FOOTNOTES:
[17] “Treatment of the Insane without Mechanical Restraints,” 1856.
[18] For details of the exposure of 1813 and 1814, see “A History of the York Asylum,” York, 1815.
[19] For a description of the state of Bethlem Hospital in 1815, see Conolly’s work above cited, pp. [26-29]. In making this record Conolly says, “Nothing can more forcibly illustrate the hardening effect of being habitual witnesses of cruelty, and the process which the heart of man undergoes when allowed to exercise irresponsible power. Partly from custom, and partly from indifference, and partly from fear, even physicians not particularly chargeable with inhumanity used formerly to see patients in every form of irritating restraint, and leave them as they found them. Such facts justify the extremest jealousy of admitting the slightest occasional appliance of mechanical restraints in any asylum. Once admitted, under whatever pretext, and every abuse will follow in time.”
[20] Memoir of John Conolly, M.D., D.C.L., by Sir James Clark, Bart., 1869; very ill-arranged.
[CHAPTER XXV.]
EMINENT SPECIALISTS.
SIR ERASMUS WILSON AND SKIN DISEASES; MORELL MACKENZIE AND THROAT DISEASES; COBBOLD AND INTERNAL PARASITES.
Specialisation is decreed by the will of the public as much as by that of the practitioner. This is true of many professions besides those of medicine. Although the general discernment has always recognised the ability of men with powers of the universal type, these men are rare, and there is a strong tendency to believe that a man cannot be master of the whole field of a science, but may more probably be master of a portion of it. Again, with hawk eye the people who want to be cured of disease mark and then swoop down upon men who appear to them specially capable in one department of medical practice, and no denunciation of specialism, no drawing back on the part of the physician, will avail against this natural selection. The man to whom crowds of patients of one kind flock naturally becomes specially skilled in dealing with them: and it is impossible to stem the tide by saying that such ought not to be the case.
Specialism has been carried to a surprising extent in America, when Dr. Morell Mackenzie informs us, in his article on “Specialism in Medicine,”[21] it would be almost impossible to find a city with ten thousand inhabitants in which there are not three or four specialists; whilst in a city of one hundred and thirty thousand inhabitants, thirteen specialists were found exclusively engaged in treating throat diseases.
The days of encyclopædic knowledge may be past, but the need of a broad, general, scientific, and professional education for the medical man, even a specialist, will never cease. If, as Dr. Mackenzie says, the leviathans of omniscience loom dim and gigantic, like the megatherium and mastodon of remote geological periods, and if the type is as utterly extinct as he believes, it is all the more incumbent on the guides of medical instruction to see that their pupils pass through a broad course of study which shall fairly represent the achievements of the past and the main features of the knowledge of the present. Erasmus Wilson was a man who undoubtedly gained a good record in general professional knowledge, and knew well the anatomy and physiology of his student days.
William James Erasmus Wilson, son of William Wilson, surgeon, a native of Aberdeen, in early life a naval surgeon, who later settled at Dartford and Greenhithe in Kent, was born on November 25, 1809, in High Street, Marylebone, where his maternal grandfather, Erasmus Bronsdorph, a Norwegian by birth, resided. He was educated at Dartford Grammar School and at Swanscombe, but very soon commenced practical medical work under his father in the parish infirmary. At the early age of sixteen he was sent to London to enter John Abernethy’s anatomical class, and there is no doubt that his teacher’s individuality powerfully impressed him. But among his friends were some who led his tastes also somewhat deeply into botany and zoology, entomological facts then learnt being destined to bear fruit in his Commentary on Diseases of the Skin.
Wilson was enabled to extend his studies to Paris in 1828 and in 1830, where he attended Cuvier’s and Geoffroy St. Hilaire’s lectures, and among others saw the practice of Dupuytren, Orfila, and Lisfranc. He became noted for his neat dissections, insomuch that he was nicknamed the “piocheur,” or “sap” in English slang. To his excellence in dissection young Wilson joined an equal faculty for drawing, derived from his mother.
