FOOTNOTES:
[12] Monthly Microscopical Journal, 1870, iii. p. 143.
[CHAPTER XIX.]
SIR THOMAS WATSON, SIR DOMINIC CORRIGAN, SIR WILLIAM GULL, AND CLINICAL MEDICINE.
The Nestor of the medical profession, Sir Thomas Watson, died in 1882, at the great age of ninety, universally beloved and honoured. Yet he had written but one extended work, the “Lectures on the Principles and Practice of Physic,” and had made no striking discovery. But to have written a book which every cultivated practitioner reads, and reads with delight and satisfaction, is an achievement given to few, many though there be who aim at it. And Sir Thomas Watson’s personal character was as unique as his advice was valuable.
Thomas Watson was born on March 7th, 1792, at Montrath (now Dulford) House, near Cullompton, Devonshire, where his father, Joseph Watson, a Northumbrian by family, was then living. He was educated at Bury St. Edmund’s Grammar School, where he was a schoolfellow with Blomfield, afterwards Bishop of London, and a great friend of Watson’s. In 1811 he entered at St. John’s College, Cambridge, and became tenth wrangler and fellow of his college. At that time only two fellows of St. John’s could retain their fellowships without taking orders, and one of these must study medicine. This circumstance availed to turn Watson’s attention to medicine in 1819 at the age of 27, when he entered St. Bartholomew’s Hospital, and came under the powerful influence of Abernethy. During the session 1820-1 he attended medical lectures at Edinburgh University, and in 1822 received his licence to practise from Cambridge. But academical pursuits were continued, and Watson took private pupils, among whom was Lord Auckland, afterwards Bishop of Bath and Wells, and served the office of proctor in 1823-4. In 1825 he took his M.D. degree, and married Miss Jones, niece of Turner, Dean of Norwich and Master of Pembroke College. Soon afterwards he established himself as a physician in Henrietta Street, Cavendish Square, London, in which street he continued to live for fifty-seven years. His wife died, to his lasting regret, five years later, leaving him with one son and daughter, to whom he was devotedly attached.
Watson was recognised from the commencement of his London career as a man of mark, and in 1827 he was elected Physician to the Middlesex Hospital. In 1828, on the opening of the University College, he was appointed Professor of Clinical Medicine, retaining his post at the Middlesex Hospital; but he transferred his services as lecturer to King’s College in 1831, becoming Professor of Forensic Medicine. Practice had come but slowly in these years. In 1831 he made his first contribution to medical literature, in the shape of “Remarks on the Dissection of Bishop, and the Phenomena attending Death by Strangulation” (Medical Gazette). Bishop had murdered an Italian organ-boy, and brought the body to King’s College for sale: Bishop was hanged, and his body, like that of his victim, came to King’s College for dissection. From this time Dr. Watson made numerous contributions to the Medical Gazette, largely embodied in his subsequent great work. In July 1832 he was chosen to accompany Sir Walter Scott from London to Edinburgh when he was returning from Italy to Abbotsford for the last time.
In 1836 Dr. Watson was appointed to the chair of the Principles and Practice of Medicine at King’s College, and in the ensuing winter delivered the first draught of those lectures on which his fame rests. They soon became well known, and they were printed weekly in the Medical Gazette in 1840-2. Finally they were published in two volumes by Parker in 1844, and became acknowledged as medical classics. Mr. Parker showed a righteous liberality when their great sale had brought in a large sum, in granting the author two-thirds of the profits instead of one-half, as had been agreed, and handing him twelve hundred pounds as a first payment. Watson had already, in 1840, resigned his chair at King’s College rather than leave his old post at Middlesex Hospital, but in 1843 he was compelled by the increase of private practice to resign even this. Henceforward, especially after the retirement of Dr. Chambers in 1848, he was at the head of London practice for many years. He was not, however, appointed one of the Queen’s Physicians-Extraordinary till 1859; in 1861 he was called in to attend the Prince-Consort in his fatal illness, and in 1866 he was created a baronet, receiving in 1870 the further appointment of Physician-in-Ordinary to the Queen. The College of Physicians elected him President in 1862, an office he held for five years. From 1858 to 1860 he represented the College on the General Medical Council. In 1857-8 he was President of the Pathological Society, and he was in 1868 the first President of the Clinical Society. In 1859 he was elected a Fellow of the Royal Society.
Two quotations from Watson’s Introductory Lecture to his course will serve to indicate some of the qualities which have given his book such popularity. Referring to the study of anatomy and physiology, he says; “Do not think that I am wandering from my proper subject when I bid you to remember how profoundly interesting, how almost awful, is the study in itself and for its own sake, revealing, as it surely does, the inimitable workmanship of a Hand that is Divine. Do not lose or disregard that grand and astonishing lesson. Do not listen to those who may tell you not to look for the evidence of purpose in this field of study, that the visible mechanism of that intricate but marvellously perfect and harmonious work, the animal body—the numberless examples of means suited to ends, of fitness for a use, of even prospective arrangements to meet future needs, of direct provisions for happiness and enjoyment—that all these have no force at all, in true philosophy, as evidences of design. For my own part, I declare that I can no more avoid perceiving, with my mental vision, the evidential marks of purpose in the structure of the body, than I can help seeing with my open eyes, in broad daylight, the objects that stand before my face.”
Again, he characterises the profession of medicine in noble terms. “The profession of medicine having for its end the common good of mankind, knows nothing of national enmities, of political strife, of sectarian divisions. Disease and pain the sole conditions of its ministry, it is disquieted by no misgivings about the justice or the honesty of its client’s cause; but dispenses its peculiar benefits, without stint or scruple, to men of every country or party, and rank and religion, and to men of no religion at all. And like the quality of mercy, of which it is the favourite handmaid, it “blesses him that gives and him that takes,” reading continually to our own hearts and understandings the most impressive lessons, the most solemn warnings. It is ours to know in how many instances, forming indeed a vast majority of the whole, bodily suffering and sickness are the natural fruits of evil courses—of the sins of our fathers, of our own unbridled passions, of the malevolent spirit of others. We see, too, the uses of these judgments, which are mercifully designed to recall men from the strong allurements of sense, and the slumber of temporal prosperity, teaching that it is good for us to be sometimes afflicted. Familiar with death in its manifold shapes, witnessing from day to day its sudden stroke, its slow but open siege, its secret and insidious approaches, we are not permitted to be unmindful that our own stay also is brief and uncertain, our opportunities fleeting, and our time, even when longest, very short, if measured by our moral wants and intellectual cravings.”
