his way home at the end of the day with his brief case stuffed with hopeful efforts—some of them now classics in ophthalmology—is an endearing memory. Always available to discuss a problem or fan an idea with anyone, he would wave them into his room with a smiling welcome as though he had nothing else to do and had, in fact, been waiting for that moment.”[1] He remained the Life President of the institute and Emeritus Director of Research after his retirement in 1965.[1]

After his graduation in 1923 and clearing his examination for the Fellowship of the Royal College of Surgeons of England, Stewart joined as a clinical assistant to Sir John Parsons, FRS at Moorfields. This was the beginning of a lifelong association and beautiful friendship. They inspired each other, exchanging ideas and collaborating in research. While a clinical assistant at Moorfields, Stewart met his future wife, Phyllis Edgar, also an ophthalmologist. She was the perfect partner, both in building a loving home together and helping him in his practice, and with his research and publications, and assisting him in writing abstracts, translations, and proof reading.[1,3] Sir Duke-Elder wanted to promote healthy collaboration amongst ophthalmologists, essential for advancement in the field. He coordinated the merger of the Council of British Ophthalmology and the Association of British Ophthalmologists to establish the Faculty of Ophthalmologists in 1945 with its headquarters in the Royal College of Surgeons of England. As its first President, he ensured the representation of the Faculty of Ophthalmologists on the Council of Royal College of Surgeons. He also persuaded the College to initiate special examination for FRCS in Ophthalmology. Prior to this, one could take this examination only after clearing FRCS in general surgery, which, only one man, F. A. Williamson Noble, had ever undertaken.

In 1926, Stewart proceeded with his research work in the University College. It was at this time that he completed his MD thesis on “Reaction of the Eye to Changes in the Osmotic Pressure of the Blood,” for which he won a gold medal.[3] His DSc thesis at St. Andrews was on “The Nature of Intraocular Fluids and the Pressure of Equilibrium in the Eye.” He was also the first person to cannulate retinal vessels and measure the intraocular pressure.[2] In 1932, the Prime Minister of England, James Ramsay MacDonald, developed glaucoma and insisted on being treated by a Scotsman. Although young, Duke-Elder had impressive credentials. Duke-Elder successfully performed surgeries for both his eyes and the following year, was bestowed with knighthood.[2] He became the leading ophthalmologist not only in Great Britain, but also around the world. He was the Surgeon Oculist to three successive monarchs, Edward VIII, George VI, and HRM Queen Elizabeth II, holding the Royal post for a remarkable 29 years.

Stewart had witnessed war and destruction, having served in the Royal Army Medical Corps during World War II, initially as an emergency lieutenant and later as consultant ophthalmic surgeon. Sir Duke-Elder rose to the occasion when he was invited to become the Hospitaller of the Order of St. John and, along with it, to be in charge of the St. John Ophthalmic Hospital in Jerusalem in 1954. At the time, the hospital was reeling from the aftermath of hostilities of 1947–1948 and functioning in a makeshift condition, not accessible to the Arabs from the West Bank. He was able to restore the hospital and make it fully equipped for clinical and research work.[1,3]

Stewart was a student at St. Andrews at a time when J. M. Barrie, the Scottish playwright and novelist, was the Lord Rector. Stewart was a prolific writer with an inimitable style, profound knowledge, and tireless ability to read and surmise a vast amount of information in a logical, understandable form. “There never has been an author in ophthalmology that was so easily read…. Stewart’s writings are fascinating and far more absorbing than most novels. He has created an enduring and colossal body of ophthalmic literature for all time.”[2] He published his first book, “Recent Advances in Ophthalmology” in 1927. His book “The Practice of Refraction” remains to this day one of the most widely read textbooks. The volumes of “Textbook of Ophthalmology” (1932) and “System of Ophthalmology” (1958) and their subsequent editions are monumental contributions by Sir Duke-Elder, with each volume being over 1000 pages thick and adorned with more than 800 illustrations. Ida Mann spoke of him in flowing terms, “My admiration for him is profound, not only for his amazing erudition and incredible capacity for sustained solid hard work, but equally for his utter lack of conceit. He has remained young, utterly accessible, strangely intuitive, yet unbelievably erudite. He is never pompous. He is witty. He is delightful.”[2] While for most ophthalmologists, the books are the Bible, for some of us, the man with a warm heart, a witty sense of humor, an abundance of energy, and a Rolls Royce with the license plate “EYE” was perhaps closer to Peter Pan![1,2]

“Future generations will judge his place in medicine, but let them heed our collective voice that he was the predominant figure in our profession for well over a quarter of a century.”[2] An ophthalmologist par excellence, a fine researcher, a formidable leader, a perfect teacher, and an undisputable writer, Sir Stewart Duke-Elder was indeed a pantheon in the form of one man!

“As soon as you can say what you think and not what some other person has thought for you, you are on the way to being a remarkable man.” James M. Barrie

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.