In 1826 young Wilson had become a resident pupil with Mr. Langstaff, father of a fellow-student, surgeon to the parish infirmary of Cripplegate. Here in Langstaff’s dissecting-room, where many pathological researches were carried on, Wilson made the acquaintance of numerous men of mark who resorted thither, including Jones Quain and William Lawrence. On the establishment of the Aldersgate School of Medicine under Lawrence’s régime, Wilson joined it as student, and in 1829-30 won both the surgical and the midwifery prizes. On the day when he attained his majority, November 25, 1830, Wilson took the Apothecaries’ Hall diploma.
Having become a member of the London College of Surgeons in 1831, Wilson was asked by Dr. Jones Quain, then Professor of Anatomy and Physiology at University College, London, to be his assistant, and he soon after was appointed Demonstrator of Anatomy under Richard Quain. Wilson was a capital teacher of anatomy, and his private museum of dissections prepared by his own hands fully illustrated his manipulative capacity. He superintended the execution of the illustrations to the celebrated Quain’s Anatomy, and also those to Liston’s Practical Surgery (1837).
When Dr. Jones Quain retired from University College Hospital in 1838, Wilson resigned his appointments also, and established a school of anatomy under the title of Sydenham College, which however did not prove ultimately successful. He then devoted himself to such private practice as he could obtain in Charlotte Street, Fitzroy Square, eking out his income by taking pupils, and by literary work. In 1838 he appeared as an author with “The Dissector’s Manual of Practical and Surgical Anatomy,” subsequently producing the “Anatomist’s Vade Mecum” (1840), of which many editions have been called for. In the same year he became Lecturer on Anatomy and Physiology at the Middlesex Hospital.
Meanwhile Wilson had made the acquaintance of a man who was destined to turn his thoughts in the direction which became permanent. His father, after retiring from the navy, had taken a mansion at Deham, Bucks, and set up a private lunatic asylum; and in connection with this establishment Wilson met Mr. Thomas Wakley, M.P., the founder of the Lancet, and coroner for Middlesex. Mr. Wakley appointed Wilson sub-editor of the Lancet in 1840, a post which he held for several years, continuing to write for that journal after resigning the more onerous post when his private practice increased. About this time he became Consulting Surgeon to the Marylebone Infirmary, and gained a very extensive experience of every department of hospital surgery. In fact, it appeared at first that Wilson would probably make his mark as a pure surgeon.
No more certain path, however, opening in this direction, Mr. Wakley considerably influenced Wilson towards choosing a special line of practice as a means of success. There was much open opposition at that time among medical men to the idea of specialisation, and Mr. Wakley succeeded in overcoming Wilson’s fear of sinking under the dreaded name of quack. The choice of a specialty was not difficult, as skin diseases or dermatology then constituted an almost uncultivated field. “I have never regretted my choice,” he remarked on one occasion;[22] “there is only one more beautiful thing in the world than a fine healthy skin, and that is a rare skin disease.”
In 1842 Wilson brought out his extended systematic work on Diseases of the Skin, and subsequently produced twelve fasciculi of folio “Portraits of Diseases of the Skin.” In connection with these we may mention that he took a large share in the well-known five volumes of Anatomical Plates, issued jointly by Dr. Quain and himself. In 1843 he was elected a Fellow of the College of Surgeons, and in 1844 a Fellow of the Royal Society, having contributed to the latter a memoir on a newly-discovered parasite on the human skin, the Entozoon folliculorum . He made himself familiar with varieties of skin diseases by extensive vacation rambles—in Switzerland and the Valais studying goitre, in Italy searching out ringworm cases among the peasantry, in the East making leprosy a special object of inquiry. He wrote the article “Skin” in Cooper’s Surgical Dictionary, a Report on Leprosy, and many articles on various subjects connected with the specialty.
Thus Wilson became a specialist of great merit as well as profitable practice, and, says the Lancet (August 16, 1884), “knew more about skin diseases than any man of his time. He cured when others had failed to cure; and his works on dermatology, though they met with pretty searching criticism at the time of their appearance, have nearly all maintained their position as text-books. The horrible cases of scrofula, anæmia, and blood-poisoning which he witnessed among the poor of London—they are happily rarer now than they were half a century ago—enlisted his warm sympathies. But he had to deal with rich patients as well as poor, and over these the masterful stamp of his mind enabled him to exercise despotism in matters of diet. Wilson was not only a consummate dietician, but he knew how to make his patients submit to have their bodies placed under martial law.” He in fact largely viewed skin diseases as expressions of internal derangement and constitutional defects. He was continually on the look out for deficiency of nutrition in children and remedying it.
