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.