These lectures had the largest sale of any similar work in the author’s lifetime. Five large editions were published under his own revision. He most unsparingly altered his previous views with the advance of science, and showed rare modesty in his expressions thereupon. Dr. Charles West has admirably sketched his friend’s character (Medical Times and Gazette, Dec. 16, 1882): “He laid no claim to genius; he made no great discovery. Though a scholar he was not more learned, though a good speaker he was not more eloquent, than many of his contemporaries whose names are now well-nigh forgotten; and yet he was by universal consent regarded as the completest illustration of the highest type of the physician. His moral as well as his intellectual qualities had much to do with the estimate which all formed of his character. His faculties were remarkably well balanced, his mind was eminently fair. He had that gift—the attribute and the reward of truth—the power intuitively to detect all specious error. Hence, while the added experience of each year gave increased value to his teachings and his writings, it brought but little for him to unlearn or to unsay. He took a wide view of every question.... He availed himself of knowledge from all sources, and for all purposes except vain display; he used theories to illustrate his facts and to point their meaning, but no further, conscious that, with imperfect knowledge, it would be idle to attempt to build up correct theory.... Take him in his teaching, all in all, he seems to me, more than any one I ever knew, to be the undoubted heir of England’s greatest practical physician, Thomas Sydenham.”
Another writer in the British Medical Journal, Dec. 23, 1882, speaks of his serene and gentle temper, his modest dignity, his benevolent kindness, his unfailing clearness of judgment. “Nothing that happened in the professional world, of human or scientific importance, was alien to him; and there are few men among his contemporaries who have not at one time or another come to him for advice and guidance. Conciliatory to the utmost bounds of kindness, he was never open to the charge of favouring compromise.... It is rare indeed to find any man of whom it may be said as of him, that there is not one man in the profession who would at any time have declined to accept Sir Thomas Watson’s judgment on any personal or professional question as final. His sense of justice, his habitual reference of all questions of detail to unassailable principle, his flexibility of mind, and his quick perception of character, gave him a rare but well-justified ascendancy over even the ablest of his contemporaries.” After a long old age spent in retirement from practice, but in continued vigorous professional study, of which he gave evidence in a little book on the Abolition of Zymotic Diseases, published as late as 1879, the venerable man died of old age at his son’s residence at Reigate, in Surrey, on December 11, 1882.
Born about ten years after the last-mentioned eminent physician, Dominic John Corrigan for many years held a position in Dublin somewhat parallel to that of Watson in London. He was a native of Dublin, born on December 1st, 1802, his father having been a merchant in Thomas Street. Educated first at the lay college of St. Patrick’s at Maynooth, he entered upon medical study as the pupil of Dr. O’Kelly of Maynooth, who had foresight to discern that his pupil was capable of rising to the highest position in the profession, and advised his being sent to the Edinburgh Medical School. Part of his medical study was, however, pursued in Dublin, where he attended clinical lectures at Sir Patrick Dun’s Hospital. His Edinburgh degree dates from 1825.
The rising science of pathology had deeply impressed young Corrigan’s mind, and he devoted himself, after settling in Dublin as physician to the Meath Street Dispensary, to original study. One of the principal fruits of his inquiries was his classic paper on “Permanent Patency of the Mouth of the Aorta, or Inadequacy of the Aortic Valves,” published in the Edinburgh Medical and Surgical Journal, April 1832. This paper commenced with the following statement, “The disease to which the above name is given has not, so far as I am aware, been described in any of the works on diseases of the heart. The object of the present paper is to supply that deficiency. The disease is not uncommon. It supplies a considerable proportion of cases of deranged action of the heart, and it deserves attention from its peculiar signs, its progress, and its treatment. The pathological essence of the disease consists in inefficiency of the valvular apparatus at the mouth of the aorta, in consequence of which the blood sent into the mouth regurgitates into the ventricle. This regurgitation, and the signs by which it is denoted, are not necessarily connected with one particular change of structure in the valvular apparatus.” One particular feature attending these cases, which Corrigan was the first fully to describe, was the extraordinary character of the pulse, since known very generally as “Corrigan’s pulse.” The strong visible pulsation in the arteries of the head, neck, and arms, bounding into a new position with each beat of the heart, and becoming prominent under the skin, has since proved the means whereby aortic valvular disease of the heart has been recognised in multitudes of cases. The full pulse, followed by almost complete collapse, has since been termed “jerking, splashing, or collapsing,” or the “water-hammer pulse.” The peculiar rushing thrill felt by the finger in the large superior arteries was also dwelt upon, as well as the “bruit de souffle” heard as an accompaniment of the heart-sounds. Corrigan had corrected Laennec’s erroneous view of the cause of this bruit, in a previous paper in the Lancet of vol. ii., 1829, p. 1.
Dr. Corrigan continued for some years zealously to investigate the functions of the heart, and he experimented largely upon the hearts of fishes and reptiles. He published an important paper “On the Motions and Sounds of the Heart,” in the Dublin Medical Transactions, 1830, part i. At this period of his career, when practice as yet was but scanty, he was much encouraged by reading “The Lives of British Physicians, from Linacre to Gooch,” published in 1830, and he referred to it afterwards as showing that “there is but one road to excellence and success in our profession, and that is by steady study and hard labour; and you will at least always have this consolation in your dreariest hour of labour, that no proud man’s contumely, no insolence of office, nor ‘spurns that patient merit of the unworthy takes,’ can bar your way.”
Resigning his post at the Meath Street Dispensary, Corrigan became successively attached to the Cork Street Fever Hospital, and to the Jervis Street Hospital. Yet the Irish College of Physicians failed to discern his great merits, and blackballed him when he was first proposed for the fellowship, a mistake which they subsequently atoned for in some measure by electing him their president for five successive years, and by commissioning a statue of him, by Foley, at the conclusion of his term of office. In 1833 he began to lecture on the practice of medicine in the Carmichael School of Medicine, and practice grew rapidly. In 1840 he was appointed physician to the House of Industry Hospitals, which post he held till 1866. Here he delivered a noteworthy course of lectures on the Nature and Treatment of Fever, which were published in 1853. He accepted and enforced the modern views as to the distinctness of typhoid from typhus fever.
In 1841 Dr. Corrigan became a member of the Senate of the new Queen’s University, of which after thirty years he was appointed Vice-Chancellor. In 1849 Dublin University gave him the honorary M.D. He was assiduously devoted to the onerous duties of a Commissionership of National Education. As to practice, he became the most popular and highly remunerated physician Dublin had ever seen, having for many years more calls upon him than he could possibly attend to, and receiving in several years as much as £9000 per annum in fees. In 1866 he was made a baronet in consideration both of his medical position and of his important services to national education. He was also Physician-in-Ordinary to the Queen in Ireland.