Wilson was much pleased to be the means of bringing forward a little work on “Infant Life: its Nurture and Care,” written anonymously by a lady, and first published in his “Journal of Cutaneous Medicine.” In the preface which he wrote to it he expresses his strong beliefs that hygiene is the first necessity of a scholastic institution, that with proper nurture almost all the diseases of infants would be extinguished, that illness following vaccination properly performed can only occur owing to neglect of proper nurture and care, and that “healthy children never suffer, never die from vaccination.”
An incident which brought Erasmus Wilson prominently before the public was the inquest held at Hounslow on a soldier who had died after a regimental flogging. Mr. Wakley held the inquest, which lasted eleven days. It was in a great measure owing to Mr. Wilson’s decided evidence that a verdict was returned declaring that the flogging had been the cause of death. The public feeling was aroused, a Parliamentary inquiry was subsequently held, and the punishment of flogging was at last removed from the regimental code.
Several works of considerable merit made Wilson’s name very widely known. One of the most popular of these was entitled “Healthy Skin,” first published in 1845. It strongly advocated that constant use of the bath which has become far more prevalent than when it was first issued. A translation of Hufeland’s “Art of Prolonging Life,” which he edited, appeared in 1853. In “The Eastern or Turkish Bath,” in 1861, Wilson gave a powerful impetus to the establishment and spread of the Turkish bath in England, and laid down principles and plans of procedure calculated to make this bath safe for persons of very varied constitutions.
In 1869 Erasmus Wilson founded at his own cost a museum and professorship of dermatology at the College of Surgeons, with an endowment of £5000, and was appointed the first professor. In this capacity he lectured for nearly ten years. Several successive series of lectures were published, as well as a catalogue of the museum. He was also the founder of the Chair of Pathology in Aberdeen University. He also endowed a pathological curatorship at the College of Surgeons. He was elected on the Council of the College in 1870, and was President in 1881. A special grant of an honorary gold medal was made to him by the College in 1884, just before his death.
His early Eastern travels had particularly interested Wilson in Egyptology, and he became by wide reading and study very competent in Egyptian lore, as is evidenced by his “Egypt of the Past,” published in 1881. His munificence in connection with the bringing of the obelisk known as “Cleopatra’s Needle” to London in 1877-8 is a familiar story. Many abortive proposals had been made to secure its being brought to England, but Government had always failed to make any arrangement. General Sir James Alexander was the means of starting the idea in Erasmus Wilson’s mind, by speaking to him of a project for raising sufficient money by a general subscription. Wilson, who was greatly interested, thought the sum needed, £10,000, would not be forthcoming, and undertook to pay the entire sum himself, Mr. John Dixon, C.E., having undertaken its successful transport. Thus Britons will ever owe to him the possession of this choice treasure of Egyptian antiquity. The book entitled “Cleopatra’s Needle: with Brief Notes on Egypt and Egyptian Obelisks,” which Wilson brought out in 1877, went through several editions.
But these were only a few of the public objects to which Erasmus Wilson devoted his wealth, which had been vastly increased by singularly skilful investments in gas and railway companies’ shares. He restored Swanscombe Church, near his birthplace, in 1873. He founded, at a cost of £2500, a scholarship at the Royal College of Music, besides contributing considerably to its general funds. He was a large subscriber to the Royal Medical Benevolent College at Epsom, and built at his own cost a house for the head-master; further, he built at a cost of £30,000 a new wing and chapel for the Sea-Bathing Infirmary at Margate, in which skin diseases are largely treated. He was a strong Freemason, and contributed liberally to various Masonic charities. In recognition of his many public benefactions he was knighted in 1881.
“From his earliest life,” says the British Medical Journal (August 16, 1884), “he was characterised particularly by his kindliness and gentleness of manner, which made him many friends; indeed, to know him was to love him. His generosity to poor patients who came to consult him was very great, not only prescribing for them gratis, but supplying the means for carrying out the treatment, and that not only after he became wealthy, but even at a time when he could ill afford to be generous. The amount of good he did privately will probably never be known, as he was one of whom it may truly be said, that he never let his left hand know what his right hand did—so unostentatious was he in regard to his charity.”
