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  • Dame Ida C. Mann Part 1: A Visionary in Ophthalmology

    By Michelle Madigan, PhD

    When internationally renowned ophthalmologist Dame Ida C. Mann died in Dalkeith, Perth, Australia, in November 1983, she left a far-reaching legacy of pioneering contributions and influence across academic and clinical ophthalmology.

    Dr. Mann led an extraordinary life and medical career, attaining numerous achievements and honors, including a doctor of science in London and becoming Oxford’s first female professor of ophthalmology. She was also a named a Commander of the British Empire in 1950, and in 1980, a Dame Commander of the British Empire. She also received an honorary medical degree from the University of Western Australia in 1977 and honorary doctor of science degree from Murdoch University in 1983.

    Dr. Mann’s life illustrates a great depth of character, quick thinking, and ingenuity that were present from the early days of her scientific and medical career. Imagine London circa 1920 … an uneasy period between world wars, pandemics, global human suffering and death, and a tremendous whirl of political, cultural, and social revolution.

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    Dame Ida Caroline Mann, MBBS (1893-1983). Image courtesy of londonremembers.com

    Into this hurly-burly, a young Dr. Mann ventured in search of scientific and medical knowledge, a quest that drove her for many years and across many countries, finally ending in Perth, Australia. Reading between the lines, one appreciates that Dr. Mann’s life encompassed more than biographical achievements or that oft-noted English matter-of-factness. Rather, there emerges a sense of a person with great energy, clear thinking, resilience and strength of purpose, and almost unlimited curiosity and passion for finding out why.

    “Ida was widely loved for her humor and intelligence but, her most remarkable feature was an inexhaustible zest for life and learning,” according to a 1984 memorial published in the Archives of Ophthalmology. These qualities may resonate with emerging clinician scientists in ophthalmology embracing population “big data,” the rich possibilities of personalized medicine driven by fields such as genetics, immunology, and pharmacology, and the ever-present background of process-driven administrators and governance.

    There are three phases in Dr. Mann’s life in medicine, research, and ophthalmology. The first early phase of medical training, extracurricular teaching plus delving into anatomy, embryology, pathology, and surgery, and a rapid decision on specializing in ophthalmology became her life passion. These years produced extensive studies documenting human eye embryology and anatomy, and complementary studies of congenital and developmental abnormalities of the eye. These works still stand as the most authoritative descriptions of development of the human eye. There were clinical adventures too, including using the new Gullstrand slit lamp biomicroscope for incredible living eye anatomy, and even a rapid surgical approach for cataracts. She undertook animal eye anatomy research and provided eye care for animals at the London Zoo.

    The second phase during World War II provided opportunities to consolidate and extend her research and clinical practice, plus exert emerging management skills. Her research for the Ministry of Supply in ocular surface responses to chemical warfare agents, notably mustard gas, led to the Imperial Cancer Research Fund’s Mill Hill Laboratories, and its director, Professor William Gye, whom she later married. These years highlighted her boundless energy, practical sense, and great skills in getting things done, working adeptly with (and at times, around) government departments, hospital committees and other administrative systems. In 1941, Dr. Mann was appointed the Margaret Ogilvie Reader in Ophthalmology at Oxford University and worked on reorganizing Oxford Eye Hospital and fundraising to establish the Nuffield Laboratory of Ophthalmology.

    Finally, after moving to Australia in 1949, Dr. Mann went through a third phase of ophthalmology life that presented after the sudden devastating death of her husband, William Gye. This phase covered more than 20 years of travel, laboratory and clinical research, and private practice. Her extensive surveys in Australia (and later worldwide) carefully documented the incidence and severity of infectious eye diseases, with significant impacts most especially for understanding and managing the previously unacknowledged widespread endemic of trachoma within Indigenous Australians.

    Early Years: Finding a Future in Ophthalmology

    “The Chase,” Dr. Mann’s autobiography published in 1986 after her death, offers a full description of her early years. She was born in London in 1893, and as usual for the time, finished school at age 16. At her father’s insistence she began work in a post office savings bank, a secure government job suitable for a woman. In the book, Dr. Mann recounts a visit with a group of co-workers to the London Hospital in Whitechapel.