As member of the General Medical Council from 1858 till his death, Sir Dominic Corrigan exercised a strong influence in favour of elevating the standard of professional education. He was an eloquent and lively debater and not at all averse to a display of verbal pugnacity, but he was much and generally beloved. In 1868 Sir Dominic was induced to come forward as an advanced Liberal candidate for the representation of the city of Dublin in Parliament; but on that occasion, however, he was defeated. In 1870 he was elected by a majority of over a thousand votes, and sat in Parliament till 1874. Originally of a fine constitution, he suffered severely from gout in his later years, and died after an attack of paralysis on Feb. 1, 1880.
The succession of clinical physicians is well sustained at the present day in the person of Sir William Withey Gull, Baronet. Born on the last day of December 1816, at Thorpe-le-soken, Essex, William Gull was educated privately, and early became a student of Guy’s Hospital, London. To this establishment he was so attached that for fifteen years he resided within its walls or immediately adjacent. In 1841 he became M.B. of London University, and in 1846 M.D. He was elected Fellow of the College of Physicians in 1846, and Fullerian Professor of Physiology at the Royal Institution in 1847, which office he held till 1849.
Very early after his graduation as M.B., Dr. Gull was appointed to assist the pupils at Guy’s in their studies, or in other words, he became medical tutor. In 1843 he began to lecture on natural philosophy. In 1846 he undertook the important lectureships of physiology and comparative anatomy in Guy’s Medical School. Meanwhile about 1843 Dr. Gull had been appointed resident superintendent of the asylum for twenty female lunatics which Guy had ordered to be maintained. He formed a close acquaintance with Dr. Conolly, whose name will ever be connected with the rational treatment of the insane in this country, and by adopting improved methods Dr. Gull was finally so successful that the patients were all discharged cured, and the wards occupied by them devoted to the treatment of acute cases more properly coming under care in a general hospital. Meanwhile Dr. Gull was appointed assistant-physician to Guy’s, and in due course succeeded to the full physiciancy. In this capacity his clinical teaching was long one of the important features at Guy’s. In 1856 he became joint-lecturer on medicine, which office he held till 1867 with great distinction. At this date he was compelled by the increasing claims of practice to resign his appointment; but he is still attached to Guy’s as consulting physician.
Practice, indeed, came upon Dr. Gull all too soon for medical science to reap the highest advantage from his original research. But whatever he has written has been of high value and worthy of deep consideration. Among his writings may be mentioned the Gulstonian Lectures on Paralysis (Medical Gazette, 1849), essays on Hypochondriasis and Abscess of the Brain, in Reynolds’ “System of Medicine,” and Guy’s Hospital Reports, 1857; on Paraplegia, in Guy’s Hospital Reports for 1856, 1858, and 1861; on Anorexia Nervosa, and on a Cretinoid State, in the Transactions of the Clinical Society, vol. vii. His Report on Cholera, with Dr. Baly, for the College of Physicians (1854), and his paper, with Dr. Sutton, on Arterio-Capillary Fibrosis (Med. Chir. Transactions, vol. lv.), rank high as original contributions, which must always be consulted by writers on those subjects.
In an oration delivered before the Hunterian Society in 1861 Dr. Gull took occasion to utter a protest against the popular prejudice for specialists. “Who can treat as a speciality,” he asks, “the derangements and diseases of the stomach, whilst its relations and sympathies are so universal? How can there be a special ‘brain doctor,’ whilst the functions of the brain are so dependent upon parts the most distant, and influences the most various? A tumour in the brain may tell of its presence only through disturbance in the stomach, and a disorder of the stomach and its appendages may have for its most prominent symptoms only various disturbances of the brain.”
In his address on “Clinical Observation in Relation to Medicine,” before the British Medical Association in 1868, Dr. Gull thus expressed his impartial attitude in medicine: “We have no system to satisfy; no dogmatic opinions to enforce. We have no ignorance to cloak, for we confess it.” “Medicine is a specialism; but of no narrow kind. We have to dissect nature; which, for practice, is better than to abstract it.” “To clinical medicine the body becomes a pathological museum. In every part we recognise certain proclivities to morbid action; and the purpose of our study is to trace these tendencies to their source on the one hand, and to their effects on the other.” “The effects of disease may be for a third or fourth generation, but the laws of health are for a thousand.” “Happily, at this day, hygiene has gained strength enough to maintain an independent position in science. To know and counteract the causes of disease before they become effective is evidently the triumph of our art; but it will be long before mankind will be wise enough to accept the aid we could give them in this direction. Ignorance of the laws of health, and intemperance of all kinds, are too powerful for us. Still we shall continue to wage an undying crusade; and truly we may congratulate ourselves that no crusade ever called forth more able and devoted warriors than are thus engaged.”
In 1870 Dr. Gull delivered the Harveian Oration before the Royal College of Physicians, and expressed himself forcibly as to the duty of preventing disease. Indeed, it is a strong article of faith with him that at some future time the office of the physician will be gone. “I cannot doubt it is on all sides imperative on us to limit, and if possible to blot out, all diseases of whatever kind. Who would assume the responsibility of letting a preventable evil fester in society, on a pretence of a knowledge of the divine purposes, or under the pretext that public morality would be thereby promoted? The duty which lies nearest to us must ever have the first claim; and it cannot but be admitted that the nearest duty each man has to his fellow is to save him as far as possible from all injury, even though that injury may arise as the consequence of his own fault. Nor will it be questioned that the cause of morality is more advanced by beneficent interference than by permitting ourselves to stand passively by whilst intemperance and vice work ruin and infect the very fountains of life.”
Meanwhile Dr. Gull had attained many of the highest honours of the profession. He was one of the first graduates of London University to attain a seat on its Senate, which he continues to occupy. He was Censor of the College of Physicians in 1859-61 and in 1872-3, and Councillor in 1863-4. Oxford conferred on him the degree of D.C.L. in 1868, the Royal Society elected him to its Fellowship in 1869, Cambridge followed suit with the LL.D, in 1880, and Edinburgh in 1884. He was appointed a Crown Member of the General Medical Council in 1871, holding office till 1883, when he resigned. His successful attendance on the Prince of Wales in 1871, in conjunction with Sir W. Jenner, became the occasion of his receiving a baronetcy in 1872, and being made Physician-Extraordinary to the Queen.