Sir Erasmus Wilson had been in ill-health for two years before his death, and for a year was quite blind, yet never lost cheerfulness. On July 23, 1884, he was at the consecration of St. Saviour’s Church at Westgate on Sea, of which he had laid the foundation-stone a year before. Within three days he became seriously ill, and died on August 7th. He had married in 1841 a Miss Doherty, who survived him. He left no family, and the bulk of his property, something like £180,000, reverts on Lady Wilson’s death to the College of Surgeons, without any restriction as to the disposal of the fund. Other legacies of £5000 each he bequeathed to the Sea-Bathing Infirmary at Margate, the Medical Benevolent College, and the Society for the Relief of the Widows and Orphans of Medical Men. Such bequests alone would place a man among great public benefactors. Wilson had not waited till death came before he became beneficent, and if his gifts are used in the spirit in which he gave them, he will rank with John Hunter as to the material if not the intellectual legacy he has bequeathed to mankind.
Descended from an old Scotch family (the Mackenzies of Scutwell), Dr. Morell Mackenzie is the son of the late Mr. Stephen Mackenzie, surgeon, of Leytonstone, by his wife Margaret, daughter of Mr. Adam Harvey of Lewes. Morell Mackenzie was born at Leytonstone, on the borders of Epping Forest, on the 7th July 1837. His father was a man of exceptional intellectual power, whose studies took the direction of metaphysics and mental diseases; hence he acquired great skill in treating nervous affections which border on insanity. His ability was testified to by Mr. Brudenell Carter in his valuable essay on Hysteria (see p. [268]). Mrs. Mackenzie was a clever woman of a highly practical tendency. The untimely death of Stephen Mackenzie in 1851, when he was thrown out of his gig and killed on the spot, left his widow with nine children very slenderly provided for.
Morell Mackenzie was educated by Dr. Greig of Walthamstow, many of whose pupils entered the service of the East India Company. Mackenzie always took a great interest in natural history, in which he was largely encouraged by his mother, and from an early period greatly desired to enter the medical profession. But a medical education being then beyond the means of the family so suddenly bereaved, he was placed at the age of sixteen in the office of the Union Assurance Company in Cornhill. Here he got on very well, but never abandoned the hope of becoming a doctor. Fortunately, by the kind aid of a relative, he was enabled to gratify this desire, and he accordingly resigned his clerkship, and became a student at the London Hospital.
On commencing his medical studies Mackenzie determined to take his degree at the University of London, combining with his hospital work the preparation for matriculation. Having become a member of the College of Surgeons in 1858, he subsequently took the M.B. degree with high honours in three subjects. At the London Hospital he obtained the senior gold medal for surgery, and the gold medal for zeal, talent, and humanity to the patients, awarded by the governors. On leaving the hospital he went to Paris, where he studied for a year under Trousseau, Nélaton, Ricord, and others. He spent another year in Vienna, where he studied pathology under Rokitansky, chest diseases under Skoda, skin affections under Hebra, and diseases of the eye under Arlt and Jäger. During his stay at Vienna Mackenzie made an expedition to Pesth in order to become acquainted with the laryngoscope, an instrument invented by Manuel Garcia, which Czermak was then beginning to use. A friendship sprang up between these two men which only terminated with Czermak’s lamented death. Czermak was very desirous that Mackenzie should translate some of his papers and publish them in the English medical journals, but he had determined to study for a few months in Italy, and before he returned home Czermak had himself come over to London and introduced the laryngoscope into England. On arriving in London Mackenzie was at once appointed Resident Medical Officer at the London Hospital, and shortly afterwards Registrar to that institution. He now began to make daily studies with the laryngoscope, and soon published cases in the medical journals which had been treated by its aid. In 1862 he completed the M.D. degree at London University.
In 1863 the Jacksonian prize for an essay on the Diseases of the Larynx was awarded to Mackenzie by the Royal College of Surgeons, and on the urgent advice of many of his medical friends, especially that of the late Dr. Herbert Davies, he determined to make throat diseases a specialty, and having established himself in practice in the West End, he was largely instrumental in founding the Throat Hospital in King Street, Golden Square, in the same year. In 1866 Dr. Mackenzie was appointed Assistant-Physician to the London Hospital, and his colleagues subsequently offered to recommend to the committee of that institution that a department for throat diseases should be established under his supervision. This however he declined, on the ground that he wished to treat diseases of every kind whilst attached to the London Hospital. He, however, gave a course of lectures on Throat Diseases at the London Hospital Medical College, whilst he also lectured on Physiology for three years. Dr. Mackenzie was afterwards obliged, owing to his increasing practice, to resign his connection with the London Hospital.