    The visit proved to be a life-changing experience that began an almost inexorable quest for learning and studying medicine. At the time there was but one medical school open to women in the United Kingdom: London School of Medicine for Women.

    Dr. Mann quickly graduated from Regent Street Polytechnic, followed by matriculation in 1914 to the London School of Medicine for Women. Outstanding first-term results surprised Dr. Mann, and on reflection, she shifted her thinking about the purpose of her life. “This meant that I must now work very hard and really try to be, and do, something worthwhile. Up until now I had simply wanted to gain knowledge and travel the world.  Now I had to do something, not merely observe,” she wrote in her autobiography.

    She completed medical studies between 1916 and 1920, qualifying with MRCS, LRCP, and MBBS degrees. This was followed by a hunt for house jobs, the next step in supervised training and acquiring clinical skills and expertise needed to begin independent medical practice in the United Kingdom. Although not initially thrilled by the possibilities, Dr. Mann began as an ophthalmic house surgeon but was soon captivated by eyes.

    “Eyes … proved fascinating. …it was live anatomy, accessible in almost every part to direct observation …” she wrote. “A beautiful model of a good deal of physiology. … linked with general medicine in many ways,”

    Ophthalmology became her specialty, and subsequently her life. Her anatomy mentor and friend from St. Mary’s Hospital Medical School, Professor Ernest Frazer, suggested she combine a passion for embryology and anatomy with studying human eyes, based on his laboratory’s unique collection of human embryo sections. The outcome was an outstanding thesis and doctor of science awarded in 1924.

    This was followed by Dr. Mann’s book, “The Development of the Human Eye,” then a complementary book, “Developmental Abnormalities of the Human Eye,” where she noted in the preface “… to evaluate the origin of any developmental anomaly a knowledge of normal growth process is essential.” These two books remain landmark resources in the field.

    During the early research years, Dr. Mann published prolifically in anatomical and ophthalmology journals, attended many conferences, and was invited to present lectures including the Anatomical Society and the Royal Society of Medicine. Her attention to detail and systematic approach to human ocular development highlight these works, all with further examples of her excellent hand-drawn illustrations. In 1927, Dr. Mann also qualified as a Fellow of the Royal College of Surgeons (FRCS), followed by honorary ophthalmic surgeon appointments at Moorfields Eye Hospital and Royal Free Hospital, and established her private practice in London.

    Dr. Mann was also an early adopter in ophthalmology. “New ideas, new apparatus, new techniques were developing everywhere,” she wrote “… I decided I must have a look at Europe.” For example, the new Gullstrand slit lamp initially captivated her with its application in living anatomy. This led to a trip to Zurich, Switzerland for classes with Alfred Vogt, a pioneer of clinical slit lamp biomicroscopy, and back to London to train others with this new expertise.

    Contact lenses had caught her attention earlier, and new ways of making glass scleral lenses from personalised moulds of patient’s eyes were being applied by Josef Dallos in Hungary around 1937. Dr. Mann persuaded Dr. Dallos to move to England and to safety just before World War II. Drs. Dallos and his brother-in-law George Nissel soon opened their first contact lens clinic soon after in London. Dr. Mann recognized that bespoke scleral lenses could potentially help vision in patients with corneal scarring or corneal surface irregularities when spectacles could not. She later reported success with scleral contact lenses for some patients who had developed keratitis some years after mustard gas exposure during World War I.

    Around this time, Dr. Mann ventured into comparative eye anatomy, with research at the London Zoo Reptile House laboratory where she used slit lamp biomicroscopy to view the iris and anterior segment of live (“chilled”) reptiles. Numerous hand-drawn slit lamp views of exquisite patterns and details of the iris vasculature and the anatomy of reptiles (and other animals) were prepared. She also provided eye care for animals in the London Zoo during these years.

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    A composite plate of images illustrating iris patterns, pupils, and vascular distribution in different species of birds and reptiles. These were drawn by Ida Mann, and published in Transactions of the Zoological Society of London, 1931.

    In one story, Dr. Ida Mann delivered the 1930 Nettleship Lecture at the Ophthalmological Society of the United Kingdom meeting at the London Zoo, using a slit lamp to demonstrate the features of reptile eye anatomy and wearing a chilled python draped around her neck — much to the surprise of those attending.