The evidence given by Sir William Gull before the Lords’ committee on intemperance, in 1877, has often been referred to as one of the most valuable aids to temperance that a medical man has rendered. He distinctly assigned a subordinate value to alcohol as a medicine, and expressed his belief that its value lay chiefly in its action on the nervous system as a sedative, not as a stimulant. He further stated that a very large number of people in society are dying, day by day, poisoned by alcohol, but not supposed to be poisoned by it. In the case of inebriates, with most patients he would not be afraid to stop the use of alcohol altogether. He sees no good in leaving off drink by degrees. “If you are taking poison into the blood, I do not see the advantage of diminishing the degrees of it from day to day.... I should say, from my experience, that alcohol is the most destructive agent that we are aware of in this country.”
His own example is powerfully instructive. “If I am fatigued with overwork, personally, my food is very simple. I eat the raisins instead of drinking the wine.... I should join issue at once with those people who believe that intellectual work cannot be so well done without wine or alcohol. I should deny that proposition and hold the very opposite.” In the life of James Hinton, by Ellice Hopkins, to which Sir William Gull has contributed a preface, we learn another secret of a popular physician’s endurance in the record of early constitutionals in the parks and remote suburbs, from six to eight in the morning.
In 1882, in the controversy on Vivisection, Sir William Gull, writing in the Nineteenth Century, showed that his sympathy with the struggles of physiologists for their science was combined with a fully answering appreciation of the value of physiological research to medicine. “Yearly in this country,” he says, “more than twenty thousand persons, children and others—mostly children—die of scarlet fever; and nearly twenty thousand more of typhoid fever; and one of the chief causes of this mortality is the high temperature of the blood, which results from the disturbance due to the fever process. No wonder therefore that physiologists and physicians have anxiously and laboriously occupied themselves in investigating that mechanism of the living body which in health maintains so constant a temperature under varying circumstances, both internal and external, and which becomes so easily and fatally deranged in disease.... The febrile state must have arrested attention from the infancy of man. The mothers of a palæolithic age must have watched their children consumed to death in it, as do the mothers of to-day. The name of this fiery state is as old as literature.... This fiery furnace, with its uncounted millions of victims, science hopes to close.”
“There is no doubt that physiological experiments are useful, useful for animals as well as for man. They are therefore justifiable.... Nothing is so cruel as ignorance. For how many centuries had human sufferers to bear pain which is now preventable by better knowledge? How many thousands festered to death in small-pox before the discovery of vaccination? How many are now dying of tubercle and scrofula whom a better knowledge of their conditions might rescue? Yet the pursuit of this knowledge is hindered in England by the outcry of cruelty—the cruelty being no more than the inoculation of some of the lower animals with tubercular and scrofulous matter, in order to study the course of the disease and the modes of prevention. The cruelty obviously lies, not in performing these experiments, but in the hindering of progressive knowledge.”
[CHAPTER XX.]
SIR JAMES PAGET AND SURGICAL PATHOLOGY.
The foremost surgical philosopher and orator of his day, Sir James Paget was called to occupy the presidential chair of the International Medical Congress which met in London in August 1881. This was the culmination of a long career of scientific usefulness and successful practice. Sir James is a younger brother of Dr. G. E. Paget, Regius Professor of Medicine in the University of Cambridge, and was born at Yarmouth in Norfolk in 1814. After a course of professional study at St. Bartholomew’s Hospital, London, Mr. Paget qualified as a member of the London College of Surgeons in 1836. His energy and acuteness were soon made manifest to the authorities, and he was selected to catalogue and describe the Pathological Museums of St. Bartholomew and also of the College of Surgeons, in conjunction with Mr. Stanley. These important works contributed not a little to establish Mr. Paget’s scientific reputation.
In July 1842 Mr. Paget, while Demonstrator of Morbid Anatomy at St. Bartholomew’s, published in the British and Foreign Medical Review an exhaustive report on the chief results obtained by the use of the microscope in the study of human anatomy and physiology; it was afterwards issued separately. Being derived from the original authorities, and full references being given, it was of great value at a critical period in the growth of the knowledge of minute anatomy. For some years Mr. Paget drew up valuable reports on the progress of human anatomy and physiology.
Forty years ago Mr. Paget was already Warden of St. Bartholomew’s College and Lecturer on Physiology in the Hospital. At the opening of the session of 1846 he addressed the students in an eloquent and practical way on “The Motives to Industry in the Study of Medicine.” His appeals to the highest motives were most forceful, and very indicative of the spirit which was to animate himself throughout life. “Do not imagine,” he said, “that your responsibilities will be limited to the events of life or death. As you visit the wards of this hospital, mark some of the hardly less portentous questions which, before a few years are past, you may be permitted to determine. In one, you will find it a doubt whether the remainder of the patient’s life is to be spent in misery, or in ease and comfort; in another, whether he and those who depend upon his labours are to live in hopeless destitution, or in comparative abundance. One who used to help his fellow-men finds ground to fear that he may be a heavy burthen on their charity. Another counts the days of sickness, not more by pain and weariness, than by the sufferings and confusion of those who are left at home without a guide, and, it may be, starving. Oh, gentlemen! I can imagine no boldness greater than his would be, who would neglect the study of his profession, and yet venture on the charge of interests like these; and I can imagine no ambition more honourable, no envy so praiseworthy, as that which strives to emulate the acquirements of those who are daily occupied in giving safe guidance through the perilous passages of disease, and who, in all these various difficulties and dangers, can act with the energy and calmness that are the just property of knowledge.”
About the same time Mr. Paget published an interesting pamphlet containing all the records of Harvey preserved in the Journals of St. Bartholomew’s, with notes elucidating them. Meanwhile, having been appointed Professor of Anatomy and Surgery to the College of Surgeons, an office which he held from 1847 till 1852, the lectures which he delivered being reported in the medical journals, as well as listened to with delight by large audiences, were recognised as among the most masterly modern contributions to surgical science. His prolonged study of the pathological collections belonging to the College and to St. Bartholomew’s in preparing the catalogues, enabled him to illustrate his lectures in a most interesting and valuable manner. The lectures were collected and published in 1853, and have ever since occupied a similar lofty position to the lectures on medicine by Sir Thomas Watson. They illustrate the general pathology of the principal surgical diseases, in conformity with modern advances in physiology. In several recent editions a distinguished pupil of Sir James Paget, Professor Turner of Edinburgh, has revised the lectures from the pathological point of view, while the author has continued to revise them in their clinical aspect.
