In celebration of International Women's Day and RANZCO’s 50th year, we sat down with one of the College’s longest practicing female Fellows, Dr Cornelia Whitehouse, to discuss her experiences as one of the first women in ophthalmology in Australia.
Can you please tell us a little bit about your experiences at medical school and during ophthalmology training?
When I attended medical school, it was just after the war. We had a lot of ex-servicemen. Overall, we had 250 men in our first year (anybody could do medicine at that time but if they hadn’t done well in the Leaving Certificate, they had to pay) and we only had seven women. It was a very male oriented thing whereas it is very different now. Back then, it was very unusual for women to do medicine. All the women and about half of the men graduated.
In terms of patient care, there wasn’t really much we could treat patients with – for instance antihypertensives weren’t there and sulphonamides and penicillin were still very new. There was very little you could actually do to help patients.
The reason I got interested in ophthalmology was that it was the only term that you could live out. I got married in my fourth year so I still had two years to go. When I did my internship, I had to live at the hospital as an intern – when you had patients at the hospital you had to do a midnight round and a 9am round. I was working at Sydney Hospital and lived on the northern beaches and, of course, the roads weren’t anything like they are now so it was not practical to try to get home.
Actually, they didn’t even have accommodation for women at Sydney Hospital at the time so they put a female friend of mine (who was also at Sydney Hospital) and me out on the veranda, which was very nice except it was open to the view of the public on Elizabeth St. We had to go and get screens from the wards, which we put up to so we could get a bit of privacy. The other thing that used to happen is the extremely long hours you’d be on call (and you’d be on call every third weekend) – you’d start your normal day at 9am on Friday and finish at 5pm and then you’d be on call all the way through to midnight on Monday so they could call you at any time. I remember getting out of bed to a call at 3am once and sitting on the side of the bed crying because I didn’t think I could do it. In those days I think they thought that the worse you were treated, the better the doctor you’d be. I’m glad that’s not the case now. Things seemed to have changed for the better.
What do you miss about your early days at the College?
Well, getting into the College I didn’t know much about anything. I went to London to do my degree – I worked at Moorfields and I got my D.O. there – and when I came back someone approached me and asked “do you want to join the College, we’re just forming?”. I said yes. I didn’t know anything about it but it seemed like a good idea at the time and I’ve been happy to be a member ever since.
One of the things that stands out is that when the College formed everybody knew everybody else – that’s something I really miss! These days I don’t really know who anybody is.
How has ophthalmology changed over 50 years? What has been the biggest change to clinical (and/or surgical) practice during your career?
When I first started practice as an ophthalmologist, a well-equipped ophthalmologist had a direct ophthalmoscope, a retinoscope, a vertometer, a slit lamp, a schiotz tonometer and a Bjerrum screen. That was it.
There were no retinal cameras, lasers, Humphreys, OCTs, applanation tonometers, indirect ophthalmoscopes, fundus lenses etc. The surgical instruments were boiled and resharpened – needles as well as Graefe knives, there were no viscoelastics, no 10-0 sutures and no proper operating lights. And, of course, no operating microscopes.
The first cataract operation I participated in I had to stand up on a stool and shine a torch onto the operation site because that was the best light the surgeon could get. Back then, we didn’t even use gloves because there were no gloves that were fine enough that you could know what you were doing and usually no sutures because the sutures weren’t fine enough either. When a patient had a cataract operation, they had to lie flat on their back for three weeks with sandbags keeping their head still. You only did cataract surgery for people who had terrible vision because the results were so bad – once you took the cataract out the patient had to wear very thick bottle-like glasses. If they moved two millimetres on the patient’s nose the whole focus would change – they were so thick. We also had a problem where men wouldn’t be able to pass urine because they had to lie down, and people going off their brain because of lying still for so long. The surgery itself was all done under general anaesthetic with all the problems that entailed for elderly patients. Modern cataract surgery, done under local or topical anaesthesia as a day procedure, is mind-blowingly different.
I was also there when the microscope was introduced and I was there when they introduced a completely different way of doing cataracts – they went from doing intracapsular to extracapsular. I can remember some American surgeons came out to demonstrate this new method. Back then, patients post-cataract would have eyes that were red and inflamed, uncomfortable and sore for weeks, but these [American] surgeons produced four patients on day one post-op and you couldn’t tell that anything had been done to the eyes. None of us believed them [the surgeons] at first and we had to have a really close look to find the evidence that the cataracts had actually been removed. This was a completely new technique where you didn’t traumatise the eyes. I remember that this was a very magical moment.
Another magical moment was the first time I used a microscope to operate because suddenly you could see bits of the eye that didn’t exist for you before except in textbooks. Microscopes have improved vastly during my career. The first one we had, you had to hand focus it and the light wasn’t coaxial so you couldn’t see nearly as well as now and we used to take an hour and a half just to do a cataract. And the incision was very big. It was 180-degree incision and then you had to sew it up with very fine sutures. So the microscopes got better and we got faster and then we were maybe doing cataracts in less than 35 minutes.
Another exciting development for me was when phacoemulsification was introduced. I remember going to New York and observing the first machine that did this process and it was the size of a huge wardrobe and had four technicians dancing all over it to keep the machine running while the surgeon operated. It took a while for surgeons to get the technique right because people had a lot of different techniques and we saw a lot of damage to patients’ eyes until the technique was worked out and standardised.
Now the phaco machine is a little box, the size of a small carry-on bag, and you can have all sorts of different settings that help you do the operation so that you can jackhammer harder or softer, which you couldn’t do before. You can suck harder or softer or increase pressures and use viscoelastics which didn’t exist back then, but now that’s all standard.
What’s your most striking memory as an ophthalmologist/Fellow?
I think it was probably looking down a microscope for the very first time. It was like magic seeing all the bits of the eye that I had only ever read about.
What has being a RANZCO Fellow meant for you?
Being a RANZCO Fellow is a bit like being part of a club – it’s nice to have other people you can ring up if you want to, get some help from or just talk to. I really like the social side of it and I enjoy attending the annual conference when I can.
Do you have any words of wisdom, particularly for young women starting out in the profession today? What do you know now that you wished you knew 50 years ago?
No, I think the women nowadays are so sophisticated and so smart – they know what they’re doing, and they know what they want. They’re doing very well!
On a side note, people keep saying that women are discriminated against and that nobody wants them because they’re a woman but, personally, I’ve never felt or experienced that. I never had that feeling that, because I was a woman, I was a second-class citizen.