Dr. Mackenzie has for many years occupied a prominent position not only as a specialist but as a champion of specialism, and has exhibited considerable persistence in his advocacy of any cause with which the interests of specialism were connected. Some years ago, when most of the special hospitals were excluded from participation in the London Hospital Sunday Fund, Dr. Morell Mackenzie led the attack upon the position taken up by the committee, with the result that the treasurer of the Fund resigned, and a modification of procedure took place. Dr. Mackenzie, among the other honorary memberships of foreign societies which have been conferred upon him, is one of the two honorary Fellows of the American Laryngological Association, Signor Garcia being the other. He has invented a number of instruments or modifications of instruments for the treatment of throat diseases, and has written copiously on the subject. His principal works are entitled “On the Use of the Laryngoscope in Diseases of the Throat,” “Essays on Throat Diseases,” “Diphtheria,” “Hay Fever,” and “Diseases of the Throat and Nose.” He has also written the article on Diseases of the Larynx in Reynolds’s “System of Medicine.”
Dr. Morell Mackenzie claims that his experience as to diseases of the throat amply justifies and necessitates specialism. “The scientific literature relating to these,” he says (Fortnightly Review, June 1885), “dates from little more than twenty-five years back, and already it has grown to a bulk that would surfeit the voracity of the most persevering bookworm, and it goes on increasing and multiplying in a manner that makes one long for a Malthus to preach some degree of moderation to its producers. Every week, every day brings one books, pamphlets, articles, lectures, reprints about all sorts of uncomfortable things in itis and osis , as seen in the throats of Englishmen, Frenchmen, Germans, Italians, Danes, Russians, Americans, and all the other offspring of Babel. A certain proportion of these, no doubt, are of great value, but not a few might be consigned to the wastepaper basket without serious loss to science; all must be read, however, lest some grains of wheat should be thrown away with the chaff. Several periodicals dealing exclusively with diseases of the throat appear with praiseworthy regularity; and there are also societies, associations, &c., founded for the same purpose, each of which, of course, issues its yearly volume of Transactions.... This may give some faint idea of the herculean labour which the specialist who wishes to keep abreast of the progress of knowledge in his own subject from the literary point of view alone has to undergo; and it must be remembered that in medicine reading is after all only subsidiary to the practical work by which skill is perfected and experience gathered and extended.”
The subject of animal parasites upon and in the human body, while certainly not one of the most attractive on a superficial view, has yet been found to yield scientific material of the highest interest, and has required great energy and care to produce satisfactory results. Among British workers in this field none is more widely known than Dr. Thomas Spencer Cobbold, F.R.S.
Dr. Cobbold is the third son of the late Rev. Richard Cobbold, rector of Wortham, Suffolk, the author of the striking “History of Margaret Catchpole,” and his grandmother, Mrs. Cobbold, was a zealous geological collector in the early days of geology, having a fossil species of mollusc (Nucula Cobboldiæ ) named in her honour. The subject of this notice was born at Ipswich in 1828, and educated for some years by the Rev. H. Burrows, at Yarmouth, and afterwards at the Charterhouse.
Young Cobbold entered upon the study of medicine at the Norfolk and Norwich Hospital in 1844, as pupil of Mr. Crosse, F.R.S. Later he proceeded to Edinburgh, and became class-assistant to Professor Hughes Bennett, and prosector to Professor Goodsir, then at the height of his career. Such men, and especially Goodsir, exercised a great awakening influence on young Cobbold, and deepened his strong tendencies towards anatomical research. In 1851 Dr. Cobbold graduated on the same day as Dr. Burdon-Sanderson, now Waynflete Professor of Physiology at Oxford, and the late Dr. Charles Murchison, all three being gold-medallists. After studying for some time in Paris, Dr. Cobbold on his return to Edinburgh was appointed curator of the Anatomical Museum, and became active in dissecting specimens of animals received at the museum. Among others his memoir on the giraffe and other ruminants formed the basis of his article Ruminantia, contributed to Todd and Bowman’s Cyclopædia of Anatomy and Physiology. When the lamented Edward Forbes was elected to the chair of Natural History, Dr. Cobbold’s attention was powerfully attached to geology, and for some years he made excursions with his class, and collected large numbers of fossils. More distant excursions to Arran, the Yorkshire and Devonshire coasts, the Isle of Wight, &c., supplied Dr. Cobbold with specimens of great service in illustrating the Swiney Lectures, which he afterwards delivered for five years with marked success at the British Museum and at the Royal School of Mines (1868-72). So popular did these lectures become that towards the close of the last course many of the visitors could not find seats.