The leading topics under which these famous lectures are comprised are: Nutrition, Hypertrophy, Atrophy, Repair, Inflammation, Mortification, Specific Diseases, and Tumours. The concluding passage of the second lecture, on “The Conditions Necessary to Healthy Nutrition,” is a fine exposition of a view of the relation between the mind and a changing brain. “In all these things, as in the phenomena of symmetrical disease, we have proofs of the surpassing precision of the formative process, a precision so exact that, as we may say, a mark once made upon a particle of blood or tissue is not for years effaced from its successors. And this seems to be a truth of widest application; and I can hardly doubt that herein is the solution of what has been made a hindrance to the reception of the whole truth concerning the connection of an immaterial mind with the brain. When the brain is said to be essential, as the organ or instrument of the mind in its relations with the external world, not only to the perception of sensations, but to the subsequent intellectual acts, and especially to the memory, of things which have been the objects of sense—it is asked, how can the brain be the organ of memory when you suppose its substance to be ever changing? or how is it that your assumed nutritive change of all the particles of the brain is not as destructive of all memory and knowledge of sensuous things as the sudden destruction by some great injury is? The answer is—because of the exactness of assimilation accomplished in the formative process; the effect once produced by an impression upon the brain, whether in perception or in intellectual act, is fixed and there retained; because the part, be it what it may, which has been thereby changed, is exactly represented in the part which, in the course of nutrition, succeeds to it. Thus, in the recollection of sensuous things, the mind refers to a brain in which are retained the effects, or rather the likenesses of changes that past impressions and intellectual acts had made. As, in some way passing far our knowledge, the mind perceived and took cognisance of the change made by the first impression of an object, acting through the sense organs on the brain; so afterwards, it perceives and recognises the likeness of that change in the parts inserted in the process of nutrition.
“Yet here also the tendency to revert to the former condition, or to change with advancing years, may interfere. The impress may be gradually lost or superseded, and the mind, in its own immortal nature unchanged, and immutable by anything of earth, no longer finds in the brain the traces of the past.”
In 1854 Mr. Paget gave one of the series of lectures on Education at the Royal Institution, in which Whewell, Faraday, and others took part. His lecture on the Importance of the Study of Physiology as a branch of education for all classes, was marked by elevation of thought and practicality of aim. One interesting point that he dwelt on was that a wider scheme of education would be more likely to discover men fitted for particular work. “It has seemed like a chance,” he said, “that has led nearly every one of our best physiologists to his appropriate work; like a chance, the loss of which might have consigned him to a life of failures, in some occupation for which he had neither capacity nor love.” The value of physiological instruction is now generally admitted, but the practical application is almost as generally neglected.
Sir James Paget has published but too few of his thoughts to the public and the profession; but all that have been given to the world have been of sterling worth. His Clinical Lectures and Essays, collected in 1875, include some of the most interesting reading imaginable. He deals among other subjects with the various risks of operations, the calamities of surgery, stammering with other organs than those of speech, cases that bone-setters cure, dissection poisons, and constitutional diseases. Some of the most instructive of the series are those which describe forms of nervous mimicry of serious diseases. An extract from “The Calamities of Surgery” gives clear expression to Sir James Paget’s views on preparation for operating:—
“Look very carefully to your apparatus. I have no doubt that you will look very carefully to the edges of your knives and your saws and all things that are mighty to handle; but look to the plaster, look to the ligatures and the sutures, and all the things which are commonly called minor. When I have seen Sir William Fergusson and Sir Spencer Wells operate, I have never known which to admire most; the complete knowledge of the things to be done, the skill of hand, or the exceeding care with which all the apparatus is adjusted and prepared beforehand. The most perfect plaster, the most perfect silk, not one trivial thing left short of the most complete perfection it is capable of. I have no doubt that the final success of their operations has been due just as much to these smaller things as to those greater things of which they are masters.”
The lecture on Dissection Poisons was especially called forth by an illness from which he suffered for three months in 1871, caught from attending the post mortem examination of a patient who had died of pyæmia. Yet he had no wound or crack of the skin of any kind. In closing the lecture Sir James remarked: “Sir William Lawrence used to say that he had not known any one recover on whose case more than seven had been consulted. Our art has improved. I had the happiness of being attended by ten: Sir Thomas Watson, Sir George Burrows, Sir William Jenner, Sir William Gull, Dr. Andrew, Dr. Gee, Mr. Cæsar Hawkins, Mr. Savory, Mr. Thomas Smith, Mr. Karkeek. In this multitude of counsellors was safety. The gratitude I owe to them is more than I can tell—more than all the evidences of my esteem can ever prove.”
In an address on Theology and Science, delivered to students at the Clergy School at Leeds, in December 1880, Sir James Paget remarks that “in theology, and in the Christian faith which it expounds, there are not only clear evidences which, in their accumulated force, cannot, I think, be reasonably resisted by those who will fairly collect and try them; but there are convictions of religious faith, not always based on knowledge, or on other evidence than the faith which is ‘the evidence of things unseen,’ which may justly be held as unalterable, because they are consistent with revelation, and have been sustained by the testimony of clouds of witnesses, and, I believe, have in many minds the testimony of God’s indwelling Spirit.” He expresses the belief that the truths and highest probabilities of science and religion may justly be held together, though on different grounds, and that they are not within reach of direct mutual attack. He advises clerical students, if they touch upon such questions, to undertake some real study in science, by observation, by experiment, by collecting, as well as by reading. “And let your reading be in the works of the best masters, that you may learn their true spirit, their strength, their methods of observing and thinking, their accuracy in describing.”
Sir James Paget appears as a champion of moderation in the Contemporary controversy on the Alcohol Question. He says that the presumption in favour of moderation is strengthened by comparing those of our race who do not and those who do habitually use alcoholic drinks. “As to working power, whether bodily or mental, there can be no question that the advantage is on the side of those who use alcoholic drinks. And it is advantage of this kind which is most to be desired. Longevity is not the only or the best test of the value of the things on which we live. It may be only a long old age, or a long course of years of idleness or dulness, useless alike to the individual and the race. That which is most to be desired is a national power and will for good working and good thinking, and a long duration of the period of life fittest for these; and facts show that these are more nearly attained by the people that drink alcohol than by those who do not.”
Sir James Paget holds or has held appointments too numerous to mention. After a long and honourable career as Assistant-Surgeon and Surgeon to St. Bartholomew’s, he became Consulting Surgeon. As a member of the Council of the College of Surgeons and for some years President, and also as a member of the Senate, and for some years Vice-Chancellor of London University, he has exercised powerful influence on the improvement of medical education and on medical politics generally. He is Surgeon to the Prince of Wales and Serjeant Surgeon-Extraordinary to the Queen. A baronetcy was conferred upon him in August 1871, and he has received honorary distinctions in abundance from both British and foreign universities.
