Regional Institute of Ophthalmology and Government Ophthalmic Hospital

The Heart of Heritage

Aerial view of Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai

“History is a cyclic poem written by time upon the memories of man.” Percy Bysshe Shelley

Amidst the sounds of hurried patter of feet of thousands of patients and the sure footfalls of ophthalmic surgeons, a murmur rises from the paths, praising the times gone by and whispering hopes for the future. Between the pre-independence Victorian architecture of the Lawley Block on one side and the modern construction of the Bicentenary Block on the other, the walls show a steadfast resolution to survive and grow. Around the fragile pages of old journals in the library and the clear glow of words on the computer screen, the air breathes calmly of science, that was, that is, and that which is yet to come. A black plaque reads, “Government Infirmary for gratuitous treatment of diseases of the eye.” The Regional Institute of Ophthalmology and Government Ophthalmic Hospital (RIOGOH) in Chennai stands tall, embracing the old and shining as a beacon for the new generation.

With large number of British soldiers contracting keratoconjunctivitis during the period of the Napoleonic battle at Abu Qir and civilians suffering from cataract and influenza-related ophthalmia, Moorfields Eye Hospital was established in London in 1805 as the first dedicated eye hospital in the world.[¹] It was not long before a similar need was felt owing to the rising eye problems among soldiers of the Madras Army. The Madras Eye Infirmary was conceived at Fort St. George, where the Board of Directors, at the suggestion of Dr. Benjamin Travers, the British ophthalmic surgeon and health advisor to the East India Company, decided to establish an eye hospital modeled in the lines of Moorfields. It was born in July 1819 in Royapettah, near the old Madras Club, with Dr. Robert Richardson as the first superintendent.[¹] Dr. Richardson was a student of Dr. Travers and was serving as an assistant surgeon in Madras Medical Service from 1905.[¹]

Alexander Lorimer, Garrison Assistant Surgeon, Fort St. George, made a Report on the Medical Topography and Statistics of the Presidency Division of the Madras Army, and one can find interesting details and account of the Madras Eye Infirmary in it.[²] The hospital could house 208 patients. The diseases being treated at that time included amaurosis, incipient and Morgagnian cataracts, acute, chronic, and suppurative ophthalmias, corneal ulcers, nebula, albugo, and nightblindness.[^1,2] In 1820, it moved to a tramshed in Egmore and was renamed Egmore Eye Hospital, one that has stuck to it and is fondly remembered by many. In 1884, it shifted again, and this time to its final location, the Marshalls Road of yesteryears.[³] In 1888, it was rechristened to Government Ophthalmic Hospital, supported by the Government of Madras.[¹] The hospital complex had three two-storied blocks. The middle building was the administration block with the surgical theater, examination room, and medical store. The southern block was for female patients and the northern block for male patients, each block with a doctor’s room for those on duty.[¹] In those days, the outpatient clinic would function from 7:00 to 9:00 am, with more than 100 patients coming in daily with eye problems.

“The practice of the hospital (GOH, Madras) is open to all members of the medical profession, both European and Native, and affords an extensive field for acquiring knowledge in the diseases of the eye,” Joseph Fayrer, Professor of Surgery, Calcutta Medical College, had remarked.[¹] Promotion and publishing of scientific knowledge was inculcated and encouraged, with numerous papers coming from the GOH on strabismus, cataract, and tumors of the eyelid.[¹] Many illustrious ophthalmologists are associated with this hospital, which was the first exclusive eye facility in Asia and the second oldest in the world.

Lt. Colonel Robert Henry Elliot

Lt. Colonel R. H. Elliot, FRCS, MS, was the superintendent from 1904 to 1913 and Professor of Ophthalmology in Madras Medical College (MMC).[¹] During his tenure, the hospital expanded exponentially both as a teaching institute and as a hospital. New inpatient blocks came into being, and the Lady Lawley Block was inaugurated on February 13, 1911 by Annie Allen Cunand, wife of Arthur Lawley, the Governor of Madras. It was declared a heritage building in 2007 [Fig. 1].