After the death of Edward Forbes, Dr. Cobbold resigned his appointments in Edinburgh, and became Lecturer on Botany at St. Mary’s Hospital. Two years later he transferred his services to the Middlesex Hospital, lecturing there for thirteen years on Zoology and Comparative Anatomy. During his connection with the Middlesex Hospital he took up the branch of zoology and medicine with which his name will be most distinctively associated. During three successive years he examined the bodies of animals dying at the Zoological Gardens, especially with a view to discovering the presence of parasitic worms in them. Many papers were contributed by him to the Linnean and Zoological Transactions and Proceedings, among which we may call attention to “Remarks on all the Human Entozoa” (Zool. Soc. Proc., 1862).
In 1864 Dr. Cobbold was elected F.R.S., and in the same year published his “Introductory Treatise on the Entozoa,” which established his reputation, the Lancet declaring that it formed a noble contribution to medical science and a credit to our national literature. Up to the year 1865 Dr. Cobbold persevered in the pursuit of pure science, refusing all inducements to practice; but finding that after his twenty years of zealous labour, no suitable scientific post opened for him, he at length commenced practice in Wimpole Street, removing later to Harley Street. Here his great knowledge of the habits and treatment of internal worm parasites became available for professional purposes, and his services were largely sought. But scientific pursuits and public lecturing still claimed his attention, and among the achievements of his later years are his book on Tapeworms, which has gone through several editions; his lectures on practical helminthology, entitled “Worms;” a manual of the “Parasites of the Domesticated Animals,” a larger treatise on Parasites, a smaller supplementary work on Human Parasites. In 1873 Dr. Cobbold received the appointment of Professor of Botany at the Royal Veterinary College, and soon afterwards a special chair of helminthology was established for him at the College, for giving instruction on the parasites and parasitic diseases of domesticated animals to veterinary students. In connection with this work. Dr. Cobbold went still more deeply into the parasitic diseases of domestic animals, such as those which caused grouse disease, ostrich and pigeon epidemics, gapes in chickens, &c. He delivered a course of lectures on the “Parasites of Animals employed as Food” at the Society of Arts. He has been the first to describe many new species of internal worms from elephants, horses, cattle, sheep, and dogs. One of the most elaborate of his special memoirs is that in which he has described the parasites of elephants, in the Linnean Society’s Transactions. With these extensive researches in comparative anatomy, Dr. Cobbold has not neglected human parasites of late years, and various papers and lectures of his have commanded much attention and elucidated important points. He contributed fifty short articles on these subjects to Quain’s “Dictionary of Medicine.” As a lecturer Dr. Cobbold’s style is highly popular and pleasing. He possesses to a great degree the power of putting himself on good terms with his audience and keeping them interested. His position in regard to the investigations with which his life has been chiefly occupied has been quite unique.
An extract from his work on Entozoa is an interesting example of a very successful mode of treating this subject. “The happiest, and perhaps after all the most truly philosophic, way of studying the entozoa, is to regard them as a peculiar fauna, destined to occupy an equally peculiar territory. That territory is the widespread domain of the interior of the bodies of man and animals. Each animal or “host” may be regarded as a continent, and each part or viscus of his body may be noted as a district. Each district has its special attractions for particular parasitic forms; yet, at the same time, neither the district nor the continent are suitable localities as a permanent resting-place for the invader. None of the internal parasites ‘continue in one stay;’ all have a tendency to roam; migration is the very soul of their prosperity; change of residence the sine quâ non of their existence, whilst a blockade in the interior, prolonged beyond the proper period, terminates only in cretification and death.”