In 1882 in his Bradshawe lecture, “On some Rare and New Diseases,” Sir James Paget remarked on the increase in the number of real students, which he has had a large share in creating. “I have been often made happy by the contrast which I have seen while working at the new edition of the catalogue of the pathological specimens in the College of Surgeons’ museum. While I was writing the last edition, between thirty and forty years ago, scarcely a student ever entered the museum. Hour after hour I sat alone; I seemed to be working for no one but myself, or for nothing but the general propriety that a museum ought to have a catalogue, though no one might ever care to study with it. Now, and for some years past, a day rarely passes without many pupils and others being at work in every part of the museum.”
In the same lecture Sir James clearly showed the value of studying cases not agreeing with the ordinary types. “We should study all exceptions to rules; never thinking of them as unmeaning or accidental. Especially, we should never use, in its popular but wrong translation, the expression, ‘exceptio probat regulam;’ as if an exception to a rule could be evidence that the rule is right. If we use it, let this be in its real meaning; translating it, as surgeons should, that an exception probes the rule, tests it, searches it—as the Bible says we should ‘prove all things’—to its very boundary.”
Finally we may quote some sentences from Sir James Paget’s lecture on “Elemental Pathology,” delivered before the British Medical Association in 1880, as expressing his philosophy of life. “I hold it to be very desirable that every one of us should, all his life long, study some science in a scientific manner. There seems to be no equally good method for maintaining the temper and the habits, which by making us always good students, will make us as good practitioners as we can be. There is no method so good for maintaining a constant habit of inquiry, with accuracy and perseverance in research, the power of weighing evidence, of calmly judging, and of accurately speaking; none better for cultivating the love of truth, the contempt for fallacies, whether others’ or our own, the gentleness and courtesy which are appropriate to the consciousness of the imperfection of our knowledge.”
[CHAPTER XXI.]
WILLIAMS, STOKES, AND DISEASES OF THE CHEST.
Although this country has not enjoyed the distinction of introducing that invaluable instrument, the stethoscope, to medical science, great interest naturally attaches to those who first used the stethoscope in this country. And among these the name of Charles John Blasius Williams is prominent.
Charles Williams, the son of a clergyman of a Cardiganshire family, was born early in the present century at Heytesbury in Wiltshire, where his father was perpetual curate, and custos of the Hungerford almshouse, in which he resided. He was educated at home by his father. His early liking for natural science and medicine may be considered to have come through his mother, who was the daughter of a surgeon, also named Williams, at Chepstow, and had been educated by Hannah More’s sisters, and received instruction in reading from Hannah More herself. Before the age of fourteen, having access to some good books on natural philosophy, he had made for himself two electrifying machines, a battery of Leyden jars, a voltaic pile, and several little telescopes, microscopes, kaleidoscopes, and æolian harps. Thomson’s Chemistry enabled him to carry on extended chemical experiments, and to start well at Edinburgh subsequently.
Astronomy, a lifelong hobby, was cultivated in the family after the reading of Chalmers’s astronomical discourses; they bought a telescope and did some really good observing. Active games were not lost sight of: and the young Charles excelled all his neighhours in leaping and running. Stilt-walking was a favourite pursuit; and the youth once made a pair of stilts with a footing twelve feet from the ground, mounted on which he could walk well, and look into the upper windows of the house. Natural history tastes were further carried out in a somewhat unusual direction. Poultry and all kinds of domestic animals were studied so minutely, and their cries imitated so closely, that Charles could influence their behaviour towards himself just as if he had been one of themselves.[13]
In the autumn of 1820 Charles Williams entered at Edinburgh University, attending Hope’s interesting lectures on Chemistry and the dry prelections of Monro tertius on Anatomy, alternated with Barclay’s extra-academical class. Later he diligently attended W. P. Alison’s courses of lectures, and had much personal instruction from him. He had not proceeded far in his medical studies before he became absorbed in chemical physiology, and especially in relation to respiration and animal heat. Carefully studying all the most recent chemical discoveries, he made new experiments showing that the change of colour between venous and arterial blood could take place when the blood was enclosed in an animal membrane out of the body, and surrounded by atmospheric air. Thus in 1823 he anticipated what Professor Graham so largely developed in relation to the general permeability of animal membranes. He further discussed the origin of animal heat, and suggested various developments of the theory of combustion. The paper, later amplified into a thesis for graduation in 1824, attracted Alison’s high commendation, although Hope had returned the paper with the remark that the subject was quite proper for a young gentleman’s thesis, but that he declined to enter into the subject.
In 1824-5 the young doctor heard Charles Bell’s lectures on the Nervous System at the London College of Surgeons, and attended the surgical practice of several of the London hospitals. At midsummer 1825 he went to Paris, and in addition to French literature studied painting, becoming a good amateur landscape-painter both in water-colours and oils. In the winter he attended Majendie’s lectures on Physiology and the practice of Dupuytren, Laennec, and many others. But Laennec, the great auscultator, then in his last year of life, gained his most ardent devotion. It was surprising, says Dr. Williams, how little he was valued by French students. Those who attended his clinique were chiefly foreigners. M. G. Andral’s post mortem examinations also he found invaluable.
The chief discoveries relating to auscultation were undoubtedly Laennec’s; yet his knowledge of acoustics was by no means profound, and he was often not successful in explaining rationally the sounds that he heard in the chest. Dr. Williams soon started in the path of applying acoustic laws in this field, and in 1828 he produced his valuable “Rational Exposition of the Physical Signs of Diseases of the Chest,” suggesting various improvements in the construction and use of stethoscopes. Returning to London, Dr. Williams derived great benefits through an introduction to Dr. (afterwards Sir James) Clark, so long attached as physician to the Queen, and from the family acquaintance with Lord Heytesbury. His work above mentioned was favourably reviewed, and soon made its way; and many of his explanations are accepted to the present day. After various travels with patients, he settled in Half Moon Street, Piccadilly, in 1830, having married his cousin, Miss Harriett Jenkins, of Chepstow.
Becoming a member of the Royal Institution, Dr. Williams was introduced to Faraday, and was soon engaged to write for the “Cyclopædia of Practical Medicine,” to which he contributed numerous valuable articles on auscultation and diseases of the chest. In these articles he recommended strongly the cure of catarrh by the heroic process of reducing the supply of fluid. The remedial uses of counter-irritation were carefully expounded: and dyspnœa, difficult or distressed breathing, was clearly described.