Figure 1: Lady Lawley Block

Elliot pioneered corneoscleral trephining for the treatment of glaucoma [Fig. 2]. The Elliot’s operation, trephining with iridectomy with creation of a subconjunctival fistula for drainage of aqueous humor, published in the British journal Ophthalmoscope, gained worldwide popularity, becoming the gold standard for surgical management of glaucoma.[¹] Elliot published several books, notably Glaucoma, A Handbook for General Practitioner (1917), The Indian Operation of Couching for Cataract: Incorporating the Hunterian Lectures (1918), Glaucoma: A Textbook for the Students of Ophthalmology (1918), Tropical Ophthalmology (1920), and The Care of the Eye Cases – A Manual for the Nurse Practitioner and Student (1921).[¹]

Figure 2: Diagram of the sclerocorneal trephining developed by Elliot. (a) Normal position of conjunctiva; (b) conjunctiva reflected onto the cornea, after splitting of that membrane; (ab) area of the crescent formed by splitting the cornea; (c) piece of sclerocornea removed by the trephine (shown shaded); (d) iris; (e) ciliary body; (f) lens; (g) cornea; and (h) sclera.[^{1 , 4}]

Lt. Colonel Henry Kirkpatrick

Dr. Kirkpatrick, ophthalmic surgeon and pathologist at GOH and MMC, succeeded Elliot as the superintendent (1914–1920).[¹] He pioneered the Elliot’s School of Ophthalmology in 1919, which opened its doors on February 16, 1920 for postgraduate training. During his tenure, the GOH was boasting of management of several diseases, including cataracts, iris prolapse, vitreous escape, dislocated lens, senile lenses, glaucoma, optic atrophy and corneal infection, and ocular syphilis.[¹] He identified the adenovirus responsible for conjunctivitis which was called Madras Eye in 1918. On his return to London, he published two books, Cataract and its Treatment and Diseases of the Eye: A Manual for the Practitioner.[¹]

Dr. Robert Ernest Wright

Dr. Wright was trained in bacteriology, pathology, and ophthalmology, had worked in Burma and Mesopotamia, at the Pasteur Institute in Coonoor, and was a Professor of Pathology and Ophthalmology at MMC. He took over as the superintendent of GOH after Dr. Kirkpatrick and served for 18 years (1920–1938).[¹] He undertook the onerous task of working for relief of preventable blindness in India.[¹] He wrote, “In an article in the Lancet for April 11, 1931, which has probably passed unnoticed by the International Association for the Prevention of Blindness, I tried to show that keratomalacia (not ophthalmia neonatorum) was the greatest cause of preventable blindness in India. I referred to the difficulty of dealing with such a huge economic problem. This, note of pessimism, has become even more justified in the last months. Still I am convinced that a great deal of good might be done by well-directed efforts to combat preventable blindness.” He started the specialist academic program, “Licentiate in Ophthalmology (LO)” in India and improved upon the Elliot School of Ophthalmology. He established the Elliot’s Museum in 1921, a rare museum dedicated to eye that boasts of an impressive collection of historic ophthalmic instruments, clinical records, eye models, and histopathologic specimens [Fig. 3]. There are also images of patients drawn by artists for doctors for a visual representation and slides, manuscripts, and case sheets describing diseases and diagnoses.[^1,3]

Figure 3: Elliot’s Museum

Diwan Bahadur Dr. Koman Nayar

Dr. Nayar was the first Indian superintendent of GOH (1940–1946). He built on the LO program of Wright and changed it to Diploma in Ophthalmology in 1942. He invented the iris repositor.

Dr. R. E. S. Muthiah

With a DO from the University of Oxford, Dr. Muthiah was the very best in ophthalmology. As the superintendent (1946–1956), he established India’s first Eye Bank in October 1947 and performed India’s first corneal transplant in 1948.[¹] He initiated the MS program in ophthalmology in 1949 and developed the curriculum for advanced ophthalmology training.[^1,5] Today, the institute is attached to the MMC and imparts training to 30 MS postgraduate students every year along with specialty fellowship in cornea, strabismus, and orbit as a part of the National Program for Control of Blindness.

In 1960, in response to the increasing demand for the excellent eye care services being provided, the Shawfield premise was acquired for a new outpatient block and inaugurated in 1969 to commemorate the 150^th anniversary of GOH. Specialty clinics to provide quality care to patients were established in this block. As a part of the Government of India’s second Five Year Plan, the School of Optometry was started in 1962, the first of its kind in the country for diploma training in optometry. Mobile Ophthalmic Scheme and mobile ophthalmic units were added to bring healthcare to the villages. In 1985, the hospital was identified as a Regional Institute of Ophthalmology under the National Program for Control of Blindness.

On August 27, 2022, during the tenure of former director Dr. M. V. S. Prakash, the Bicentenary Block was inaugurated [Fig. 4]. This is a multistoried building with state-of-the-art equipment and infinite scope for academic and medical growth.

Figure 4: Bicentenary Block

RIOGOH is,

A treasure of our past,

A call to action in the present, and

A barometer to the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.