    Her growing research profile in ocular embryology and anatomy, comparative anatomy, and pathology, produced many landmark publications and led to conference travels, teaching invitations in the United States, and prestigious awards. They include the Oxford Ophthalmological Congress’ Doyne Lecture and Medal in 1929 and the Ophthalmological Society of the United Kingdom’s Nettleship Medal and Lecture in 1930.

    She first visited Australia in 1939, invited as inaugural speaker to a newly formed Ophthalmological Society of Australia. Australians and their way of life made a positive impression, perhaps later remembered in her decision to move there in 1949. Not long after returning to England while on holidays in Scotland, World War II exploded, and she rushed back to London to find Moorfields Eye Hospital closed by the Ministry of Health, and a new phase of her career and life began.

    World War II Years: 1939 to 1949

    Several reviews and autobiographical insights from the “The Chase” provide great details of Dr. Mann’s extensive activities during World War II.

    Moorfields Eye Hospital, which she helped rescue after a sudden Ministry of Health decree closed its doors, was turned it into a first aid station. Not long after, Moorfields reopened, and Dr. Mann pushed on despite many contradictory administrative directives and prevailing confusions. In between London private practice, clinics, and surgery at Moorfields Eye Hospital and its annexes, were brief visits to Oxford, Dr. Mann researched, corneal vascularization and the underlying causes for chronic keratitis in patients with post-mustard gas exposure.

    Dr. Mann did research at the Imperial Cancer Research Fund Laboratories, Mill Hill, and soon extended her studies of the ocular effects of various toxic substances and chemical warfare agents under the direction of the Ministry of Supply. She led a small research team in the government’s Chemical Defence Research Department. At Mill Hill, she met her future husband, Professor WIlliam Gye, whom she worked with on laboratory studies of cancer and viruses.

    In 1941, Dr. Mann was invited to be the Margaret Ogilvie Reader in Ophthalmology at the University of Oxford, and moved from an exhausting environment of constant bomb threats, raids, rationing, and dealing with rubble, to fully immerse herself in this new demanding role. During her first years at Oxford, she worked tirelessly to reorganise and expand Oxford Eye Hospital, restart postgraduate medical training, and secure funding and established the now internationally renowned Nuffield Laboratory of Ophthalmology.

    Dr. Mann established her own research group, began an orthoptics school, and pushed the restart of the Oxford Ophthalmological Congress. In “The Chase,” she explained her Herculean efforts: “Before the war, the average annual outpatient attendance had been 2,000; it was now 22,000 and no extra staff had been appointed,” she wrote. “In the ensuing nine months I cleared the Augean stable.”

    Dr. Mann’s straightforward approach showed a remarkable ability to navigate mazes of administrative, social, and political systems, and mostly male-dominated university and hospital committees, boards, and hierarchies. She had a capacity to see beyond obstacles, and there were many, by all accounts, to find practical solutions quickly, and to get things done, exemplified her hallmark energy, drive, and resilience. During this time, her research continued, including corneal wound healing and epithelial cell migration, clinical testing of a new synthetic mydriatic, and using intraocular penicillin injections for eye infections or injuries (collaborating with the Floreys), years before intravitreal injections of antibiotics or steroids became part of mainstream clinical ophthalmology.

    In 1942, the University of Oxford awarded Dr. Mann a chair, the first woman to receive an Oxford professorship. Then in 1944, Dr. Mann “succumbed to matrimony,” finally marrying William Gye, the director of the Imperial Cancer Council Laboratories at Mill Hill.

    Not long after the war ended, ill health led her husband to retire. At the time, Dr. Mann was juggling post-war clinical and administrative battles at both Oxford University and Moorfields Eye Hospital. Combined with the challenges of reconciling public and private clinical practice and patient care, and the start of the National Health Scheme (NHS) in the UK, they decided it was time for a change, and a fresh start in Australia. With characteristic pragmatism, a need for warmer weather, family connections via Ida’s Australian cousins, and the prospect of new adventures, Ida took three months leave from Oxford University and Moorfields, and in 1949, the couple went by ship to Australia. After finally settling on Perth as their new home, Dr. Mann’s resignation from Oxford and Moorfields was swiftly executed, and the next phase of her life unfolded.