In 1833, while practice grew but slowly, the second edition of the Rational Exposition was brought out, containing an enlarged section on the sounds of the heart in health and disease. For some years Dr. Williams had considered the questions involved, and by experimental inquiries in 1835 he established that several causes to which they had hitherto been ascribed could not be the cause of the sounds of the heart, and that the first sound was produced by the muscular contraction of the ventricles, and the second by the reaction of the arterial blood tightening the semilunar valves. His anticipation by Rouanet in 1832 in the latter point has, however, been more recently made evident. A third edition of his book, now of increased importance, was published in 1835, under the title of “The Pathology and Diagnosis of Diseases of the Chest, illustrated especially by a Rational Exposition of their Physical Signs.” It was reprinted in America, and translated into German and Swedish. The same year he was elected F.R.S.
In 1836 Dr. Williams was asked to give lectures on Diseases of the Chest at the Anatomical School in Kinnerton Street, connected with St. George’s Hospital. In 1836-7 he was president of the Harveian and the Westminster Medical Societies. In the summer of 1837 he worked to prepare for the second Report of the British Association Committee on the sounds of the Heart, in which were brought forward important experimental results in regard to morbid murmurs associated therewith. In 1835 he had shown that the true ground of distinction between different forms of disease of the heart’s valves lay in the different direction in which the sonorous currents spread the sounds, and imparted them to the chest walls. Thus he first established the distinction between basic and apex murmurs, developing his views more fully in 1836-7-8.
In 1839 Dr. Williams was elected Professor of Medicine to University College, and physician to its hospital on Elliotson’s retirement. Work now crowded upon him; in the first winter session he gave 150 lectures and examinations in six months, visited the hospital almost every day, and gave a weekly clinical lecture. Up to this period post mortem examinations at the hospital had been made in a mere open shed, with a wooden shelf, scarcely screened, and without a table or a supply of water. Dr. Williams himself planned a proper post mortem theatre; and with the plan he offered £50 towards the cost,—a munificent mode of action which speedily secured the building of the required theatre. Dr. Williams’s practical teaching and luminous lectures caused the Medical School to increase still more rapidly. He had a class of over two hundred. In 1840 an experimental research in which Dr. Williams was assisted by Prof. Sharpey proved the muscular contractility of the bronchial tubes, and confirmed the great influence of belladonna and stramonium as remedies in asthma, in suspending this contractility.
The winter of 1840-1 was occupied largely with original experiments on congestion, determination of blood, and inflammation, which Dr. Williams treated of in the Gulstonian Lectures at the College of Physicians in 1841. His results and views were, as acknowledged by eminent men recently, twenty-five years in advance of his time. Both Virchow and Burdon-Sanderson have acknowledged their great value. Dr. Williams claims that he first pointed to enlargement of the arteries leading to a part as the direct physical cause of determination of blood to that part. “When the web of a frog’s foot is gently irritated by an aromatic water, the arteries may be seen through the microscope to become enlarged, and to supply a fuller and more impulsive flow of blood to the capillaries and veins, which then all become enlarged too: the whole vascular plexus, including vessels which before scarcely admitted red corpuscles, then becomes the seat of a largely increased current” (London Medical Gazette, July 1841).
The year 1841 was marked by the first public steps taken to establish the Hospital for Consumption and Diseases of the Chest, which originated with Mr. (afterwards Sir) Philip Rose. A clerk in his firm suffering consumption found no hospital willing to admit him, on the plea of the lingering and incurable nature of the disease. This started the idea of a special hospital, which Dr. Williams cordially supported, and to which he became consulting physician. The history and great success of the Brompton Hospital cannot be followed here; in 1882 it had 331 beds. The great Virchow, when he visited it in 1881, said, “Here everything is done for the sick.”
In 1843 Dr. Williams published the “Principles of Medicine,” a work in which physiology and pathology were largely employed to form a basis for scientific medicine. It was received with high approval, and became a standard work in America. New editions appeared in 1848 and in 1856. Sir James Paget and Sir James Simpson among others have given it the stamp of their marked approbation. The Lancet gave it almost unqualified praise. In 1846 the Pathological Society of London was established, and Dr. Williams was chosen its first president. Its objects were the exhibition, description, and classification of morbid specimens, and the promotion of pathological research by systematic observation and experiments. In his opening address, Dr. Williams answered the sceptical question, “What is the use of opening bodies? We never find what we expected:” by describing a post mortem examination of a remarkable case of pulmonary disease. The examination had been concluded before Dr. Williams arrived, and he was told that there was enlargement of the heart, which the physician in charge expected, and was satisfied. Dr. Williams insisted on careful inspection of the lungs, which disclosed extensive consolidation, and in addition an unexpected general dilatation of the bronchial tubes. This was the case in which he first discovered the connection between that change and pleuro-pneumonia. The very appropriate motto of the Society, “Nec silet mors,” was suggested by Dr. Williams.
At the end of the winter session of 1849 Dr. Williams resigned his professorship and physiciancy, his health having severely suffered from overwork, and private practice increasing rapidly. He removed to Upper Brook Street, and here continued for twenty-four years in full practice. In January 1849 Dr. Williams published his first account in the London Journal of Medicine, on Cod-Liver Oil in Pulmonary Consumption. He had been studying its application for three years, but of course the priority in recommending it belongs to Dr. Hughes Bennett. It was only in 1846, when a purified oil had been prepared from the fresh livers of the fish, that Dr. Williams found patients willing to take the oil, and in 1848 he wrote that he had prescribed the oil in 400 cases of tubercular disease of the lungs, and in 206 out of 234 recorded cases its use was followed by marked improvement. The administration of cod-liver oil is such a commonplace of the present day that it can scarcely be realised that it is a novelty almost exclusively belonging to the present half of the nineteenth century. And to Dr. Williams very much of the credit, and of the proof of its efficacy, is due. A lady first visited on September 3, 1847, appeared at the verge of death. Cod-liver oil restored her in a few weeks, and she lived many years after. This was a sample of the experience which, after many years’ testing, led Dr. Williams to say, in the great work on pulmonary consumption published by himself and his son, Dr. C. T. Williams, in 1871, that the average duration of life in phthisis had been at least quadrupled. Of 1000 cases tabulated, 802 were still living at the last report, and many were expected to live for years.
The New Sydenham Society, started in 1858, also found an apt first president in Dr. Williams. Its usefulness in improving medical literature by translations and republications has been and is very great. The Lumleian Lectures at the College of Physicians followed in 1862, and were entitled “Successes and Failures in Medicine.” They were not published till 1871, when they appeared in the Medical Times and Gazette. Great attention was directed in them to the hopes and prospects of prevention of disease. In 1873 Dr. Williams was elected to the Presidency of the Royal Medical and Chirurgical Society, which he held for two years, though suffering from gradually increasing deafness. In 1874 he was appointed Physician-Extraordinary to the Queen. In 1875 he retired to Cannes, where he has since renewed his earlier astronomical studies, and made some important observations on sun spots. So in scientific recreations, and in Biblical studies in which he has long been deeply interested, the veteran physician whom Dr. Quain describes as “the principal founder of our modern school of pathology,” passes the closing years of a protracted life.
The Irish Schools of Medicine have had a briefer history than those of Edinburgh and London, but have produced men whose character and labours rank among the highest. William Stokes, born in July 1804 in Dublin, was the son of Whitley Stokes, Regius Professor of Medicine in the University, a man of lofty aims and untiring energy, and a very successful teacher of medicine. Father and son alike were students of the Edinburgh Medical School; but the son owed much to personal companionship with his father. After a few months at Glasgow, young Stokes entered at Edinburgh early in 1823, and soon came in contact with Dr. Alison, who exercised a profound influence upon him; “the best man I ever knew,” he declared. Such striking progress did he make, that before he left Edinburgh, in 1825, he had written and published a little book on “The Use of the Stethoscope,” which he was fortunate enough to sell for £70.
On settling in Dublin, young though he was, Stokes was elected Physician to the Meath Hospital, in succession to his father. His colleague, Graves, one of the most remarkable men Dublin had produced, exercised a striking influence over him. At twenty-two Stokes was already lecturing and giving clinical instruction to a crowd of pupils. The time was one of acute distress and poverty in Ireland; fever raged in Dublin, owing to the distress caused by the failure of the potato crop in the summer of 1826. The Meath Hospital was crowded, and the young physician was taxed to the utmost, and his benevolent charity became fixed as a second nature.
During these years of activity, a powerful special object was employing his most persistent thought and observation. He was diligently storing his mind with every fact and inference bearing on diseases of the lungs. In 1837 his observations were published in the classic work on “Diseases of the Chest.” It at once placed him, says Sir Henry Acland in the memoir prefixed to the edition published by the New Sydenham Society in 1882, in the front rank of observers and thinkers. His exposition of the use of auscultation in bronchitis and the affections of the chest was most valuable.
In 1842 Stokes became Regius Professor of Physic in Dublin University, in succession to his father. From this time, though he contributed occasional papers, lectures, and cases of value to the Dublin Journal of Medical Science, and to the medical societies, he published no book till 1854, when a valuable treatise on Diseases of the Heart confirmed his reputation. In this he paid great attention to functional disturbances of the heart, where no organic disease was present. He says with great modesty, “the diagnosis of the combinations of diseases, even in so small an organ as the heart, is still to be worked out.... As the student fresh from the schools, and proud of his supposed superiority in the refinements of diagnosis, advances into the stern realities of practice, he will be taught greater modesty, and a more wholesome caution. He will find, especially in chronic disease, that important changes may exist without corresponding physical signs—that as disease advances its original special evidences may disappear—that the signs of a recent and trivial affection at one portion of the heart may altogether obscure, or prevent, those of a disease longer in standing and much more important—that functional alteration may not only cause the signs of organic lesion to vary infinitely, but even to wholly disappear—that the signs on which he has formed his opinion to-day may be wanting to-morrow; and, lastly, that to settle the simple question between the existence of functional and that of organic disease, will occasionally baffle the powers of even the most enlightened and experienced physicians.”
This treatise is acknowledged to be one of the most acute, graphic, and complete accounts of the clinical aspects of heart disease. In 1854 also he published a series of lectures on Fever in the Medical Times and Gazette, which were collected into a volume, with additions in 1874. Here he showed himself as still sceptical of the advances made by Jenner, Murchison, and others. As he wrote in one of the lectures, “there is nothing more difficult than for a man who has been educated in a particular doctrine to free himself from it, even though he has found it to be wrong,” and he could never free himself from Alison’s strong belief that fevers were essentially alike.
Very early in his career Stokes was overwhelmed with private practice. On more than one occasion he spoke and wrote strongly regarding the exertions and the mortality of Irish doctors in combating fevers and cholera, while receiving the merest pittance from Government for their services. His feelings as to everything relating to the welfare of the profession and the general culture of the student were actively displayed. “Let us emancipate the student,” he said, “and give him time and opportunity for the cultivation of his mind, so that in his pupilage he shall not be a puppet in the hands of others, but rather a self-relying and reflecting being. Let us ever foster the general education in preference to the special training, not ignoring the latter, but seeing that it be not thrust upon a mind uncultivated or degraded.”
Prevention of disease, too, engaged Stokes’s earnest attention, before sanitary science had come into fashion. “A time may come,” he said, in closing one of his addresses, “when the conqueror of disease will be more honoured than the victor in a hundred fights.”
Sir Henry Acland says of Stokes: “The study of man was with him an instinct, both on the material and on the intellectual side. On the material side; for he was a physiognomist, a great judge of character, and had a keen perception of all physical characteristics, qualities which he obtained by intense observation of men in disease, of men in health, and of persons in every class of society and every kind of occupation. On the intellectual side; for the phenomena of man’s external nature were to him only expressions of the mind working within,—mind the result of inheritance—mind formed by itself—mind the result of circumstance. The second thing to be remarked was his intense interest in every form of human character, in persons of every age, occupation, and condition. He had that which many accomplished persons have not, the keenest sense of humour, which sparkled up in a way quite indescribable. He combined with real delight in all intellectual development the most tender human interest.”
Stokes was passionately fond both of natural scenery and of landscape art; and he enjoyed the companionship and friendship of the best artists, and at the same time appreciated greatly the interests of humble life and the racy humour of the Irish peasantry. He wrote some charming descriptions of scenery, and was well acquainted with various schools of art. The antiquities and history of Ireland too, found in him an accomplished and appreciative student; and it was felt to be an appropriate tribute to his variety of taste as well as his professional skill when he was chosen President of the Royal Irish Academy in 1874.
One valuable habit Dr. Stokes ascribed to his father. “My father left me but one legacy, the blessed gift of rising early.” This often meant getting up between four and five, when he would study and write till eight. During a long day’s practice he was always exercising the most genial influence, whether over refractory students or harassed patients. At the close of the day his hospitality was as attractive as his professional manner during the earlier hours.
In 1870 Mrs. Stokes died, and from this blow her husband never fully recovered. In 1876 he found himself compelled to withdraw from his many public posts, and retire to his cottage at Carigbraig, where to the last the flights of birds which he had encouraged and trained came to seek their food at his hands. He died on January 6, 1878.